Lyme Disease: Do You Know the Facts?
Ready for a pop quiz? How much do you know about Lyme disease? (Or is it Lyme’s disease?) By reading this article, you will find the answers to these questions:
- Can you get Lyme disease from a mosquito?
- Should everyone bitten by a tick go to the doctor?
- What is the association between Lyme disease and Bell’s palsy?
- Can Lyme disease be diagnosed with a simple blood test?
- Is Borrelia burgdorferi a famous Italian chef who invented the hamburger?
- Is there an exotic tropical drink equally effective as antibiotics in treating Lyme disease?
DEPENDENT ON THE
DEGREE TO WHICH
THE DISEASE HAS
As I concluded the last edition of Doc’s Digest on the removal of ticks (“Ticked Off,” July/August 2008 Court Report), I promised I would discuss further the diagnosis and treatment of Lyme disease. This topic was largely chosen because several HSLDA members expressed an interest in exploring the facts about this increasingly prevalent disorder. Not surprisingly, they all live in the northeastern United States, where just about everybody knows somebody who has been afflicted with Lyme disease. For physicians practicing in the Northeast (including myself), antennae must always be up for the possibility of Lyme disease. In other parts of the country, however, the only cases of Lyme disease are found in those who were already infected when they moved to the area. If you are curious if Lyme disease is found in your neck of the woods, go to www.cdc.gov and type “Lyme map” in the search box to find a map that depicts the distribution of reported Lyme disease cases in the U.S.
Although the Lyme disease organism, known scientifically as Borrelia burgdorferi, is found in many common wild critters, it is transmitted to humans solely via the black-legged tick. There are two versions of this tick, a western version and an eastern version. The eastern version is nicknamed the “deer tick.” When an infected tick attaches, it takes 24 to 48 hours before its mouth parts make contact with your blood stream, thereby creating the pipeline necessary for the Lyme organism to enter your system. This is really good news, because if the tick is discovered less than a day after it attaches, the risk of Lyme disease is virtually zero. Also noteworthy is the fact that only a small percentage of black-legged ticks are carriers of the organism. So even if a tick has been attached for more than 24 hours, the chance of infection is still slim. For this reason, treatment is usually deferred unless a person manifests the typical symptoms of infection.
If you find a tick, and you’re not sure how long it has been attached, what sort of symptoms should prompt a visit to the doctor? Early in the course of Lyme disease, a person will generally develop a rash and flu-like symptoms, such as fever, headache, neck pain, and general malaise. The rash, called “erythema migrans,” occurs in about 80% of infections.
It typically has a “bull’s-eye” configuration starting right at the site of the bite and sometimes migrating to involve other parts of the body. If the infection goes untreated, the person will frequently develop muscle inflammation (even involving the heart muscle), joint pain, and nerve problems.
I recently saw a young teenager with a case of Bell’s palsy (partial or total paralysis of the portion of the face supplied by the facial nerve). Never having seen this disorder in children, I set about doing a bit of research. I was surprised to discover that, when found in children, 50% of Bell’s palsy cases are the result of a Borrelia burgdorferi infection. Blood work and a classic rash subsequently confirmed my suspicions.
Diagnosing Lyme disease is a challenge. Although blood work can be very helpful in confirming cases where there is a high level of suspicion, it is decidedly unhelpful in cases where the probability of Lyme disease is low. This is why doctors are hesitant to order blood work for Lyme disease if the history and physical findings are only non-specific. The results may come back falsely positive, and treatment be given for a disease that is, in reality, nonexistent.
Treatment is dependent on the degree to which the disease has progressed. In the early stages, a simple two-week course of oral antibiotics is all that is needed to effectively eradicate the organism. Later in the course of the disease, it may be necessary to treat with intravenous antibiotics. Oh, by the way
while exotic tropical drinks may take a person’s mind off the symptoms of Lyme disease, the only known cure at this time is antibiotics.
Now, go back and take the quiz again. Why not give it to your kids during supper tonight? They are sure to be impressed—especially if you are having hamburgers.
|About the author
Rodger Sayre, MD, FAAFP, has been an HSLDA board member since 1997. He and his wife, Mary, homeschool their 11 children. Dr. Sayre received his medical degree from Thomas Jefferson University, is a Diplomat of the American Board of Family Medicine, and is a Geisinger Medical Group associate with a busy practice in Tunkhannock, Pennsylvania.