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Lyme Disease
Lyme disease is a bacterial disease acquired by humans through the bite of an infected tick. Lyme disease is the most common tick borne disease in the United States. The tick, Ixodes dammini (the deer tick) is endemic to the Northeastern United States. It is roughly the size of a sesame seed and in its nymph stage (responsible for up to 50% of the cases) is only the size of a poppy seed. The disease is transmitted in 33 of the 50 states with a concentration of cases reported in the New England states (Connecticut, Massachusetts, New Jersey, New York, and Rhode Island). The disease was first described in 1977, following a large outbreak of the disease among children in Lyme, Connecticut. Lyme disease has had a surge in recognition in the past 15 years. Evidence suggests it probably existed many years prior to the 1970's. The majority of cases are reported between late spring and late summer with a peak incidence in July. Lyme disease represents a disease that includes a constellation of symptoms not all of which are consistently present. Less than one-third of patients recall having a tick bite. These facts contribute to the difficulty of diagnosing this illness. Any patient with a rash, flu-like symptoms, and who has had exposure to a tick bite, particularly in the Northeast, is a possible candidate. Common symptoms include: a typical rash with large, distinctive, circular lesions and is first seen around the area of the bite (only 50-60% of infected patients will have this rash). The rash can "come and go," making disease documentation even more difficult. The incubation period (time from the bite to the onset of symptoms) is approximately 14 days. Other symptoms include: malaise, fever, headache, muscle aches, and swollen lymph glands (neck, armpits, or groin). If not treated early, this disease can affect the heart function and cause arthritis (joint pain and swelling), commonly affecting the larger joints (hips, shoulders, and knees). Evaluation will include history (for potential tick exposures) and careful physical examination (for evidence of a rash or arthritis). There is a special blood test (serology) that is diagnostic for Lyme disease, however, it may take several days or more to obtain results. Treatment in the early stage (prior to the onset of arthritis) is effective with antibiotics (tetracycline). Complications of advanced Lyme disease are MORE difficult to treat. Immediate physician evaluation is recommended. Your doctor can assist you in the appraisal of this complex problem.
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