Lyme Disease
A tick-borne illness whose hallmark symptom is a bull’s-eye-shaped red rash surrounding a tick bite. Untreated Lyme disease can cause a host of problems, including arthritis and disorders of the heart and central nervous system. The disease is most commonly found in the northeast coastal states from Maine to Maryland, in the upper Midwest, and on the Pacific coast. It is usually contracted in the late spring or early summer, when ticks are abundant, although it may occur whenever the temperature is above 40°F for several consecutive days.
While the disease has been portrayed in sometimes frightening fashion, most of the time it is easily treated and does not progress to the chronic stages. It probably causes severe long-term effects in fewer than 10 percent of untreated children; moreover, recent studies indicate that many people who think they have Lyme disease actually have other conditions.
The number of new cases of Lyme disease has doubled in the United States since 1991, from more than 9,000 cases in 1991 to nearly 18,000 new cases in 2000. In 2000 Lyme disease cases increased by 8 percent compared to 1999, when 16,273 cases were reported. The increases in new cases may be partly due to better awareness and reporting of Lyme disease, but it also may be due to the fact that more people were exposed to ticks in densely populated areas.
Most of the new cases in 2000 were reported by 12 states in the northeastern, mid-Atlantic, and north-central United States, including Connecticut, Rhode Island, New Jersey, New York, and Delaware. The highest number of cases was reported by Columbia County, New York. Only six states reported no cases of Lyme disease in 2000: Colorado, Georgia, Hawaii, Montana, New Mexico, and South Dakota. Children aged five to nine are among the hardest hit groups, because they are more likely to be exposed to infected ticks and are less likely to use protective measures than other age groups.
History
In the United States, the disease was first recognized in Lyme, Connecticut, after two mothers were told in 1975 that their children had juvenile rheumatoid arthritis, a type of disabling arthritis of childhood characterized by swollen, painful joints. When the women discovered many others in the area had the same disease—which does not normally occur in clusters—they took their concerns to Yale University.
By the late 1970s Yale researchers discovered that many patients they studied were afflicted with a mysterious disease that produced a variety of symptoms in addition to joint swelling. They determined the cause was apparently a microorganism transmitted by at least one species of tick found widely in the woods around Lyme. In 1982 the bacteria was identified by Willy Burgdorfer in Montana, who discovered the spiral-shaped bacterial species that today bears his name: Borrelia burgdorferi.
Once scientists knew the cause, they confirmed that a group of skin conditions and neurological syndromes identified in Europe were also manifestations of Lyme disease. European patients suffer slightly different forms of the disease, probably because of differences in the strains of B. burgdorferi active in different parts of the world. Europeans experience long-term neurological complications, such as thinking problems and dementia; up to 10 percent of untreated Europeans also suffer for many years with a skin condition in which the affected areas of the skin become red, thin, and wrinkled. These symptoms are rarely found among patients with Lyme disease in the United States. Researchers have now identified the disease throughout the world, including Australia, Africa, and Asia.
Cause
The spirochete form of the bacteria is transmitted primarily by the deer tick, the tiniest of which is about the size of the period at the end of this sentence. These ticks are found on deer, birds, field mice, and other rodents. The tick must be attached to its victim for between 36 to 48 hours before an infectious dose of spirochetes are transmitted. For this reason, simply by checking children often for ticks, most can avoid being infected.
Most children are diagnosed in the spring, summer or early fall. In the northern states, about half of all adult Ixodes scapularis ticks are infected. In some places, such as Block Island and Nantucket, the numbers are even higher. Even so, in most sections of the northeast, only between 1 percent and 3 percent of children have contracted Lyme disease.
The tick that transmits Lyme diseases in California relies on intermediate hosts, such as lizards, that are resistant to infection. For this reason, ticks (and, consequently, humans) are infected much less often in the state of California than in the states of the Northeast.
Symptoms
Most children who do become infected with lyme disease usually display one or more symptoms between three days and a month after becoming infected. About 60 percent of victims will notice a small red spot that expands over a period of days or weeks, forming a circular, triangular, or ovalshaped rash. Sometimes the rash resembles a red, raised bull’s-eye with a clear center. The rash can range in size from a dime to the entire width of a child’s body. As the infection spread, several rashes can appear at different places on the body. Without treatment, the rash begins to disappear within days or weeks.
As the spirochetes move through the body via the blood, other symptoms affecting other parts of the body may appear. These may include such flulike symptoms as headache, stiff neck, appetite loss, body aches, and fatigue. Although these symptoms may resemble those of common viral infections, Lyme disease symptoms tend to persist or may occur intermittently.
About 20 percent of children may experience early neurological problems. Some children may have facial paralysis, MENINGITIS, ENCEPHALITIS, or numbness or tingling in other parts of the body.
Complications
After several months of being infected, slightly more than half of those children not treated with antibiotics develop recurrent attacks of painful and swollen joints that last a few days to a few months. The arthritis can shift from one joint to another; most often, the knee is infected. About 10 percent to 20 percent of untreated patients who experience temporary arthritic symptoms will go on to develop chronic Lyme arthritis. In contrast to many other forms of arthritis, Lyme arthritis typically is not symmetrical.
One out of 100 Lyme patients develop temporary heart problems (such as irregular heartbeat) several weeks after infection. Most children will not be aware of this problem unless their doctor detects it. Other nervous system complications include memory loss, concentration problems, and changes in mood or sleeping habits. Nervous system abnormalities usually develop several weeks, months, or even years after an untreated infection. These symptoms may last for weeks or months and may recur.
Diagnosis
Lyme disease is not easy to diagnose because its symptoms mimic those of many other diseases, such as viral infections or MONONUCLEOSIS. Joint pain can be misdiagnosed as inflammatory arthritis, and neurologic signs may be misidentified.
Diagnosis includes a history of exposure to ticks, typical symptoms, and blood tests revealing antibodies to Lyme bacteria. The tests are most useful in later stages.
Treatment
Antibiotics usually provide a complete recovery if given early enough. Most children who are treated in later stages of the disease also respond well. Unfortunately, cases that are not diagnosed soon enough may resist antibiotic treatment. In a few children, symptoms of persistent infection may continue, or the disease may recur, so that doctors prescribe repeated long courses of antibiotics. The value of this approach remains controversial.
Children with chronic Lyme disease may exhibit varying degrees of permanent damage to joints or the nervous system. This usually occurs among children who were not diagnosed in the early stages of the disease, or for whom early treatment was not successful. Deaths from Lyme disease have been reported only rarely.
However, experts at the Centers for Disease Control and Prevention do not recommend automatic treatment with antibiotics after every tick bite. Instead, they say it is better to avoid ticks in the first place.
Prevention
Lyme vaccine Although a vaccine against Lyme disease (LYMErix) had been approved in 1998 for people aged 15 to 70 years, in, 2002 the manufacturer announced that the vaccine would no longer be commercially available, citing poor sales. LYMErix had caused controversy in recent years, as patients complained that they were sickened by the vaccine and asked the government to restrict sales; some filed lawsuits against maker GlaxoSmith Kline. Federal health officials insisted there was no evidence that the vaccine was dangerous.
When the vaccine was first approved, the Centers for Disease Control and Prevention (CDC) had urged that only people at high risk of Lyme disease get vaccinated because the expensive vaccine did not offer complete protection. Studies had showed it was 80 percent effective after people got all three required shots. After vaccinations began, however, some patients reported arthritis, muscle pain, and other symptoms similar to Lyme disease itself. Because 15 percent of the U.S. population has arthritis anyway, scientists found it difficult to determine how the symptoms were connected to LYMErix.
When the CDC reexamined 905 possible side effects reported to the government between 1998 and July 2000, they found no signs that LYMErix caused arthritis although they did find 22 cases of allergic reaction. Nevertheless, at least 60 patients are suing the manufacturer for monetary damages. Other class action suits also have been filed.
Other prevention Ticks do not hop, jump, fly, or descend from trees, although they may blow in a strong breeze. In the woods, children should walk only on trails and avoid brushing against low bushes or tall grass. To prevent tick bites, children should wear protective clothing, with long-sleeved shirts and pants tucked into boots or socks. Light-colored clothes allow ticks to be more easily spotted.
An insect repellent may be used on bare skin and clothing, but all insect repellents should be used with caution in children and should not be used on hands or face. Repellent should not be used at all on infants.
Ticks and their hosts (chipmunks, voles, mice, and other small mammals) need moisture, a place hidden from direct sun, and a place to hide. Therefore, the cleaner the area around a house, the less chance there will be of getting a tick bite. All leaf litter and brush should be removed as far as possible away from the house. Low-lying bushes should be pruned to let in more sun. Leaves should be raked up every fall, since ticks prefer to overwinter in fallen leaves. Woodpiles are favorite hiding places for mammals carrying ticks; to discourage mammal visitors, woodpiles should be neat, off the ground, in a sunny place, and under cover. Gardens should be cleaned up every fall; foliage left on the ground over the winter provides shelter for mammals that may harbor ticks. Stone walls on the property increase the potential for ticks as well. Shady lawns may support ticks in epidemic areas; lawns should be mowed and edged. Entire fields should be mowed in fall, preferably with a rotary mower. Bird feeders attract birds that carry infected ticks, so feeders should not be placed too close to the house. The ground should be cleaned under the feeder regularly. Bird feeding should be stopped during late spring and summer, when infected ticks are most active. Building eight-foot fences to keep out deer may significantly reduce the abundance of ticks on large land parcels. Pets allowed outside should be examined daily.
While the disease has been portrayed in sometimes frightening fashion, most of the time it is easily treated and does not progress to the chronic stages. It probably causes severe long-term effects in fewer than 10 percent of untreated children; moreover, recent studies indicate that many people who think they have Lyme disease actually have other conditions.
The number of new cases of Lyme disease has doubled in the United States since 1991, from more than 9,000 cases in 1991 to nearly 18,000 new cases in 2000. In 2000 Lyme disease cases increased by 8 percent compared to 1999, when 16,273 cases were reported. The increases in new cases may be partly due to better awareness and reporting of Lyme disease, but it also may be due to the fact that more people were exposed to ticks in densely populated areas.
Most of the new cases in 2000 were reported by 12 states in the northeastern, mid-Atlantic, and north-central United States, including Connecticut, Rhode Island, New Jersey, New York, and Delaware. The highest number of cases was reported by Columbia County, New York. Only six states reported no cases of Lyme disease in 2000: Colorado, Georgia, Hawaii, Montana, New Mexico, and South Dakota. Children aged five to nine are among the hardest hit groups, because they are more likely to be exposed to infected ticks and are less likely to use protective measures than other age groups.
History
In the United States, the disease was first recognized in Lyme, Connecticut, after two mothers were told in 1975 that their children had juvenile rheumatoid arthritis, a type of disabling arthritis of childhood characterized by swollen, painful joints. When the women discovered many others in the area had the same disease—which does not normally occur in clusters—they took their concerns to Yale University.
By the late 1970s Yale researchers discovered that many patients they studied were afflicted with a mysterious disease that produced a variety of symptoms in addition to joint swelling. They determined the cause was apparently a microorganism transmitted by at least one species of tick found widely in the woods around Lyme. In 1982 the bacteria was identified by Willy Burgdorfer in Montana, who discovered the spiral-shaped bacterial species that today bears his name: Borrelia burgdorferi.
Once scientists knew the cause, they confirmed that a group of skin conditions and neurological syndromes identified in Europe were also manifestations of Lyme disease. European patients suffer slightly different forms of the disease, probably because of differences in the strains of B. burgdorferi active in different parts of the world. Europeans experience long-term neurological complications, such as thinking problems and dementia; up to 10 percent of untreated Europeans also suffer for many years with a skin condition in which the affected areas of the skin become red, thin, and wrinkled. These symptoms are rarely found among patients with Lyme disease in the United States. Researchers have now identified the disease throughout the world, including Australia, Africa, and Asia.
Cause
The spirochete form of the bacteria is transmitted primarily by the deer tick, the tiniest of which is about the size of the period at the end of this sentence. These ticks are found on deer, birds, field mice, and other rodents. The tick must be attached to its victim for between 36 to 48 hours before an infectious dose of spirochetes are transmitted. For this reason, simply by checking children often for ticks, most can avoid being infected.
Most children are diagnosed in the spring, summer or early fall. In the northern states, about half of all adult Ixodes scapularis ticks are infected. In some places, such as Block Island and Nantucket, the numbers are even higher. Even so, in most sections of the northeast, only between 1 percent and 3 percent of children have contracted Lyme disease.
The tick that transmits Lyme diseases in California relies on intermediate hosts, such as lizards, that are resistant to infection. For this reason, ticks (and, consequently, humans) are infected much less often in the state of California than in the states of the Northeast.
Symptoms
Most children who do become infected with lyme disease usually display one or more symptoms between three days and a month after becoming infected. About 60 percent of victims will notice a small red spot that expands over a period of days or weeks, forming a circular, triangular, or ovalshaped rash. Sometimes the rash resembles a red, raised bull’s-eye with a clear center. The rash can range in size from a dime to the entire width of a child’s body. As the infection spread, several rashes can appear at different places on the body. Without treatment, the rash begins to disappear within days or weeks.
As the spirochetes move through the body via the blood, other symptoms affecting other parts of the body may appear. These may include such flulike symptoms as headache, stiff neck, appetite loss, body aches, and fatigue. Although these symptoms may resemble those of common viral infections, Lyme disease symptoms tend to persist or may occur intermittently.
About 20 percent of children may experience early neurological problems. Some children may have facial paralysis, MENINGITIS, ENCEPHALITIS, or numbness or tingling in other parts of the body.
Complications
After several months of being infected, slightly more than half of those children not treated with antibiotics develop recurrent attacks of painful and swollen joints that last a few days to a few months. The arthritis can shift from one joint to another; most often, the knee is infected. About 10 percent to 20 percent of untreated patients who experience temporary arthritic symptoms will go on to develop chronic Lyme arthritis. In contrast to many other forms of arthritis, Lyme arthritis typically is not symmetrical.
One out of 100 Lyme patients develop temporary heart problems (such as irregular heartbeat) several weeks after infection. Most children will not be aware of this problem unless their doctor detects it. Other nervous system complications include memory loss, concentration problems, and changes in mood or sleeping habits. Nervous system abnormalities usually develop several weeks, months, or even years after an untreated infection. These symptoms may last for weeks or months and may recur.
Diagnosis
Lyme disease is not easy to diagnose because its symptoms mimic those of many other diseases, such as viral infections or MONONUCLEOSIS. Joint pain can be misdiagnosed as inflammatory arthritis, and neurologic signs may be misidentified.
Diagnosis includes a history of exposure to ticks, typical symptoms, and blood tests revealing antibodies to Lyme bacteria. The tests are most useful in later stages.
Treatment
Antibiotics usually provide a complete recovery if given early enough. Most children who are treated in later stages of the disease also respond well. Unfortunately, cases that are not diagnosed soon enough may resist antibiotic treatment. In a few children, symptoms of persistent infection may continue, or the disease may recur, so that doctors prescribe repeated long courses of antibiotics. The value of this approach remains controversial.
Children with chronic Lyme disease may exhibit varying degrees of permanent damage to joints or the nervous system. This usually occurs among children who were not diagnosed in the early stages of the disease, or for whom early treatment was not successful. Deaths from Lyme disease have been reported only rarely.
However, experts at the Centers for Disease Control and Prevention do not recommend automatic treatment with antibiotics after every tick bite. Instead, they say it is better to avoid ticks in the first place.
Prevention
Lyme vaccine Although a vaccine against Lyme disease (LYMErix) had been approved in 1998 for people aged 15 to 70 years, in, 2002 the manufacturer announced that the vaccine would no longer be commercially available, citing poor sales. LYMErix had caused controversy in recent years, as patients complained that they were sickened by the vaccine and asked the government to restrict sales; some filed lawsuits against maker GlaxoSmith Kline. Federal health officials insisted there was no evidence that the vaccine was dangerous.
When the vaccine was first approved, the Centers for Disease Control and Prevention (CDC) had urged that only people at high risk of Lyme disease get vaccinated because the expensive vaccine did not offer complete protection. Studies had showed it was 80 percent effective after people got all three required shots. After vaccinations began, however, some patients reported arthritis, muscle pain, and other symptoms similar to Lyme disease itself. Because 15 percent of the U.S. population has arthritis anyway, scientists found it difficult to determine how the symptoms were connected to LYMErix.
When the CDC reexamined 905 possible side effects reported to the government between 1998 and July 2000, they found no signs that LYMErix caused arthritis although they did find 22 cases of allergic reaction. Nevertheless, at least 60 patients are suing the manufacturer for monetary damages. Other class action suits also have been filed.
Other prevention Ticks do not hop, jump, fly, or descend from trees, although they may blow in a strong breeze. In the woods, children should walk only on trails and avoid brushing against low bushes or tall grass. To prevent tick bites, children should wear protective clothing, with long-sleeved shirts and pants tucked into boots or socks. Light-colored clothes allow ticks to be more easily spotted.
An insect repellent may be used on bare skin and clothing, but all insect repellents should be used with caution in children and should not be used on hands or face. Repellent should not be used at all on infants.
Ticks and their hosts (chipmunks, voles, mice, and other small mammals) need moisture, a place hidden from direct sun, and a place to hide. Therefore, the cleaner the area around a house, the less chance there will be of getting a tick bite. All leaf litter and brush should be removed as far as possible away from the house. Low-lying bushes should be pruned to let in more sun. Leaves should be raked up every fall, since ticks prefer to overwinter in fallen leaves. Woodpiles are favorite hiding places for mammals carrying ticks; to discourage mammal visitors, woodpiles should be neat, off the ground, in a sunny place, and under cover. Gardens should be cleaned up every fall; foliage left on the ground over the winter provides shelter for mammals that may harbor ticks. Stone walls on the property increase the potential for ticks as well. Shady lawns may support ticks in epidemic areas; lawns should be mowed and edged. Entire fields should be mowed in fall, preferably with a rotary mower. Bird feeders attract birds that carry infected ticks, so feeders should not be placed too close to the house. The ground should be cleaned under the feeder regularly. Bird feeding should be stopped during late spring and summer, when infected ticks are most active. Building eight-foot fences to keep out deer may significantly reduce the abundance of ticks on large land parcels. Pets allowed outside should be examined daily.
Tags: Arthritis, bulls-eye-shaped red rash, central nervous system, disorders of the heart, Lyme Disease, tick bite, tick-borne illness
Posted in Health and Wellness
Related Articles you might be interested:
Southern Tick-Associated Rash Illness (STARI)
An infection causing a rash similar to that produced by LYME DISEASE affecting residents in southeastern and south central United States. Southern tick-associated rash illness (STARI) is ass...Read More
Sensory Integration
The process of taking in sensory information, organizing this information in the central nervous system, and using the information to function smoothly in daily life. Sensory integration is ...Read More
Rabies
An acute viral disease of the central nervous system that is usually transmitted to humans by a bite from an infected warm-blooded animal. Untreated, the disease is a swift, deadly killer, a...Read More
Disorders of the Joints
A joint is the point at which two or more bones meet. It is made up of the bones and muscles brought together at the joint, the ligaments (which connect bone to bone), the tendons (which con...Read More
