Lyme disease, if untreated,
can cause serious problems
Posted 6/18/03

They're out there . . . waiting for you. From May through July, deer ticks‹the size of a poppy seed‹lie in wait for an animal or human to latch onto. The ticks can carry Lyme disease, an infection that, if left untreated, can cause joint, nervous system and heart problems.

Minnesota and Wisconsin have the highest incidences of infection in the north-central states, and July is the peak month of infection for this region. Lyme disease has been reported in 48 states and the District of Columbia.

The disease develops when the Borrelia burgdorferi bacteria, carried by deer ticks, is transmitted to humans (through a tick bite) and travels through the bloodstream into various areas of the body. Approximately 16,000 Lyme disease cases occur in the United States each year, making it the country's most common tick-borne illness. It's estimated that deer ticks are responsible for 90 percent of all Lyme disease cases. Knowing how to prevent the disease is crucial. And if you're infected, knowing the early symptoms can increase your chances for a full recovery.

Because not all ticks are infected, a bite does not always result in Lyme disease.

Even if the tick is infected, it may not transfer the disease to you. It's important to note that the longer the infected tick is attached to your skin, the greater your risk of getting Lyme disease. A tick needs 48 to 72 hours to transmit the disease; therefore, it's important to check for deer ticks after being outdoors.

Symptoms of Lyme Disease

Because early symptoms of Lyme disease can be mild and mimic those of influenza, the disease can be easily overlooked. Common symptoms of early Lyme disease may include:

€Flu-like symptoms, such as achiness, headache, fatigue and fever (100 to 103 degrees). These symptoms can occur with or without a rash and can last five to 21 days.

€A solid red or bull's-eye rash called erythema migrans. This rash is present in 80 to 90 percent of all Lyme disease cases and usually appears at‹or near‹ the site of the tick bite. The rash appears about a week or two after the bite; however, it may show up as soon as three days and up to a month after the bite. The rash usually develops on the thigh, buttock or trunk in older children and adults, and on the head or neck in young children. The rash can first appear as a pimple-like spot that expands over the next few days into a purplish circle with a deeper red rim. The circle may reach up to six inches in diameter. In some cases the ring is incomplete, forming an arc rather than a full circle. The center of the rash often clears or may turn bluish. Secondary rings may develop within the original ring, creating a bull's-eye pattern.

€Conjunctivitis (eye infection). The infection may cause inflammation and redness in the eye.

Because these symptoms often occur within days of the initial tick bite, testing for Lyme disease may not immediately confirm the infection, and retesting may be necessary. Furthermore, ticks that transmit the disease often attach to the scalp, armpits, buttocks and other inconspicuous areas, so the rash can be easily overlooked. In addition, the tick's bite is painless, so only about half of people with Lyme disease recall being bitten.

Left untreated, Lyme disease can cause arthritis, nervous system dysfunction and heart problems.

Prevention tips

It's important to remember that prevention measures can be effective in reducing your exposure to infected ticks. Whenever possible, avoid entering areas that are likely to be infested with ticks, particularly in spring and summer when nymph ticks feed. Ticks favor a moist, shaded environment, especially areas with leaf litter and low-lying vegetation in wooded, brushy or overgrown grassy habitats. In addition:

€Keep your yard clear of bushes (ticks will jump from leaves and shrubbery).

€When camping or in a wooded area, tuck your pants inside socks and wear light-colored, long-sleeved clothing so ticks are visible.

€After being in a wooded area, check the scalp, groin, buttocks and other areas of the body for ticks. This is best done after bathing.

€Use insect repellents containing DEET on clothes and exposed skin. Don't use DEET products, however, on children under age one.

How to remove a tick

Embedded ticks should be removed using fine-tipped tweezers. Grasp the tick firmly and as close to the skin as possible. With a steady motion, pull the tick's body away from the skin. The tick's mouth parts may remain in the skin, but don't be alarmed. The bacteria that cause Lyme disease usually are contained in other parts of the tick. Cleanse the area with an antiseptic.

Treatment

Prompt treatment with antibiotics is very effective in curing Lyme disease in nearly all infected people, including children. It should be noted, however, that even if Lyme disease is successfully treated, it's possible to become reinfected. That risk appears to occur only in patients who had been treated for the rash. In those who developed arthritic symptoms as well, the antibody response appears to persist and prevent reinfection.

Who's at risk for Lyme?

Individuals who live or work in residential areas surrounded by tick-infested woods or overgrown brush are at risk for Lyme disease. Persons who work or play in their yards, participate in recreational activities away from home (such as hiking, camping, fishing and hunting) or engage in outdoor occupations (such as landscaping, brush-clearing, forestry, and wildlife and parks management in endemic areas) may also be at risk of Lyme disease.

The risk of getting Lyme disease from an identified deer-tick bite is about three percent. In addition, a good number of bites that are thought to be from deer ticks are actually from different ticks or spiders, further decreasing your risk of infection.

Case Studies

Case Study 1

In June, a 15-year-old boy sees his physician because of a fever that had developed five days earlier. He also has a stiff neck and a rash on his back. He and his family live in northern Minnesota. His mother reports that he was hiking in the woods with some friends recently.

The boy tested positive for Lyme disease. He was put on a course of antibiotics and his symptoms subsided within two weeks.

Case Study 2

A 9-year-old girl from eastern Wisconsin comes into the hospital with fever, aching joints and inflammation of the eyes. The child does not have a rash, nor do the parents remember finding a tick on the child. The girl was not immediately diagnosed with Lyme disease.

In the following weeks, however, she developed a severely swollen knee. Tests revealed that she had Lyme arthritis, and she's currently being treated.