Lyme Disease: It’s here…it’s us…
Robert Grimshaw MD FACP
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As you can see from the map, Lyme disease is found primarily in the Northeast. In fact, the 6 northern
towns of Westchester County are a major hot-bed of Lyme. Lyme was first described in the town of Old
Lyme Connecticut after Dr. Allan Steere was put on the trail by a local artist, Polly Murray, who had
found that many area residents, including a large number of children had been diagnosed with
"juvenile rheumatoid arthritis." Steere and his Yale group were able to trace the disease to the "deer"
tick Ixodes scapularis, and a germ in it, Borrelia burgdorferi. There have been over 161,000 cases
reported in the US; 2,580 this year so far.
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Tick Life:
No deer, no Lyme is the bottom line.
Although other animals, specifically
white-footed mice, are important in
the tick life cycle, the disease is
where the deer are. On Grand
Island, a peninsula off Cape Cod, all
the deer were "harvested" – and no
more Lyme occurred!
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Symptoms:
Early Disease: flu-like headache, fever, muscle
aches, fatigue and the famous "bulls-eye rash."
Disseminated Disease: nerve problems, such as
facial droop (Bell’s palsy), arthritis (usually a few
red, hot joints) and slow heart beat (heart
block). Memory issues and trouble working with
numbers have also been reported. According to
the Centers for Disease Control, "Lyme disease
is rarely, if ever, fatal."
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Diagnosis:
Early Lyme is diagnosed from the rash. Blood tests
are not helpful at this stage. In disseminated Lyme,
the diagnosis is made by history and physical exam,
supported by lab tests. The main blood tests are a
screening ELISA and a more specific "Western Blot".
Unless antibiotics have been given, the tests, in my
experience, are very good, especially for Lyme
arthritis.
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Treatment:
Early Lyme is treated with 10 to 21 days of antibiotics.
Doxycycline (Doryx, Vibratabs) is preferred, because it
penetrates the joints, the central nervous system and
covers for a frequent co-infection, Ehrlichiosis (see
below). Stay out of the sun (due to rash)!
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Disseminated Lyme
Treatment has become controversial. First therapy is 30 days
of oral antibiotics, doxycycline again preferred. Studies have
shown that this works as well as intravenous (IV) drugs, such
as Rocephin (ceftriaxone). It’s good to remember that
improvement can continue for up to 6 months, "coasting"
after therapy is finished. IV meds are used if oral treatment
fails. Unfortunately, there is a subset of patients who don’t
get better, no matter what. A recent study showed no
improvement with long-term antibiotics. But it’s been faulted
for only using 1 month of IV meds and 2 months of oral
therapy.
More data is needed!
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Prevention:
Stopping ticks from biting is the best way – no bite,
no Lyme. Long sleeves and long pants help. Picking the
ticks off also helps: they have to feed for at least 36 hrs
to infect you.
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Antibiotics for Tick Bite?
A report from NY Medical College shows Lyme can
often be aborted by giving one dose of 200 mg
doxycycline, if you’ve got a blood-engorged deer tick.
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LYMERix Vaccine
Generated some controversy, but was deemed effective and safe
by the FDA. In March 2002, it was voluntarily withdrawn from
the market by the manufacturer, GlaxoSmithKline.
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Lyme FAQs:
•
•
•
•
You can get Lyme again.
Ticks walking on you haven't infected you.
Testing ticks is NOT helpful.
DON'T LIVE IN "TICK FEAR!!"
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Here's how to remove ticks:
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Don’t Forget Ehrlichiosis:
In our area, ½ adult deer ticks carry Lyme; ½ also carry the
germ that causes Ehrlichiosis; 1/4 carry both! Of the young
nymphs, the figures are 1/4 for each and 1/8 for both.
Symptoms: a flu-like complex of headache, fever, fatigue and
muscle aches comes 5-10 days after the bite. If you get
these, get in right away! Ehrlichiosis can cause serious
pneumonia and can be fatal.
Diagnosis is made from history and exam, supported by a blood
count and liver tests. The best test is response to treatment;
a specific blood test is expensive and slow.
Treatment is with doxycycline for a week; other drugs are
available.
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COUGH HISTORY QUESTIONNAIRE
Babesiosis can also be carried by the deer tick, but hasn’t been
reported in our area - yet. Patients with both Babesiosis and
Lyme have been seen in Nantucket and treatment is
complex and difficult.
A New Lyme-like Germ was reported in May by Dr. Durland Fish
at Yale. They don’t know yet if it causes human disease.
Could it be the reason some patients do poorly?
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