The Beginning

The mystery of Lyme disease became apparent in 1975. Two mothers became alarmed by an increase in cases of arthritis in
the communities of Lyme and East Haddam, Conn. and contacted public health authorities. Scientists from Yale University, led by Allen Steere, M.D., identified 39 children and 12 adults as having "Lyme arthritis."

Three years later Dr. Steere and his team discovered that a tick was transmitting the disease to humans. In the years since, the deer tick has been implicated as the vector for Lyme disease in the eastern and midwestern United States; the California black-legged tick has been implicated in the west and Pacific Northwest.

Lyme disease (LD) is a multi-system bacterial infection caused by a the spirochete Borrelia burgdoferi (Bb). The pathogen was named in honor of the discoverer and a founding board member of the Lyme Disease Foundation, Willy Burgdorfer, PhD, MD (hon). Research has proven that the bacterium that causes Lyme disease has been in the U.S. for over 100 years.

These spirochetes are maintained in nature in the bodies of wild animals and are transmitted from one animal to another through the bite of an infective tick. These ticks can be anywhere - in the woods, by the seashore or even in your backyard. The body does not maintain a natural immunity to the disease. Thus, a person can be reinfected with the disease on subsequent tick bites.

While ticks can bite year-round, peak tick season in the northeast is April - September, and on the West coast is November - April. Ticks can survive under a variety of conditions as long as adequate moisture is available.

An infective tick with local infection must be attached to the host for a day or more before transmission of Bb occurs. However, a systematically infected tick or improper tick removal may cause transmission of LD much sooner.

The Clinical Signs

Signs and symptoms of Early Local Lyme Disease often starts with flu-like feelings of headache, stiff neck, fever, muscle aches, and fatigue. About 60% of light-skinned patients notice a unique enlarging rash, referred to as erythema migrans (EM), days to weeks after the bite. On dark-skinned people, this rash resembles a bruise.

Disseminated Lyme Disease

Some people do not notice the early indicators of infection. Early manifestations usually disappear and disseminated (other organ system involvement) infection may occur.

General -- Profound fatigue, severe headache, fever(s), severe muscle aches/pain.

Brain -- Nerve conduction defects (weakness/paralysis of limbs, loss of reflexes, tingling sensations of the extremities - peripheral neuropathy), severe headaches, stiff neck, meningitis, change in smell/taste; difficulty chewing, swallowing or speaking; hoarseness or vocal cord problems; facial paralysis - Bell's palsy; dizziness/fainting; drooping shoulders; inability to turn head; light or sound sensitivity; change in hearing; deviation of eyeball [wandering or lazy eye], drooping eyelid, stroke, abnormal brain waves or seizures, sleep disorders, memory problems, difficulty in word finding, confusion, decreased concentration, problems with numbers and behavioral changes (depression, personality changes).

Other psychiatric manifestations that have been reported in the scientific literature include: panic attacks; disorientation; hallucinations; extreme agitation; impulsive violence, manic or obsessive behavior; paranoia; schiziphrenic-like states, dementia and eating disorders.

Eyes -- Vision changes, including blindness, retinal damage, optic atrophy, red eye, conjunctivitis, "spots" before eyes, inflammation of various parts of the eye, pain, double vision.

Skin -- Rash not at the bite site (EM) - This skin discoloration varies in size and shape; usually has rings of varying shades, but can be uniformly discolored; may be hot to the touch or itch; ranges in color from reddish to purple to bruised-looking and can be necrotic (crusty/oozy). The rash may develop a bull's-eye rash or target look. The shape my be circular, oval, triangular or a long-thin ragged line.

Heart and Blood Vessels -- Irregular beats, heart block, myocarditis, chest pain, vasculitis.

Joints -- Intermittent or chronic pain, usually not symmetrical; sometimes swelling; TMJ-like pain in jaw.

Liver -- Mild liver function abnormalities.

Lungs -- Difficulty breathing, pneumonia.

Muscle -- Pain, inflammation, cramps, loss of tone.

Stomach and Intestines -- Nausea, vomiting, diarrhea, loss of appetite, anorexia.

Spleen -- Tenderness, enlargement.

Pregnancy -- Miscarriage, premature birth, stillbirth, and neonatal deaths (rare). Congenital LD has been described in medical literature.

Tick's mouthparts have reverse harpoon-like barbs (image at right), designed to penetrate and attach to skin. Ticks secrete a cement-like substance that helps them adhere firmly to the host. If you find that you or your pet has been bitten by a tick, it is important to remove it properly.   Removal Procedure:

• Use fine-point tweezers to grasp the tick at the place of attachment, as close to the skin as possible. 

• Gently pull the tick straight out.

• Place the tick in a small vial labeled with the victim's name, address and the date.

• Wash your hands, disinfect the tweezers and bite site.

• Mark your calendar with the victim's name, place of tick attachment on the body, and general health at the time.

• Call your doctor to determine if treatment is warranted.

• Watch the tick-bite site and your general health for signs or symptoms of a tick-borne illness. Mark any changes in your health status on your calendar.

• If possible, have the tick identified/tested by a lab, your local health department, or veterinarian.

Prevention

Ticks like to rest on low-lying brush and 'catch a ride' on a passing animal or person. The areas that hold a high risk of tick infestation are wooded areas, low-growing grassland, and the seashore. You should exercise caution where you go.

To reduce your chance of getting a tick-bite:

1) Avoid tick infested areas, when possible. Avoid short-cuts through heavily wooded, tick-infested areas. Use caution when you are entering tick-infected areas. Stay in the center of paths, avoid sitting on the ground and conduct frequent tick-checks.
 
2) Dress properly. Wear light-colored clothing. This allows you to more easily see ticks on your clothing and gives you the opportunity to remove them before they can attach to your skin and feed.

3) Wear a long-sleeved shirt and long pants. This reduces the skin area exposed to ticks. Also, tuck your shirt into your pants and pants into your socks. This keeps the ticks on the outside of your clothing and thwarts their efforts to crawl onto your skin. However, during warm or hot weather, this is not practical. So, if this advice is ignored, we suggest that you increase your vigilance in conducting tick-checks.

4) Use EPA-approved tick repellents. During the summer months, it can be inconvenient to wear pants and long-sleeved clothing, so using repellents can help protect yourself from ticks. Wash off the repellents when you return inside, and children should always have an adult apply the repellent for them.

5) Conduct frequent tick-checks. This includes a visual inspection of the clothing and exposed skin, followed by a naked, full-body examination in a private location. Be sure to check the scalp, behind and in the ears and behind any joints.

6) Remember to check your pets too! This is not only for your pets' safety but for your family's as well. Pets can bring ticks in from outside and put you and your family at risk for infection.