Infectious Disease Experts Offer Advice To Prevent And Treat Lyme Disease

"With tick season upon us, it's important to put Lyme disease into perspective," said Gary P. Wormser, MD, chairman of the IDSA expert panel on Lyme disease and chief, division of infectious diseases, department of medicine, New York Medical College, Valhalla. "The vast majority, more than 95 percent, of people who do contract the disease are easily treated and cured with short-term antibiotic therapy."

Lyme disease caused by Borrelia burgdorferi is a bacterial infection transmitted by a particular type of tick that typically feeds on small mammals, birds and deer but may also feed on cats, dogs and humans. Although the disease has been reported in nearly all states, most cases are concentrated in the Mid-Atlantic and northeast states. A number of cases also have been reported in Wisconsin, Minnesota and northern California.

Most people who are infected have a circular, red rash surrounding the site of a tick bite, swelling in their joints and, sometimes, facial paralysis. "The symptoms are sometimes alarming, but with proper diagnosis and treatment almost all will go away in a few weeks," Dr. Wormser said.

Preventing Lyme Disease

"The best method for managing Lyme disease is to avoid tick-infested areas. If exposure to ticks is unavoidable, measures should be taken to decrease the risk that ticks will attach to the skin," he said. Some simple steps to avoid the tick bites that cause Lyme disease include:

• Wear protective, light-colored clothing that minimizes exposed skin and provides a contrast to ticks, making them more visible.
• Use tick and insect repellents and apply them to your exposed skin or clothing, following directions on product labels.
• If you are outdoors and may have been exposed to ticks, check your entire body every day to locate and remove ticks, especially at the end of the day.
• Check children's skin thoroughly, including skin folds and the head, scalp and neck area.

Treating Lyme Disease

Persons who remove attached ticks should be monitored closely for signs and symptoms of tick-borne diseases for up to 30 days. Single-dose doxycycline therapy may be considered for deer tick bites when the tick has been on the person for at least 36 hours.

Most patients who develop Lyme disease are cured with a single course of 14-28 days of antibiotics, depending on the stage of their illness. Occasionally a second course of treatment is necessary. More prolonged antibiotic therapy is not recommended and may be dangerous, according to Dr. Wormser.

"Nearly all people -- more than 95 percent -- who do get sick with Lyme disease and are treated with the recommended course of antibiotics get better and go on with their lives," said Dr. Wormser, lead author of IDSA's 2000 guidelines on Lyme disease. He also is chair of the expert panel currently considering revisions to the guidelines, which are due out later this summer. The expert panel reviews the published scientific literature related to the topic before reaching consensus on guideline recommendations.

Chronic or Post-Lyme Disease Syndrome

A small number of patients report a variety of non-specific symptoms such as generalized pain, joint pain or fatigue following an episode of Lyme disease that has been treated appropriately.

A small number of physicians advocate treating these patients with repeated or prolonged courses of oral or intravenous (IV) antibiotics, but Dr. Wormser cautioned that "there are no convincing published data showing such treatment to be effective."

Furthermore, long-term antibiotic therapy may be dangerous and it also can lead to drug-resistant superbugs that are impossible to treat, he added.

"These patients with symptoms that persist for weeks, months or longer appear to be a heterogeneous group, and they report non-specific symptoms that also are associated with a number of other medical diseases, both infectious and noninfectious," he said.

Patients who continue to have symptoms that persist after appropriate antibiotic treatment for Lyme disease should consult their physicians about whether the diagnosis was accurate or if they may have a different or new illness.

More information about Lyme disease - including a fact sheet for the public and practice guidelines for physicians - can be found on the IDSA website at www.idsociety.org.

IDSA is an organization of physicians, scientists and other health care professionals dedicated to promoting human health through excellence in infectious diseases research, education, prevention and patient care. Major programs of IDSA include publication of two journals, The Journal of Infectious Diseases and Clinical Infectious Diseases, an Annual Meeting, awards and fellowships, public policy and advocacy, practice guidelines and other membership services. The Society, which has 8,000 members, was founded in 1963 and is headquartered in Alexandria, VA.

Facts About Lyme Disease
From the Infectious Diseases Society of America (IDSA)

Causes of Lyme Disease

• Lyme disease is an illness caused by a bacterium, Borrelia burgdorferi. It is transmitted through the bite of a tick infected with the bacterium. The disease is most common in the Mid-Atlantic or northeast states of New York, Connecticut, Pennsylvania, New Jersey, Massachusetts, Maryland, Rhode Island and Delaware. Other areas where the disease is prevalent include Wisconsin, Minnesota, and northern California.
• Ticks known to carry the disease include black-legged ticks, Ixodes scapularis, also known as the deer tick, and Ixodes pacificus. These ticks are found in shrubs and woodlands and adjacent grassy areas. They feed on a variety of animals, including humans and domestic and wild animals.

Symptoms

• The most common sign of Lyme disease is a characteristic rash called erythema migrans. Usually, it appears as an expanding red ring surrounding the site of a tick bite, although many people may not be aware they were bitten.
• Other symptoms may include arthritis, meningitis and facial paralysis.

If You Think You Have Lyme Disease

• Individuals who experience these symptoms -- especially rash -- after removing a tick or being in tick-infested areas should seek prompt medical attention.
• If not treated early, people with Lyme disease may develop late symptoms such as meningitis, numbness, tingling or burning sensations in the extremities, arthritis and an abnormally slow heart rate.
• Lyme disease is usually diagnosed by the presence of a characteristic rash and a history of recent tick exposure. If only non-rash manifestations are present laboratory tests should be used appropriately to support the diagnosis, and other possible diagnoses should be ruled out.

Treatment

• Antibiotic treatment of 14 -- 21 days is recommended for early Lyme disease. Late symptoms require longer antibiotic treatment for 14 -- 28 days.
• More prolonged oral or intravenous (IV) treatment is not recommended and may be dangerous.
• Single-dose doxycycline therapy may be considered for patients bitten by infected deer ticks in high-risk geographic regions.

Avoiding Tick Bites is the Best Protection: Be Tick-Aware

• Wear protective clothing, with pant legs tucked into socks and shirts tucked into pants.
• Wear light-colored clothing because dark ticks can be more easily spotted against a light background.
• Inspect clothing frequently for ticks.
• Apply insect repellent to exposed skin or clothing (follow manufacturer's directions).
• Stick to paths and avoid walking or hiking through uncleared woodlands, shrubs, bushes and grassy areas next to woodlands.
• Brush off clothing and pets' coats before going indoors so unattached ticks are not brought into the house.
• Inspect your entire skin surface frequently for ticks.
• Inspect children frequently for ticks, including the head, neck and scalp.

Removing Ticks

• When ticks attach to the skin, prompt removal greatly reduces the chances of infection.
• The best method for removal is to grasp the tick as close to the skin as possible with thin tweezers and gently pull straight up.
• Do not attempt to remove ticks by applying heat or other agents.
• Save the removed tick and bring to your health care provider within 72 hrs of removal to discuss whether single-dose antibiotic prophylaxis (prevention) may be warranted.