How is Lyme Transmitted?
There are several species of deer ticks across the US that become infected with the spiral bacterium, Borrelia burgdorferi. Unsuspecting humans and animals walking through woodlands and brushy areas may be bitten by a tick and never know it. The tiny ticks, some the size of poppy seeds, may stay on your body for hours to days. The tick engourges itself with blood. If infected, the spirochete is transmitted to the bloodstream of the person or animal during the bite.
Currently there is no reliable test to determine if someone has contracted Lyme disease or is cured of it. False positives and false negatives often occur, though false negatives are far more common. In fact, some studies indicate up to 50% of the patients tested for Lyme disease receive false negative results. As a result, the CDC relies on physicians to make critical diagnosis based on a patient's symptoms, health history, and exposure risks. Doctors who are experienced in recognizing Lyme disease will treat when symptoms typical of illness are present, even without a positive test, in an effort to prevent the development of chronic Lyme disease.
Research: Persistent Infection After Antibiotic Treatment
Questions & Answers
An Interview with Dr. Kerry Clark, MPH, PhD, University of North Florida, Jacksonville, Fl.
Q: What is Lyme Disease?
A: Lyme disease (LD) is the most commonly reported arthropod-borne infection in the United States, with an average number of approximately 19,000-20,000 cases reported each year. Surveys of doctors have revealed that the actual number of cases may be as many as 10x that reported. The infection is caused by a spiral shaped bacteria known as a spirochete, and transmitted by several species of ticks.
Q: What are the Signs and Symptoms of LD?
A: Most patients experience general “flu-like” symptoms of fever, headache, body aches, and fatigue. Sometimes, but not always, a skin rash is present at or near the tick bite site. This rash is often round or oval shaped, and sometimes has a lighter area in the center (which can resemble a bullseye). This is called an erythema migrans or EM lesion. It is reportedly recognized in approximately 50—60% of cases. If not treated early, the infection can spread to joints, the heart, and the nervous system. Patients who develop late stage infection often experience neurological symptoms including chronic headache, fatigue, stiff neck, memory lapses, tingling sensations in the arms or legs, and vision problems.
Q: How is LD Diagnosed?
A: LD is diagnosed based on signs and symptoms (e.g., EM rash, flu-like symptoms, recurrent or relapsing arthritis), combined with the possibility of exposure to ticks. Current laboratory tests for LD are not very sensitive; thus, it is very difficult to get a positive result for LD with most lab tests available today. On the other hand, in my experience false positive lab test results for LD are rare. Laboratory testing may be helpful for confirming infection, and for diagnosis during the later stages of disease, but it is not necessary and generally not recommended for diagnosis of patients with EM lesion and a history of tick bite or tick exposure. In many cases, the patients do not remember being bitten by a tick.
Q: How is LD Treated?
A: Most cases of LD can be treated successfully with several weeks of antibiotics if recognized and treated early. Doxycycline is most commonly prescribed for early stage infection, and taken orally for 3-4 weeks duration. The success rate for treatment of later stages of illness is less certain, and may require long term, intravenous antibiotic therapy. Thus, early recognition and treatment are critical.
Q: Where does LD occur?
A: LD occurs worldwide, and cases have been reported from every state in the continental U.S.
Q: Does LD Occur in Florida?
A: Yes, it does. The same tick species (the blacklegged or “deer” tick) that we know transmits LD in the northeastern U.S. is very common in Florida. Plus, there is evidence that another tick species (the lone star tick) may also be transmitting the infection in southern states. Published research has shown that the bacteria is established in wild animals and ticks, and recent findings (as-yet-unpublished) document infection in humans in Florida. Patients often say that their doctors tell them that we don’t have LD in Florida, or that we don’t even have the tick vector for LD here. This is absolutely false. There is no doubt that people are acquiring LD infections from tick bites in Florida.
Q: How Much LD Occurs in Florida?
A: At this time, we do not have accurate estimates of the true incidence in Florida. In the southern U.S., the disease is likely still significantly under-recognized due to lack of awareness, and misdiagnosis. The poor sensitivity of clinical diagnostic tests exacerbates this problem.
Q: Who is at risk for LD?
A: Practically anyone who spends time outdoors in grassy, brushy, or wooded areas or who has contact with pet animals who frequent such areas, could come into contact with an infected tick. Ticks infected with the LD bacteria have been collected at dozens of sites throughout Florida. LD infection can be acquired in national forests, state parks, and literally in our own backyards. The bottom line is that it doesn’t matter where someone lived previously, where he/she has traveled, or where he/she lives today. When a person sees a doctor here in Florida, and that person has signs or symptoms consistent with LD any time of the year, that person could have LD.
Q: When are people at risk for LD?
A: People are at risk for LD in Florida year round. The climate in Florida allows some human biting species of ticks to be active throughout the year.
Q: What should you do if you get bitten by a tick?
A: You should remove the tick as soon as possible. Do not burn it, cover it with finger nail polish or petroleum jelly, or use other folk methods to remove it. Instead, use tweezers to grasp the tick as close to the skin as possible, and pull it out with firm, steady pressure. Clean the bite site with soap and water. Very importantly, SAVE THE TICK! Put the tick in a plastic ziplock type bag. Include a notecard or small piece of paper that records the date and where you believe you picked up the tick. If you wish to have the tick identified, send it to my lab at UNF. We may also test the tick for LD or other disease organisms.
Q: What should you do if you think you might have LD?
A: See your health care provider. If you saved the tick that bit you, take it to show your doctor (but don’t throw it away). If your doctor thinks you might have LD, and you are willing, he/she may agree to collect and send a blood sample to the UNF lab for research testing. (Note: test results may not be used for patient diagnosis; the testing is for research purposes only.) You can obtain more information about the research study by contacting me (Dr. Clark) or the Northeast Florida Lyme Association (NEFLA).
Q: How can you reduce your risk for LD or other Tick Transmitted Infections?
A: Avoid areas infested by ticks. Apply repellents such as those that contain DEET or permethrin (always follow label directions). Wear light colored clothing that makes it easier to see ticks on you Check yourself and your children for ticks often during outdoor activities in tick-infested areas.
Q: Is anyone else conducting research on LD in Florida?
A: I am one of very few people studying LD in Florida at this time. Unfortunately, funding for research on LD or other tickborne diseases is limited, especially for research in the southern U.S. I believe that LD is significantly under-recognized and underreported in Florida and some other southern states. Because awareness is so low, cases are often misdiagnosed, or diagnosis is delayed, which leads to patients developing complications from late stage infections that are then much more difficult to treat.
Q: Can you say a little more about your research?
A: I have developed a very sensitive DNA-based test for LD, and my research testing has confirmed dozens of cases of the disease in patients from Florida and other states across the country in the past several years. Recently, we identified the presence of 2 additional species of Lyme group Borrelia in humans with Lyme-like illness in Florida and other states. Prior to this finding, only 1 species of Lyme Borrelia had been reported as pathogenic to humans in the U.S.
Q: Any Final Recommendations?
A: LD is alive and well in Florida, but awareness of the risk is very poor. Because of that, there are many, very sick people with LD in Florida, as elsewhere. We need to do a better job of recognizing the illness, we need to continue efforts to improve public awareness, and we need to do a lot more research to find out just how common LD is here, and what tick species are transmitting it.
Q: Who can I contact for more information?
A: Contact NFLA at www.FLDA.org or contact Dr. Clark at UNF
What is the Treatment?
It is reported that Lyme disease can be treated successfully with antibiotics if caught early in the infection. Prevention is the best cure for infection. Patients whose disease is caught late often need to be on antibiotics for longer periods of time. There is controversy between physicians as to the length of treatment. ILADS physicians feel treatment should continue for 2 months after the patient feels better. Ehrlichiosis is often treated with many of the same anitbiotics used for Lyme disease. Babesia is often treated with Mepron and Zithromax. Many physicians believe that they need to treat the Babesiosis before treating Lyme disease to achieve clinical success.
Dr. Burrascano: http://www.lymenet.org/BurrGuide200810.pdf
Cowden (herbal): http://www.nutramedix.com
Buhner (herbal): http://buhnerhealinglyme.com
Byron White: http://byronwhiteformulas.com
Protomyxzoa rheumatica: http://protomyxzoa.org/wp-content/uploads/2013/05/Protomyxzoa_rheumatica.pdf
Detailed critique of IDSA Guidelines: http://www.peh-med.com/content/5/1/9