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The Lyme Wars: Lyme disease numbers on the rise

Original source: http://www.washingtontimes.com/news/2017/may/11/lyme-disease-numbers-on-the-rise/

Thursday, May 11, 2017By Laura Kelly, The Washington Times 

Black-legged and deer ticks have spread into new areas across the country, carrying Lyme disease into places where it didn’t exist 20 years, according to the federal Centers for Disease Control and Prevention.

The CDC estimates that about 30,000 U.S. residents are infected with Lyme disease each year, but notes that underreporting could put the actual count at 300,000 cases.

“Since the late 1990s, the number of reported cases of Lyme disease in the United States has tripled, and the number of counties in the northeastern and [upper-midwestern] United States that are considered high-risk for Lyme disease has increased by more than 300 percent,” research biologist Rebecca Eisen wrote on the CDC website.
“One explanation for this trend is that the ticks that can transmit Lyme disease have expanded their geographic range and are now being found in places they weren’t seen 20 years ago,” said Ms. Eisen, who works at the National Center for Emerging and Zoonotic Infectious Diseases, Bacterial Diseases Branch, Division of Vector-Borne Diseases. “This makes it more important than ever for people to take steps to prevent tick bites, particularly during the spring and summer when ticks are most active.”

The CDC says that 96 percent of cases occur in 14 states: Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Virginia and Wisconsin — but instances of Lyme disease are expanding to Canada and even Europe.

Over the past few years, researchers have increased their understanding of Lyme disease, and are experimenting with ways to predict how severe tick season will be.

It starts with acorns.

“The bottom line, stated briefly, is that acorn mast [fruit of forest trees] affects tick populations in oak forests,” Howard Ginsberg of the U.S. Geological Survey told The Washington Times in an email. “While the acorns are not directly related to nymph ticks — the stage at which ticks contract the bacteria associated with Lyme’s disease — large numbers of acorns attract more deer and rodents, providing a suitable hosting environment for ticks to feed, grow, drop off and lay eggs that will affect the tick population the following year.”

Richard Ostfeld, a disease ecologist at the Cary Institute of Ecosystem Studies in Millbrook, New York, says the white-footed mouse is the most dangerous culprit in transferring to deer ticks the Borrelia burgdorferi bacteria, which causes Lyme disease.

“More acorns leads to more mice, leads to more infected ticks, leads to more Lyme disease in us,” Mr. Ostfeld said in a CBS New York interview earlier this month.

Areas where the predator population has decreased — such as foxes, bobcats and owls — allow the mice population to thrive and play host to nymph ticks, he said.

USGS’ Mr. Ginsberg and his colleagues are studying the differences between southern and northern ticks. Higher humidity and temperatures force southern ticks to protect themselves by hiding under loose foliage, robbing them of a chance to latch onto a passing human leg. Northern ticks readily attach themselves to passers-by because they hide in tall grass.

Ticks are very small, and the tell-tale sign of Lyme disease — a bull’s-eye rash — is not always apparent. Symptoms can include fever, headache and fatigue.

The disease is treated with antibiotics, but if left untreated for weeks or months, more serious complications can arise, such as infection and swelling in the joints, the heart and the nervous system, inflammation of the brain and spinal chord and problems with short-term memory.

No vaccine is available for humans, but there is one for pets, which should be checked frequently in case of carrying a tick into the home.

A less common but equally worrisome tick-borne illness is Powassan virus, or POW. There have been only 75 cases of POW in the last 10 years, but the CDC calls for extra vigilance to avoid a tick-borne infection.

A potentially fatal disease, POW can cause inflammation of the brain or the membranes surrounding the spinal chord.

“Symptoms can include fever, headache, vomiting, weakness, confusion, loss of coordination, speech difficulties, and seizures,” the CDC says on its website.

Causes and Important Facts

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Lyme disease is caused by bacteria called Borrelia burgdorferi (B burgdorferi). Blacklegged ticks and other species of ticks can carry these bacteria. The ticks pick up the bacteria when they bite mice or deer that are infected with B burgdorferi. You can get the disease if you are bitten by an infected tick.

Lyme disease was first reported in the United States in 1977 in the town of Old Lyme, Connecticut. The same disease occurs in many parts of Europe and Asia. In the United States, most Lyme disease infections occur in the following areas:

  • Northeastern states, from Virginia to Maine
  • North-central states, mostly in Wisconsin and Minnesota
  • West Coast, mainly in the northwest

There are three stages of Lyme disease.

  • Stage 1 is called early localized Lyme disease. The bacteria have not yet spread throughout the body.
  • Stage 2 is called early disseminated Lyme disease. The bacteria have begun to spread throughout the body.
  • Stage 3 is called late disseminated Lyme disease. The bacteria have spread throughout the body.

Important facts about tick bites and Lyme disease:

  • A tick must be attached to your body for 24 to 36 hours to spread the bacteria to your blood.
  • Blacklegged ticks can be so small that they are almost impossible to see. Many people with Lyme disease never even see or feel a tick on their body.
  • Most people who are bitten by a tick do not get Lyme disease.
Prevention

Original source: http://www.clinicaladvisor.com/infectious-diseases-information-center/cdc-releases-tips-for-preventing-lyme-disease-and-tick-bites/article/655447/ and http://pennstatehershey.adam.com/content.aspx?productId=117&pid=1&gid=001319

To prevent against getting a tick bite, the CDC recommends the following:

  • Avoid high grass and leaf litter and walk in the center of hiking trails.
  • Use repellent that contains 20% or more DEET, picaridin, or IR3535 on exposed skin.
  • Use products that contain permethrin to treat clothing and gear, including boots, pants, socks, and tents, or look for clothing pretreated with permethrin.
  • Wear light-colored clothing so that if ticks land on you, they can be spotted and removed.
  • Wear long sleeves and long pants with pant legs tucked into your socks.
  • Treat dogs for ticks using tick collars, sprays, shampoos, or monthly “top spot” medications.
  • Bathe or shower after coming indoors to wash off and easily find any crawling ticks.
  • Conduct a full-body tick check using hand-held or full-length mirror. Parents should also help children check thoroughly for ticks. Remove any ticks right away.
  • Dry clothes in a dryer on high heat for 10 minutes to kill ticks on dry clothing.
How to remove an attached tick.

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If a tick is attached to you, follow these steps to remove it:

  • Grasp the tick close to its head or mouth with tweezers. DO NOT use your bare fingers. If needed, use a tissue or paper towel.
  • Pull it straight out with a slow and steady motion. Avoid squeezing or crushing the tick. Be careful not to leave the head embedded in the skin.
  • Clean the area thoroughly with soap and water. Also wash your hands thoroughly.
  • Save the tick in a jar.
  • Watch carefully for the next week or two for signs of Lyme disease.
  • If all parts of the tick cannot be removed, get medical help. Bring the tick in the jar to your doctor.
Symptoms

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Localized Early Stage

Symptoms of early localized Lyme disease (stage 1) begin days or weeks after infection. A red rash appears within a few weeks of a tick bite, starting as a small red spot at the site of the bite. The spot gets bigger over time, making a circle or oval and sometimes looking like a bull’s eye. Often there is a clear area in the center. The rash can range in size from that of a dime to the entire width of a person’s back, this rash is called erythema migrans. Without treatment, it can last 4 weeks or longer. As the infection spreads, rashes can show up at different places on the body. You may also have flu-like symptoms that include:

Symptoms may come and go. Untreated, the bacteria can spread to the brain, heart, and joints.

Early Disseminated Stage

Symptoms of early disseminated Lyme disease (stage 2) may occur weeks to months after the tick bite, and may include:

  • Numbness or pain in the nerve area
  • Pain and swelling in the large joints, such as the knees
  • Heart problems, such as skipped heartbeats (palpitations), lightheadedness, fainting, chest pain, and shortness of breath, which may develop in fewer than 10% of people with Lyme disease. Symptoms may show up several weeks after infection and last a few days or weeks.
  • Neurological symptoms, such as a stiff neck and severe headache (may indicate meningitis), temporary paralysis of muscles in the face (Bell’s palsy), numbness, pain or weakness in the limbs, or poor motor coordination. 

Late Stage

Symptoms of late disseminated Lyme disease (stage 3) can occur months or years after the infection. The most common symptoms are muscle and joint pain. Other symptoms may include:

  • Abnormal muscle movement
  • Joint swelling
  • Muscle weakness
  • Speech problems
  • Thinking (cognitive) problems
  • Arthritis, 60% of people not treated with antibiotics develop recurring attacks of arthritis, most often in the knees, that last a few days to a few months. About 10 to 20% people who are not treated will develop chronic arthritis.
  • Neurological problems, up to 5% of people who do not get treatment develop long-lasting problems, including numbness and tingling in hands or feet, shooting pains, and short-term memory problems. 
  • Sudden loss of hearing, which may occur among a subset of people with Lyme disease.
Who is at risk?

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Your risk of Lyme disease may be higher if you:

  • Spend time in heavily wooded areas where there are ticks
  • Spend time outdoors in summer and fall
  • Young children and young adults are more likely to get Lyme disease.
  • Having a pet that may carry infected ticks home
  • Live in the coastal northeast, as well as in Wisconsin, Minnesota, California, and Oregon, where the majority of cases show up
What to ask your doctor.

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Where on my body am I most likely to get a tick bite?

  • How large are ticks and tick bites? If I have a tick bite, will I always get Lyme disease?
  • Can I get Lyme disease even if I never noticed a tick bite on my body?
  • What can I do to prevent getting tick bites when I am in a wooded or grassy area?
  • In what areas of the US am I more likely to get a tick bite or Lyme disease? At what time of the year is the risk higher?
  • Should I remove a tick if I find one on my body? What is the proper way to remove a tick? Should I save the tick?

If I get Lyme disease from a tick bite, what symptoms will I have?

  • Will I always have symptoms soon after getting Lyme disease (early or primary Lyme disease)? Will these symptoms get better if I am treated with antibiotics?
  • If I do not get symptoms right away, can I get symptoms later? How much later? Are these symptoms the same as the early symptoms? Will these symptoms get better if I am treated with antibiotics?
  • If I am treated for Lyme disease, will I ever have symptoms again? If I do, will these symptoms get better if I am treated with antibiotics?

How can my doctor diagnose me with Lyme disease? Can I be diagnosed even if I do not remember having a tick bite?

What are the antibiotics used to treat Lyme disease? How long do I need to take them? What are the side effects?

Will I have a full recovery from my Lyme disease symptoms?

What to expect at your provider's office.

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Lyme disease can be hard to diagnose because many of its symptoms look like those of other illnesses, and there is no definitive lab test for Lyme disease. About 20% of people with Lyme disease do not get a rash. Tell your doctor if you think you may have been bitten by a tick. Your doctor may order these tests:

  • ELISA test, which detects antibodies to the bacteria that causes Lyme disease. This test may result in false positives.
  • Western blot test, which detects antibodies to proteins of the bacteria
  • Polymerase chain reaction (PCR), which detects bacteria in joint fluid and is used for people who may have Lyme arthritis.
Treatment

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People bitten by a tick should be watched closely for at least 30 days to see if a rash or symptoms develop.

A single dose of the antibiotic doxycycline may be given to someone soon after being bitten by a tick, when all of these conditions are true:

  • The person has a tick that can carry Lyme disease attached to his or her body. This usually means that a nurse or doctor has looked at and identified the tick.
  • The tick is thought to have been attached to the person for at least 36 hours.
  • The person is able to start taking the antibiotic within 72 hours of removing the tick.
  • The person is 8 years or older and is not pregnant or breastfeeding.
  • Local rate of ticks carrying B burgdorferi is 20% or higher.

A 10 day to 4-week course of antibiotics is used to treat people who are diagnosed with Lyme disease, depending on the choice of drug:

  • The choice of antibiotic depends on the stage of the disease and the symptoms.
  • Common choices usually doxycycline (Vibramycin), amoxicillin, and cefuroxime (Ceftin) are prescribed. Later-stage Lyme disease may require intravenous (IV) antibiotics, either ceftriaxone (Rocephin) or penicillin. Note: pregnant and breastfeeding women, and children under 8 years of age should not take doxycycline.

Pain medicines, such as ibuprofen(Advil, Motrin) or naproxen (Aleve), are sometimes prescribed for joint stiffness.

Complementary and Alternative Therapies

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You should never treat Lyme disease with complementary therapies alone. Anyone who has Lyme disease needs to take antibiotics to cure the disease and avoid complications. Lyme disease does affect many parts of your body, so including complementary therapies along with standard treatment may help.

Some people believe they have long-lasting complications from Lyme disease. Using CAM therapies to treat these long-lasting complications is controversial. Conventional doctors believing that CAM practitioners may be attributing too many random symptoms to Lyme disease. Make sure you see reputable doctors, whether conventional or CAM practitioners, and educate yourself so that you can be your own advocate.

Always tell all of your doctors about the herbs and supplements you are using or considering using.

Nutrition and Supplements

  • Probiotic supplement (containing Lactobacillus acidophilus): 5 to 10 billion CFUs (colony forming units) a day. Probiotics, or “friendly” bacteria, help maintain intestinal health. If you take antibiotics to treat Lyme disease, the antibiotics will kill the “good” bacteria along with the bad. That can cause diarrhea or yeast infections. Taking probiotics may reduce these side effects. People with weakened immune systems, or those who take drugs to suppress their immune systems, should ask their doctors before taking probiotics.
  • Beta-glucan: which is a kind of fiber, is sometimes used to help fight Lyme disease, although there are not any studies to say whether it works or not. Beta-glucan is thought to stimulate the immune system, so people with weakened immune systems, or those who take drugs to suppress their immune systems, should ask their doctors before taking it.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider. Some helpful herbs include:

  • Garlic (Allium sativum): which has antibacterial effects, and one study suggested it may help prevent tick bites. In that study, people who took garlic reported fewer bites than those who took a placebo. More study is needed to tell whether garlic can help repel ticks. Garlic may increase the risk of bleeding, especially if you also take blood thinners such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin. Garlic can potentially interfere with several medications, including drugs used to treat HIV/AIDS, and even some birth control medications. Speak to your doctor.
  • Essaic: burdock root (Arctium lappa), sheep sorrel (Rumex acetosella), slippery elm (Ulmus fulva), rhubarb (Rheum palmatum); Some herbal practitioners may prescribe Essaic to help treat Lyme disease, although there are not any studies to say whether it works. Essaic is a formula that contains several different herbs, and may interact with many medications and potentially cause some dangerous side effects. DO NOT take Essaic on your own. Make sure you have the supervision of an experienced herbal practitioner, and let your doctor know what you are taking.

Homeopathy

Few studies have examined the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend treatments for Lyme disease based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person’s constitutional type, including your physical, emotional, and intellectual makeup.

In some cases, such as Lyme disease, a professional homeopath may prescribe specific remedies without considering the individual’s constitutional state. Such remedies for Lyme disease include:

  • Arsenicum album
  • Borrelia burgdorferi nosode
  • Carcinosin
  • Lac canimum
  • Ledum
  • Mercurius
  • Syphilinum
  • Thuja
Additional Resources

For additional tips and helpful information visit CDC’s Lyme Disease prevention toolkit.

 

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