Table of Contents
After reviewing the following article, be sure to visit our
Trauma section to view our pictures
of a Lyme
Lyme Disease is one of only a few tick-transmitted infectious
agents. Lyme Disease has received a lot of attention over
the last 10-15 years, and was first recognized in 1975 in
Lyme, Connecticut. Other tick-borne illnesses that are very
similar to Lyme Disease include Babesiosis and Ehrlichiosis.
In 1996, there were approximately 16,000 cases reported, in
approximately 45 states. This is most likely an underreported
number, and this number is likely to increase over the years
as more cases are reported. This is in part due to greater
media attention regarding Lyme Disease.
Areas with the highest incidence of Lyme Disease include
Connecticut, Rhode Island, New Jersey, Delaware, New York
State, Pennsylvania, Maryland, and there is an area in northwest
Wisconsin which also has a fairly high incidence of Lyme Disease.
The lifecycle of a tick is approximately two years, and includes
three blood meals in the spring. The adult female tick releases
her eggs, which hatch six-legged larvae during the summer,
and the larvae stage lasts approximately two days. They enter
a dormant phase in the fall weather. The ticks molt in the
spring, and they enter their second phase as an eight-legged
nymph, which is approximately the size of a numeral of the
year on a penny. They also take a blood meal, which lasts
2-3 days, and then they molt. In the fall, you have the adult
tick. Hence you have the lifecycle of the tick.
Lyme disease has been detected in 45 states. Survive Outdoors
has had one case of Lyme Disease from Jackson County in Southern
Illinois. Please refer to pictures of the typical Lyme Disease
rash on the Survive Outdoors website. The Lyme Disease rash
is called erythema migrans. This rash is usually around 5
cm. or greater in diameter. The rash in the photo measures
approximately 7 cm., has the typical bulls eye appearance
with a central clearing pale area in the middle, surrounded
by a pale to bright red rash. This area may or may not be
itchy or tender to touch. Only about 70% of individuals who
do have Lyme Disease actually experience the rash. Allergic
reactions can also be confused with erythema migrans. Only
about 70% of all Lyme Disease cases will have the rash.
A common myth is that when a tick bites, it burrows underneath
the skin. When a tick bites, the head of the tick is just
barely under the epidermis, and the rest of the tick’s
body extrudes out of the skin. It has been studied that a
female and a nymph tick usually has to be attached greater
than 72 hours, greater than 3 days at which point they were
much more likely to induce Lyme Disease than a tick attached
less than 72 hours. The nymph tick is primarily the culprit
in inducing Lyme Disease. This may be in part because the
nymph tick is so tiny, and cannot be detected until they have
already transmitted Lyme Disease.
Recent Lyme statistical reports
There were 17 reported cases of Lyme disease in Illinois
in 1999. There has been a slow increase since 1996. In 1996
there were 10 reported cases, in 1997 13 cases, 1998 14 cases,
and in 1999 17 cases. This is actually down from 1990, where
there were 30 cases reported in Illinois. The decline may
be due to individuals utilizing proper precautions, public
awareness of Lyme disease, as well as awareness of the symptomatology
to look for.
Lyme Disease Symptoms
Lyme Disease can be divided into 3 stages
- The first stage is the early stage, and this is the stage
that the Lyme rash, or the erythema migrans is most typically
seen. It takes approximately 7-10 days after the tick bites
for this rash to appear. It can occur as long as 28-30 days
later. At this time you can also experience swollen lymph
nodes. Fever is usually low-grade, around 102-103 degrees,
and the fever is more common in children than adults. After
3-4 weeks, the rash does fade without any treatment. If
antibiotics are given, the rash resolves much more quickly.
IT IS VERY IMPORTANT NOT TO PANIC IF YOU HAVE A RASH, AND
YOU HAVE BEEN IN THE OUTDOORS. Please go to the photo section
on Survive Outdoors, and you will see common allergic reactions
from tick bites which are not the Lyme Disease rash.
- Stage 2 usually occurs within weeks after infection.
About 50% of patients will encounter numerous rashes throughout
the body that are similar to the erythema migrans. Sometimes
there is blistering that occurs. Fever, swollen lymph nodes,
and nausea and vomiting may occur, as well as an enlarged
spleen. Severe headaches are not uncommon. Some dizziness,
as well as emotional changes, perhaps insomnia, may occur,
as well as muscle aches and pains, and joint pain. During
this phase, it is not uncommon for Lyme Disease to be confused
with a generalized virus. Heart problems develop in only
about 4-7% of patients with untreated Lyme, and the onset
of that usually ranges from 3-21 weeks. In approximately
60% of untreated individuals with Lyme Disease, arthritis
develops after approximately 4 weeks, and can be delayed
up to 2 years. It is very common to have pain and enlarged
joints. This may be one, or multiple joints. In this stage,
antibiotics have been successfully used in treatment.
- The late stage, Stage 3, usually begins a year or more
later, after the Lyme rash has first appeared. Chronic arthritis
is common in about half of the patients. Although rare,
strokes, seizures, and severe dementia may occur. This phase
can persist for many years, even decades.
Lyme Disease Treatment
Healthcare Provider - Medical Treatment
With Lyme disease, it is important to
ascertain some important historical information before implementing
- It is helpful to know where this person
acquired the tick, what geographic range. Certain areas
are more endemic to Lyme than others.
- It has been shown that although a Lyme
infected tick can transmit Lyme in less than 72 hours, it
is much more likely that the individual could contract Lyme
disease if the tick has been attached for 72 hours or greater.
I always ask the patient if they have any idea now long
the tick has been attached before removing it. That does
sway me towards treatment.
- Please be advised that after being bitten
by a tick, red areas is not necessarily Erythema Migrans.
Many individuals have hypersensitive reactions to the tick
bite. A healthcare provider needs to be aware of the difference.
One should note that the IgM antibody titers usually peak
around the 4th to 6th week after the onset of illness. If
there was early treatment by another healthcare provider or
yourself prior to this, this could suppress antibodies. It
is also important to note that IgM and IGG antibodies can
persist for quite a few years.
For this website, we will target early localized disease.
For late disseminated neurological and arthritic conditions,
as well as carditis from Lyme disease, we will refer you to
Wilderness Medicine by Paul Auerbach, since this is beyond
the scope of Survive Outdoors.
Treatment for early, isolated Lyme disease
as recommended by Dr. Auerbach, go with Tetracycline, 250
mg., 4x/day for 14-28 days, Doxycycline, 100 mg. 2x/day for
14-28 days, Amoxicillin, 500 mg., 3x/day for 14-28 days, Cefuroxime,
500 mg., 3x/day for 14-28 days. For children, they recommend
Amoxicillin, 50 mg./kilo 3x/day for 14-28 days. However, this
author has seen recommendations of going up to 80 mg./kilo.
Over 8 years old, Doxycycline, 100 mg. bid for 14-28 days,
Erythromycin, 30-50 mg./kilo qid 14-28 days. It is important
to note that Zithromax has also been recommended by Sanford.
It is not the optimal treatment. However, if you have a pregnant
female who is allergic to Amoxicillin, this may be one of
the routes you may want to go, and prescribe Zithromax.
It has been recommended
and shown to be clinically appropriate if in an endemic area
and the tick has been on for 72 hours, it is recommended to
prescribe Doxycycline, 200 mg., one dose, and has been shown
to be beneficial for prophylaxis, if caught early enough.
This is somewhat controversial. Some clinicians do not recommend
the prophylactic dose, and others do. Survive Outdoors will
let you be the judge.