26 July 2017
Due to an increase in both the deer and white-footed mouse population, 2017 is slated to be a particularly bad year for Lyme disease. In fact, cases of Lyme disease have increased steadily over the last 2-3 decades.
Lyme disease is caused by an infection from the spirochete Borrelia burgdorferi (a parasite). This is most often transmitted to humans through a bite from an infected nyphmal ixodes tick. NOTE: An infected tick needs to be attached to its host for 36-48 hours before Lyme can be transmitted.
Lyme disease has three stages: early localized, early disseminated and late
Fortunately, 90% of children infected with Lyme disease exhibit the classic red “bullseye” rash that is typical of this early stage, developing within 7-14 days after a tick bite. This rash is usually flat, not painful, is at least 5 cm in diameter and continues to expand over days, possibly weeks. It may also be accompanied by additional symptoms, including fever, headache, dizziness, body aches and fatigue.
Testing for Lyme infection at this stage is not helpful because results are often negative and an accurate diagnosis can be made visually. Early stage Lyme disease is easily treated with 14-21 days of oral antibiotics and 90% of patients have complete resolution of symptoms.
Early disseminated stage
The early disseminated stage of Lyme disease occurs 3-5 weeks after the initial bite and can cause multiple red bullseye rashes, facial nerve palsies (Bell’s palsy), meningitis and carditis. In children with Lyme, 3% will exhibit facial nerve palsy and 1% meningitis.
Late stage Lyme disease includes arthritis with redness, pain and swelling of a joint, as well as more significant cardiac and neurologic symptoms. Depending upon the individual case, early disseminated Lyme and late stage Lyme can be treated with 21-28 days of oral or IV antibiotics.
The most important tool in the fight against Lyme is prevention
Checking your children and yourself for ticks at the end of a day spent outdoors is the best prevention. If a tick is removed quickly, it cannot transmit Lyme.
The best way to remove a tick: Using a wet, soapy towel, rub counterclockwise over the tick. This technique removes the majority of ticks without leaving mouth parts behind. However, it is important to note that if parts are left behind, they are not dangerous and will not cause Lyme disease. Similar to removing a splinter, the best thing to do is clean the area with soap and water, then continue to soak the area with wet compresses or in the tub until they come out.
Insect repellent is also important. The most effective repellents are ones that contain 10-30% DEET. If used properly, they are safe to use on infants and children over the age of 2 months. Citronella products do not repel ticks nor protect against Lyme. Other botanicals such as geranium, sandalwood and soy may be effective, but studies have not shown them to work as well as DEET. Permethrin is also effective, but can only be applied to your clothing and should never be applied directly to the skin. Also, combination products that contain sunscreen and DEET should not be used because in order for the sunscreen to be effective, you need to apply every 2 hours and this would not be safe for DEET.
We do not recommend sending a tick to a lab for testing. Many of our parents ask us if they should get a tick tested for Lyme after they have removed it. This is not helpful for several reasons. First, if the test is positive, it does not mean that the tick has actually transmitted Lyme to its human host, and therefore treatment would not be recommended. Second, chances are that it will take several weeks for the test results to come back. However, if a child develops symptoms during that time, we would recommend starting treatment regardless, right away. Third, a negative test can give a false sense of security. Many cases of Lyme disease are likely contracted from tick bites that go undetected, and even though one test may be negative, it does not mean that a different bite from an infected tick has not happened as well.
Antibiotic prophylaxis for a tick bite. In certain cases, a single dose of doxycycline can be used as prophylaxis after a tick bite. Small studies have shown effectiveness when the tick was an adult or nymphal ixodes tick, it was attached for at least 36 hours, treatment is initiated within 72 hours of the bite and the patient is able to take doxycycline. Doxycycline is not recommended for children less than 8 years of age due to concerns over tooth enamel hypoplasia and permanent discoloration of the teeth. Again, it is important to remember that many cases of Lyme are caused by undetected tick bites. If the tick is detected and removed within 48 hours, Lyme disease will not have been transmitted.
As always, it is important to contact your physician if you have any questions or concerns
There is a lot of misinformation on the internet. A conversation with a doctor whom you know and trust is the best way to stay informed.
If you think your child has been bitten by a tick, please contact us
If you suspect your child may have contracted Lyme disease from a tick bite, please make an appointment with Westchester Health Pediatrics to see one of our pediatricians for an accurate diagnosis and treatment. The sooner we can begin treatment, the faster we can stop the development of the disease and prevent long-lasting consequences.