Ticks and Lyme Disease
Tick bites are a very common incident in this part of the country due to our local environment and heavily wooded areas. The single best thing that you can do to prevent developing Lyme disease is to do a thorough tick check on your children every single day. In particular, be sure to check behind the ears, armpits, the back of the neck, elbows, knees, groin, under scrotum, between toes, etc. Wearing effective repellent and covering up when outdoors can also be quite helpful.
WHAT TO DO IF YOU FIND A TICK THAT IS IMBEDDED
When you find a tick on yourself or your child, removing it promptly is suggested. Using old-fashioned remedies like petroleum jelly, nail polish or a match will not make the tick detach from the skin and may actually increase the risk of transmitting Lyme if the tick is infected. The best thing to do is to use a pair of fine tipped tweezers as close to the skin as possible when the tick is lifted up (legs pointing up away from the skin) and then lift straight up from the skin. The imbedded tick doesn't detach easily and the skin will tug and it may take a bit of a pull to remove it from the skin.
Per the CDC recommendations:
- Use fine-tipped tweezers to grasp the tick as close to the skin's surface as possible.
- Pull upward with steady, even pressure. Don't twist or jerk the tick; this can cause the mouth-parts to break off and remain in the skin. If this happens, remove the mouth-parts that are above the surface of the skin with tweezers. If you are unable to remove the mouth easily with clean tweezers, leave it alone and let the skin heal. Do not dig at the skin.
- After removing the tick, thoroughly clean the bite area and your hands with rubbing alcohol, an iodine scrub, or soap and water.
Dispose of a live tick by submersing it in alcohol, placing it in a sealed bag/container, wrapping it tightly in tape, or flushing it down the toilet. Never crush a tick with your fingers.
The tick that typically causes Lyme disease is the blacklegged tick (Ixodes scapularis). These are very small ticks and depending on the age of the tick and the season of the year, they can vary from light to darker brown in color and the size can be very tiny (the size of a poppy seed) up to about 1/4in. They need to be firmly attached and feeding for 36 hours or more to transmit the germ that causes Lyme so a tick found right after a hike that is not fully attached is not a risk to your health. Even a tick found a day after being exposed carries very low risk if it is removed once it is discovered.
We often get calls about “not getting it all out” and what risk that poses to your child. In looking at a photograph of a tick, you will see that in addition to the mouth piece in the center of the head, there are 2 other antenna-like projections. This is not where the tick stores or transfers saliva which is how the Lyme spreads. The role of these structures is to bury into skin to hold the tick firmly in place so that the tick can then bite and feed. If the tick is lifted straight up from the skin, the mouthpiece will come off but these “antennae” are likely to stay in the skin. They are barbed and therefore, very difficult to pull out of the skin. Once the tick is gone, these remaining pieces are NOT a risk to transmit any disease. They are similar to very tiny slivers that will work themselves out over the next few days. It is recommended NOT to pick at them or dig into the skin to remove these tiny remnants because the risk of developing a skin infection is greater than the risk of leaving them alone. Clean the skin after removing the tick.
After removing a tick that may have been attached for more than 36-48 hours, the area should be cleaned and then checked daily for up to 30 days after the tick was discovered.
“Preventative” treatment with antibiotics has been studied in adults but not in children. The medication used in these studies is an antibiotic that we do not give to young children. There can also be side effects from use of preventative antibiotics that are riskier than waiting to watch for any signs of Lyme.
EARLY SIGNS OF LYME DISEASE
If a tick happened to be missed on daily tick checks, and it was a tick that carried Lyme (only 25-32% of ticks tested in CT are positive for Lyme with most recent data collections), the symptoms can begin as early as 2-3 days after the bite but may not begin for up to 30 days after the bite.
ANY insect bite can leave a bit of redness that is often raised at the exact site of the tick bite. This is not Lyme; it is just a reaction to being bitten by an insect and is similar to a mosquito bite but usually less itchy.
70-80% of individuals who become infected will develop the classic “Bullseye” rash of Lyme disease. This rash is called Erythema Migrans (EM). “Erythema” means red and “Migrans” means that it moves or migrates. This rash will appear as a red ring that is typically flat, NOT raised, painful or itchy. It starts in the area around the initial tick bite and it expands so that the red ring is bigger day by day and usually expands to 12 or more inches across. The middle of the ring remains typical skin color—it does not look red which is why the ring gives the appearance of a bullseye. Sometimes, if the rash appears very early, the “bite” at the center will still look red or even a bit bruised so the very center can be reddish with normal skin tone surrounding the bite mark but inside the expanding red ring.
This rash is much more likely to be discovered in children than in adults. Because it is not itchy, raised or painful, it can go undetected in areas that adults do not look at frequently on themselves—the back of your neck, armpits, back, buttocks, behind knees, etc. but in children, parents are often helping them with bathing and dressing and are much more likely to notice this type of rash.
Rarely, the EM rash can appear on other parts of the body or there may be other EM rashes that show up on other parts of the body at the same time so that there are many “bullseyes.”
Early symptoms can also include fever, chills, headache, fatigue, joint aches and muscle aches that occur WITHOUT other signs of illness that would explain this. (No congestion, cough, runny nose, stomach upset, diarrhea, etc.)
When a person has classic EM rash, they should be treated for Lyme disease with a course of oral antibiotics. The type of antibiotic depends on the age of the patient. Testing the tick or performing blood tests on the patient is not necessary because it is clear what the diagnosis is and what the treatment should be.
LATER SIGNS OF LYME DISEASE
Occasionally, a tick may be missed and the early symptoms may be missed or very mild. If a person is infected and does not develop any of the early signs of Lyme that were discussed in the last section, he or she may develop other symptoms. These may include severe headache with neck stiffness (this is a symptom that should ALWAYS be evaluated emergently, especially if it occurs with fever because meningitis can have similar symptoms). Arthritis with severe joint pain and swelling (typically the knees but can involve other joints) would need to be evaluated for Lyme. Facial palsy (Bell’s palsy) can occur with Lyme disease as well. This is a sudden onset of drooping of the muscles on one side of the face.
More rarely, Lyme can affect the heart and symptoms would include heart palpitations, irregular heartbeat, dizziness and shortness of breath. Lyme meningitis can also rarely occur which would cause fever, severe headache and stiff neck. Shooting pains with numbness, tingling, nerve pain, and short-term memory problems have also been seen with Lyme in a small number of patients.
CAN LYME BE A CHRONIC DISEASE?
Very rarely, Lyme symptoms can last for more than 6 months. The overwhelming majority of patients recover after the usual course of oral antibiotics. Sometimes patients will develop a condition called “Post-treatment Lyme Disease Syndrome” or PTLDS. The treatment can be controversial but there are many studies ongoing to determine the best course of action for these patients. The NIH Lyme Disease Website has the most up to date information.
TREATMENT OF LYME DISEASE
For children <8 years old are usually treated for 2-4 weeks with oral amoxicillin. Older children and teens would take doxycycline for the same length of treatment.
Almost all patients who are treated appropriately and complete the course of antibiotics will recover fully within a short period of time.
The CDC website has the most up to date recommendations for treatment of Lyme disease.
General information for parents can be found at the following links:
http://www.cdc.gov/lyme/resources/toolkit/factsheets/10_508_lymedisease_parent.pdf
http://www.cdc.gov/lyme/resources/toolkit/factsheets/10_508_lyme-disease_hikerscampers_factsheet.pdf