Racial Differences In Incidence
Lyme disease is reported primarily in whites, although it occurs in individuals of all races. No genetic explanation is known for this the disparity most likely stems from social or environmental factors and possibly to the fact that erythema migrans is more difficult to diagnose in dark-skinned individuals.
Post Lyme Disease Persistent Symptoms
Non-specific post Lyme disease persistent symptoms can occur after adequate treatment of the initial infection. This does not require retreatment with antibiotics as this has not been shown to be beneficial. Furthermore, additional antibiotic therapy will promote colonization with resistant bacteria and can cause harm. Instead, care should be provided to either establish another diagnosis or provide ongoing support.
Should I Remove A Tick And How
Yes, remove a tick. But do not manhandle the tick by squeezing it, putting Vaseline over it, or holding a hot match to it, as this may increase the chance of transmitting disease.
The tick should be removed with fine pointed tweezers. Grasp it from the side where it meets the skin, and, using steady gentle pressure, gently pull in the opposite direction from which it embedded, until the tick is released. Expect to see the skin tent as you gently pull. Place the tick in a lidded container or zip-lock bag. Wash and disinfect the bite site, your hands, and your tweezers. Avoid handling the tick.
If you use a tick removal device like a tick scoop or tick key, follow the directions given on the package for safe and effective use.
Routine prophylaxis after a recognized tick bite is not recommended. A guideline from the Infectious Disease Society of America recommends prophylactic antibiotic therapy for adults and children older than 8 years, using a single 200-mg dose of doxycycline only if all of the following criteria are met :
The attached tick can be reliably recognized as a nymphal or adult Ixodes scapularis
The tick has been attached for at least 36 hours, as determined by the degree of engorgement of the tick or certainty about the time of exposure to the tick
Prophylaxis can be started within 72 hours of the time the tick was removed
The local rate of infection of these ticks with Borrelia burgdorferi is at least 20%
Doxycycline treatment is not contraindicated
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Transmission Of Bb Via Ixodes Spp Vectors
The black-legged ticks, Ixodes scapularis and Ixodes pacificus on the West Coast, are the primary vectors of Bb in the USA. In endemic areas, the proportion of Ixodes spp. ticks infected with Bb can be remarkably high. One recent survey of the pathogen burden of 197 Ixodes scapularis ticks collected from New York and Connecticut where LD is endemic, revealed 111 ticks were infected with Bb and 37 were co-infected with more than one human pathogen . The high pathogen burden is consistent with previous tick surveys in the same region . In contrast, the percent of infected ticks in other regions of the USA is much lower. In recently published surveys across California, for example, fewer than 5% of Ixodes spp. ticks were infected . Ixodes ticks sometimes carry multiple strains of Bb that may impact the course of disease in people that are co-infected. One tick survey showed that 39% of Ixodes ticks in North America are infected with multiple genotypes of Bb .
Antimicrobials That Kill Growing Phase Spirochetes
- Amoxicillin 500 mg 1 to 2 pills 3 times a day. Alternatively as an alternative to IV antibiotics take 3 to 4 pills 3 times a day.
- Amoxicillin/Clavulanic Acid 875 mg/125 mg 1 pill 2 times a day
- Bicillin LA 2.4 million units IM 3 times a week with one day between each injection
- Ceftriaxone 2 gm IV 2 times a day for 4 days in a row then off for 3 days of each 7 days
- Cefotaxime 2 gm IV every 8 hours
- Cefuroxime 500 mg 1 pill 2 times a day
- Cefdinir 300 mg 1 pill 2 times a day
Additional IV Antibiotics
Vancomycin, imipenem, and ertapenem are possible alternatives if someone is allergic to Ceftriaxone or Cefotaxime.
Intracellular and Extracellular
- Clarithromycin 500 mg 2 pills 2 times a day
- Azithromycin 500 mg 1 time a day or 500 mg IV 1 time a day
- Doxycycline 100 mg 1 or 2 pills 2 times a day or 200 to 400 mg mg IV 1 time a day
- Minocycline 100 mg 1 pill 2 times a day
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What Causes Lyme Disease In A Child
Lyme disease is caused by bacteria that are spread to people by tick bites. The ticks that carry the bacteria are:
- Black-legged deer tick. These are found in the Northeastern, Mid-Atlantic, and North-Central U.S.
- Western black-legged tick. These are found on the West Coast of the U.S.
Not all ticks carry the Lyme disease bacteria. Depending on the location, less than 1 in 100 to more than half of ticks in that area may be infected with Lyme.
What Is The Treatment For Lyme Disease
The first-line standard of care treatment for adults with Lyme disease is doxycycline, a tetracycline antibiotic. Other antibiotics that have activity against borrelia include the penicillin-like antibiotic, amoxicillin, and the second generation cephalosporin, Ceftin. The mainstay of treatment is with oral antibiotics, but intravenous antibiotics are sometimes indicated for more difficult to treat cases of neurologic-Lyme disease, such as meningitis, and cases of late Lyme arthritis.
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What Can I Expect Long Term If My Child Has Lyme Disease
If Lyme disease is caught and treated early, most children will make a full recovery. Some children with Lyme disease go on to experience what’s called a post-infectious syndrome with symptoms that may include feeling fatigue, joint aches and pains, headaches, difficulty sleeping, and problems concentrating. Since the infection itself is gone by this time, doctors generally don’t prescribe antibiotics. Each child is different, but it’s not uncommon for symptoms of post-infectious syndrome to linger for months, or even years, and they can be made worse by stress or other illness. But most children do make a full recovery.
Blacklegged, or deer, ticks are very small, so it helps to know what to look for when doing a tick check. Adults are about the size of sesame seeds and in the nymph or larva stage, they can be as tiny as a poppy seeds.
Lyme Has Two Growth States
Research published in 2015 shows that Lyme has two different growth states. There is a growing phase of the germs and there is a persister phase. Think of the persisters as germs that are in hibernation. These persisters – hibernating phase germs – ignore regular standard antibiotics we traditionally use to treat Lyme.
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How Can Ld Be Prevented
Physicians should be aware of the epidemiology of tick-borne LD in their area, and recommend some basic precautions for families living, hiking or camping in rural or wooded areas where they may be exposed to ticks.
- Where play spaces adjoin wooded areas, landscaping can reduce contact with ticks. A pictogram from the Centers for Disease Control and Prevention is available at: www.cdc.gov/lyme/prev/in_the_yard.html
- Apply 20% to 30% DEET or icaridin repellents. Repellents can be applied to clothing as well as to exposed skin. Always read and follow label directions.
- Do a full body check every day for ticks. Promptly remove ticks found on yourself, children and pets. Shower or bathe within two hours of being outdoors to wash off unattached ticks.
For more information on how to prevent tick bites, refer to a recent practice point from the Canadian Paediatric Society at: www.cps.ca/en/documents/position/preventing-mosquito-and-tick-bites.
Stage : Late Disseminated Lyme Disease
Late disseminated Lyme disease occurs when the infection hasnt been treated in stages 1 and 2. Stage 3 can occur months or years after the tick bite.
This stage is characterized by:
- arthritis of one or more large joints
- brain disorders, such as encephalopathy, which can cause short-term memory loss, difficulty concentrating, mental fogginess, problems with following conversations and sleep disturbance
- numbness in the arms, legs, hands, or feet
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When To See A Doctor
A person should see a doctor if they have recently received a tick bite. It is not possible to know whether a tick is carrying Lyme disease, and the symptoms may take weeks to appear.
The earlier a person receives a diagnosis and treatment, the higher the likelihood of a quick and complete recovery.
It is not always possible for a person to tell if a tick has bitten them. As such, people should also see a doctor if they experience any Lyme disease symptoms. A doctor will ask about the persons symptoms and duration and whether the person has spent time in tick-infested areas.
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What Is Lyme Disease
Lyme disease is a bacterial infection. You get it when the blacklegged tick, also known as a deer tick, bites you and stays attached for 36 to 48 hours. If you remove the tick within 48 hours, you probably wonât get infected.
When you do get infected, the bacteria travel through your bloodstream and affect various tissues in your body. If you donât treat Lyme disease early on, it can turn into an inflammatory condition that affects multiple systems, starting with your skin, joints, and nervous system and moving to organs later on.
The chances you might get Lyme disease from a tick bite depend on the kind of tick, where you were when it bit you, and how long the tick was attached to you. Youâre most likely to get Lyme disease if you live in the Northeastern United States. The upper Midwest is also a hot spot. But the disease now affects people in all 50 states and the District of Columbia.
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Treatment For Chronic Lyme Disease
Sometimes, people go through treatment for Lyme disease but their symptoms donât go away. If this lasts over 6 months, itâs known as chronic Lyme disease or âpost-treatment Lyme disease syndromeâ .
Doctors still arenât sure why some people get PTLDS. Some believe that getting Lyme disease may cause damage to your tissues or immune system. Others believe itâs because the bacteria that causes Lyme hasnât completely gone away.
There is little evidence that taking more antibiotics at this stage will help. They may actually be harmful. Instead, your doctor will focus on treating the symptoms youâre still having. This will be different for everyone. Some people could benefit from a medicine that relieves fatigue, while others may need a drug that can help with headaches or very sensitive skin.
Your doctor could also have you try a treatment that helps people with chronic fatigue syndrome or fibromyalgia.
More research is needed to figure out how best to treat PTLDS. Itâs something that can be frustrating. Just remember: Many people who have this condition do start feeling like their old selves after a few months.
How Is The Diagnosis Of Ld Made
Testing should be carried out at an approved provincial, territorial or national public health laboratory in Canada. Test results from private laboratories not approved by Health Canada, provincial or territorial governments cannot be relied upon for accuracy nor validity.
Early, localized disease: In general, the diagnosis of LD is clinical , supported by a history of potential tick bite in an area where it is known or suspected that black-legged ticks have been established. However, because tick populations are expanding, it is possible that LD can be acquired outside of currently identified areas. Such a possibility should be considered when assessing patients. Patients with EM should be diagnosed and treated without laboratory confirmation, because antibodies against B burgdorferi are often not detectable by serodiagnostic testing within the first four weeks after infection .
Later disease: All other clinical manifestations of possible LD should be supported by laboratory confirmation. Two-tiered serological testing, including an ELISA screening test followed by a confirmatory Western blot test, is used to supplement clinical suspicion of extracutaneous LD . Two-tiered testing is necessary because the ELISA may yield false-positive results from antibodies directed against other spirochetes, viral infections or autoimmune diseases. Table 1 provides information related to the performance characteristics of serological assays in different clinical presentations of LD.
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What Are The Treatments For Lyme Disease
Lyme disease is treated with antibiotics. The earlier you are treated, the better it gives you the best chance of fully recovering quickly.
After treatment, some patients may still have pain, fatigue, or difficulty thinking that lasts more than 6 months. This is called post-treatment Lyme disease syndrome . Researchers don’t know why some people have PTLDS. There is no proven treatment for PTLDS long-term antibiotics have not been shown to help. However, there are ways to help with the symptoms of PTLDS. If you have been treated for Lyme disease and still feel unwell, contact your health care provider about how to manage your symptoms. Most people do get better with time. But it can take several months before you feel all better.
What Are The Clinical Manifestations Of Ld
Clinical manifestations are divided into early, localized disease, and later disease.
Early, localized disease: Erythema migrans a rash at the site of a recent tick bite is the most common presentation in children and adults . EM typically develops seven to 14 days after a tick bite. EM is usually > 5 cm and mainly flat. There may be central clearing or some bluish discoloration but a classic bulls eye is uncommon. EM is usually asymptomatic but is not painful to the touch, like a cellulitis. EM can be confused with a localized hypersensitivity reaction from a tick or insect bite, which is usually swollen, smaller in size and pruritic). There can be either a single erythema migrans rash or multiple rashes without extracutaneous manifestations. However, fever, malaise, headache, mild neck stiffness, myalgia and arthralgia often accompany EM.
Without treatment, EM resolves spontaneously over a four-week period, on average.
Later disease: Approximately 20% of children with LD first present to a health care provider with extracutaneous signs or symptoms that are compatible with LD. These cases may also have a recent past history of EM lesions and non-specific low-grade fever, myalgia, and fatigue upon questioning further.
Figure 4) Erythema migrans rash showing the classic bulls eye form. Reproduced from reference 1 © All rights reserved. With permission from the Minister of Health, 2014
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Treatment For Erythema Migrans
People treated with appropriate antibiotics in the early stages of Lyme disease usually recover rapidly and completely. Early diagnosis and proper antibiotic treatment of Lyme disease can help prevent late Lyme disease.
Treatment regimens listed in the following table are for the erythema migrans rash, the most common manifestation of early Lyme disease. These regimens may need to be adjusted depending on a persons age, medical history, underlying health conditions, pregnancy status, or allergies. Consult an infectious disease specialist regarding individual patient treatment decisions.Treatment regimens for localized Lyme disease.
|30 mg/kg per day orally, divided into 2 doses||500 mg per dose|
*When different durations of antibiotics are shown to be effective for the treatment of Lyme disease, the shorter duration is preferred to minimize unnecessary antibiotics that might result in adverse effects, including infectious diarrhea and antimicrobial resistance.
NOTE:For people intolerant of amoxicillin, doxycycline, and cefuroxime, the macrolide azithromycin may be used, although it is less effective. People treated with azithromycin should be closely monitored to ensure that symptoms resolve.
How Is Ld Treated
Treatment of LD should follow the clinical practice guidelines by the Infectious Diseases Society of America and the American Academy of Pediatrics .
There has been a shift to using shorter durations of antimicrobials and to more permissive use of oral drugs in select circumstances . Additionally, data on the safety of short courses of doxycycline for children < 8 years old, coupled with its proven efficacy for treating LD, including meningitis, has prompted more permissive use of this antimicrobial.
Arthritis frequency has decreased in the United States, probably because of improved recognition and earlier treatment of patients with early LD. Up to one-third of LD patients with arthritis experience residual synovitis and joint swelling, which almost always resolve without repeating the antibiotic course. For patients who have persistent or recurrent joint swelling after a recommended course of oral antibiotic therapy, some experts recommend retreatment with another four-week course of oral antibiotics or with a course of parenteral ceftriaxone. For cases with ongoing arthritis, consultation with an expert is recommended. Consider hospitalization and constant monitoring for a child with heart block and syncope that may rapidly worsen enough to require a pacemaker.
The Jarisch-Herxheimer reaction can occur when therapy is initiated. Nonsteroidal anti-inflammatory agents should be started and the antimicrobial agent continued.
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What’s The Best Way To Prevent A Tick Bite
Ticks can’t fly or jump. But they live in shrubs and bushes and can grab onto you when you pass by. To avoid getting bitten:
- Wear pants and socks in areas with lots of trees and when you touch fallen leaves.
- Wear a tick repellent on your skin and clothing that has DEET, lemon oil, or eucalyptus.
- For even more protection, use the chemical permethrin on clothing and camping gear.
- Shower within 2 hours after coming inside. Look for ticks on your skin, and wash ticks out of your hair.
- Put your clothing and any exposed gear into a hot dryer to kill whatever pests might be on them.
How do you know if you’ve been bitten?
Since ticks are so small, you’ve got to have pretty good eyes to see them.
If you have a small, red bump on your skin that looks like a mosquito bite, it could be a tick bite. If it goes away in a few days, itâs not a problem. Remember, a tick bite doesnât necessarily mean you have Lyme disease.
If you notice a rash in the shape of a bull’s-eye, you might have a tick bite. Talk to your doctor about treatment.
If you have an allergic reaction to ticks, you’ll notice a bite right away.