For many of us, summer is the time to finally get outdoors, whether you enjoy hiking, biking, or basking in the warm weather. But all that time outside increases our exposure to ticks, and the diseases that they carry. As a pediatric rheumatologist, I’m often asked questions about Lyme disease: what it is, how to prevent it, and how to treat it. This post covers the top five questions I get asked — and some important advice to consider for protecting your family this summer.
- What is Lyme disease?
Lyme disease is an infection caused by the Borrelia burgdorferi bacteria, which is transmitted by the bite of the Ixodes tick. It is often found in the Northeastern USA, though there are other types of ticks and bacteria which can cause similar infections in other parts of the world. Disease onset typically occurs during the summer, though some symptoms may take many months to manifest. Lyme disease cannot be transmitted from person to person, and you can’t catch it from your pets (though they may act as vehicles for infected ticks!)
- How can I protect my family from ticks?
The easiest way to avoid a tick bite is by avoiding the places ticks like to hang out, including wooded areas, tall grasses, and brush. When walking or biking, stick to well-cleared paths, and don’t allow kids or pets to wander off the trail. Limit exposed skin, by wearing long sleeves and pants while hiking, and tucking your pants into your socks. In addition to being cooler, white or light clothing makes it easier to spot ticks that have attached. Use over the counter insect-repellent on clothes and skin (read the bottle to make sure its ingredients are safe for children) and if you have pets, ask your vet about methods of tick prevention for animals. After spending time outside, check every family member over (pets included!) Ticks particularly like to hide in warm, dark spots, so make sure not to forget armpits, groin and scalp when doing a tick check.
- I found a tick! Now what?
Don’t panic! Typically, ticks must be attached for at least 2-3 days before transmitting the bacteria which causes Lyme disease, so daily tick checks and prompt removal may be enough to prevent infection. If you find a tick, it is important to remove it as soon as possible, using the correct technique. If available, use a fine-tipped tweezer to grasp the tick as close to the skin surface as possible, and gently but firmly pull straight up until it releases its hold on the skin. Try not to twist, jerk, squeeze or crush the tick. If any pieces break off into the skin, try to remove them with the tweezers, but if you can’t get them out easily, just leave them alone. Place the tick into a container (without crushing it), and disinfect the skin and your hands with rubbing alcohol or soap. Depending on local infection rates and how long the tick has been attached, you may benefit from a dose of antibiotics — call your doctor to discuss.
- What are the symptoms of Lyme disease?
The symptoms of Lyme disease depend on the stage of illness. There are three phases of Lyme disease — early localized disease, early disseminated disease, and late disease. Early localized disease usually occurs about 1-2 weeks after a tick bite, and consists of a rash called erythema migrans, which often (but not always) has a bulls-eye appearance. People with early localized disease may also have non-specific, flu-like symptoms, including fever, headache, joint pain and fatigue. Blood testing is NOT recommended during this stage, as it may be falsely negative.
The second stage of Lyme disease, early disseminated disease, usually occurs weeks to months after a tick bite. Multiple erythema migrans lesions, as well as cardiac and nervous system involvement (both rare) may happen at this stage, and patients may again have flu-like symptoms.
Late disease, which occurs months or even years after a tick bite, most typically consists of arthritis (inflammation) in a single joint. Some patients develop late-stage disease without ever having early disease symptoms. Early disseminated and late stage Lyme disease are diagnosed with blood tests (ELISA screening tests and Western Blot confirmatory tests).
- Is Lyme disease treatable?
Yes! Lyme disease is treatable with antibiotics in all three phases. Typically, oral antibiotics are sufficient, though in rare cases with cardiac or neurologic involvement, IV antibiotics may be used. The type of antibiotic and duration of treatment is chosen based on a number of factors, including the age of the patient and the symptoms. Early localized disease is often treated by a general practitioner, while disseminated or late disease is best managed by a pediatric rheumatologist or infectious disease specialist. If you or your child is diagnosed with Lyme disease, your doctor can help direct you to appropriate care.
Dr. Sarah Taber is a pediatric rheumatologist at HSS, and is board certified in both pediatrics and pediatric rheumatology. Dr. Taber specializes in the diagnosis and treatment of children with rheumatic diseases, including juvenile idiopathic arthritis, childhood systemic lupus, dermatomyositis, vasculitis, and systemic and localized scleroderma. She has been a featured speaker for the Scleroderma Foundation, Charla de Lupus, and A Lasting Mark Foundation, and is a Consult Editor of Rheumatology for Medscape.
