Hello patients, families, and friends. Welcome to our monthly blog at RHP! We are excited to share timely, topical, relevant and reliable medical information about once per month with you.
There are so many pressing items right now with school shootings weighing heavily on my mind, Fortnight taking over my basement, and obesity an ongoing health crisis. Despite these issues, I thought I would start with LYME disease, as it is Tick Bite season and affects all of us in Connecticut! There is also a lot of FALSE information on the internet about ticks and Lyme Disease.
How do people get Lyme Disease? Deer ticks carry the infectious agent (called a spirochete) that causes Lyme Disease. Deer ticks are very small, dark brown or black, and the size of a “period” at the end of a sentence. A tick must be embedded in the skin for at least 24 hours (many authorities believe > 48 hours) to potentially cause “Lyme disease.” The bite is often painless and, in 50% of patients with Lyme, people are unaware of ever having been bitten. In contrast, dog or wood ticks are quite large (the size of a watermelon seed) and DO NOT cause Lyme.
What is Lyme Disease? Lyme disease is an infection caused by a spirochete (similar to a bacteria)that lives in the belly of an infected deer tick. Deer ticks live in forests, grassy wooded areas, marshy areas near rivers, lakes, oceans. However, you can also be bit in your own backyard! Typically, bites occur from late spring to early fall.
What are the Stages of Lyme Disease? Lyme Disease is categorized into three different stages of infection based on how long the spirochete has been in the body.
Stage 1: Occurs 1-30 days after a bite. A “bulls- eye” rash is a pink, flat rash with a bulls-eye appearance (concentric rings, like the “Target” store logo) that is more than 2 inches in diameter (the size of a baseball or orange). The medical term for this rash is “erythema migrans.” The rash is not painful or itchy. It can last for a few days to a few weeks. It may also grow over a few days, but take a picture of it to show us! Some kids will have multiple bulls-eyes. Sometimes kids will get a fever, malaise, fatigue, and feel almost like the “flu” (though no vomiting or cough) for 1 week. Any fever (>101) for more than 7 days in the summer, makes us think about Lyme. If there is not a bulls-eye rash but your child has a fever we may do a blood test to check for Lyme.
Stage 2: May occur 2-12 weeks after the bite. Some children may get a severe headache with this stage, which is certainly a reason to call us at the office. Others can have facial weakness (Bell’s Palsy). Rarely children can get Lyme meningitis (infection of the tissue surrounding the brain and spinal cord).
Stage 3: Typically this stage occurs 6 weeks to 2 years after the bite. This is VERY RARE, contrary to what the internet often reports. We mostly see a single joint arthritis, where the affected joint is not only painful but red and swollen. Most often we see a very swollen knee with no history of injury.
How to handle finding a tick on you or your child:
If your child has a tick that is crawling on the skin but can be easily brushed off (is not yet attached firmly to the skin), the there is no need to worry about Lyme Disease. The tick cannot transmit the spirochete that causes Lyme Disease if it is not firmly attached to the skin.
What to do if your child has a tick that is firmly attached (has “bitten” him or her)
Rub a cotton ball on a bar of soap and then rub it counter clockwise for 60 seconds on the tick and it should “unscrew” and come off on the cotton swab.
If that doesn’t work, use a tweezers, get close to the skin and pull straight up. Even if a small part of the head remains, that is okay because the “Lyme” is in the belly of the tick.
Wash the area with soap and water and apply bacitracin.
It is normal to have a red swollen bump that is 1-2 cm in size at the site where the tick was attached. This may itch and be present for several days similar to a bug bite. This is just irritation from being bitten and is not the classic Lyme Disease rash. (See above for a description of the characteristic rash.)
When do we treat for Lyme Disease?
We don’t treat every tick bite! It is simply not necessary. If the tick has been on for more than 24-48 hours we ask you to observe for the rash or flu like symptoms for the next 4 weeks and call if they develop.
If you see a possible Lyme or “bulls-eye” rash, call and we will see your child.
If your child has “flu like” symptoms or a fever for more than 3-4 days, please call the office.
If your child develops a facial palsy - a crooked smile, or a very swollen joint, please call us.
We use common antibiotics and thankfully they are almost always effective at CURING Lyme Disease.
The state of Connecticut does not test ticks for Lyme but some towns do and there are private laboratories that will do this for you. We do not recommend testing the tick. If the tick does carry the spirochete that causes “Lyme Disease”, this does not necessarily mean that it was able to transmit it to your child. Therefore, we follow the above treatment guidelines regardless of what testing the tick shows. DEET containing products (10-30%) are the best defense as well as long pants, tucking socks into pants and wearing long sleeves, especially when hiking or out in tall grass. Be sure to do a tick check each night as the ticks are small, black (the size of a period at the end of a sentence) and easy to spot on most children. Short of preventing bites, getting ticks off within 24 hours is one of the best ways to prevent your child from being infected. (After bath or before bed are great times to check!) There is also a chemical called permethrin that can be used to treat clothing and has shown great efficacy at repelling ticks. For those that love to camp or hike, this could be a good way to help prevent infection.