Lyme-The Imitator and Quiet Epidemic of the Northeast

Fever, chills, muscle aches-first thought these days…maybe it is COVID-19?  That has been at the forefront of our minds for several months. With the guidelines in place to help reduce the spread of COVID-19, more and more people are participating in outdoor activities.  But it is important to realize that as we focus on the pandemic, much of the northeastern US, is part of a growing epidemic.

Lyme disease was first recognized in the United States in 1975, after a mysterious outbreak of arthritis near Lyme, Connecticut. It is known as an imitator of many other conditions. Many times, making it difficult to diagnose, initially.  Over the past 40+ years Lyme disease has become very prevalent in certain areas of the country. It is one of the fastest-growing vector-borne infections in the United States. As you can see on the map of the United States below, each dot represents a reported case.  Pennsylvania is essentially covered in blue. So much so that you cannot tell from the key that the state has a “high incidence” label.

One example from the PA Department of Health lists reported cases over the years.  Butler County had only 7 cases in 1999.  In 2018, the number jumped to 654, making them the second highest in reported cases in PA. This year, due to the mild winter that we experienced and the humidity, the numbers are expected to again be high.

Lyme disease is spread by the bite of a tick. Specifically, the blacklegged tick, also known as a deer tick.  Larvae and nymphs can become infected with Lyme disease bacteria when they feed on infected small animals, particularly the white-footed mouse. The bacteria remain in the tick as it changes from larva to nymph or from nymph to adult. Once infected, Lyme disease bacteria can be transmitted to other small rodents, other animals, and humans, through a bite. Below the life cycle of the blacklegged tick is shown in this image from the CDC website. 

The lifecycle of blacklegged ticks (lxodes scapularis and lxodes pacifus) generally lasts two years. During this time, they go through four life stages: egg, six-legged larva, eigh-legged nymph, and adult. After the eggs hatch, the ticks must have a blood meal at every stage to survive. Blacklegged ticks can feed from mammals, birds, reptiles, and amphibians. The ticks need to have a new host at each stage of their life as shown below:

Transmission Lifecycle of BlackLegged Ticks

The majority of Lyme disease is spread from the bite of the nymph.  These are the immature ticks. They are as small as a fleck of pepper or a poppy seed. This makes it difficult to see them.  Adult ticks can also carry Lyme disease, but because of their size they are usually discovered much more quickly than the nymph. 

Ticks cannot fly or jump.  They get around by waiting on grass to latch onto animals or humans. This is called “questing”.  Holding on with their back legs they reach out and grab a passerby with their front legs, hitchhiking a ride and then they try to find a feeding site. They like to hide in areas such as the groin, armpits, behind the knee, and scalp.  It is important, especially after spending time outside, to do daily checks. Many times, the bite of a tick can go undetected because their saliva has numbing properties. The tick may also fall off before it is noticed. Generally, a blacklegged tick needs to be embedded for 36-48 hours to transmit the Lyme bacteria.

If a tick is discovered here are some tips from the CDC on how best to remove it.

Not only is it essential to remove the tick as soon as possible but getting a quick diagnosis and swift treatment is also key if you suspect Lyme disease. It is important to be aware of the signs and symptoms that can be experienced. Left untreated, Lyme disease can affect the joints, the heart, the brain, and/or the central nervous system.  It can become a severely debilitating disease.   

Below are some of the signs and symptoms that may accompany a Lyme infection. This is not a complete list and it can vary from person to person.   Several of these symptoms could be misinterpreted as being many other conditions such as, meningitis, fibromyalgia, chronic fatigue syndrome, multiple sclerosis, Parkinson’s, influenza, COVID-19 and hundreds more. Making it even more challenging to diagnose, 30% of people with Lyme will not develop the telltale bullseye rash. In some cases, the rash may present in a different pattern.  

Early Signs and Symptoms (3 to 30 Days After Tick Bite)

Fever, chills, headache, fatigue, muscle and joint aches, and swollen lymph nodes may occur in the absence of rash.

“Classic” Erythema Migrans Rash (EM)

• Occurs in approximately 70 to 80 percent of infected persons
• Begins at the site of a tick bite after a delay of 3 to 30 days (average is about 7 days)
• Expands gradually over several days reaching up to 12 inches or more (30 cm) across
• May feel warm to the touch but is rarely itchy or painful
• Sometimes clears as it enlarges, resulting in a target or “bull’s-eye” appearance
• May appear on any area of the body
• Does not always appear as a “classic” erythema migrans rash

Later Signs and Symptoms (days to months after tick bite)

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