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Davis Square Family Practice
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Deborah Bershel, MD
Michelle Clark, NP
Carmen Phillips, NP
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Barbara Kaplan, LICSW
Christopher Mulvey, NP
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Lyme Disease - Overview of Acute Illness
This summary was written by me in April 2010. If you want a very complete and detailed summary by UpToDate please click on the following link : Lyme Disease Overview

You will be able to see picture os ticks and the skin rash imbedded in the article.

While I've seen patients come in with acute Lyme disease in the winter, April through all of October are peak time to contract it. The ticks are found anywhere there is grass and bushes. Even backyards are not safe areas to roll around unless you do a tick check at night. While walking in the woods/bushes, it is advisable to wear long pants with the socks over the bottom of the pant leg -( ignore any outcries from children who donít want to appear nerdy).

Here is more bad news that is not well-disseminated --- even the dog tick, and not just the much smaller dear tick, can transmit Lyme disease. And while animals don't transmit the disease to humans your pet's ticks can travel over to you.

What is Lyme disease- It is a tick borne illness caused by borrelia burgdorfi bacterium. It is a spirochete bacterium that behave in ways similar to syphilus. It can infect multiple organs such as the heart and brain many years after the initial symptoms have passed - if the initial attack was not treated

Symptoms of Lyme disease -Appear within a day to a week after contact. There is often a bull's eye rash but honestly any sort of rash can appear (and sometimes no rash at all). There can be a high fever, muscle ache, joint aches, mental confusion. 50% of the time there is no recollection of a tick bite. If you think you have the flu but there is no respiratory illness (like a prominent cough) think of lyme disease. In general, I would recommend a call to our office or the covering physician if you have these symptoms. It may just be a virus but place the burden on us.

Diagnosis -It's made by history and physical exam. I tend to always do the more expensive Western Blot test as it is more sensitive the standard Lyme screen.

Treatment - 14 to 21 day course of doxycycline for those over 9 years of age or amoxicillin or a cephalosporin for children under that age. This
regimen is usually effective but fatigue and joint aches may persist beyond the treatment period - this usually doesn't necessitate additional antibiotics. Ibuprofen can help fever and joint pain. If the story and exam are suggestive of Lyme I do not wait for the test results to come back - the sooner you treat it the more likely a quick and complete recovery will occur.

What should you do if you have a tick bite and no symptoms?  My approach is different than the official recommendations of the CDC. The evidence says that it takes 24 hours for the tick to imbed and have a blood meal and thus get the borrelia bacteria into your bloodstream. I have heard too many anecdotal stories of symptoms occurring within 24 hours of a tick bite. The consequences of untreated Lyme are so extreme (potentially) that I recommend prophylactic antibiotics for all tick bites (deer and dog). The prophylactic treatment is one dose of doxycycline 200 mg or amoxicillin (adjusted according to weight) for those under 9 years old. BTW, of course remove the tick.
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