By John T. Rafalli, MD FACP | Infectious Disease
Diagnosis and management of tickborne diseases can be very complex and anxiety provoking. Unlike other problems patients have to solve, the internet search results may yield overwhelming amounts of conflicting information. Further, doctors may not even agree with one another on diagnosis and management of the same patients. At CareMount Medical, we follow the Infectious Diseases Society of America and Centers for Disease Control and Prevention guidelines. These are guidelines that have been subject to rigorous scientific scrutiny and studies and are considered the mainstream management of Lyme disease. The term “evidence-based medicine” is used a great deal nowadays and refers to managing medical problems based on the best quality research (evidence) available. That is what we strive for.
Lyme disease can be a difficult medical problem and clearly, prevention is very important and likely underutilized. Preventing tick bites can also prevent other diseases including Babesia and Anaplasma. The CDC offers these tips for tick bite prevention.
Lyme disease is spread by blacklegged ticks called Ixodes scapularis during one part of their lifecycle: when they are nymphs. Not every nymph, however, spreads Lyme; as a matter of fact, most do not! From spring (late April) to late summer (August), the nymphs are looking for and taking 36-48 hour blood meals that can spread Lyme disease.
A tick will wait in long grass or other vegetation for a host (they prefer a mouse or a deer) to come along and will then climb on and find a place to feed. When they attach to humans, ticks prefer to feed at warm folds, particularly in the groin or behind a knee. Removing embedded ticks does help to prevent Lyme disease. Showering after at-risk activities helps to displace ticks before they can transmit Lyme disease. Within 72 hours of a tick bite, adult patients may be candidates to receive a single dose of an antibiotic to prevent Lyme infection. Discuss with your health care practitioner to see if this applies to you.
In the summertime, we generally see early Lyme disease. Untreated or undertreated Lyme disease can become asymptomatic. Unrecognized, these patients may present years later with manifestations of late Lyme disease (which are treatable). These late manifestations can present at any time of year, but early manifestations only occur in spring to summer.
Patients with Lyme disease for over 30 days are expected to have a positive Lyme ELISA/ Western blot. In those patients with more than 30 days of symptoms but negative test results, the challenge is to find the disease diagnosis that is mimicking symptoms of Lyme disease and treat it. This can require several specialists for patient management.
Diagnosis and management of Lyme disease can be complex and requires individualized management. If you have any questions regarding Lyme disease or other tickborne diseases, ask your doctor.