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Lyme Disease |
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| Kenneth McIntosh, MD |
The number of reported cases of Lyme disease in the United States has more than doubled over the last decade, probably mostly as a result of increased public knowledge about the disease and more accurate diagnosing by doctors.
But despite its prevalence, controversy continues over how best to diagnose and treat Lyme disease.
"There's so much information out there on Lyme disease, especially on the Internet, that people can get confused about it," says Ken McIntosh, MD, a consultant in Children's Hospital Boston's Division of Infectious Diseases. "In fact, most cases are quite straightforward, and easy to diagnose and treat."
What is it?
Lyme disease is an infection caused by a bacterium called Borrelia burgdorferi. This bacterium is injected into people through the bite of several types of tiny black tick. These ticks are found in certain parts of the country (the North and Mid-Atlantic states, the northern Midwest, and the west coast), and are often found on white-footed mice and white-tailed deer most commonly living in woods and high grass. Lyme disease attacks many of the body's organ systems, including the skin, heart, nervous system and joints.
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Three to 30 days after being bitten by a tick, you may see a characteristic rash appear on your child's skin, consisting of one or more round or oval pink spots. The spot, or spots, are often clear in the middle like a bull's eye, and is often accompanied by symptoms such as headache, enlarged lymph nodes, muscle or joint pain, and fatigue. The combination of symptoms and having recently been in an area where these particular ticks are prevalent makes Lyme disease relatively easy to spot.
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Stage I - Antibiotic treatment early on is almost always effective, so a physician will probably prescribe two to three weeks of an antibiotic. But problems can occur if a child or adult isn't seen by a doctor until later in the disease, or in rare instances when someone doesn't respond completely to treatment (usually because for some reason the person has not taken all treatment doses).
Stage II - Symptoms of Stage II Lyme disease, which occurs weeks to months after a tick bite if a person has not received successful treatment, include arthritis, multiple bull's eye rashes, and neurologic syndromes like lymphocytic meningitis and facial nerve paralysis. But like Stage I Lyme disease, treatment with antibiotics is almost always effective.
Stage III - In Stage III, Lyme disease in children is characterized by arthritis in the major joints. Adults with Stage III Lyme disease may show memory loss, mood changes and sleep disturbances, but these symptoms are very uncommon in children. Arthritis can occur weeks or even years after the initial infection, but again, oral antibiotic treatment, recommended for 30 days in Stage III, is usually effective. If not, intravenous antibiotics (administered through an IV into a vein) may be helpful.
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Despite the fact that the disease occurs more often in children than adults, McIntosh has rarely, if ever, seen a child with the neurologic symptoms of late-stage Lyme disease.
"People get very worried about the disease because troublesome symptoms like memory loss and dizziness are common, and are attributed to Lyme disease more often than they should be," he says. "But the fact remains that if you catch and treat the disease early, you'll achieve a full cure in close to 100 percent of patients."
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There is no vaccine available to prevent Lyme disease, so it's important to try to avoid ticks and tick bites, or get treatment for the infection very early. Some general guidelines for preventing Lyme disease:
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- Light-colored clothing so you can see the ticks that might be on it.
- Long-sleeved shirts tucked into pants.
- Socks and closed-toe shoes.
- Long pants with legs tucked into socks.
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All parts of the body that bend: behind the knees, between fingers and toes, in the underarms and groin.
Other areas where ticks are commonly found: belly button, in and behind the ears, neck, hairline, and top of the head.
Areas of pressure points, including:
- Where underwear elastic waistband touches the skin.
- Where pants waistband touches the skin.
- Anywhere else clothing presses on the skin.
- Visually check all other areas of the body and hair.
- Run fingers gently over skin.
- Run a fine-toothed comb through your child's hair to check for ticks.
- Ticks must be attached for more than 24 hours to transmit the Lyme disease bacterium, so one thorough check per day is enough, and much better than several hasty checks.
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Walk on cleared paths or pavement through wooded areas and fields when possible
Shower after all outdoor activities are over for the day. It may take four to six hours for ticks to attach firmly to skin. Showering will help remove unattached ticks.
Check pets for ticks and treat as needed.
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- Products that contain DEET are tick repellents, but do not kill the tick and are not 100 percent effective.
- Use a children's insect repellent for your children.
- Check with your child's physician before using insect repellent if your child is younger than 1 year of age.
- Treat clothing with a product that contains permethrin, which is known to kill ticks on contact. Do not use permethrin on the skin.
If you find a tick that has been attached for more than 24 hours (ticks may swell up if they have been on you for a long time), pull the tick off carefully, put it in a bottle, and bring it to your doctor right away. If it is the right kind of tick, your doctor may prescribe antibiotics then to prevent Lyme disease from developing.
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Source: Ken McIntosh, MD, consultant in Children's Hospital Boston's Division of Infectious Diseases.
Please keep in mind that the text provided is for informational purposes only and is not a substitute for professional medical advice, examination, diagnosis or treatment. Always seek the advice of your physician or other qualified health professional before starting any new treatment or making any changes to existing treatment.
Children's Hospital Boston©, 2005. This page may be reproduced for educational purposes. Reprint permission is required for all other uses.
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