Lyme Disease

By Kelli Tapley of Birmingham Pediatric Associates

As summer approaches, primary care physicians’ ears perk up when our patients

present with “went on Boy/Girl Scout retreat a month ago and came back with a weird

rash. Now seems tired and complains of headache, joint pain and had a painless, nontender

swelling of the face before his/her face started to droop.” DING, DING, DING.

But most of us aren’t lucky enough to get such a gift from the gods of Textbook

Presentations for Lyme Disease. Rather, we are often faced with vague symptoms like

fever, abdominal pain, fatigue and headache with no mention of rash or camping trips,

much less tick exposure.

A recent report from the CDC’s Summary of Notifiable Diseases stated that cases of

Lyme Disease have increased 400% from 2005-2008. In light of the increased incidence

of Lyme Disease, as well as other tick-borne illnesses such as babesiosis and

anaplasmosis which are both transmitted via Ixodes scapularis, and the early arrival of

spring, it’s helpful to review the diagnostic and preventative measures. Although, there

is some controversy among Infectious Disease experts as to why there has been an

increase; climate change, better diagnostic assays, improved reporting and awareness

among physicians have all been suggested as potential reasons.

First, it’s important to counsel our patients and their parents that the sooner the tick is

removed, particularly if it’s noted and removed within 72 hours, the smaller the chance

of developing Lyme Disease. Suggest that parents have their children bathe or shower

immediately after being outdoors and frequently inspect for ticks. While the likelihood of

our patients wearing long sleeves and pants with pant legs tucked into socks in the

sweltering southern summers is somewhat unrealistic, a more practical solution would

be to recommend repellants with 10-30% DEET in children 2 months and older and

spraying pesticides around the perimeter of yards.

While it can take some time for the symptoms of Lyme Disease to manifest after a tick

bite, if they meet the criteria developed by the American College of Physicians (a recent

history of having resided or traveled to an endemic area for Lyme Disease and risk

factor for exposure to ticks and symptoms consistent with early disseminated disease or

late lyme disease) administering the ELISA before the Western Blot can eliminate the

likelihood of false positives. The guidelines for interpretation are available at

www.aafp.org.