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Lyme disease

Lyme disease is caused by the bacterium Borrelia burgdorferi and is transmitted to humans through the bite of infected blacklegged ticks (“deer” tick). These ticks are tiny and often very difficult to see; they are often between the size of a poppy seed and a sesame seed depending on their age/stage. In order for the tick to transmit Lyme disease, it must attach for at least 1-2 days, so if you caught the tick crawling around, you have no risk of contracting the disease. In addition to Lyme, ticks can transmit other serious infections such as Rocky Mountain spotted fever and ehrlichiosis.

Lyme disease typically causes a fever, headache, fatigue, and a “bull’s-eye” skin rash called erythema migrans. If left un-treated, the infection can spread to the joints, the heart, and the nervous system. Lyme disease is diagnosed based on symp-toms, physical findings (e.g., rash), and the possibility of exposure to infected ticks. Laboratory testing is sometimes help-ful if the diagnosis is not clear. Most cases of Lyme disease can be treated successfully with 2-3 weeks of antibiotics. Steps to prevent Lyme disease include using insect repellent, removing ticks promptly, applying pesticides, and reducing tick habitat.

Prevention: Insect repellent, tick checks, and showers
The best way to prevent Lyme disease is to protect yourself from tick bites. To reduce your chances of getting a tick bite, use an insect repellent with either DEET or Picardin (at least 20%) when going outdoors, particularly if you are gardening, camping, hiking, or golfing. Permethrin is another repellent that can also be used to treat clothing, boots and camping gear (it is not effective if applied on skin). Once applied, permethrin will last on your clothes for approximately one month, even after washing them. After returning indoors, be sure to check for ticks on your clothing and on exposed skin (legs and arms). Also check your hair, armpits, and groin. Always shower after coming indoors as this can help remove any ticks that have not attached to your body. Showering is a good opportunity to do a tick check, and has been shown to reduce your chances of getting Lyme disease.

What to Do if You Find an Attached Tick?
Don’t panic. It is fairly simple to remove a tick.
01. DO NOT TRY TO BURN OFF THE TICK.
02. Use fine-tipped tweezers to grasp the tick close to the skin surface.
03. Pull upward with steady, even pressure. Don’t twist or jerk the tick; this can cause the mouth-parts to break off and remain in the skin. If this happens, remove the mouth-parts with tweezers. If you are unable to remove the mouth easily with clean tweezers, leave it alone and let the skin heal.
04. After removing the tick, thoroughly clean the bite area and your hands with rubbing alcohol, an iodine scrub, or soap and water.
05. Dispose of a live tick by submersing it in alcohol, placing it in a sealed bag/container, wrapping it tightly in tape, or flushing it down the toilet. Never crush a tick with your fingers.
06. If you feel very uncomfortable doing this, visit your doctor or a local Urgent Care Center.

Next Steps
Watch for signs of illness such as rash or fever in the days and weeks following the bite, and see your doctor if these develop. Your risk of acquiring a tick-borne illness depends on many factors, including where you live, what type of tick bit you, and how long the tick was attached. If you develop a rash or fever within several weeks of removing a tick, see your doctor or go to your local Urgent Care Center. Be sure to tell the doctor about your recent tick bite, when the bite occurred, and where you most likely acquired the tick.

Lyme Disease: Early Signs and Symptoms (3 to 30 days after tick bite)
01. Fever and chills
02. Headache
03. Fatigue
04. Muscle and joint aches
05. Erythema migrans (EM) rash:
Occurs in approximately 70 to 80 percent of infected persons
Begins at the site of a tick bite after a delay of 3-30 days (average is about 7 days)
Expands gradually over a period of 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, and there may be more than one bull’s-eye lesion

Lyme Disease: Later Signs and Symptoms (weeks to months after tick bite)
01. Severe headaches and neck stiffness
02. Arthritis with severe joint pain and swelling, particularly the knees and other large joints.
03. Facial or “Bell’s” palsy (causes facial droop due to paralysis of face muscles)
04. Heart palpitations or an irregular heart beat (Lyme carditis)
05. Episodes of dizziness or shortness of breath
06. Inflammation of the brain and spinal cord
07. Nerve pain
08. Shooting pains, numbness, or tingling in the hands or feet

If your doctor suspects Lyme disease, blood tests can be ordered to confirm the diagnosis. However, blood tests are not reliable in patients without symptoms.

Patients treated with appropriate antibiotics in the early stages of Lyme disease usually recover rapidly and completely. Antibiotics commonly used for oral treatment include doxycycline, amoxicillin, or cefuroxime. Early Lyme is generally treated for 2-3 weeks. Patients with certain neurological or cardiac forms of the illness may require intravenous treatment with drugs such as ceftriaxone or penicillin.

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Shobhit Arora