All You Wanted to Know About Ticks and Lyme Disease Part II
Dear Readers,
Last week I discussed some general information about Lyme disease; how you may contract Lyme Disease and the best way to remove ticks from the skin. Today, I would like to share the warning signs of this disease.
General Symptoms of Lyme Disease in its Early Stage Include:
Flu Like Symptoms
Fevers, Chills, Muscle Soreness and Fatigue in the first days or weeks after the tick bite.
Bull’s-eye Rash – A.K.A Erythema Migrans
Luckily, in about 80% of infected patients, within 3-30 days after the tick bite, the body will show a distinctive rash that can be easily identified as Lyme Disease.
The rash is red and circular, outwardly expanding and usually painless. Classically, the innermost portion remains dark red and the outer edge remains red; the portion in between clears, giving the appearance of a Bull’s-eye (see attached picture). The rash can appear anywhere on the body, not just in the vicinity of the tick bite.
Having worked as an pediatric attending in Kiryas Joel – Monroe, New York for 6 years, I came across about two dozen cases of Lyme Infection in kids. I must say that Lyme Disease, like other diseases does not always follow the text-book description.
I distinctly remember two cases in which I was consulted by patients who had a red circular rash without a clear or pale center that were subsequently confirmed to be Lyme Disease.
So if you see a rash that is suspicious, even if it doesn’t look like the classic rash of Lyme Disease, be safe and show it to your physician. Below is a typical Lyme rash.
Joint Swelling/ Lyme Arthritis
Moishe C. a teenager, who enjoyed dancing feverishly on Simchas Torah, came limping to my office on Isru Chag. Upon examination, he was found to have a swollen right knee. I first thought that Moishe may have been a bit too “Leibidik” while dancing during the preceding days, but I was puzzled by the fact that he had swelling on one knee only.
Luckily (with great divine intervention), I tested his Lyme titers which were positive and a few days later Moishe’s knees were back to themselves.
Lesson to be learned: in our area, were Lyme Disease is endemic (prevalent), think about Lyme Disease with any joint swelling that can not be fully accounted for by other causes.
The swelling can occurs most commonly on the knees followed by the ankles, hips and elbows.
Headaches
One of my physician friends once shared a story with me that illustrated how painful and dangerous Lyme Disease could be. Her 12 year old boy had developed “Migraine Headaches” that were only partially responsive to pain medicines. His routine blood tests and examination did not reveal any abnormalities. After a few weeks elapsed, she consulted with a neurologist who ordered an MRI scan of the head which was negative. His headaches worsened for the next two months. A few days prior to his Bar Mitzvah, he could barely get out of bed. At this point his frightened and desperate mother took him to the local Emergency Room for a full evaluation. The doctor there asked to perform a lumbar puncture to rule out meningitis. The mother helped perform the test and was asked to fill out the laboratory test requisition. She told me how nervous and emotional she was. While filling the forms she tried to check off as many tests as she could and luckily (again, guided by divine intervention), she checked off the Lyme Test Panel (To put things into perspective, as a Pediatric resident, I performed close to 100 lumbar punctures and maybe only once I was instructed to test for Lyme Disease). Usually Lyme Disease is caught much before it spreads to the brain. Her son had Lyme Disease that went ignored for months, and with Gd’s help he fully recovered after a few weeks of IV antibiotics.
Lessoned to be learned - Lyme Disease can cause persistent headaches with or without fevers.
Late Symptoms of Lyme Disease:
Neurological & Cardiac Deficits:
Can cause a “Bell’s Palsy” which paralyzes the facial muscle on one or both sides of the face and leaves the distinctive “facial droop”.
Polyneuropathy - involves shooting pains, numbness, and tingling in the hands or feet.
A neurologic syndrome called “Lyme Encephalopathy” is associated with subtle cognitive problems, such as difficulties with concentration and short-term memory
Heart Block - If Lyme Disease spreads to the heart, a person may feel an irregular or slow heartbeat. (Rarely, this may happen in the early stages of the disease). Do Not Panic!!!
Dear readers, the point of the article is to educate you and make you aware of common illnesses. Diagnosing Lyme disease could be tricky, but I sincerely believe that most of you don’t have to rush to your physicians and demand a Lyme Test after reading this article.
I do however hope that after reading this information you will take it to heart to mention to your physician on your next sick visit that you have recently gone camping or removed a tick from your or your child’s skin. Your physician will couple this information with your symptoms and physical exam and will be able to easily diagnose you.
I firmly believe that as a pediatrician, my ability to diagnose a medical problem quickly and effectively is dependent on the quality of history I can get from the patient and the parents. For example, in the above mentioned exciting case, if Moishe’s mom would have informed me that she had removed a tick from his skin a month prior to his knee swelling, making this diagnosis would have been a simple task!
The Good News!
If caught early, Lyme Disease could be treated with a course of a simple antibiotic such as Amoxicillin. So please partner with your physician to prevent this dangerous disease from affecting you and yours.
Wishing you a great summer vacation,
David E. Simai M.D
