MassGeneral Hospital for Children News

Chadi El Saleeby, MD, a Pediatric Infectious Disease specialist at MassGeneral Hospital for Children (MGHfC) discusses effective Lyme disease prevention and treatment methods.

Prevention, early diagnosis key to successfully battling Lyme Disease

22/Jun/2011

Like clockwork, the onset of spring and the summer raises concerns about Lyme Disease.  Chadi El Saleeby, MD, a Pediatric Infectious Disease specialist at MassGeneral Hospital for Children (MGHfC) says that prevention and early diagnosis and treatment are the best ways to successfully prevent Lyme Disease from becoming a major health concern.

Lyme Disease is caused by a bacteria called Borrelia burgdorferi, which are carried by tick vectors belonging to the genus Ixodes.  In the United States, this tick is common in wooded areas of southern New England, the forests of the Pacific coast and the upper Midwestern states.  In some of these areas, up to 20% of all deer ticks may carry the B. burgdorferi bacteria.  During the spring and summer months, when there is an increase in outdoor or recreational activities, ticks attach themselves to human skin and feed on human blood transferring the B. burgdorferi bacteria to that person.

“Preventing a deer tick bite in the first place is the best way to avoid contracting the disease,” says El Saleeby.  “Wearing longer sleeves and avoiding heavily wooded areas will help prevent ticks from attaching themselves to your body.  If that is not possible, use tick repellants as recommended by the product manufacturer.”

Ticks prefer parts of the body that are difficult to visually inspect such as the nape of the neck, behind the earlobes, under the armpits, on the scalp, around the genital areas, under the breasts of adult women and under skin folds for overweight individuals.  The infection however does not start immediately but only if the infecting tick stays attached to the human host for 48-72 hours or more.  

El Saleeby says that if you have been outside, inspecting yourself and others, especially children, for ticks is very important.  “It is very hard to self inspect for ticks because they usually hide in spots not readily visible to us,” says El Saleeby.  “It is best to find someone else to help you with the inspection.  Parents should inspect their children regularly during the warmer months specifically after a day outside.  If a tick is found during inspection, use a pair of tweezers to hold the tick as close to the skin as possible and extract the tick gently away from the skin.  If this is done within the first 24 to 48 hours of the bite and the tick is not engorged with blood, no resulting infection will take place.  However, you should always consult your physician to be on the safe side if you find a tick during an inspection. In some select situations, your physician might elect to give your child one dose of antibiotic therapy for prophylaxis against infection”

If infection does take place, then the disease progresses in stages.  The first stage, called the early localized disease stage, usually manifests itself in the form of a target-shaped rash, a red circle with a clear center, at the site of the tick bite.  The type and size of rash can however vary and it can appear as early as a few days after the tick bite or up to a week or longer at times.  Fevers, fatigue and general malaise can sometimes accompany the appearance of the rash.

“Most patients infected with Lyme will come in with early localized disease,” says El Saleeby.  “The treatments that are available to treat this stage will generally prevent the disease from progressing any further.”

If the early localized rash goes unnoticed and the disease progresses further, the next stage, known as the early disseminated disease, may present itself several weeks after an infective tick bite. The disease-causing bacteria spread throughout the body and can affect multiple areas of the skin, the cranial nerves, the meninges of the brain, and can cause conjunctivitis in the eyes or carditis or inflammation of the heart.  The last stage of the disease, called late Lyme Disease, sometimes comes years after the initial tick bite, causing further neurological problems and inflamed, swollen and painful joints, known as Lyme arthritis.  For any stage of the illness, El Saleeby recommends immediate contact with your physician to devise an appropriate stage-specific and symptom-specific treatment plan.

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