Blood-sucking ticks coming to a field and forest near you.
That may sound like the latest horror film, but unfortunately it is a reality due to a surge in ticks that spread Lyme disease this spring.
Fortunately, the media interest in Lyme disease appears to be growing with the threat. At the start of the month I was interviewed on Martha Stewart Living Radio about Lyme disease.
The Perfect Storm for Lyme Disease
A perfect storm happens when two conditions converge to amplify each other's effects. Two conditions are creating what may become the perfect storm for transmission of Lyme disease this spring:
- An unusually warm winter, which left deer ticks alive, hungry and looking for a meal.
- A dramatic flip-flop in the acorn cycle: A large crop of acorns in the fall of 2010 and a very small crop in 2011 in the East. This means fewer mice for the ticks to feed upon, as I explain below.
These two conditions mean tons of deer ticks that are hungry and lacking their typical food supply. You could be their next meal.
Ticks Transmit Lyme and Other Diseases
The bacteria that cause Lyme disease, Borrelia burgdorferi, are transmitted to humans by the bite of a deer tick (Ixodes dammini).
Deer ticks live for two years and in their lifetimes take only three blood meals: the first as newborn larvae, the second a year later as immature nymphs and the third a season later as adults.
Mice and Other Rodents Carry Ticks Too
If you don't see any deer and think the coast is clear, think again.
Deer ticks live in vegetation and hitch rides on animals on which they feed, not only deer, but mice and other rodents.
White-footed mice may be the most efficient carriers of deer ticks for human infection. White-footed mice thrive in vacant lots and small wooded parcels near homes because their natural predators cannot survive in those environments.
The mice feed on acorns and store them for winter. The fall of 2010 brought a bumper crop of acorns, which led to a surge in the mouse population and created abundant homes for tick larvae last spring.
In the fall of 2011 the acorn crop was the smallest it's been in two decades, decimating the mouse population over the winter and leaving a huge number of displaced nymphs that are looking for warm-blooded hosts, like humans. Ixodes nymphs are especially good at transmitting Borrelia to humans.
Read Spring Surge in Lyme DiseaseThe Challenge of Preventing Lyme Disease
One of the key challenges with Lyme is getting people to change their behavior. Prevention starts with awareness. THINK LYME. You're as likely, maybe even more likely, to get bit by a deer tick in your backyard as hiking in a forest.
Steps to Prevent Lyme Disease
- Do daily tick checks. Deer ticks are tiny, about the size of poppy seeds, and easy to miss.
- You may need to spray your clothes and your yard with permethrins or other pesticides, but chemical tick control is never enough.
- Remove debris and clutter on your property to discourage rodent populations. Keep grass and weeds cut short in areas you use for recreation.
- Strong sunlight kills deer ticks by drying them out. Since ticks cannot hop or fly they find you by dropping onto you from vegetation, after sensing your presence. If pesticides have been sprayed on the upper surface of a plant, the tick will simply hide on the under surface.
- If you find a tick, remove it with small-tipped tweezers, grasping it as close to the skin as possible. Try to get it all, slowly but firmly pulling the tick away from the skin. Save the tick in a sealed plastic bag or a container of alcohol. State health departments and private laboratories can test the tick for the presence of bacteria that cause Lyme disease.
- In many areas the majority of ticks are infected with Borrelia. Talk to your doctor about pre-emptive therapy and check the website Treat the Bite (www.treatthebite.com). Once you have removed the tick, wash your hands and disinfect the tweezers by leaving them in alcohol for several hours.
The Challenge of Diagnosing Lyme Disease
Lyme disease is a great masquerader, which makes getting a proper diagnosis of Lyme a real challenge. Lyme can cause symptoms in multiple organs, including skin, heart, nervous system, joints and muscles and gastrointestinal tract. Involvement of the lungs, eyes or urinary tract has also been reported.
For some people, fatigue or brain fog is the only symptom of Lyme disease. Sometimes the most prominent symptom is a change in mood or personality.
Symptoms may begin days or months after a tick bite. Many victims of Lyme disease are unaware of having had a tick bite. The majority of Lyme patients I've seen never had the classic "bull's eye rash" that can be an early sign of the disease.
Doctors usually use blood tests to make a diagnosis of Lyme disease, but several factors limit their value:
- These tests rely on antibodies, proteins made by your immune system to attack Borrelia. Antibodies may not be measurable for a month after the tick bite.
- Early treatment with antibiotics may prevent antibody formation without curing Lyme disease.
- People who are immune-suppressed may not make antibodies.
- The results of antibody testing at different labs can vary greatly.
- Deer ticks may carry pathogenic microbes other than Borrelia. These other infections will not be detected by a test for Lyme disease but may produce distinct illnesses like babesiosis, ehrlichiosis or bartonellosis that overlap symptomatically with Lyme disease.
At the present time, the diagnosis of Lyme disease is a clinical diagnosis, not a laboratory diagnosis. It requires a clinician with Lyme experience.
The Challenge of Treating Lyme Disease
There is a great deal of controversy about optimal treatment for Lyme disease. The Infectious Disease Society of America recommends two to three weeks of antibiotics as the treatment for Lyme disease, but more than two dozen studies have documented persistence of illness among patients with Lyme disease after a 2-3 week course of antibiotics.
More on the controversy: Under Our Skin -- Lyme Disease Film
Persisting symptoms are often associated with evidence of persisting infection with Lyme disease. The presence of other tick-borne infections usually impairs the treatment response to Lyme disease.
When it comes to Lyme disease, many people feel that their concerns have not been adequately addressed by the conventional medicine approach. Learn more about what makes Lyme so elusive in Lyme Disease -- Why Lyme is the Mystery Disease.
Now I'd like to hear from you:
Do you have unexplained symptoms?
Have your been tested for Lyme or other tick-borne diseases?
How do you think you may have gotten Lyme disease?
Please let me know your thoughts by posting a comment below.
Leo Galland, M.D.
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Leo Galland, MD is a board-certified internist, author and internationally recognized leader in integrated medicine. Dr. Galland is the founder of Pill Advised, a web application for learning about medications, supplements and food. Sign up for FREE to discover how your medications and vitamins interact. Watch his videos on YouTube and join the Pill Advised Facebook page.
References and Further Reading
Ostfeld, R. S. 2011. Lyme disease: The ecology of a complex system. Oxford University Press
Keesing, F., J. Brunner, S. Duerr, M. Killilea, K. LoGiudice, K. Schmidt, H. Vuong and R. S. Ostfeld. 2009. Hosts as ecological traps for the vector of Lyme disease. Proceedings of the Royal Society B, Biological Sciences 276:3911-3916.
Schauber, E. M., R. S. Ostfeld, and A. S. Evans, Jr. 2005. "What is the best predictor of annual Lyme disease incidence: Weather, mice, or acorns?" Ecol. Appl. 15:575-586
Eisen, Rebecca J.; Piesman, Joseph; Zielinski-Gutierrez, Emily; Eisen, Lars. "What Do We Need to Know About Disease Ecology to Prevent Lyme Disease in the Northeastern United States?"Journal of Medical Entomology, Volume 49, Number 1, January 2012 , pp. 11-22(12)
Stricker RB, Johnson L, "Lyme Disease: the next decade", Infect Drug Resis 2011: 4: 1-9.
Weber K, Bratzke HJ, Neubert U, Wilske B, Duray PH. "Borrelia burgdorferi in a newborn despite oral penicillin for Lyme borreliosis during pregnancy." Pediatr Infect Dis J. 1988;7:286-289
Schmidli J, Hunziker T, Moesli P, Schaad UB. "Cultivation of Borrelia burgdorferi from joint fluid three months after treatment of facial palsy due to Lyme borreliosis." J Infect Dis. 1988;158:905-906.
Cimmino MA, Azzolini A, Tobia F, Pesce CM. "Spirochetes in the spleen of a patient with chronic Lyme disease." Am J Clin Pathol. 1989;91:95-97.
Preac-Mursic V, Weber K, Pfister HW, et al. "Survival of Borrelia burgdorferi in antibiotically treated patients with Lyme borreliosis. Infection." 1989;17:355-359.
Haupl T, Hahn G, Rittig M, et al. "Persistence of Borrelia burgdorferi in ligamentous tissue from a patient with chronic Lyme borreliosis." Arthritis Rheum. 1993;36:1621-1626.
Priem S, Burmester GR, Kamradt T, Wolbart K, Rittig MG, Krause A. "Detection of Borrelia burgdorferi by polymerase chain reaction in synovial membrane, but not in synovial fluid from patients with persisting Lyme arthritis after antibiotic therapy." Ann Rheum Dis. 1998;57:118-121.
Liegner KB, Shapiro JR, Ramsay D, Halperin AJ, Hogrefe W, Kong L. "Recurrent erythema migrans despite extended antibiotic treatment with minocycline in a patient with persisting Borrelia burgdorferi infection." J Am Acad Dermatol. 1993;28(2 pt 2):312-314.
Chancellor MB, McGinnis DE, Shenot PJ, Kiilholma P, Hirsch IH. "Urinary dysfunction in Lyme disease." J Urol. 1993;149:26-30.
Preac-Mursic V, Pfister HW, Spiegel H, et al. "First isolation of Borrelia burgdorferi from an iris biopsy." J Clin Neuroophthalmol. 1993;13:155-161.
Oksi J, Kalimo H, Marttila RJ, et al. " Inflammatory brain changes in Lyme borreliosis. A report on three patients and review of literature." Brain. 1996;119:2143-2154.
Kirsch M, Ruben FL, Steere AC, Duray PH, Norden CW, Winkelstein A. "Fatal adult respiratory distress syndrome in a patient with Lyme disease." JAMA. 1988;259:2737-2739.
Masters E. "Spirochetemia after continuous high-dose oral amoxicillin therapy." Infect Dis Clin Prac. 1994;3:207-208.
Lawrence C, Lipton RB, Lowy FD, Coyle PK. "Seronegative chronic relapsing neuroborreliosis." Eur Neurol. 1995;35:113-117.
This information is provided for general educational purposes only and is not intended to constitute (i) medical advice or counseling, (ii) the practice of medicine or the provision of health care diagnosis or treatment, (iii) or the creation of a physician -- patient relationship. If you have or suspect that you have a medical problem, contact your doctor promptly.
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