Early Diagnosis Of Symptoms Suggest Lyme Disease Present
By Sally Maxwell, Managing Editor
Friday, March 4, 2005 3:23 PM CST
A Sallisaw resident faces a diagnosis of Lyme disease after being bitten by a tick last weekend.
The patient sought medical attention at Sequoyah Memorial Hospital in Sallisaw where a presumptive diagnosis was made for Lyme disease.
A three-week antibiotic series was prescribed for the patient, who most likely will suffer no continuing symptoms because of the early treatment, Charles Wade, Sequoyah Memorial Hospital administrator, said.
Wade confirmed the hospital did have a "presumptive diagnosis" of Lyme disease, but due to confidentiality ethics, he could not reveal the name of the patient.
Wade reviewed the symptoms and dangers of tick bites.
"Physicians now believe that, what they call a presumptive diagnosis, is better than waiting for two to four weeks for blood tests to come back," Wade said, "especially if the patient has at least one of the six symptoms associated with Lyme disease." He explained that treatment protocols now call for the patient with a Lyme disease symptom to be put on antibiotics immediately.
"If any one of the six indicators are there," Wade said, "therapy is started immediately.
"It takes two to six weeks to confirm the Lyme disease diagnosis through blood tests," Wade said.
He said, "Lyme disease is difficult to diagnose, and physicians now believe that, if we are going to err, it is best to err on the side of caution."
Wade said healthcare professionals are concerned about tick bites this year, because of the mild winter. Ticks are already showing up with winter's mild temperatures.
Laurence Burnsed, epidemiologist with the Communicable Disease Division of the Oklahoma Department of Health, said Thursday that the department tracks tick-borne diseases, and a confirmed case of a tick-borne disease will be reported to the state. He said March is when ticks are first seen.
"We are early in the season," Burnsed said. "The season runs from March through October or November, depending on the weather."
A Lyme disease case is unusual for Oklahoma though, Burnsed said. "In general the southwest and Oklahoma are considered low risk for Lyme disease as compared to the northeast, in states like Connecticut."
However, Burnsed reported, "Oklahoma is among the top five states for diseases like Rocky Mountain spotted fever, tularemia and human ehrlichiosis. They are very common, and should be considered dangerous."
Burnsed cautioned, "As we get into the warmer months, if a person develops symptoms of a tick-borne disease, they should see a doctor immediately, and, if they can remember when they were bitten by a tick, be sure to give that information to their physician."
Lyme Disease
Wade offered the following information on Lyme disease from the American College of Physicians.
Doctors diagnose Lyme disease based on the patient's symptoms, history and blood test results. Lyme disease has three stages: early, early disseminated, and late Lyme disease.
The first-stage symptoms are:
Fatigue
Chills and fever
Headache
Muscle and joint pain
Swollen lymph nodes
Erythema migrans
Erythema migrans, according to the college of physicians, is a skin rash associated with Lyme disease. The rash occurs in a circular pattern that continues to grow. It may appear anywhere from one day to one month after the infected tick's bite, but it usually appears in about seven days. The center of the rash may clear as it grows, giving it the appearance of a bull's-eye. The rash may be warm, but it is usually not painful. Sometimes the rash includes many red patches that appear in different shapes and sizes around the body.
The rash is different from that caused by an allergic reaction to a tick or insect bite. Those symptoms usually appear as a redness within hours to a day after a bite, do not grow, and disappear within a day or two.
The second stage of Lyme disease, known as early disseminated Lyme disease, means the infection of bacteria is beginning to spread and is affecting certain body functions. This stage occurs weeks to months after the bite of an infected tick.
Problems include:
Numbness and pain in arms or legs
Paralysis of facial muscles, usually on one side of the face
Meningitis - fever, stiff neck and severe headaches
Abnormal heart beat (rare)
Third-stage symptoms are called late or chronic Lyme disease. This stage can occur weeks, months or even years after infections in patients who either never received antibiotic treatment for early Lyme disease or whose treatment did not kill all of the bacteria that cause Lyme disease.
Patients with late Lyme disease may get:
Chronic Lyme arthritis - brief bouts of pain and swelling usually occurring on one or more of the large joints, especially the knees
Nervous system problems, including memory loss and difficulty concentrating
Chronic pain in muscles and unrestful sleep
The American College of Physicians also points out that reporting a known tick bite to the doctor will help with the diagnosis. However, many people with Lyme disease do not remember being bitten by a tick.
Deer ticks and western black-legged ticks are tiny and often go unnoticed. For example, nymphal deer ticks, the most common transmitters of Lyme disease, are often about two mm, or the size of this dot (€).
Blood tests cannot diagnose Lyme disease alone, but are used to confirm a diagnosis. Other tests can help with the diagnosis but may take up to two to six weeks because the body must first develop antibodies to the disease, and the antibodies are what are sought in the tests. Other bacterial infections and diseases may also cause false positives, and increasing the number of tests also leads to false positive tests.
What To Look For
According to information provided by the Oklahoma State University (OSU) Extension Service, the black-legged tick, a known carrier of Lyme disease, "doesn't have colorful markings and is a three-host tick. It is an important pest of livestock and wildlife in the eastern half of Oklahoma. It is also known to inflict painful bites on man. It awaits its host along paths, trails and roadways.
"The adults become active in late September and October and are present until March or April. During the early fall, it is often the most common tick on deer and cattle in Oklahoma. The larvae and nymphs are active in the spring and summer and feed on lizards and small mammals. This tick is considered a vector in the transmission of anaplasmosis to cattle. The nymphal stage is thought to be the main carrier of Lyme disease."
Information on ticks is a available at the OSU Extension Service office in the Sequoyah County Courthouse in Sallisaw.
The OSU pamphlet on ticks also points out that:
The American dog tick is the only proven vector of Rock Mountain spotted fever in Oklahoma and is also an important carrier of tularemia. The tick may also cause tick paralysis in people and dogs.
The lone star tick receives its name from the lone spot on the dorsal shield of the female. The lone star tick is active from early spring to late fall, and is known to transmit human ehrlichiosis, tularemia and American Q fever.
The OSU information also points out that the symptoms of Rocky Mountain spotted fever appear three to 14 days after the tick bite. Symptoms include sudden fever, chills, muscle aches and headaches. Nervous symptoms such as sleeplessness, restlessness and delirium may also occur. Ina bout 50 percent of the patients, a characteristic spotty rash occurs on the feet and hands within two to three days of the fever. The rash may move to the rest of the body but does not start on the trunk of the body like rashes caused by measles and other diseases.
If someone develops these symptoms and knows they have been bitten by a tick, they should seek medical help immediately. When diagnosed early, Rocky Mountain spotted fever can be successfully treated with antibiotics, which can lead to complete recovery. If the disease is not treated, the mortality rate can be as high as 20 percent.
Lyme disease, according to the OSU information, has been detected in Oklahoma, but remains rare.
Since 1988 there has been a range of between 13 and 28 cases per year in the state. The black-legged or deer tick is very abundant in Oklahoma and is considered to be the most probably species involved in the transmission of Lyme disease in the state.
"Lyme disease very rarely causes death," according to the OSU information, "although it can cause a great deal of pain and discomfort and long-term disability if allowed to progress to the later stages."
Tularemia is believed to be transmitted most often by the lone star tick.
Symptoms include influenza-like illness, an initial severe fever, temporary remission, and an additional fever period of two weeks. After the initial two weeks, there are often localized lesions, possible conjunctivitis, and a reddening of the mucous membranes in the eye and enlarged, tender lymph nodes. Pulmonary complications are not uncommon and mimic community-acquired pneumonia.
The first case of human ehrlichiosis was reported in Arkansas in 1986. Since then human cases have been found in 12 southern states including Oklahoma, and it is thought to be a rare human disease.
The suspected tick carriers are the long star tick and possibly the brown dog tick.
Symptoms can be mild to severe, requiring hospitalization and include fever, chills, headache, aches and pains in joints and muscles, loss of appetite, eye pain, nausea and vomiting. There is usually no rash.
How To Avoid Tick Bites
When in tick habitat (grassy, brushy, or woodland areas), take these precautions to minimize tick bites:
Tuck your pant legs into your socks. Tuck your shirt into your pants.
Wear light colored clothing.
Inspect your clothes for ticks often while in tick habitat.
Wear repellents, applied according to label instructions.
Inspect your head and body thoroughly when you get in from the field.
When working in tick habitat on a regular basis, do not wear work clothing home.
Source: National Park Service
What To Do If Bitten By A Tick
Remove the tick as soon as possible. The easiest method is to grasp the tick with fine tweezers, as near to the skin as you can, and to gently pull it out. You may want to save the tick in a small jar for later identification. Check to see whether the mouth parts broke off in the wound. If they did, seek medical attention to get them removed. If you get any symptoms of Lyme disease in the following week to several months, see a physician immediately. Be sure to tell the doctor that you were bitten by a tick. A blood test can help determine if you have been exposed to Lyme disease.
Source: National Park Service
|
