Lyme Disease In Northern California
No summer dermatology series would be complete without a few words on ticks and Lyme disease. While relatively uncommon in the north state, Lyme disease is here and likely gaining ground. Traditionally, we think of Lyme disease as being an East Coast problem, but it is now found across 48 states. To put it in perspective, there were 1,964 cases confirmed in Connecticut in 2010, compared to California’s 126 cases confirmed. The disease is admittedly underreported, but we still pale in comparison to the East Coast.
The Cause Of Lyme Disease
Lyme disease is caused when a tick passes on the germ known as Borrelia burgdorferi. The germ is passed while the tick is sucking blood from its victim. Borrelia is a corkscrew shaped bacterium closely related to syphilis. Throughout history, syphilis was known to doctors as “The Great Imitator,” due its ability to manifest as seemingly unrelated symptoms. It is interesting that Lyme is from the same family and displays the same characteristic to affect vastly different organ systems.
A Quick History Of Lyme Disease
It was discovered in Lyme, Connecticut in the late 1970s, when researchers were investigating the cause of strange clusters of children suffering from what was believed to be rheumatoid arthritis. Medical textbooks usually classify Lyme as an, “emerging infection.” Perhaps it is the recognition of this disease that is just “emerging.” The famous 5,300-year-old Neolithic mummy discovered in the Alps is believed to be the oldest known sufferer of Lyme disease. The “Iceman,” or Otzi, as he has been named, was murdered and his corpse left to rot in the Alps. Evidently, Otzi was frozen in snow, and then preserved in a glacier until two hikers stumbled upon him in the 1990’s.
Given his remarkable state of preservation, researchers have recovered DNA from the Lyme bacteria off his frozen remains. Scientists may never know the affects of the severity of Lyme disease within Otzi. Most of the tick-transmitted diseases have only been discovered in the past 40 years. An entire invisible soup of organisms is likely responsible for vague maladies we’ve yet to discover. After all, the children in whom Lyme was first discovered were all told they had rheumatoid arthritis. It seems a new tick-born disease is being discovered every few years.
Signs And Symptoms Of Lyme Disease
Lyme disease traditionally gets lumped into the realm of dermatology because of the famous “bull’s eye” rash it can trigger, however, the skin is the least consequential organ involved. Left untreated, Lyme can damage nerves, the heart and your joints. Sometimes it can trigger a partial facial paralysis that resembles stroke symptoms. Studies show that about half of the people with Lyme disease will develop this rash (some studies even report only 15 percent), and sometimes the rash may be on the scalp or other areas not easily seen.
Informal surveys support that only half of the patients with confirmed Lyme disease even remember a tick bite. The rash is the earliest stage of infection and the more severe symptoms can take years to develop. If there is no memory of a tick bite or rash, it can go easily undiagnosed. I’ve even had patients request that I evaluate a “new mole,” only to find little spindly legs hanging off their “mole.”
Lyme Disease Infection And Tick Presence
The only known way to become infected without a tick involved is for a mother to pass it to her unborn child. It can result in miscarriage, or birth defects. If detected early on, it can be treated with antibiotics.
Ticks are not insects, but arachnids, cousins to spiders. Whereas, spiders eat pesky insects, I really cannot think of any redeeming qualities in ticks from a human being’s perspective. It’s worth remembering that ticks do not have wings and cannot jump or fly onto you. Classically, ticks from the genus Ixodes, transmit Lyme disease (more commonly known as the “Black-legged Tick). The term “Deer Tick” is used in various regions as well. Deer are classically the host organism. Any gardener will tell you our deer population is out of control. I haven’t heard anyone sound the alarm about swarms of deer ticks yet but it stands to reason, that if the host is thriving, so must the parasite.
Researchers have linked a rising rate of Lyme infections with a decline in red fox populations in the northeast. It seems that the coyote is a relatively new Eastern predator and is gobbling up significant numbers of red foxes. The foxes’ diet of smaller mammals like mice, shrews and chipmunks are believed to be responsible for the growing Lyme infections, since their deer population has stabilized. The loss of red foxes can result in an increase in the abundance of the smaller animals that serve as hosts for bacteria-carrying ticks. Red foxes may have once kept those populations under control.
There are various ways to recognize these ticks, but I’ve found none to be reliable every time. A tick’s appearance varies from male to female, and nymph stage to adult, which can make identification challenging at times. So, don’t shrug off a tick bite just because it doesn’t fit the description of what you consider to be “a dangerous breed.”
The commonly recognized “Dog Tick,” however, is not known to harbor the bacteria. Usually, if the tick hasn’t fed upon you more than 24 hours, there is no need to seek medical attention. Despite what grandpa taught you, it is a bad idea to use hot matches and kerosene to remove ticks. In fact, this may make matters worse by irritating the tick and stimulating it to release additional saliva, increasing the chances of transmitting infection. To remove a tick, grasp the tick close to the skin with tweezers and pull it straight out. It helps to make agonized faces to elicit sympathy from anyone watching.
Lyme Disease Patients And Chronic Lyme Disease
This article is not meant to address the controversy surrounding chronic Lyme disease. There exists a contentious and often spiteful dialogue about chronic Lyme in the public arena. If you want to get a feel for the controversy on this issue, I recommend watching “Under Our Skin” on YouTube. I’m not condoning everything presented in the video, but it voices the frustration with the medical establishment many patients are feeling.
Patients desperately want answers and unfortunately some questions are just unanswerable. One patient was quoted as saying, “As my symptoms increased, I sought the help of over 40 doctors. I was misdiagnosed with chronic fatigue syndrome, fibromyalgia, multiple sclerosis, immune dysfunction, hypoglycemia, rheumatoid arthritis, Lupus, chronic mononucleosis, and Addison’s disease.” His case was featured on the Discovery Channel’s Mystery ER program’s first season and does a good job conveying his frustration getting a correct diagnosis.
Remember, Lyme disease is 100 percent treatable if you get antibiotics early. If you believe you’re suffering from Lyme disease, the American Lyme disease Foundation (ALDF) keeps a national list of doctors familiar with the diagnosis and treatment of Lyme disease, and other tick-borne infections. Beware that many treatments that exist outside the mainstream are charlatans preying on sick people with open wallets.
Lyme Disease Vaccine
For several years there was an effective vaccine named LIMERix. The vaccine had an unusual mechanism of action, while a tick was feeding upon its prey, the vaccine helped the body to release antibodies that attacked the Lyme bacteria, located within the stomach of the tick. Though the vaccine was about 75 percent effective, the manufacturers could not protect it from bad press.
Reports of arthritis being induced by the vaccine led to formation of anti-vaccination groups and lagging sales. Subsequent studies disproved this association but the damage in the public’s mind had been done. In 2002, the vaccine was withdrawn from the market. There is currently no vaccine for Lyme disease, and the series of frivolous lawsuits filed against LYMERix served as a cautionary tale to industry against further development.
Lyme Disease Myths & Being Safe
It has been pointed out that the “track record” of the “conventional wisdom” regarding Lyme disease is not very good. First off, it was said to be a new disease, which it wasn’t. Next, it was thought to be viral, but it isn’t. Doctors believed all cases were easily treated by short courses of antibiotics, which sometimes it isn’t. Then, it was blamed exclusively on a type of tick, which we now know is not even a valid tick species. Typically, when a major dogmatic statement has been made about Lyme disease, it has been proven wrong.
So go enjoy the outdoors, but keep in mind many critters are looking for a comfortable host and a good blood meal.
Dr. Derrick Adams is a board-certified dermatologist and the medical director of Vita Dermatology and Laser Institute, a division of Lassen Medical Group in Red Bluff. His office can be reached at 528-VITA.