Lyme Disease

Lyme Disease

Overview of Lyme Disease

Lyme disease (Lyme borreliosis) is the most prevalent tick-borne infectious disease in the United States. The disease is caused by spiral-shaped bacteria, predominantly in the Borrelia genus (commonly B. burgdorferi), carried by a number of species of the Ixodes genus of tick (commonly the deer tick or black-legged tick). The bacterium is transferred via the tick's saliva into the bloodstream of its victim. Once infected, symptoms may include fever, neck stiffness, mild to severe fatigue, arthritis, and neurological problems.

In humans, the disease is most often contracted between spring and late summer. The Ixodes nymphs first appear in the spring in the leaf litter and brush at the edges of wooded lots, and are often no bigger than the head of a pin. The adult-stage tick, which is more common later in the summer, is about the size of an apple seed. Once bitten, the classic sign that infection has occurred is a red "bulls-eye" rash. This rash usually appears within three days after the bite, but may take as long as 30 days to develop. Although classic the rash is not a reliable diagnostic indicator, however, as it appears in only 37% to 70% of people infected (depending upon the source quoted).

If treated early enough, the likelihood is good that the B. burgdorferi spirochete can be completely eliminated with antibiotics, and the bite sufferer completely cured. In a percentage of those who are treated, and additionally in those who don't know they've been infected and who therefore go untreated, the disease can become a chronic condition, accompanied by a complex set of symptoms including fatigue, arthritis, joint pain, heart problems, and neurological problems, among others, that in some cases become debilitating.

The Lyme Disease Trajectory

The disease was first reported in the Lyme, Connecticut region in 1975, from whence the name originates. Although the organisms involved are of ancient origin, Lyme is characterized as a "potent emerging disease" because of its rapid expansion in time and place.

Data from the CDC show reported annual incidence rates doubled in the United States between 1992 and 2006, from almost 10,000 reported cases in 1992 to almost 20,000 cases in 2006, with the vast majority concentrated in the Northeast and Midwest. A total of nearly one-quarter million new cases were reported to the CDC during this 15-year period.

The most recent CDC data (for 2008) show nearly 29,000 confirmed cases, and nearly 6,300 probable cases that year. It is believed among some Lyme experts, however, that the actual incidence of Lyme disease could be as much as ten times higher than CDC data indicate, and tens of thousands of cases, if not many more, have not been reported at all.

During that same 15-year period more than 90% of the cases came from ten states—Connecticut, Delaware, Maryland, Massachusetts, Minnesota, New Jersey, New York, Pennsylvania, Rhode Island and Wisconsin—where deer ticks are most common. Children between the ages of 5 to 14 were reported as having the highest incidence of infection, with over half the cases occurring among young males.

The reported geographic range of the Ixodes tick has expanded in these ten states, and its spread is predicted to continue to expand beyond the tick's previously established natural range. Bioclimate data suggest that milder winters and more humid conditions are dominant features in this expansion of Ixodes scapularis populations, posing a serious challenge to human health.

Fortunately, awareness of the disease among health care providers is also growing. Yet many health care providers are not highly "Lyme-literate," and may have difficulty diagnosing Lyme disease if the telltale rash does not appear or goes unnoticed. The nature of disease progression in Lyme disease can be complex and highly variable, presenting symptoms easily confused with other ailments. Further complicating diagnosis is the possibility of co-infection with other tick-borne diseases carried by the Ixodes tick. If you feel you may have been bitten and have the signature "bulls-eye" rash, or if the rash does not appear but you are experiencing flu-like symptoms, it's important that you be checked by a knowledgeable doctor about the possibility of Lyme infection. Early detection and treatment are the best means for avoiding the damaging long-term effects of chronic Lyme disease.

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