SAFETY - Branch of Operations Technical Memo OP89.05

LYME DISEASE - FIGHT THE BITE

Lyme disease is the number-one tickborne disease in the U.S.
Originally identified in 1975, in Lyme, CT, it has now been
identified in at least 33 states.  It is most prevalent along
coastal areas in the northeastern states from DE to MA and also
in WI, MN, and northern CA.  Lyme disease is not unique to the
U.S.  Cases have been reported in Europe, China, Soviet Union,
and the Orient, and it is now considered a global problem.

Lyme Disease is an infection resulting from the bite of a tick
called Ixodes dammini.  The lone-star tick (Amblyomma americanum),
a common southern species, and the CA black-legged tick (Ixodes
pacificus), a western tick, can also transmit Lyme disease.
These ticks are much smaller than the common dog tick.  They are
approximately the size of a sesame seed or pinhead.  Females are
dark red and black; males black.  When engorged the tick is about
the size of a sunflower seed.  They usually live in grassy and
wooded areas where they feed on small and large animals like mice
shrews, birds, raccoons, dogs, possums, deer, horses and
occasionally humans.  The tick feeds most actively from April
through October, the peak time being May through September.

Lyme disease is caused by a coiled bacterium - a spirochete -
called Borrelia burgdorferi, named in honor of its discoverer,
Dr. Willy Burgdorfer of the U.S. Public Health Service.  The tick
is believed to transmit the spirochete to humans by inoculation
from its salivary glands.  It is reported that the tick stays on
the body for several hours before it bites and that it must
feed for twenty-four hours for transmission to be effected.  This
time amy vary depending on the tick species and further research.

Three to thirty days after a tick bite, Lyme disease may begin
with a red rash around the site of the bite.  The rash may have
reddened edges and appear ring-like (much like a "bulls eye")
with a firm spot in the center.  The tick bite is not painful and
often goes unnoticed.  A tick may simply bite, draw blood for its
nourishment and drop off.  If the tick should happen to be infected
with spirochetes, it may transmit them during the feeding process.
It is important to note, however, that a tick bite does not
always result in Lyme Disease.

The slowly expanding red rash that may develop is called erythema
migrans.  Rashes may very in shape and size and not all people
who contract Lyme disease will experience this rash (about 75%
will), maiking diagnosis difficult.  About the time the rash
occurs, other common symptoms may develop such as flu-like
illnesses, fatigue, headache, muscle and joint pain and stiffness,
fever, nausea and weight loss.  Less common symptoms include
chest, ear, and/or back pain, swollen lymph glands and spleen,
sun sensitivity, sore throat, dry cough and testicular swelling.  If
treated in this stage, with appropriate antibiotic therapy, Lyme
disease is usually very curable.  If left untreated, these early
symptoms may disappear, but more serious problems may follow.

The rash, if present, will expand for several weeks then slowly
fade -- sometimes nothing more happens.  However, later compli-
cations of the disease can be quite severe occurring as much as
two years after infection.  The most common later problem is
arthritis, usually of the large joints; the knee joint frequently
is affected.  The joint symptoms can be very similar to rheumatoid
arthritis with joint pain and swelling.  Other symptoms appearing
later in the disease are complications of the heart occuring one
to three weeks after the rash starts and may include dizziness,
weakness, and irregular heartbeat.  Nervous system problems
develop about one month after the rash first appears and are
characterized by headaches, difficult concentrating or sleeping,
irritability, neck stiffness, poor muscle coordination, tingling
in the extremities, loss of confidence and lethargy.  Weakness of
facial muscles with drooping of the eyelid or corner of the mouth may
also appear.  Meningitis with fever, severe headache and stiff neck
may occur weeks to months after the tick bite.  Treatment of these
later symptoms is more difficult and often not as succcessful as for
early symptoms of the disease.  Treatment of this stage of the illness
would still include antibiotic therapy and medicines for relief of
particular symptoms, such as steroids for joint pain.

Early treatment and prevention of Lyme disease is very important.
Taking precautions to minimize the chances of being bitten by
ticks is one of the best defenses against Lyme disease.  The
following precautions are recommended:

1.  Avoid tick habitats if possible.

2.  Wear proper clothing - a hat, tucked-in shirt with snug collar and
    cuffs, long pants tucked into socks and good shoes.  Wear light-
    colored clothing so that dark colored ticks can be easily spotted
    and picked off.

3.  Use tick/insect repellents containing DEET or metheprim and apply
    to shoes, socks, cuffs, and pant legs.  Deer ticks attach to feet
    and leggs and then climb up.

4.  Inspect clothes for ticks often while in tick habitats.  While in
    the field, have a companion inspect your back.

5.  Monitor yourself, your partner, children, and pets immediately
    after coming inside.  Inspect clothes, head, and body.  Have a
    companion check your back or use a mirror.  Shower and wash
    clothes as soon as possible.

6.  Keep lawns mowed and brush cut.

7.  Tick collars or powders may help keep ticks off pets.  Be alert
    to symptoms of lameness in your pets.

If you find you have been bitten by a tick it should be removed as
soon as possible.  Using a small tweezers, grasp the tick near its
mouth parts.  Do not squeeze the tick's body. Pull the tick gently but
firmly being sure to remove all tick parts.  If unable to remove all
tick parts, seek medical attention to have the them removed.  Wipe the
bite area thoroughly with an antiseptic.  Save the tick in a jar or
snippet of scotch tape and label it with the date, body location of
the bite and the place where the tick may have been acquired.  Your
doctor will find this information helpful in diagnoses.  Monitor
yourself for any of the symptoms associated with the Lyme disease
and see your doctor immediately if any of the symptoms arise.  Be
sure and tell your doctor that you were bitten by a tick.  A blood
test can help determine if you have been exposed to Lyme disease.

Lyme disease research is extensive and widely varied.  Areas of
research include a new blood test to detect Lym disease sooner
than the present test which cannot positively determine Lyme
disease until three weeks after infection.  Another possibility
being explored is a test that detects the organism in urine.
The potential for future development of a vaccine against Lyme
disease is also being studied.

Recent studies have been done that suggest a possible link between
Lyme disease and abnormal pregancies.  Pregnant women living in
high risk areas for Lyme disease should use special precautions
in avoiding tick bites and should seek medical attention for
any suspicious symptoms.

Tick control is another option to controlling Lyme disease.  One
study that has shown promise in controlling the tick population
involves lacing cotton balls, which mice readily use to build
their nests, with a potent pesticide.  The pesticide, permethrin,
is harmless to the mice and effectively wards off ticks from attach-
ing to mice and being further distributed to other animals
including humans.

There is still much to be learned about Lyme disease, but increased
awareness of the disease, its cause, treatment and prevention, is
one of our best tools in combating the disease.

                                  Joanne Ebner and Roz Bugen
                                  Reston Health Unit, x7333