If you’re heading out of town this holiday weekend, don’t just protect your skin from the sun. There is another serious summer menace: Lyme disease. Because of an increase in the mouse population due to a bountiful acorn crop a couple of years ago combined with a milder winter, blacklegged ticks are out in full force and with them comes the potential to become infected with Lyme disease.
In 1977 Lyme disease was recognized in Lyme, Connecticut and it was first mistaken as juvenile rheumatoid arthritis. It wasn’t until the early 1980s that the scientist Willy Burgdorfer made the link between a spiral-appearing bacterium that lives on deer ticks and the disease. Because of his discovery, the bacterium — a type of spirochete — was named Borrelia burgdorferi. The bacterium causes flu-like symptoms, fever, muscle and joint aches. If not treated with antibiotics early enough, the infection can even spread to the heart and nervous system and settle into joints.
But can you get Lyme disease in New York City? Well, yes and no. Theoretically, there are some parts of NYC where deer and mice may be more prevalent such as Staten Island and the northern Bronx, but most New Yorkers who get Lyme disease are infected when they leave town and go to places such as upstate New York where deer ticks are more widespread.
However, as more people and their pets go back and forth from endemic areas (essentially any wooded areas where deer, mice and people converge), ticks will be increasingly brought into NYC and the possibility of local transmission will occur.
Since there is no available vaccine for Lyme diesease (vaccines were introduced in the early 1990s, but were controversial because of possible side effects and were consequently pulled from the market), prevention is still the number one defense. If you’re going to be outside this summer in heavily forested areas where deer and mice are prevalent, wear long pants and shirts, hats, and use bug spray. On the skin, DEET should be applied using a 20 to 30 percent concentration for best efficacy without toxicity. You can spray your clothes and sneakers with Permethrin for added protection. Take a shower after being outside to wash off any possible unattached ticks. And you can throw your dry clothes in the dryer at high heat for 10 minutes to kill any surface ticks.
The next line of defense is the tick check. I cannot stress this enough. To get infected with Lyme disease, the tick needs to stay attached to your body for at least 24 hours. This means you have time, even if there is a tick on you, to not get infected with Lyme disease. Check your head, behind the ears, your arm pits, your groin, behind your knees, and if you can’t reach, ask a friend or family member to help you. If there is a tick on you, relax, take a deep breath, and don’t get the matches. Just get the tweezer and start at the head of the tick and pull it out with firm, even pressure. If the tick is not engorged, it is unlikely to have had a blood meal and transmitted the disease-causing bacteria. Make sure to disinfect the area afterwards. Save the tick in the plastic bag if you want to get it identified for the Lyme bacteria, or throw it away in the plastic bag to make sure it is properly discarded. Watch for any flu-like symptoms or rash within a two-week time period.
Call your doctor if these symptoms occur: fever, severe headaches and neck stiffness, bull’s-eye-shaped rash at the site of the bite that appears about a week later, joint stiffness, or nerve pain. Keep in mind the rash may be missed, or may not present in about 20 to 30 percent of patients. It can also vary in appearance and look like a red sunburn patch or patches that expand, so look carefully. Blood tests are available, but if the symptoms are typical, testing may not be necessary.
Remember too that ticks can carry other pathogens such as the parasite Babesia and bacteria in the Anaplasma family. These too cause flu-like illness and make you sick as a dog, but like Lyme disease all are treatable.
So this summer, be sure to stay one step ahead of those dreaded insects and add tick check to your nightly routine. And don’t forget to pack the tweezers along with the sunscreen, bathing suits and flip-flops.
Dr. Christine Stavropoulos is a Senior Faculty member in the Department of Medicine, Division of Infectious Diseases at Mount Sinai Health System