LYME DISEASE MYTHS REFUTED

Common and long-standing misnomers about lyme disease, it’s symptoms, it’s geographic distribution, and vectors of transmission may pose significant risks to patients who contract this disease.  Early detection and treatment are critical, as this disease can be debilitating or fatal if not quickly or adequately treated.  The physicians and doctors at FirstCare Center between Highland  and New Paltz are knowledgeable and experienced in diagnosing and treating lyme disease.

Controversies surrounding this illness are many, and on-going, evolving research, paired with uncertainty regarding testing methods (NIAID, 2012) is causing doctors, regulators, researchers, and the public to re-examine what we know so far.  Past and current studies offer several reasons to update our thinking on even the more ‘basic’ aspects of this disease.

The CDC recently revised its previous estimates of 30,000 new annual Lyme disease cases in the U.S. to300,000 or more new annual cases.  This could indicate that an overwhelming majority of Lyme patients are unlikely to recognize their symptoms and unlikely to be recognized by doctors as having Lyme disease.

Diagnosis can be dangerously complicated by multiple factors, including the timing of testing and considerable overlap with other conditions and diseases (NIAID, 2012).  Common, long-standing myths and misnomers may further complicate early diagnosis and make patients less likely to seek early treatment.

Many aspects of Lyme diagnosis and care have inspired considerable controversy (NIAID, 2012), and the following are not the only prevalent myths pertaining to Lyme which doctors, agencies, and legislators are working to better understand or correct.  But these are some of the myths that pose the greatest potential to cause delays in care or misdiagnosis through lack of early consideration of Lyme disease.

Myth: If a patient contracts Lyme disease, they will see a ring-shaped rash.

Truth: Although a ring-shaped rash, Erythema migrans, is a well-known sign of Lyme disease (CDC, 2013a), many patients don’t remember ever seeing a rash (NIAID, 2012; CDC, 2013a).  When a rash is present, it may not take the typical shape and coloration associated with Erythema migrans.

Myth: Lyme disease is only transmitted to humans through the bite of an infected Deer tick.

Truth: Certain species of black legged (hard bodied) ticks, particularly, were long considered the only species to transmit Lyme to humans.  However, researchers have suspected, and have recently demonstrated, that multiple tick species (soft bodied as well as black legged/hard-bodied ticks), including the lone star tick, also transmit Lyme to humans (UNF, 2013).

Evidence is also growing for transmission through other biting insects and from mothers to babies in utero (congenital Lyme disease). A recent study supports the potential for sexual transmission of Lyme disease (Middelveen, et al., 2014).

Myth: A tick must be embedded for 36 hours or longer to transmit Lyme disease.

Truth: This has been widely accepted for decades by credible medical institutions and agencies alike, but scientists, doctors, and patients have found that this is not always the case.  The longer the tick is embedded, the greater the risk (NIAID, 2012).  But diligence is warranted following any length of exposure or observation of symptoms, particularly since:

  • Doctors and patients have reported that Lyme has been contracted through a tick embedded for less than 12 hours, with documentation of contraction after as little as 6 hours (Patmas and Remora, 1994).
  • Laboratory animals exposed to infected ticks were more likely to contract Lyme after 24 to 48 hours in multiple studies, but infection occurred for some animals in less than 24 hours in the same experiments (Matuschka and Spielman, 1993; Piesman et al., 1987).
  • Many patients do not recall being bitten at all (Nadelman, 2002, NAID 2012).

Myth: Lyme disease can only be contracted in certain states or regions.

Truth: Although the abundance of ticks is greater in some areas than others, and the abundance of infected ticks is greater in some states (especially in the northeast), the risk is greater in, but not limited to, those area.  Lyme disease cases have occurred and been reported in all 50 states.  Estimated ranges of black legged ticks were previously linked to expected distributions of Lyme disease, causing many states to preclude the presence of Lyme disease based on estimated tick distributions, but this is being re-examined, in no small part because of:

  • Increasing mobility of people, pets, and migratory wildlife;
  • Expected and suspected changes in distributions and seasonal activities of both animals and insects in response to climate change;
  • New research, noted earlier, supporting transmission through multiple vectors;
  • The need for more recent or thorough regional tick species survey and monitoring efforts to verify presence, absence, and distribution of tick species.  North Dakota is the most recent example, having found deer ticks and Lyme infected ticks in recent surveys according to recently released results (Russart, et al., 2014).

Careful attention should be paid to any symptoms developing after a tick bite, since Lyme disease is only one of many tick-borne illnesses that warrant prompt medical attention.  The same is true for short or long term symptoms that start to overlap with those of a tick-borne illness.   Symptoms that seem to be unrelated at the time can be part of the bigger picture later, and you doctor will need your assistance in providing the details that make that picture more clear.

 

References

CDC, 2008.  Surveillance Data.  http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5710a1.htm?mobile=nocontent

CDC, 2013a. Lyme Disease (Sings and Symptoms, CDC). http://www.cdc.gov/lyme/signs_symptoms/

CDC, 2013b. Press Release (Centers for Disease Control and Prevention). http://www.cdc.gov/media/releases/2013/p0819-lyme-disease.html

Lymedisease.org, 2014.  Recent study suggests that Lyme disease can be sexually transmitted. http://lymedisease.org/news/lyme_disease_views/lyme-sexual-transmission.html#sthash.nugdtg38.dpuf

Matuschka FR, Spielman A., 1993.   Risk of infection from and treatment of tick bites. Lancet 1993;342;8870:529-30

Middelveen, M., et al., 2014.  Abstract – Isolation and Detection of Borrelia burgdorferi from Human Vaginal and Seminal Secretions.  J. Investig Med.  2014;62:280-281.\Presented at the Western Regional Meeting of the American Federation for Medical Research, Carmel, CA, January 25, 2014. http://afmr.org/Western/.

NAID, 2012. Lyme Disease (Diagnostics Research, NIAID, NIH). http://www.niaid.nih.gov/topics/lymedisease/research/pages/diagnostics.aspx

Patmas, MA, Remora, C., 1994.   Disseminated Lyme Disease After Short-Duration Tick Bite. JSTD 1994; 1:77-78.

Piesman, J, et al., 1987.   Duration of Tick Attachment and Borrelia Burgdorferi Transmission. J Clin Microbiol. 1987 Mar;25-3-:557-8.

Russart, N., et al., 2014.  Survey of Ticks (Acari: Ixodidae) and Tick-Borne Pathogens in North Dakota.  J. Med Entomol. 2014; 51 (5): 1087 DOI: 10.1603/ME14053

UNF, 2013. UNF Professor Discovers Two Lyme Bacterial Species Can Infect Humans.  Media Relations (University of Northern Florida).http://www.unf.edu/publicrelations/media_relations/press/2013/UNF_Professor_Discovers_Two_Lyme_Bacterial_Species_Can_Infect_Humans.aspx

Middelveen, M., et al., 2014.  Abstract – Isolation and Detection of Borrelia burgdorferi from Human Vaginal and Seminal Secretions.  J. Investig Med.  2014;62:280-281. \Presented at the Western Regional Meeting of the American Federation for Medical Research, Carmel, CA, January 25, 2014. http://afmr.org/Western/.

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