Friday, April 28, 2006

Tick Bite and Lyme Disease Prevention


Last week I removed a tick from a patient. It was smaller than the one pictured, but still she had some concerns. So let's review a few facts about ticks and Lyme disease prevention.

First of all in the United States, unless you live in the Northeast, upper Midwest, or Northwestern regions, the risk of the infection is low. I am not familiar with the statistics in Europe and Asia.

What: The tick, Ixodes scapularis, carries Borrelia burgdorferi, the spirochete bug, which causes Lyme disease, a multisystem inflammatory condition involving the joints, heart, and nervous system.

How: Once the tick hops on to you it has to bite and hold on to you for at least 24 - 48 hours before it can transmit the infection.

When: Spring/summer is feeding time for the nymph which is the smaller and more infectious stage of the tick.

Prevention: 1) Wear long sleeves and pants and tuck the pants into the socks. 2) Use DEET containing mosquito repellent. 3) Wear light colored clothing so to see the ticks better. 4) Check for ticks after an outdoor activity. 5) If you see a tick remove it with a tweezer. See here for the removal procedure. There is no vaccine available. It was taken off the market.

Treatment: Prophylactic antibiotics are usually not given unless you live in an endemic area. If you see a rash, erythema migrans, then see your doctor in which case antibiotics would be considered. If treated early, Lyme is an easily curable disease.

References: Treatment of Lyme DiseaseThe Medical Letter, Inc. Volume 47 (Issue 1209) May 23, 2005. How Can We Prevent Lyme Disease? Edward B. Hayes, M.D., and Joseph Piesman, D.S. New England Journal of Medicine, 2003 Jun 12;348(24):2424-30.

Image: courtesy of movie poster Ticks.

46 comments:

Eugene said...

That is very useful info, thanks! But I don't want to wear long sleeves in SUMMER! :-X What about sunburn!?

Anonymous said...

Well, the long sleeves will help protect you against sunburn as well.

juliette3 said...

hey i came across your site and i think it's great, i am also new to blogger, i am 39 and i am currently doing my VCE, i am studying Biology which i am finding really interesting. I wanted to know whether you are updated about antidepressants because i have to change mine and i was looking for advice on them, i have been thriough many side effects.

Dan said...

In Southern New Jersey, ticks and Lyme Disease is very prevalent. I know literally dozens of people who are infected with it and it was virtually impossible to go outside during certain times of the year without getting a tick on you - it was pretty scary!

Anonymous said...

Yes, NJ, is in the top 4 with 2.349 cases in 2002.

In case you were wondering about other rankings:

1. NY, 5,399 cases (This is one time when NJ shouldn't mind being out ranked by NY :)
2. CT, 4,631
3. PA, 3,989
5. MA, 1,807.

And according to the UCSF Infectious Disease Conference 4/26/06, these rates are increasing in that part of the country.

Siščanka iz drevne Siscije said...

very useful informations, especially when I work in my garden

Imran Khan said...

Lymes occours all over the world. Cases from Eastern Europe have shown heart disease caused by this. In the US the disease usually goes undiagnosed and these patients develop autoimmune diseases.

http.www.cidpusa.org

viruswitch said...

Hello,

I can say a few things about Ticks in Europe. I lived in Austria for 3 years and I was surprized when in 2001 they had us all vaccinated in the academy I studied, against the infection caused by Ticks. 2 other vaccinations should have followed a few months later but I never went to do them. I would be very interested to know why they removed the vaccine from the market.

From what I heard this is a pretty serious infection that can cause death. Is that correct?

I remember that they recommended the following way of removing Ticks: to apply oil over the area so that the tick unable to breath gets out on its own. I wonder if that is acceptable from the medical point of view.

Dr. Taraneh Razavi said...

Viruswitch,
The vaccine was removed because of concerns that it may produce a mild form of the disease or arthritis disorders.
The infection can be serious if it is not treated early.

Please refer to the blog for the removal instructions. There is a link that describes how to do it. I am not familiar with the oil technique.

3pillars said...

The tweezer technique doesnt work. From past experience in the field, when ticks are clamped with tweezers, they clamp down on the person's skin and then when you yank the tweezers then tick falls apart. This causes a great hassle because you need to pick out every piece of tick (ie. each leg has to be removed separately).

The easiest and most eefective way is to take vaseline and smother the tick with it. The tick can't breathe and releases the skin to try and get above the vaseline to get some air. All you need to do is take a tissue and wipe the vaseline off the skin and the tick is off. That's probably what viruswitch was referring to.

SF Photorama said...

Let's just hope I can avoid those critters!

Taylor said...

Very nice blog, you may be interested in mine, I am a pre-medicine major from West Virginia doucmenting my journey through the program http://drkuykendall.blogspot.com/. I'd love to be in touc hwith you if you have any advice for me, taylor.kuykendall@gmail.com

Notta Wallflower said...

Useful info. I notice you're in Mountain View - I'm just next door in Sunnyvale. I am from the Northwest and when I did my internship in a hospital (for speech therapy), one of our patients was a school teacher who had contracted lyme disease. She was in ICU as long as I was there, but I heard that she eventually got better. Scary stuff. :-/

frederick Adu-Acheampong said...

great and wonderful site of much information. i have always loved to visit your site.kindly drop in at my site to share your view on my alternative medicine stuff.

Neurotic said...

Very useful information. Thanks for sharing.

wayne said...

thequickdomain excellent blog will return...

Hesam said...

salam.
midoonam ke baraye goftane in harf dir shode, amma moteassefane man taze ba khabar shodam.
khastam faghat peyvastan be webloger haro behetoon tabrik begam. omid varam movafagh va pirouz bashid.

LatestCelebrityGossip said...

I too am new to your site and it is wonderful! Such awesome info! I wish I would have had this info when my family was camping last year. My husband had a "tic attack" and it was pretty scary when you don;t know what to do.
Great job!

viruswitch said...

Thanks for the reply. I dont know if it a coincidence but the year after I got the vaccine I developed an arthritis related problem at my feet. The doctors said it was due to the point-shoes and my intensive ballet training though. I guess we will never know the truth.

viruswitch said...

@3pillars: The vaseline technique sounds even more effective than the oil one. I had heard about the oil techique on the austria radio during the "dangerous" tick time, it was spring I think.

Taymoor Zahoory said...

Dr Razavi

This is Taymoor Zahoory, your patient for about 15 years. Hopefuly will be your patient longer

you rae not only very knowlegeble, but very kind and caring. if you like to see damavand's picture go to my blog at http://damavandblog.blogspot.com/

wish you the best

Dr. Taraneh Razavi said...

Hello Mr. Zahoory

What a wonderful surprise to see you on the comment list!
How did you come across this blog?

Great pictures and even greater job climbing Damavand.
I look forward to seeing you soon.

Rick Laferriere said...

Dr. Razavi,
Thanks for posting on Lyme disease. Ticks can be nasty creatures who may be carrying more than just Borrelia.

I wanted to comment about tick removal technique. A few comments have mentioned using oil and vaseline to remove a tick.

I am not a doctor, but I do know that you absolutely can not safely remove a tick using such methods other than with tweezers as described in the link given here on the blog. A hot match, oil and vaseline to disturb or suffocate the tick forcing it to release it's grip on a patient is just an urban legend.

Thanks for listening.

Dr. Taraneh Razavi said...

Thank you for the clarification Rick. That is my understanding as well.

ashapiro7@comcast.net said...

from Ridgefield, CT...my husband has had two ticks imbedded in his waist this past month...the last one, I removed with a tweezer...it was fully engorged...he went to the doctor with the tick....they no longer send the ticks out to be examined....the newest treatment is two Doxycylines and watch for the bullseye...if it doesn't appear, forget about it. Sue Shapiro, tweezer woman

maximilian said...

never use oil. the tick will vomit and this will increase your chances of getting infected. use an appropriate tool. do not turn the tick (can break of the head). if really you cannot get a tool, try to grab it with your nails and very slowly remove the tick so that it will not try to bite deeper into the skin. Do not pull too quickly you might break off the head.

viruswitch was quite certainly vaccinated against encephalitis in Austria, not lyme disease.

mic said...

my cat keeps getting ticks, which are brought inside the house when it turns in.So I get the pleasure to remove them, and after a four year practice and some learning from vets my advice is to use self-blocking tweezers, to grip the tick and rotate it while pulling. Not rotating results in breaking the tick head which gets stuck under the skin, while the rotating motion simply disloges the tick. my 2 cents (and btw frontline does not keep ticks away!!)

Bim said...

There are now dedicated tick removal tools, which work on the same principle as tweezers, but require less skill.

This is illustrated in a web site:
about defending yourself against tick-borne disease/

It's very worrying that treatment isn't offered unless the bullseye rash appears, as the rash only appears in 50% of known cases.

The most insidious aspect of this disease seems to be its ability to mimic other infections, which often means that treatment is given too little or too late.

Cases of Lyme borreliosis have more than doubled in England and Wales since 2001, and have trebled in Scotland.

I know sufferers who have been paralysed, lost their sight and suffered extreme pain or totally dibilitating fatigue.

It isn't worth taking risks: do what the doctor says; cover up to avoid being bitten and if that fails remove the tick safely.

Anonymous said...

it's really scary that "medical professionals" are still so ignorant about this disease. do your own research on lyme disease and you'll find alot of disagreement with what this doctor is saying. this is outdated, useless and dangerous information from someone who obviously hasn't kept up with the facts of this horrible disease.

Anonymous said...

I don't know about tweezers. I used a tick removal solution and it worked just fine. I found it at
tickremoval.org. Ticks in my backyard are just to tiny for ant tweezers, there was nothing to grab on to.

Anonymous said...

This doctor is right about some things and misinformed about others.

There are some especially high risk areas, but Lyme Disease is a serious concern all over the country now.

More than 50% of Lyme sufferers never had a rash or saw a tick. And it is wrong to say that it is "easily curable" when it's treated early... from ILADS (International Lyme and Associated Diseases Society):

"There has never been a study demonstrating that 30 days of antibiotic treatment cures chronic Lyme disease. However there is a plethora of documentation in the US and European medical literature demonstrating by histology and culture techniques that short courses of antibiotic treatment fail to eradicate the Lyme spirochete. Short treatment courses have resulted in upwards of a 40% relapse rate, especially if treatment is delayed."

Early treatment is important, but it has to be aggressive enough... unfortunately it often isn't.

Most doctors are not informed about how to diagnose and treat Lyme properly. (It took over 13 years and seeing over 30 doctors before I was diagnosed, despite the fact that I live in a "high-risk" area, and my story is not unusual.)

To find a Lyme-literate doctor, go to ILADS.org or "seeking a doctor" at LymeNet.

There is an excellent FAQ about Lyme here.

Anonymous said...

There is a documentary coming out soon about Lyme called ”Under Our Skin: The Untold Story of Lyme Disease”...you can see the trailer here.

Anonymous said...

NEVER try to smother, burn, poison or sqeeze an attached tick... doing any of those things increases the chance that it will regurgitate Lyme bacteria into your skin.

How to properly remove a tick.

Anonymous said...

I would like to recommend the Trix Tick Removers.

Tested both hooks and the Trix lasso - The Trix was more successful every time!

Never use chemicals or vaseline etc it is the worst thing you can do

Glen said...

Hi my Neice got bit by a tic in her scalp. the tic was removed without the syptoms of Lyme. But now every summer the spot the tic was at gets inflamed and irritated. any ideas of what might be causing this?

Anonymous said...

This site has very oopd onfo on acute lyme, for chronic Lyme please see www.cidpusa.org

Anonymous said...

Nice, the northeast is actually lyme disease central. Also no mention of the bullseye rash, or other tick borne diseases like rocky mountain or ehrlichiosis. Or the fact that these diseases can have devestating effects on you pet.spring break flysofree

Anonymous said...

Some tick bites can leave a nasty bite for as long as six months. It's wierd some bites itch for a few days and others seem to last forever. Working at a state park, I get bit several times a week. It is critical to check yourself very thoroughly, those suckers can end up in the most unsual places. Some of the larve (babies) look like specs of pepper they are so small.

Thanks mike

Anonymous said...

i scratched off ticks on two separate occasions, the first one was a little over a week ago. theres to rash but its like a mosqueto bite, i think the other one is kinda the same but smaller. Can this be a lyme diseased tick?

Sunny said...

Nice to read your post and your advice about Lyme Disease Prevention
For more information about these disease prevention topic, please check out our news article archives

Dr. Taraneh Razavi said...

To Anonymous who scratched off the ticks: It's hard to comment without examining you. In general most ticks have to be on you for at least 24 hours before they transmit anything to you.

Anonymous said...

Northern Alberta?

I think I have a tick bite. It's about a month old. Just keeps itching. I can't see it. I've scratched and picked at it a lot, and it just itches again.

City park, where there are sometimes deer, lollypopping the decorative trees.

How could ticks live here? I have no health coverage so I'm not going to a doctor.

Anonymous said...

Tick tubes (www.ticktubes.com - aka Damminix) are very effective at removing ticks from your own property. Even better if you can get your neighbors also to use them. Although they are called deer ticks, the suspect ticks generally feed on field mice, and it is via the mice that they come into contact with humans (in semi-urban and suburban areas, anyway). Tick tubes treat the mice, (without harm to them) and rid your yard of these dangerous bugs. Spread the tubes around, and also, keep your grass short!

Anonymous said...

My mother has used vaseline very sucessfully for years on people and animals and never had a problem. I've seen it done and it is not an urban myth

Anonymous said...

Hey great information but one thing is it dangerous if you just see a tick crawling on you and what should you do in that situation

MATT said...

PLEASE DO NOT REMOVE WITH TWEEZERS. THIS CAN CAUSE THE TICK TO THROW UP THE CONTENTS OF IT'S STOMACH INTO THE WOUND AND CAN BE DANGEROUS. USE YOUR FINGERNAILS GRIP AS CLOSE TO THE SKIN AND PULL STRAIGHT OUT, DON'T TWIST OR THE HEAD MAY BECOME SEPERATED FROM THE BODY.