Lyme Disease Increases in Western PA

Nowalk_Andrew_MD_Pediatric Infectious Disease_CHP_12_02_2008The state of Pennsylvania has reported more cases of Lyme disease than any other state in 2014, and we are experiencing an epidemic in western Pennsylvania. Here are some frequently asked questions about Lyme disease, prepared by Andrew Nowalk, MD, one of Children’s pediatric infectious disease experts.

What is Lyme disease?
Lyme disease is an infection which children get from the bite of an infected deer tick.  The bacteria that cause Lyme disease, called Borrelia burgdorferi, can infect many different mammals, including humans, but you can only be infected by a deer tick bite – mosquitoes and other insects don’t transmit it.

How is Lyme disease spread?
Lyme disease is spread from tick to human when an infected deer tick bites a child and the bacteria are able to enter through the bite site.  Lyme disease is only found in areas of the United States where there are enough infected ticks to spread the disease. In the last few years, western Pennsylvania has had a big increase in the number of Lyme disease cases in children because of an increasing rate of infection in deer ticks.

What are the symptoms of Lyme disease?
Lyme disease develops in stages. In the first few weeks after an infected tick bites a child, the only symptom is a red rash in the shape of a ring. It often expands outwards with time – this rash is called erythema migrans. If the infection continues, it can spread to other organs.  Lyme disease can affect the nervous system, causing facial weakness and eye drooping, as well as meningitis.  It can also affect the heart, causing problems with the heart rhythm, and the joints, causing swelling and pain (called arthritis).  Untreated Lyme can last for months to years. The late stages of infection typically cause chronic arthritis, which can last for weeks to months.  At any stage, Lyme disease can also appear to be a flu like illness, with fever, muscle and joint pains, and fatigue.

If you observe any of these specific symptoms– rash, joint complaints, facial weakness – and you think your child may have Lyme disease, you should see your primary care provider or come to the Children’s Hospital of Pittsburgh Emergency Department if the symptoms are more serious.  Depending on the timing of the complaint and the symptoms your child is showing, a doctor may or may NOT decide to have your child’s blood tested. Keep in mind that blood testing is more accurate the longer the child has been infected. Since a blood test for Lyme disease may not appear positive until 4-6 weeks after infection, children with only a rash who are in the earliest stages of disease should not have a blood test, but should get antibiotics. Sometimes, a doctor may order a later, second test if the first test was negative to confirm the diagnosis.

The antibiotics for Lyme disease are safe and effective.  You can expect that your child will receive between 2 to 4 weeks of antibiotics, depending on their stage of infection.  A common myth about Lyme disease is that it remains in your body forever, despite treatment.  This is untrue, as we know from studies of animals and humans that antibiotics are safe, effective, and clear the infection.  Some patients do have symptoms that persist after antibiotic treatment – these are not caused by active infection, but are most likely the result of the inflammation which accompanies infection and persists even when the bacteria are gone.

How do I keep my children from getting Lyme disease?
Since Lyme disease can only be acquired by a tick bite, checking your child for a tick is the best way to prevent infection.  Unfortunately, deer ticks are very small (younger stages are smaller than the tip of a pen).  If your child is playing outside in warmer weather, try simple things like wearing long pants and shirts, or using insect repellent like DEET. If you find a tick on your child’s body, remove the attached tick as soon as you notice it by grasping with tweezers, as close to the skin as possible, and pulling it straight out (see http://www.cdc.gov/ticks/removing_a_tick.html for instructions). Watch for signs of illness such as rash or fever in the days and weeks following the bite, and see a health care provider if these develop.  In some cases, when you are certain that you have been bitten by a deer tick and it was on the body for at least 36 hours, your provider might give you a dose of antibiotic to prevent infection. If this is case, contact your primary care provider.

For more information, please visit www.chp.edu.