NEJM Group (March 29, 2023) – In this Double Take video from the New England Journal of Medicine, Sam Telford and Robert Smith provide a clinical overview of the various tickborne diseases commonly encountered across the United States, including Lyme disease, babesiosis, and anaplasmosis, among others.
Starting with characteristics of ticks and their ability to act as disease vectors, the video reviews the clinical presentation of these infections, clues on physical examination, and laboratory tests to consider when encountering a patient with a potential tickborne infection.
Tick-borne diseases are transmitted through the bite of an infected tick. These include Lyme disease, Anaplasmosis, Ehrlichiosis, Babesiosis, Powassan (POW), Rocky Mountain Spotted Fever, and Tularemia. Ticks can be infected with bacteria, viruses, or parasites.
Lyme disease has infected more than 14% of the world’s population, according to a new study. “It’s significant,” says Dr. Bobbi Pritt, director of the Clinical Parasitology Laboratory at Mayo Clinic.
“If you look at the numbers and how it breaks down in regions across the United States, in some areas, that exceeds 50% seropositivity. That means people are walking around with antibodies in their blood that are detectable. That shows they’ve been exposed to Lyme disease at some point in their life,” says Dr. Pritt. “Now whether it was in the past and they’ve been successfully treated, or whether they have it right now, you can’t tell by that result, but it’s a marker of exposure.”
Lyme disease is high on every hard-to-diagnose disease list, because it is relatively uncommon, and can produce a variety of disturbing symptoms often classified as psychosomatic.
It is caused by a deer tick bacterial injection of the Borrelia genus, which can progress to cause widespread problems. Not every tick bite will inject the bacterium, and ticks that have been attached for less than 12 to 24 hours are unlikely to have done so.
Risk factors include living in a wooded area, particularly on the east coast. With people fleeing the cities in the wake of Covid, exposure is more common.
The NYT columnist, Ross Douthat wrote a book about his travails: “patient heal thyself“. In this day and age of overworked doctors, and with the huge variety of medical information available online, more and more people are going on a “medical odyssey”.
A painless red swelling, followed by an expanding area of red(erythema migrants), is often the best medical clue. Flu-like symptoms and enlargement of the lymph glands can accompany the “rash”. Tests are not positive for several weeks, and may be negative if and when the late symptoms of Lyme disease develop.
The earlier you get treated with a 10-day course antibiotics, the better. The problem is that not all tick bites produce infection, and so overtreatment is a real possibility.
Late symptoms can include fatigue, mental symptoms arthritis, liver problems and a variety of other symptoms. Like another bacterial disease, syphilis, lyme disease can be the great mimic.
Prevention is paramount. People living in endemic areas should wear long sleeves and pants when they go out into the woods, use insect repellent , and make sure their animals are kept tick-free.
A DWWR article on Nootkatone may be worth your time to read, since DEET and many other insecticides are toxic and have to be used with care.
Please refer to the following article by the Mayo clinic for more organized information.
-Dr. C.
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