The Trouble with Ticks
Written by Lydia Humphrey, MSN, CRNP
Lyme disease is the most common tick-borne illness. Around 500,000 people are diagnosed and treated for Lyme disease each year. Mid-Atlantic, Northeastern, and upper Midwestern states are the most common areas where transmission occurs. Black-legged ticks are carriers for Lyme disease; nymphs and adult sized ticks more commonly carry Lyme disease specifically.
Symptoms can include erythema migrans (EM) rash (bullseye), fatigue, fever, headache, muscle/joint aches, joint swelling, chills, or enlarged lymph nodes. The EM rash typically occurs first within 3 days to 1 month after exposure. The other symptoms occur 1-3+ months after exposure if untreated.
If you find a tick embedded on your skin, you may be a candidate for post exposure prophylaxis. Criteria for prophylaxis includes:
Endemic area (PA)
Tick estimated to be attached 36+ hours.
Deer tick identified as adult or nymph size.
Prophylaxis started within 72 hours of removal.
A single dose of doxycycline is recommended. Prophylaxis is not recommended if the tick was not fully embedded, super engorged, or embedded for less than 36 hours.
Testing is not recommended early on with Lyme disease as the antibodies take time to develop and the tests may often be negative. If testing is indicated, your provider should order a two-step serologic test as this is FDA approved. The two antibodies measured are IgG and IgM which are part of the second step of testing. IgG antibodies may not be positive until 2-3 weeks with infection, which is why it is better to wait for testing.
If your child develops an EM rash, we recommend evaluation in the office because we should treat for presumed Lyme infection. The recommended treatment for Lyme disease of all stages (early and late infection) is Doxycycline, which has been considered safe for use for all ages if the course is less than 21 days. If the course of treatment is over 21 days based on the stage, we use alternative medications such as Amoxicillin or Cefuroxime. Rarely are children hospitalized, but it is possible if there is cardiac involvement or failed outpatient treatment.
Often people think that you should have the tick evaluated for these diseases. Testing a tick is not necessary because even if they are a carrier for the Lyme disease bacteria it does not mean the disease was transmitted to the person. It is possible to be re-infected with Lyme disease if another infected tick is found embedded.
Tick prevention is key. Here are the best ways to prevent Lyme disease:
EPA repellents are recommended (i.e., Deet).
Clothes should be treated with permethrin 0.5%.
Daily tick checks around the ears, scalp, belly button, legs, waist, and knees.
Bathe within 2 hours of coming indoors.
Dry clothes in a dryer on high heat for 10 minutes which should kill any ticks.
Clean out brush around your house.
If your child has a rash or other symptoms concerning Lyme disease, please call and schedule an appointment. Because the decision to treat/test for Lyme disease should be personalized based on timing and length of tick attachment we highly recommend you come see us over an urgent care or emergency room for this problem.
