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North Hills Monthly

Pennsylvania Leading the Nation in Lyme Disease Cases

Sep 01, 2017 08:30AM ● By Shari Berg

Summer is the perfect time to enjoy the outdoors in western Pennsylvania. Unfortunately, being outside, especially in wooded areas or in those with high grass, increases the likelihood of bringing home unwanted guests—ticks. 

Pennsylvania currently leads the nation in the number of Lyme disease cases, with the U.S Centers for Disease Control and Prevention reporting 12,092 cases in 2016. The Pennsylvania Department of Environmental Protection is also reporting alarming figures where ticks are concerned, noting that blacklegged ticks–more commonly known as deer ticks–have been discovered in all 67 counties in the state for the first time since the department began tracking them in 2012. While Lyme disease statistics for 2017 are not yet available, officials are predicting it could be an even worse year for ticks and the transmission of the disease than in 2016. 

Ticks can also hitch a ride into homes on family pets, especially dogs. Ticks that have not fully attached themselves to dogs can transfer to humans or other animals in the household. Pennsylvania leads the nation in the number of dogs infected with Lyme disease. 

Dogs often do not display symptoms of the disease, though some show lameness or have trouble walking due to inflammation of the joints; there may also be a lack of appetite and depression. If Lyme is discovered, it can be treated with a course of antibiotics. There is also a Lyme vaccine available for dogs. A vaccine for humans was available in the late 1990s, but was pulled from the market due to lack of demand for the product. 

Deer ticks can carry bacteria called Borrelia burgdorferi, which is responsible for causing Lyme disease. Not all ticks carry the bacteria; roughly one-third of the deer ticks in the area are carriers. The bacteria can be transmitted between a deer tick and its host once the tick embeds itself into the skin. Ticks have something called a hypostome, which sticks into the skin; it is covered in barbs, which helps the tick to stay embedded. The tick’s saliva contains an anesthesia to numb the skin, so the host is often unaware of its presence. Its saliva also transmits an anticoagulant, which keeps blood from clotting and instead flows freely from the host to the tick. 

Dr. Michelle Paulson, with Allegheny Health Network’s Infectious Disease Division, said that her office is seeing a lot of Lyme disease cases this year. She cautioned that finding a tick on your body does not automatically mean you will develop Lyme disease. 

“It takes approximately 36 hours for a tick to transmit Lyme disease to a host,” she said. For individuals who find ticks on their bodies fairly soon after being exposed, the likelihood of developing Lyme disease is greatly reduced. 

However, because deer ticks are so small, and have a habit of attaching themselves in places that are not easily seen (armpits, folds of skin, belly button, groin), so it is possible to miss one during a detailed skin examination, or a “tick check.” If that happens, the tick will feed on its host until it is completely engorged, then detach. The host may have no idea that a tick was even present unless they begin to develop symptoms of Lyme. 

Symptoms of early Lyme disease can be similar to those of the flu, said Dr. Paulson. “Approximately 70 to 80 percent of people infected with Lyme also develop a rash that sometimes looks like a bulls-eye or a big, red blotch,” she said, adding that they may also develop joint and muscle pain and headaches.

An enzyme-linked immunosorbent assay (ELISA) blood test detects the presence of antibodies to Borrelia burgdorferi, and a western blot test can be used to confirm the diagnosis. According to Dr. Paulson, the majority of patients with Lyme disease can be successfully treated with a 10- to 21-day course of oral antibiotics. Treatment works best when the disease is caught in the early stages. 

Sometimes, individuals either do not show the early signs of Lyme disease or do not associate those symptoms with the disease soon enough, and complications can occur. Dr. William Ayoub, a rheumatologist with the Allegheny Health Network, said that these are the patients who generally end up in his care for treatment of what is known as stage two and stage three of Lyme disease. 

Dr. Ayoub explained that in stage two, patients may develop Bell’s palsy, a type of facial paralysis that leaves a person unable to control the muscles on the side of the face affected by the condition. Patients in stage two also might experience a slower heart rate and light-headedness. In stage three, which Dr. Ayoub said can occur as late as a year following exposure, individuals can develop arthritis and other joint and muscle pain. 

Individuals who discover a tick on their skin can attempt to remove it on their own. According to Dr. Paulson, the best method for removal is to grab the tick with tweezers where it is attached to the skin and gently apply pressure to lift it straight out. Both Dr. Paulson and Dr. Ayoub said it is worth visiting your healthcare provider if you discover a tick on your skin, even if you are able to remove the tick on your own. Healthcare professionals may treat patients with doxycycline as a preventative measure against Lyme. 

Unfortunately, persons who have had Lyme previously are not protected from future infections, so it is important to remain diligent to avoid areas in which ticks are prone and take other measures to protect from infection.

Protect Yourself from Ticks

Fewer things can be more panic-inducing than discovering a tick on your body. Unfortunately, spending time outdoors or with family pets increases your risk of having this experience. 

There are a few things you can do to protect yourself from becoming an unwilling meal for a deer tick, according to Dr. Michelle Paulson, a physician with the Allegheny Health Network’s Infectious Disease Division. 

• When possible, avoid wooded areas or those with high grass, as deer ticks are readily found in these environments. 

• Wear light-colored clothing that will allow you to easily spot ticks. Because of their size and dark coloring, ticks often go undetected on the clothing or body. 

• Wear clothing that covers as much of the body as possible without risking heat exhaustion from overdressing. 

• Use a product with DEET in it. You can also spray Permethrin on your clothes. Permethrin is an insect repellant that kills black flies, ticks and mosquitoes. 

• After spending time outdoors, complete a tick check of your body. Make sure to check hard-to-see areas including the folds of the skin, belly button, armpits and groin. If necessary, have someone assist you in checking the areas you cannot easily see. 

• Take a shower after coming in from outside to wash off loose ticks.

“If you do find a tick that is already attached, and you feel confident that you can remove it yourself, go ahead and use tweezers, gripping the tick as close to the skin as possible, and gently apply upward pressure,” said Dr. Paulson.