An uptick in Lyme disease
Summer is the most common time for cases of the deer tick-borne disease, which is on the rise in Maryland
By Chris Emery | Sun Reporter
Kelly Strzelecki has a new reason to avoid ticks -- not that she needed one. "I hate them -- who doesn't?" she asked, prefacing her latest experience with the tiny bloodsuckers.
Her son, Graham, 7, developed a rash last month while the Catonsville family was attending a YMCA camp in tick-infested woods. A week later, the boy fell ill. "He had these unexplained fevers, and he was lethargic and kind of pale," recalled Strzelecki.
Medical tests showed Graham had contracted Lyme disease, a tick-borne infection that's notoriously difficult to spot and well-entrenched in the forests of Maryland and neighboring states.
Confirmed Lyme disease cases have grown steadily over the past decade in the United States. In Maryland, the number of reported cases more than doubled between 2001 and 2006 from 608 cases to 1,248, according to the Maryland Department of Health and Mental Hygiene.
As of July 14, the Centers for Disease Control and Prevention had received 675 unconfirmed reports in Maryland this year, a 26 percent increase over the same period last year.
Public health officials said the number of Lyme disease infections is probably on the rise, but cautioned that growing public awareness of the disease might also be responsible for more diagnoses.
Epidemiologists first recorded Lyme disease as a discrete illness in the United States in the mid-1970s, after a number of children in Lyme, Conn., developed joint pain and circular red rashes. Scientists identified Borrelia burgdorferi, the spiral-shaped bacteria that cause the disease, in 1983.
The bacteria are carried by tiny, black-legged ticks that are no larger than a sesame seed. Also known as deer ticks, they feed on deer, mice and other mammals, then pass the Lyme-causing bacteria to humans and domesticated animals. The ticks are particularly common in wooded areas with dense brush, tall grass and heavy leaf litter.
Most people contract the infection in May, June and July, but symptoms often appear in late summer and early fall.
Dr. Charles A. Haile, chief of infectious disease at Greater Baltimore Medical Center, said family doctors have become more comfortable diagnosing and treating Lyme disease in recent years.
In fact, he might not notice a rise in infections, he said, because general practitioners now refer fewer patients to specialists like him. "The expertise in diagnosing Lyme has grown a lot in Maryland over the past 10 years," he said.
The actual number of people contracting the disease may be on the rise as well. One possible reason, experts say, is the increasingly frequent collision between deer and mouse populations and suburban sprawl.
The five Maryland jurisdictions with the most reported Lyme cases are home to large suburban populations: Carroll, Anne Arundel, Frederick, Howard and Harford counties. Cecil County, which has one of the highest per capita rates of infection, is also one of the fastest-growing regions in Maryland.
"We continue to create the environment for the transmission of this disease," said John Krick, director of epidemiology and disease control programs at DHMH. "We build houses on newly cleared land, putting ourselves closer to the forest and wild animals."
While the deer population has fluctuated in recent years, the Maryland Department of Natural Resources estimates that there are about 240,000 white-tailed deer in Maryland, the same number as a decade ago.
Douglas Hotton, leader of DNR's deer management program, said deer numbers may have little to do with the spread of Lyme disease. In fact, he suggested that the very name "deer tick" is misleading. "It ought to really be called the 'mouse tick,'" he said, since the white-footed mouse is the main host for the Lyme-causing bacteria.
Hotton said only a few deer are required to sustain a large number of ticks, and that fluctuations in the population appear to have little effect on the incidence of Lyme disease. Water, which ticks require to thrive, may play a larger role in sustaining a tick population than the sheer number of deer and mice.
Efforts to reduce tick populations in neighborhoods with insecticides are effective, but difficult to implement statewide, Hotton said.
One device scientists have tried applies tick killer to a deer's neck when it sticks its head into a man-made feeder. Another method involves cardboard tubes stuffed with insecticide-soaked cotton balls. Mice use the cotton as nesting material and in the process coat their fur with the tick killer.
Removing brush and leaf litter around homes and edging yards and sports fields with buffer zones of gravel or wood chips can also reduce tick populations, according to the CD
A vaccine for Lyme disease was approved by the Food and Drug Administration in 1998, but the manufacturer pulled it from the market in 2002, citing poor sales.
Preventing disease
To prevent ticks from biting, experts recommend using tick repellents containing DEET or Permethrin.
Health officials also recommend wearing light-colored pants and long-sleeve shirts when going into brushy areas. The shirt prevents the ticks from burrowing into the skin, and the color makes them easier to spot.
If a tick does bite, removing it quickly can prevent Lyme, since it must be attached to the skin for at least 24 hours to transmit the infection.
In the days or weeks after infection, people often develop a round, red rash on their skin, sometimes in a characteristic "bulls-eye" pattern. Flulike symptoms such as fever, chills and headache are other indicators, along with muscle and joint pain and losing control of facial muscles.
The CDC estimates that 200,000 people are infected each year, but only a 10th of those cases are reported to health officials.
Many cases go unnoticed and untreated, doctors said, because the symptoms may be confused with a flu or cold -- and the characteristic rash may never appear.
"I can't tell you how many people have delayed treatment because they didn't have a round red rash," said Dr. John N. Aucott, an infectious disease expert at Johns Hopkins at Green Spring Station.
Erlene Michener, a teacher at Fair Hill Nature Center in Elkton, found out she was infected only after going to the doctor for what she thought was a spider bite. She can't recall experiencing any of the typical Lyme symptoms, but tested positive for the bacteria.
She attributes the infection to running through the countryside with her fox hounds. "There are places where those deer ticks seem thick as flies," she said. "Nothing seems to kill them. I think you could put them on the moon [and] they could survive there."
Like most Lyme-positive patients, both she and Graham Strzelecki were treated with a three-week course of antibiotics, which usually eradicates the bacteria.
The Strzeleckis spend plenty of time outdoors -- the family dog is named Hiker -- and were aware of the symptoms of Lyme disease. But they also had difficulty spotting Graham's infection. He appeared tick-free at the YMCA camp, so they assumed his skin rash was from the summer heat.
"We are in the woods a lot," Kelly Strzelecki said. "So we are used to seeing wood ticks and deer ticks."
Treatment debated
If left untreated, the infection can spread to the joints, heart and nervous system, causing permanent damage. Such patients may require a second, four-week dose of antibiotics, according to the CDC.
Treatment of persistent Lyme disease is a matter of heated debate between some patients' groups and the mainstream medical establishment.
The patients' groups insist ridding a person of late-stage Lyme disease, referred to as "chronic" Lyme disease, can require taking antibiotics for several months or years at a time -- longer than most doctors will prescribe them or insurers pay for them.
The CDC and the Infectious Diseases Society of America advise against taking the drugs for longer than four weeks, warning they can lead to serious complications.
Hopkins' Aucott said diagnosing and treating late-stage Lyme disease is complicated because the disease manifests in different ways in different patients. "Some of the chronic cases are probably real," he said, "but the sides are so polarized, it's probably going to take years to sort it out."
GBMC's Haile said one point of confusion in diagnosing Lyme is the infections that can accompany it. Doctors are less likely, he said, to diagnose ehrlichiosis or babesia, tick-borne diseases contracted with about one in 10 Lyme disease infections.
"There are so many variations on a theme," he said. "Lyme can imitate other things and others can imitate it. People should ask their doctors [to] check for those other things."
How to prevent Lyme disease:
• Wear lightweight, light-colored clothing with long sleeves and long pants when outdoors. Make sure trouser legs are tucked into socks and shirts are tucked into pants.
• Use over-the-counter tick repellents. Read instructions carefully before applying, especially to children.
• Check your body for ticks after spending time outdoors, particularly in woods, tall grass or brush areas. Also, be sure to check children and pets every day after they spend time outdoors.
• Remove any crawling or attached tick from the skin promptly, before it has a chance to attach or to feed.
Lyme disease warning signs:
• Bite mark ringed by a red rash on the skin, typically in a "bulls-eye" pattern, which can grow to two or more inches across.
• Other symptoms include chills, fever, headache, tiredness, joint pain, stiff neck and swollen lymph nodes.
• If you experience symptoms typical of Lyme disease or find a tick on your skin that has been attached for more than 24 hours, contact your doctor.
[Source: Maryland Department of Health and Mental Hygiene
Summer is the most common time for cases of the deer tick-borne disease, which is on the rise in Maryland
By Chris Emery | Sun Reporter
Kelly Strzelecki has a new reason to avoid ticks -- not that she needed one. "I hate them -- who doesn't?" she asked, prefacing her latest experience with the tiny bloodsuckers.
Her son, Graham, 7, developed a rash last month while the Catonsville family was attending a YMCA camp in tick-infested woods. A week later, the boy fell ill. "He had these unexplained fevers, and he was lethargic and kind of pale," recalled Strzelecki.
Medical tests showed Graham had contracted Lyme disease, a tick-borne infection that's notoriously difficult to spot and well-entrenched in the forests of Maryland and neighboring states.
Confirmed Lyme disease cases have grown steadily over the past decade in the United States. In Maryland, the number of reported cases more than doubled between 2001 and 2006 from 608 cases to 1,248, according to the Maryland Department of Health and Mental Hygiene.
As of July 14, the Centers for Disease Control and Prevention had received 675 unconfirmed reports in Maryland this year, a 26 percent increase over the same period last year.
Public health officials said the number of Lyme disease infections is probably on the rise, but cautioned that growing public awareness of the disease might also be responsible for more diagnoses.
Epidemiologists first recorded Lyme disease as a discrete illness in the United States in the mid-1970s, after a number of children in Lyme, Conn., developed joint pain and circular red rashes. Scientists identified Borrelia burgdorferi, the spiral-shaped bacteria that cause the disease, in 1983.
The bacteria are carried by tiny, black-legged ticks that are no larger than a sesame seed. Also known as deer ticks, they feed on deer, mice and other mammals, then pass the Lyme-causing bacteria to humans and domesticated animals. The ticks are particularly common in wooded areas with dense brush, tall grass and heavy leaf litter.
Most people contract the infection in May, June and July, but symptoms often appear in late summer and early fall.
Dr. Charles A. Haile, chief of infectious disease at Greater Baltimore Medical Center, said family doctors have become more comfortable diagnosing and treating Lyme disease in recent years.
In fact, he might not notice a rise in infections, he said, because general practitioners now refer fewer patients to specialists like him. "The expertise in diagnosing Lyme has grown a lot in Maryland over the past 10 years," he said.
The actual number of people contracting the disease may be on the rise as well. One possible reason, experts say, is the increasingly frequent collision between deer and mouse populations and suburban sprawl.
The five Maryland jurisdictions with the most reported Lyme cases are home to large suburban populations: Carroll, Anne Arundel, Frederick, Howard and Harford counties. Cecil County, which has one of the highest per capita rates of infection, is also one of the fastest-growing regions in Maryland.
"We continue to create the environment for the transmission of this disease," said John Krick, director of epidemiology and disease control programs at DHMH. "We build houses on newly cleared land, putting ourselves closer to the forest and wild animals."
While the deer population has fluctuated in recent years, the Maryland Department of Natural Resources estimates that there are about 240,000 white-tailed deer in Maryland, the same number as a decade ago.
Douglas Hotton, leader of DNR's deer management program, said deer numbers may have little to do with the spread of Lyme disease. In fact, he suggested that the very name "deer tick" is misleading. "It ought to really be called the 'mouse tick,'" he said, since the white-footed mouse is the main host for the Lyme-causing bacteria.
Hotton said only a few deer are required to sustain a large number of ticks, and that fluctuations in the population appear to have little effect on the incidence of Lyme disease. Water, which ticks require to thrive, may play a larger role in sustaining a tick population than the sheer number of deer and mice.
Efforts to reduce tick populations in neighborhoods with insecticides are effective, but difficult to implement statewide, Hotton said.
One device scientists have tried applies tick killer to a deer's neck when it sticks its head into a man-made feeder. Another method involves cardboard tubes stuffed with insecticide-soaked cotton balls. Mice use the cotton as nesting material and in the process coat their fur with the tick killer.
Removing brush and leaf litter around homes and edging yards and sports fields with buffer zones of gravel or wood chips can also reduce tick populations, according to the CD
A vaccine for Lyme disease was approved by the Food and Drug Administration in 1998, but the manufacturer pulled it from the market in 2002, citing poor sales.
Preventing disease
To prevent ticks from biting, experts recommend using tick repellents containing DEET or Permethrin.
Health officials also recommend wearing light-colored pants and long-sleeve shirts when going into brushy areas. The shirt prevents the ticks from burrowing into the skin, and the color makes them easier to spot.
If a tick does bite, removing it quickly can prevent Lyme, since it must be attached to the skin for at least 24 hours to transmit the infection.
In the days or weeks after infection, people often develop a round, red rash on their skin, sometimes in a characteristic "bulls-eye" pattern. Flulike symptoms such as fever, chills and headache are other indicators, along with muscle and joint pain and losing control of facial muscles.
The CDC estimates that 200,000 people are infected each year, but only a 10th of those cases are reported to health officials.
Many cases go unnoticed and untreated, doctors said, because the symptoms may be confused with a flu or cold -- and the characteristic rash may never appear.
"I can't tell you how many people have delayed treatment because they didn't have a round red rash," said Dr. John N. Aucott, an infectious disease expert at Johns Hopkins at Green Spring Station.
Erlene Michener, a teacher at Fair Hill Nature Center in Elkton, found out she was infected only after going to the doctor for what she thought was a spider bite. She can't recall experiencing any of the typical Lyme symptoms, but tested positive for the bacteria.
She attributes the infection to running through the countryside with her fox hounds. "There are places where those deer ticks seem thick as flies," she said. "Nothing seems to kill them. I think you could put them on the moon [and] they could survive there."
Like most Lyme-positive patients, both she and Graham Strzelecki were treated with a three-week course of antibiotics, which usually eradicates the bacteria.
The Strzeleckis spend plenty of time outdoors -- the family dog is named Hiker -- and were aware of the symptoms of Lyme disease. But they also had difficulty spotting Graham's infection. He appeared tick-free at the YMCA camp, so they assumed his skin rash was from the summer heat.
"We are in the woods a lot," Kelly Strzelecki said. "So we are used to seeing wood ticks and deer ticks."
Treatment debated
If left untreated, the infection can spread to the joints, heart and nervous system, causing permanent damage. Such patients may require a second, four-week dose of antibiotics, according to the CDC.
Treatment of persistent Lyme disease is a matter of heated debate between some patients' groups and the mainstream medical establishment.
The patients' groups insist ridding a person of late-stage Lyme disease, referred to as "chronic" Lyme disease, can require taking antibiotics for several months or years at a time -- longer than most doctors will prescribe them or insurers pay for them.
The CDC and the Infectious Diseases Society of America advise against taking the drugs for longer than four weeks, warning they can lead to serious complications.
Hopkins' Aucott said diagnosing and treating late-stage Lyme disease is complicated because the disease manifests in different ways in different patients. "Some of the chronic cases are probably real," he said, "but the sides are so polarized, it's probably going to take years to sort it out."
GBMC's Haile said one point of confusion in diagnosing Lyme is the infections that can accompany it. Doctors are less likely, he said, to diagnose ehrlichiosis or babesia, tick-borne diseases contracted with about one in 10 Lyme disease infections.
"There are so many variations on a theme," he said. "Lyme can imitate other things and others can imitate it. People should ask their doctors [to] check for those other things."
How to prevent Lyme disease:
• Wear lightweight, light-colored clothing with long sleeves and long pants when outdoors. Make sure trouser legs are tucked into socks and shirts are tucked into pants.
• Use over-the-counter tick repellents. Read instructions carefully before applying, especially to children.
• Check your body for ticks after spending time outdoors, particularly in woods, tall grass or brush areas. Also, be sure to check children and pets every day after they spend time outdoors.
• Remove any crawling or attached tick from the skin promptly, before it has a chance to attach or to feed.
Lyme disease warning signs:
• Bite mark ringed by a red rash on the skin, typically in a "bulls-eye" pattern, which can grow to two or more inches across.
• Other symptoms include chills, fever, headache, tiredness, joint pain, stiff neck and swollen lymph nodes.
• If you experience symptoms typical of Lyme disease or find a tick on your skin that has been attached for more than 24 hours, contact your doctor.
[Source: Maryland Department of Health and Mental Hygiene
