FACTORS THAT MAKE LYME DISEASE LESS LIKELY

- Ixodes scapularis, the tick that carries Borrelia burgdorferi, is not commonly found in the southern
United States.
- The majority (80%) of patients with early localized (primary) Lyme disease (within days of the tick
bite)
have the classic erythema migrans rash with or without constitutional symptoms. The absence of a
rash
and the presence of a high fever and hematologic and liver enzyme abnormalities make Lyme
disease
less likely.
- Finally, absence of any prominent neurologic (eg, encephalitis, cranial nerve palsy, radiculopathy)
or
cardiac (eg, heart block, pericarditis) manifestations of early disseminated (secondary) Lyme disease
makes Lyme unlikely. These would more commonly occur several weeks to months after the initial
tick
bite.
- Serology is not recommended for early disease as it is very insensitive and usually negative. After
the
appearance of EM, IgM antibodies usually develop within 1-2 wks and IgG antibodies typically
appear
within 2-6 wks. Serology however should be performed in pts with signs of early disseminated or late
disease.
HOW TO REMOVE TICK IF FOUND ATTACHED:
- CDC recommendations: if tick is found attached to body, grasp the tick with tweezers as close to
body as
possible and then remove the tick with steady upward pressure.
- If mouth parts break off and remain in the skin, they can be left alone as the infective body is no
longer
attached.
- Risk of developing Lyme dis. Is low if the tick remains attached for less than a month.
- Pts should be advised to seek medical attention if bull’s eye rash (erythema migrans) develops over
the
next month.
- One dose of doxycycline should be administered if all the criteria (as below) of prophylaxis are met
PREVENTION IN LYME ENDEMIC AREAS
- Wear long sleeved shirts and pants
- Application of insect repellents contain DEET should be applied on skin and permethrin on clothes
- Daily checking of entire body for ticks
- Bathing immediately after exposure to tick infested environments
PROPHYLAXIS CRITERIA OF LYME DISEASE
Although anaplasmosis and babesiosis are typically transmitted soon
after tick attachment, B burgdorferi resides in the gut of the tick and
requires 48-72 hours of feeding before salivary gland migration. As such,
patients with a tick attached for 􀑄36 hours are extremely unlikely to
acquire Lyme disease and do not require antimicrobial prophylaxis. Ticks
should be removed with tweezers as close to the skin surface as
possible.
Surrounding erythema during tick attachment is due to skin irritation,
not the transmission of B burgdorferi or the cutaneous spread of
organisms (erythema migrans).