Lyme disease: a seasonal risk - tick-borne illness

Nation's Business, August, 1994 by Janet L. Willen

Managing well includes managing your own health; here is advice to help you do that better.

Richard Gerstner thought he had the flu when he became ill at his Long Island home in the late 1980s.

Months after the first flulike symptoms passed, however, he developed staff joints, neurological dysfunction, fatigue, and numbness. The pain became so severe in 1989 that he took a leave of absence from the company where he was an executive. Over the next 2 1/2 years, the pain and fatigue compelled him to take other leaves and, ultimately, to retire. Only after he stopped working did he learn that his "flu" symptoms were the first signs of Lyme disease.

When he was finally diagnosed in 1992, Gerstner began treatment with antibiotics. Three to four weeks of antibiotics can usually eradicate Lyme disease in its early stages, but because Gerstner's illness was diagnosed late, he was treated with oral and intravenous antibiotics for 18 months.

In some cases the damage from Lyme disease is permanent, but Gerstner was lucky. Now CEO and president of Telular Corp., a wireless-communications company in Buffalo Grove, Ill., he says, "For the past year, I've been symptom-free, basically, with minor aches and pains."

Lyme disease is a multisystem infection that can affect the skin, the nerves, the joints, the heart, and the brain. The tick-borne infection is caused by a cork-screw shaped bacterium called Borrelia burgdorferi, named after Dr. Willy Burgdorfer, who discovered it in 1981. Three species of the ixodes tick may transmit the disease.

Ticks typically acquire the infection by feeding on white-footed mice and other small mammals. People pick up ticks in wooded, brushy, and grassy areas during the spring and summer. The American Lyme Disease Foundation, an educational group in Somers, N.Y., says less than 1 percent of adult ticks south of Maryland are infected with B. burgdorferi, but in heavily infested areas of the Northeast, up to 50 percent of adult ticks are.

The disease, which is named after Lyme, Conn., where it was first identified, has shown up in 48 states, but it is most prevalent in the Northeast, the upper Midwest, and the Pacific Northwest. Researchers suspect ticks spread by latching onto deer or birds.

The number of cases reported to the Centers for Disease Control and Prevention is small but growing. More than 9,600 cases were reported in 1992, but that may be just a fraction of the total.

"A lot of doctors don't bother reporting the disease," says Dr. Leonard Sigal. He is chief of the division of rheumatology at the University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, in New Brunswick.

In tick-infested areas, where doctors are attuned to the disease, it is usually diagnosed in its early stages, says Dr. Kathy Orloski-Snider, an epidemic intelligence service officer at the Centers for Disease Control and Prevention. In 60 to 80 percent of Lyme disease cases, an early manifestation of the disease is one or more skin rashes that are usually circular. Some people may experience viruslike symptoms, as Gerstner did; they may feel fatigue, headache, and stiffness, or they may have a fever, swollen glands, or conjunctivitis.

If the disease is not caught early, it may spread throughout the body and become harder to spot and treat. "People may come in with vague symptoms that their physicians can't diagnose," Orloski-Snider says.

One challenge for doctors is that tests are unreliable. "The problem with the diagnoses is that tests available for measuring antibodies are not as precise as they should be," says Dr. Patricia Charache, professor of pathology and medicine at Johns Hopkins Hospital, in Baltimore. Most doctors advise that diagnoses be based on examinations and medical histories.

Research is under way to find a better diagnostic test. None has been adopted as a nationwide standard. Vaccines against the disease are also being evaluated.

The best advice doctors can give is to take precautions in tick-infested areas. Health departments and park services have information on where these areas are. The Centers for Disease Control and Prevention suggests these tips:

* Wear light-colored clothing so ticks are visible.

* Tuck pant legs into socks, and tuck shirts into pants.

* Spray a bug repellent containing deet on clothes and exposed skin except the face, or treat clothes with permethrin.

* Wear a hat and long-sleeved shirt.

Once inside, check your clothing and body for ticks. Ticks must be attached to the body for about 36 hours before they can transmit an infection. Remove a tick with tweezers, pulling steadily at the mouthpart. Be sure not to crush the tick's body, which may contain infectious fluids.

Disinfect the tick-bite area and check for symptoms for the next eight weeks.

The key to prevention is caution. Says Sigal: "Once people know what to look for and to do, Lyme disease will be significantly less of a problem."