Dr. Gottesman on Lyme: The Not so Novel Pandemic

The word, ‘pandemic,’ has been seen in every news cycle for the past year. But this is nothing new. A pandemic is an infectious disease prevalent across large swathes of geography. Smallpox, the Spanish Flu, and the Black Death stick in our memories.

In 1975, in rural Connecticut strange rheumatoid arthritis -like symptoms were reported- Causes unknown.

Over time, the culprit was discovered. A deer tick, as small as a poppy seed, was responsible for this crippling disease. Unlike Covid-19 which we have seen spread mainly from person to person- Lyme disease requires an animal host. This is referred to as a zoonotic infection.

Like all infectious diseases, there are three main arms to combating Lyme.

The first arm is the most effective and safe –  take preventative measures. If you are going to spend anytime in a place where ticks can be found: Wear clothes that minimize exposed skin.

Treat clothes with safe, natural pesticides. And always be sure to check for ticks after you return indoors. Even if a tick is embedded in the skin for up to  24- 48 hours it is unlikely to be problematic. If you find a tick, keep it for testing.

The second arm is post-infection detection and diagnosis. To the never-ending frustration of doctors, researchers and patients – Lyme is especially difficult to detect very early on. This can lead to an incorrect diagnosis and failed treatment. Fortunately, there is a two-tier antibody test which, with careful interpretation, can provide straightforward results.  Unfortunately, just as in COVID, there is a subset of patients who experience bewildering and uncomfortable, lingering symptoms.

Symptoms of Lyme may, first, be skin-related, secondarily joint involvement particularly of a single knee, and thirdly Lyme may result in cardiac and neurologic dysfunction.

The third arm of infectious disease management is treatment. As opposed to COVID, there is a very effective treatment for Lyme – if caught early enough. Doxycycline is generally given to people over 8 years of age. Under the age of 8  and many doctors avoid Doxycycline, but to be clear that is not a consensus opinion. A major advantage of Doxycycline is that it also treats some other tick-borne diseases as well as MRSA, which other antibiotics do not treat. When there are lingering symptoms post-treatment more sophisticated regimens may be recommended.

In many areas of the US where Lyme is endemic, it is quite common to be very proactive about Lyme diagnosis and treatment.  Here, we recommend families who have spent more than a few days in areas with a high possibility of contracting Lyme disease get a Lyme test at the soonest convenience, starting about a month after the last possible exposure. Of course, if there is a known exposure or the person is ill, then the diagnosis and test changes.

One key takeaway is to understand the principles of prevention, detection and treatment of infectious disease. And recognizing the potential long-term effects of all infections (Long COVID, Long LYME, Long STREP, Long MONO and otherwise). The answers are rarely easy or straightforward. We encourage anyone with questions to reach out to their Primary Care Provider.

For more in-depth reading on Lyme disease please see https://www.cdc.gov/lyme/index.html

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