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Time for Lyme's recommendations after a tick bite

By Time for Lyme

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At last...those lazy, hazy days of summer, days of sunshine, warm breezes... and ticks? Unfortunately, the same weather that drives people and their pets outdoors also creates ideal conditions for the transmission of tick-borne illnesses, especially the most common of them: Lyme disease. According to the U.S. Centers for Disease Control and Prevention (CDC), the incidence of Lyme disease has tripled over the last fifteen years to almost 40,000 cases in 2009. While Lyme is most prevalent in the northeast, mid-Atlantic and upper mid-west, infected ticks have been identified in all fifty states and in the most heavily affected regions, up to 50% of ticks may be infected.

"The critical factor for people to understand is the importance of early diagnosis and treatment," says Dr. Harriet Kotsoris, medical director at Time for Lyme, Inc. (TFL), a Greenwich, CT-based non-profit group that raises funds for research on Lyme and other tick-borne diseases. "Lyme disease can be cured if caught early when the infection is still localized," she explains, "but left untreated or under-treated, it can spread to other parts of the body and cause a vast array of debilitating symptoms that may persist as a chronic condition."


Time for Lyme offers the following questions and answers for people to consider if they have reason to believe that they have been bitten:

Have I been bitten? Lyme disease can only be transmitted from a bite by an infected deer tick, not from another person or animal, although pets commonly bring ticks into the home. All family members and pets should beinspected immediately and carefully after exposure to tick environments. You've been bitten if you find a tick attached to the skin; the longer it has been attached, the greater the risk of disease.

How should I remove the tick? The proper way to remove a tick is with a set of fine point tweezers. Do not attempt to burn the tick or use your finders or soap or any other substance on it, as these may irritate the tick and cause it to inject bodily fluids into the wound.

Using fine point tweezers, grasp the tick as close to the skin surface as possible, near the head of the tick. Pull backwards gently but firmly, using an even, steady pressure. Do not jerk or twist. Do not squeeze, crush, or puncture the body of the tick, as this may cause transmission of infection-causing organisms. If any mouth parts of the tick remain in the skin, leave them alone; they will be expelled naturally.

If the tick is found crawling, a good way to remove it is by using a piece of tape: adhere the tick to the tape and then suffocate it by sealing it into the tape; otherwise, you can dispose of it in alcohol and/or flush it down the toilet. After removing the tick, wash the skin and hands thoroughly with soap and water.

Should I have the tick tested? If the tick is attached, you will definitely want to send the tick to a laboratory to be tested for Lyme. You can ask your doctor where to send the tick or check online*. But testing the tick cannot definitively confirm or rule out the presence of disease in the bitten person and generally cannot detect the presence of diseases other than Lyme which can be contracted from the same tick bite. Some labs can test the tick for other co-infections in addition to Lyme disease. In any case, testing may take a week or more, during which time the disease can spread throughout your system with or without noticeable symptoms. The test will provide useful information for you and your doctor but do not delay seeking medical treatment while waiting for the result.

If you decide to send the tick for testing, place it, alive or dead, in a small plastic bottle or sealed plastic bag and package it suitably for shipping. If the tick is alive, place a moist cotton ball in the bag or bottle along with the tick.

What should I watch for after a tick bite? The site of the bite should be monitored for expanding redness, which would suggest erythema migrans (EM), the characteristic rash of Lyme disease, which appears in less than half of cases. The EM rash is usually a reddish color, typically expands over a few days or weeks. It often develops into a series of concentric rings giving it a "bull's-eye" appearance, but the rash can vary in size and shape. The rash usually causes no symptoms, although burning and itching have been reported. In people with early localized Lyme disease, EM occurs within one month of the tick bite, typically within a week, although only one-third of people recall the bite that gave them Lyme disease. Note that not everyone who contracts Lyme disease develops a rash and not all EM rashes are located at site of bite.

Other typical symptoms that may develop within a few days of being bitten include headache, stiff neck, swollen glands, fatigue, dizziness and migratory pains that come and go.

In addition, it is important to keep a watch out for other tick-borne co-infections including babesia, typically presenting with night sweats and anaplasmosis (previously called ehrlichia), often presenting with fever lower white blood count, as these can complicate treatment and recovery of Lyme disease.

When should I go to the doctor? You should see a medical professional if you have been in a tick environment and have any of the symptoms described above, even if you are unaware of having been bitten. The longer the tick attachment, the greater the chance of tick infection from an infected tick. Current blood tests for Lyme are unreliable, so the diagnosis is generally made based on the circumstances and clinical observation. Once diagnosed, early-stage Lyme may be easily and effectively treated with a course of antibiotics. Weigh all of these facts with your doctor while determining whether or not to treat after a tick bite.

"Late-stage Lyme is far more complex and dangerous than early, localized disease," Dr. Kotsoris emphasizes, "making 'wait and see' a potentially dangerous strategy. Only an experienced medical professional can determine when prophylactic antibiotic treatment is warranted but patients should educate themselves, bring that knowledge with them to the doctor's office and use their judgment about whether to see a Lyme specialist."

About Time for Lyme: Time for Lyme's mission is to fund & promote research for Lyme and other tick-borne diseases. For more information call 203-969-1333 or visit www.timeforlyme.org

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