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Lyme disease (LD) is an infection caused by the spirochete Borrelia burgdorferi, named after its discoverer, Willy Burgdorfer, PhD. A spirochete is a spiral shaped bacterium. Other diseases caused by spirochetes include relapsing fever and syphilis.

Lyme disease was first recognized in 1975 after researchers investigated why unusually large numbers of children were being diagnosed with juvenile rheumatoid arthritis in Lyme and two neighboring towns.

The investigators discovered that most of the affected children lived near wooded areas likely to harbor ticks. They also found that the children’s first symptoms typically started in the summer months coinciding with the eight of the tick season. Several of the patients interviewed reported having a skin rash just before developing their arthritis and many also recalled being bitten by a tick at the rash site.

Further investigations resulted in the discovery that tiny deer ticks infected with a spiral-shaped bacterium or spirochete (which was later named Borrelia burgdorferi) were responsible for the outbreak of arthritis in Lyme.

LD is most commonly transmitted by a tick bite (usually painless). The tick vectors include Ixodes scapularis (Deer Tick), Amblyomma americanum (Lone Star Tick) and Ixodes pacificus. Ixodes dammini was thought to be the only species responsible for transmission until it was shown to be the same as Ixodes scapularis in 1993. The Deer and Lone Star ticks can be found in New Jersey. The ticks prefer to live in wooded areas, low growing grassland, seashores and yards. Depending on the location, anywhere from less than 1% to more than 90% of the ticks are infected with spirochetes.

The Deer tick has a 2 year life cycle and must feed 3 times. In the larvae stage, it is tan, the size of a pin head and feeds on small animals like the mouse where it can pick up the spirochete. During the nymph stage the tick is the size of a poppy seed, beige or partially transparent and feeds on larger animals such as cats, dogs and humans. The adult ticks are black and/or reddish and feed on cattle, deer, dogs and humans. The female Lone Star tick is grey with a white dot.

April through October is considered the "tick season" even though Lyme disease is a year round problem. Ticks are very active in the spring and early summer.

Cases of Lyme disease have been reported in virtually every state, although the Northeastern, Great Lakes, and Pacific Northwest areas are particularly endemic.

Lyme disease is called the "Great Imitator" because it can mimic many other diseases, which makes diagnosis difficult. A rash can appear several days after infection, or not at all. It can last a few hours or up to several weeks. The rash can be very small or very large (up to twelve inches across). A "bullseye" rash is the hallmark of LD. It is a round ring with central clearing. Unfortunately, this is not the only rash associated with Lyme. Various other rashes associated with LD have been reported. One bite can cause multiple rashes. The rash can mimic such skin problems as hives, eczema, sunburn, poison ivy, flea bites, etc. The rash can itch or feel hot or may not be felt at all. The rash can disappear and return several weeks later. For those with dark skin the rash will look like a bruise.

If you notice a rash, take a picture of it. Some physicians require evidence of a rash before prescribing treatment.
Early Symptoms: Several days or weeks after a bite from an infected tick, a patient usually experiences "flu-like" symptoms such as aches and pains in their muscles and joints, low grade fever, and/or fatigue.

Other Possible Symptoms -- No organ is spared:
Jaw -- pain, difficulty chewing
Bladder -- frequent or painful urination, repeated "urinary tract infection"
Lung -- respiratory infection, cough, asthma, pneumonia
Ear -- pain, hearing loss, ringing, sensitivity to noise
Eyes -- pain due to inflammation, sensitivity to light, scleritis drooping of eyelid, conjunctivitis, blurring or double vision
Throat -- sore throat, swollen glands, cough, hoarseness, difficulty swallowing
Neurological -- headaches, facial paralysis, seizures, meningitis, stiff neck, burning, tingling, or prickling sensations, loss of reflexes, loss of coordination, MS like syndrome
Stomach -- pain, diarrhea, nausea, vomiting, abdominal cramps, anorexia
Heart -- weakness, dizziness, irregular heart-beat, myocarditis, pericarditis, palpitations, heart block, enlarged heart, fainting, inflammation of muscle or membrane, shortness of breath, chest pain
Joint -- arthralgias or arthritis, muscle inflammation and pain

Other Organs -- liver infection, elevated liver enzymes, enlarged spleen, swollen testicles, irregular or ceased menses
Neuropsychiatric -- mood swings, irritability, poor concentration, cognitive loss, memory loss, loss of appetite, mental deterioration, depression, disorientation, sleep disturbance
Pregnancy -- miscarriage, premature birth, birth defects, stillbirth
Skin -- single or multiple rash, hives

Lyme Disease is treatable. Antibiotics are recommended for a minimum of four to six weeks. More chronic cases may require a longer treatment. Some physicians are combining more than one drug for more difficult cases. There is a vaccine available for dogs. There is no vaccine available for people yet. Humans do not develop an immunity to Lyme Disease. Reinfection is possible.

Treatment should be given:
If you are bitten by a tick that tests positive for spirochetes
If you are bitten by a tick and you have symptoms
If you are bitten by a tick and are pregnant
If you are bitten by a tick and live in an endemic area

Treatment is either oral or intravenous. Those diagnosed later may require I.V. treatment.

In Europe, a skin rash similar to that of Lyme disease had been described in medical literature dating back to the turn of the century. Lyme disease may have spread from Europe to the United States in the early 1900’s but only recently became common enough to be detected.

The ticks most commonly infected with the B burgdorferi usually feed and mate on deer during part of their life cycle. The recent resurgence of the deer population in the northeast and the influx of suburban developments into rural areas where deer ticks are commonly found have probably contributed to the diseases’ prevalence.

Lyme disease is still mistaken for other ailments, and it continues to pose many other challenges: it can be difficult to diagnose because of the inadequacies of laboratory testing; it can be troublesome to treat in its later phases; and its prevention through the development of an effective vaccine is hampered by the elusive nature of the bacterium.

Lyme disease patients with neurological symptoms are usually treated with the antibiotic ceftriaxone given intravenuously once a day for a month or less. Most patients experience full recovery. When a patient with possible Lyme disease symptoms does not develop the distinctive rash, a physician will rely on a detailed medical history and a careful physical examination for essential clues to diagnose, with laboratory tests playing a supportive role.

To prevent the lyme disease , it is suggested that you avoid ticks, apply insect repellent containing permethrin to clothing, wear light-colored clothing so that ticks can be easily spotted, wear long-sleeved shirts and closed shoes, and check pets for ticks as well.