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Lyme disease update.

Lyme disease poses a double bind for doctors and health officials: many people who have it don't know it, and many others are convinced they have it but don't. Though there's much debate about exactly how prevalent this tick-borne disease is, more cases of it are reported each year. A total of 9,344 cases were reported to the Centers for Disease Control in 1991, compared to 7,943 in 1990 (about a 17% increase). Yet despite some media hype, there is no reason to panic or, as some people are doing, to avoid spending time outdoors. There is good reason, nonetheless, to take steps to protect yourself if you live in or visit an area where the disease is common - especially New York, Connecticut, Pennsylvania, and other Atlantic states, as well as northern California.

One problem is that Lyme disease is very difficult to diagnose early - and can be even harder to diagnose in its later stages. Its symptoms can vary from person to person and may be vague. The Lyme disease spirochete is transmitted by the deer tick, which makes its home on deer and mice - except in California, where the culprit is the closely related black-legged tick, which also lives on wood rats. People bitten by an infected tick do not necessarily develop the disease. No single symptom appears in all cases, nor within any predictable time span. Most commonly, within a few weeks of being bitten by an infected deer tick, an infected person develops a small red bump at the site, surrounded by a rash that gradually grows and then fades. At the same time, he may experience flulike symptoms such as fatigue, chills, headache, and pain in muscles and joints (especially the knees). After a latent period of several months to a year or longer, up to half of untreated people may develop recurring or chronic arthritis. Many infected people don't develop a rash or arthritis, and just have a general achy and lethargic feeling. However, such long-term flulike symptoms can be related to any number of other maladies - or even to psychological problems.

No reliable tests - yet

So far the available blood tests for Lyme disease are neither sensitive nor specific enough, yielding an unacceptable number of false negatives and false positives. The results of the tests vary from lab to lab, and the meaning of the results is not standardized. This greatly compounds the problems of diagnosis. In particular, during the first four weeks after someone becomes infected, the test is unlikely to detect the small amount of antibodies the body has produced in response to the bacteria. Even in the later stages of the disease, the current tests, as routinely performed, aren't foolproof. Better tests are on the way, though no one can say when they'll arrive.

Recent reports about a vaccine for Lyme disease have been encouraging but premature - don't expect a vaccine in the near future.

If in doubt, antibiotics?

Lyme disease is treatable and almost always curable, especially in its early stage. If you have - or had - the characteristic rash, your doctor will probably put you on antibiotics. Similarly, if you live in an area with a high incidence of the disease and find a tick on you, and it can be identified as a deer tick (or western blacklegged tick, if you're in California), your doctor may put you on antibiotics, even if you have no symptoms.

What if you have only the flulike symptoms, fatigue, or joint pain, but no memory of a tick bite? Some people may shop around till they find a physician who will treat them with antibiotics. But overuse of antibiotics has a serious downside. All antibiotics can have adverse effects in sensitive people. Pregnant women, in particular, shouldn't be stampeded into unwarranted antibiotic treatment by overblown news reports of the birth defects caused by Lyme disease. And the overuse of these drugs can eventually produce antibiotic-resistant organisms. But follow the advice of your physician.

Block that tick

If you live in an area where the disease is prevalent, and spend time in the woods or even in your yard - especially between May and September - take these steps:

* Cover your body as much as possible; wear long pants (tucked into your shoes or socks), a long-sleeved shirt, and closed shoes. It's easier to spot ticks on light-colored clothes.

* Check yourself occasionally for ticks, especially if you're in the underbrush or forest. When you get home, do a thorough check of your entire body, clothes, and gear. Deer ticks and blacklegged ticks are smaller than dog ticks; when engorged with blood the eight-legged ticks look like blood blisters. The immature ticks, called nymphs, are even smaller (about the size of a pinhead), and are responsible for up to 90% of all cases of Lyme disease. A nymph will feed on you for two to three days, an adult tick for up to a week. The sooner you remove it, the better your chance of avoiding infection. Recent studies reveal that if the tick is on you for less than 24 hours, it is improbable that you'll develop the disease.

* Inspect children daily, especially during the summer, when they spend lots of time outdoors.

* Check pets after they've been outdoors. They can carry ticks to your home or property, or develop the disease themselves.

* Use an insect repellent. See box below.

* Remove a tick with thin-tipped tweezers - always carry a pair with you when outdoors. (It is almost impossible to remove a small tick with your fingers.) Exert a slow, steady pull. Don't twist the tick. This may break off the mouthparts and lead to a secondary infection.

* Put the tick in a small jar containing alcohol (carry one with you if you're out hiking) so you can take it to your doctor or health department for identification.

New way to repel bugs

One of the best ways to ward off ticks is to use an insect repellent containing DEET (short for N,N-diethyltoluamide). The problem with DEET is that it causes allergic reactions in some children, and researchers worry that it may be hazardous if too much is absorbed through the skin. The higher the concentration of the chemical (some products are 100% DEET), the greater the risk. So it's good news that there's now a repellent designed specifically for kids, called Skedaddle. It contains only 10% DEET in an oil-based medium that slowly releases the compound and limits its absorption through the skin. It's effective for adults, too. Skedaddle comes in a carton of 12 individual application pouches, which retails for about $4. It is available at some drugstores, and can also be ordered by calling 800-243-2929.
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Title Annotation:includes related article on insect repellants
Publication:The University of California, Berkeley Wellness Letter
Date:Aug 1, 1992
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