A spring or early summer walk in the woods is an excellent way to say goodbye to the winter blahs. But no matter how warm the temperature, make sure you leave the shorts and sandals at home.

One of the most dangerous creatures you’ll encounter in the woods at this time of year is the deer tick, about the size of a poppy seed but able to bring about rather severe symptoms now known as Lyme disease.

Lyme disease is an infection with Borrelia burgdorferi, passed on to humans by a tick, usually a deer tick. The disease includes not only a characteristic rash but fever, headache, stiff neck, body aches and fatigue. If left untreated, the disease can progress to persistent, sometimes chronic, symptoms such as fatigue, arthritis, heart or nerve problems (sometimes including partial facial paralysis) and even disturbances of memory and attention.

First identified among children living near Lyme, Connecticut in 1975, Lyme disease is believed to have existed in Europe many years earlier and became more prevalent in the United States with the increase in the deer population and the influx of suburbia into rural, wooded areas. Incidence of the disease is increasing fairly rapidly in this country, with the number of cases nearly doubling from 1991 to 2000. It has now been identified in virtually every state, although 95 percent of cases still occur in 12 where deer ticks are most prevalent–Connecticut, Rhode Island, New Jersey, New York, Delaware, Pennsylvania, Massachusetts, Maryland, Wisconsin, Minnesota, New Hampshire and Vermont.

Ticks pick up the bacteria from the blood of mice, other mammals or birds, then spend much of their adult life on deer, before dropping off in late winter to lurk on grass blades or fallen leaves. Mid-May to mid-June is peak season for ticks, and they are most likely to be found in woods or nearby shady grasslands. Ticks are particularly fond of places where the woods and grasslands merge, and those, of course, are good areas for spring outings.

There’s no need to worry about deer ticks jumping or flying at you or dropping on you from tree limbs; humans usually pick them up at the level of the knee or below. Once it’s on the human body, the tick then crawls to a more secure location on the torso, often on the back of the neck or the hairline.

Children and older adults are most at risk of Lyme disease, but anyone spending time in wooded habitats of states with high populations of deer ticks can be infected. That includes not just hikers and campers but those who walk or run on wooded trails and even golfers who send an occasional shot into the rough.

When detected early, Lyme disease is readily treated with antibiotics, but an even better approach is to keep the ticks off from the beginning.

Tips for Prevention
If you can’t avoid the places where deer ticks might be lurking, you should be sure to keep your skin covered, particularly your legs and feet. Wear closed shoes, long sleeved shirts and pants that fit snugly at the ankles. Some hikers even tape their pant legs closed or clamp pet tick collars around their ankles. Ticks show up better on light-colored clothing.

Before venturing out, spray insect repellant containing DEET on exposed skin except for the face, following the instructions, of course, for safety. Clothing can be sprayed with the insecticide permethrin.

After your walk, shower as soon as possible and wash your clothing. Although water will not necessarily kill ticks, it may wash them away, and spin drying at high temperatures will kill them.

Even if a tick attaches itself to you, your risk of infection is estimated at less than two percent. Nevertheless, check your skin carefully several times a day and before going to bed. Areas preferred by ticks include the belt line, just under the breasts, around the arm pits and groin and above the hair line. Because they are so small, ticks are hard to spot and easily mistaken for a freckle or a speck of dirt.

Remove any ticks you find with fine-tipped tweezers, grasping the tick firmly as close to the skin as possible and pulling gently without squeezing the tick’s body. Mouth parts of the tick left in the skin should not transmit disease, and you may cause more damage to the skin trying to get every piece out. Be sure to wash the area thoroughly and then apply antiseptic.

A vaccine, Lymerix, was approved by the Food and Drug Administration in 1998, but pulled from the market by the manufacturer on February 26, 2002. The vaccine was effective for only about 75 percent of cases, and there were claims of arthritis and other side effects, none of which were confirmed in a placebo-controlled re-evaluation conducted by the Centers for Disease Control. Facing numerous lawsuits, the manufacturer cited poor sales and lack of demand for the vaccine.

Early Treatment Is Key
Because the risk of getting an infection from a tick bite is low, most doctors don’t prescribe antibiotics unless there are other signs of Lyme disease. A new rapid blood test can be performed in the doctor’s office, but it’s useful primarily as a first step and does not establish a diagnosis.

The characteristic skin rash of Lyme disease, known as erythema migrans, starts as a small red spot at the site of the bite, expanding over a period of days or weeks to form a circular or oval shape resembling a bull’s eye. It can range in size from a dime to the entire width of a person’s back. Only about 80 percent of Lyme disease patients, however, have a rash.

The flu-like symptoms of early Lyme disease are more likely to be persistent or to recur intermittently compared to those of a viral infection.

If necessary and administered early enough, antibiotic treatment is usually sufficient to head off long-term complications. One recent study found that 10 days of the antibiotic doxycycline were as effective as 20 days for treatment of early Lyme disease.

There are still many misconceptions about Lyme disease, particularly regarding long-term complications such as persistent joint and muscle pain and thinking or memory problems.

In the past, some patients have been given treatment with antibiotics for extended periods for these complications but a study published in The New England Journal [July, 2001] found that long-term antibiotic treatment was no more effective than placebo. The researchers found no evidence of continuing infection. The persistent symptoms, some believe, may be an autoimmune reaction.

While long-term complications can be severe and disabling, they are not as common as many Americans fear, and they can nearly always be prevented by early detection and treatment.

On a beautiful spring day, it’s a shame to have your outdoor pleasures spoiled by fear of tiny creatures lurking in the undergrowth. But if you live in an area that could be inhabited by deer or deer ticks, it’s better to be safe than sorry.

REFERENCES:
“Antibiotic Treatment in Patients with Persistent Symptoms and a History of Lyme Disease,” Clinical Oncology Alert, October, 2001.
Centers for Disease Control, “Lyme Disease–United States, 2000,” Morbidity and Mortality Weekly Report, January 18, 2002.
“Chronic Lyme Disease Symptoms Not Helped by Intensive Antibiotic Treatment,” Medical Laboratory Observer, August, 2001.
Stacy DiLoreto, “New Ways To Prevent and Treat Lyme Disease,” Patient Care, August 30, 2001.
Michael A. Gerber and Eugene D. Shapiro, “Late Lyme Disease: Clearing Up Confusion,” Contemporary Pediatrics, July, 2001.
Silvia E. Hines, John N. Aucott, Leonard H. Sigal and Robert P. Smith, “Lyme Disease: The Debate Continues,” Patient Care, June 15, 2001.
Bruce Jancin, “Early Lyme Disease: Doxycycline for 10 Days as Good as 20,” Internal Medicine News, December 1, 2001.
Melinda Leader, “Ticked Off,” Ladies Home Journal, July, 2001.
Jennifer Lufkin, “The Lyme Debate,” New Jersey Monthly, November, 2001.
Dan Merenstein and Dan Rosenbaum, “Can Antibiotic Prophylaxis within 72 Hours of a Tick Bite Prevent Lyme Disease?” Journal of Family Practice, October 2001.
National Institute of Allergy and Infectious Diseases, “Lyme Disease: The Facts, The Challenge.”
“Prevalence in the United States Is Increasing,” Medical Letter on the CDC & FDA, February 10, 2002.
“Rapid Test for Lyme Disease,” Medical Laboratory Observer, November, 2001.
“Vaccination Is Effective Preventive Medicine,” Vaccine Weekly, August 15, 2001.