By Dr. Dana Kornfeld

Now that we have made it though the winter, we can all celebrate the warm

weather! But, as always, the warm weather brings with it critters that can

cause disease, and as our children spend more time playing outdoors in the

grass and in the woods, they are more vulnerable to tick bites. Ticks can

cause many different diseases, but one of the more common ones in our area

is Lyme disease.

Lyme disease is an infection spread to humans by deer ticks infected with the

Lyme bacterium. Lyme disease is not transmissible from person to person.

These tiny ticks are barely perceptible when they attach to humans, and look

like a tiny dot made by a pencil. In order for the tick to transmit these bacteria

to people, the tick needs to be attached to the skin for at least 24 hours.  An

individual who is bitten by a tick has a very low risk of acquiring Lyme disease if the tick is removed before it is engorged (filled with blood). This is why doing careful “tick checks” on your child after she has been outdoors is important. Ticks can also attach to pets and be carried into the home, so checking pets is a good idea too. Only specific types of ticks harbor the Lyme bacterium, and therefore the size and color of the tick can help determine what kind of tick it was. A tick that was not attached, was easy to remove, was flat and not full of blood could not have transmitted Lyme disease or any other infection since it has not yet taken a blood meal.

How to Remove a Tick

1. Use fine tweezers to grasp the tick as close to the skin surface as possible

2. Pull backwards gently but firmly, using even steady pressure

3. Do not squeeze, crush or puncture the body of the tick, since its bodily fluids may contain infection causing organisms

4. After removing the tick wash the skin and hands with soap and water

5. If any mouthparts of the tick remain in the skin, these should be left alone as they will be expelled on their own. Attempts to remove these parts may result in significant skin trauma.

Making the Diagnosis

In many cases the first symptom of Lyme disease is a rash that begins as a pink or red circle several inches in diameter that can sometimes, but not always, have a pale center, giving it a bulls eye appearance. This is usually where your child was bitten and may appear from 3-30 days after the bite occurred. Most people have a single lesion, but some have multiple lesions. People with an allergy to tick saliva can develop a red rash at the site of the tick bite soon after being bitten. This rash typically lasts for 1-2 days but may continue for a week. This reaction is often confused with the rash of Lyme disease. However, an allergic rash begins earlier after the tick bite and does not expand outward in the way that the rash of Lyme disease does.

Early in the disease there can be fatigue, fever, headache, joint and muscle pain. Many viruses have the same symptoms so unless there is a characteristic rash, the diagnosis of Lyme disease is not usually made at this early stage. Children can also present later in the course of the disease with a swollen joint, or weakness on one side of the face which is called a facial palsy. Lyme disease is still very treatable at this stage. It is very rare for children to present with late signs of Lyme disease such as meningitis because there are almost always symptoms earlier that offer the clue of the disease.

In the very early stage of Lyme disease, at the time of the rash, the diagnosis of Lyme disease is made clinically, because the body has not had time to mount an immune reaction and therefore the blood test will not show evidence of the disease. In later stages of the disease there are blood tests to make the diagnosis.

Treatment
In the vast majority of children treatment with antibiotics is extremely effective in eliminating symptoms, preventing progression to later manifestations of the disease, and curing the infection. Depending on the age of the child either doxycycline or amoxicillin will be used.

Need for Treatment after A Tick Bite

The Infectious Diseases Society of America (IDSA) recommends preventive treatment with antibiotics after a tick bite only in people who meet ALL of the following criteria:

1. The attached tick is identified as a deer tick

2. The tick has been attached for many hours based upon how engorged the tick appears or the amount of time since outdoor exposure

3. The antibiotic can be given within 72 hours of tick removal

4. The child can take doxycycline (is more than 8 years old)

If the child meets all of the above criteria, it is recommended to give a single dose of doxycycline. Antibiotic treatment is highly effective if Lyme disease were to develop. It is recommended to monitor for symptoms of Lyme disease and not to treat, if the above criteria are not met.

Prevention

When possible, cover the arms and legs with protective clothing, tuck pants into sock and wear a hat to help keep ticks away from the scalp. And try to remember to do tick checks with high risk outdoor activity.

Now, go outside and enjoy a walk in the woods!