Student guest post by Kyle Malter
In many areas of the country there is a vile blood sucker that lurks in our forests, our parks and even our backyards. What concerns us is not what this creature takes but rather what it leaves in our body after it bites us: corkscrew shaped bacteria called spirochetes and with the name Borrelia burgdorferi. When the bacteria invade our bodies and cause problems along the way we call it Lyme disease.
It is Lyme, not “Lymes” disease, and here’s how it got that name. In the early 1970’s a large number of cases emerged involving children with a “bulls-eye” rash followed by arthritis and they were concentrated in a small area in and near Lyme, Connecticut. Initially, the cause of the disease was unknown. A clue to the mystery was that most of the kids lived near a wooded area. After more investigation, ticks that feed on deer were identified as likely suspects. The medical community learned that the “deer tick” transmitted the spirochete bacteria which was likely infecting the children and causing symptoms. A researcher named Willy Burgdorfer helped identify the organism and in honor of his contribution the bacterium was named Borrelia burgdorferi.  Wouldn’t it be fun to have a nasty bacteria named after you?
Signs of Lyme disease can vary from a mild rash to serious pain and disability. If infected, a “bull’s-eye” rash occurs in most people because of the inflammation left in the trail of the migrating bacteria. They move from the bite site away leaving the classic target appearance. When this bug spirals though your joints, organs and tissues it can cause damage and a wide range of symptoms including fever, headache, lethargy, stiffness and general soreness. In some cases, more serious and long-term problems with swollen joints, arthritis, Bell’s palsy, and even heart disease can result. The symptoms can come and go and may last a lifetime.  This is one serious problem if you have the disease-spreading tick in your environment. Most people refer to the species as the “deer tick” or the “black-legged tick” although the proper name is Ixodes. Don’t forget about your dogs either. They are also commonly infected in endemic states, can get permanent arthritis, and can rarely even die from the disease. 
Lyme disease has been diagnosed in all 50 states but is heavily concentrated in the northeast and upper Mid-West.  Approximately 96% of cases come from only 13 states.  CDC data by state, maps and disease forecast models show a clearly increasing trend. Why such a steep increase in the number of cases? There are probably many reasons. First, surveillance is probably higher now than it was 15 years ago. We simply weren’t looking for it as much then. Another contributor is the increased population of the white-footed mouse in some regions.  This rodent is a reservoir for the bacteria meaning they harbor the bug until the tick larva come for a meal. They are like a bank filled with Borrelia ready for every tick to make a withdrawal. Once the tick has the bug in its gut, it is a loaded gun.
The recent increase in the white-footed mouse population may be the result of a cascade of events. “Change one thing. Change everything.” Ohio reported two recent “banner years” for acorn production with a 36% increase in white oak acorns between 2011 and 2012. A more abundant supply of “mouse food” in the way of acorns could result in more mice because they replicate much more efficiently. More white-footed mice means more banks filled with Borrelia. Ticks have a much better chance of making a withdrawal with every meal. More ticks with Borrelia means more animals and humans infected. So that’s how more acorns could mean more Lyme disease.
If you are unsure if Lyme bacteria are in your area just ask your dog. Some studies suggest that dogs that live in your area may be able to predict your risk level.    For those in the northeast and upper Mid-West you don’t have to ask. It is ubiquitous in these parts of the country. Veterinarians in many non-endemic states are now screening dogs yearly to see if they have ever been infected with Borrelia. If some dogs in your region are positive you should be more vigilant. The CDC will keep track as well so check their Lyme page annually.
Preventing Lyme disease can be a very big challenge. For dogs, very effective vaccines are available to protect them.   So if this is such a potentially devastating disease in people why don’t we have a vaccine for humans? Well, we did. In the late 1990’s a vaccine was approved by the FDA to aid in the prevention of Lyme disease in humans. While the safety and efficacy during the approval studies were good, there were skeptics and strong opponents in the public and medical community. Some people claimed that the vaccine caused Lyme disease rather than prevent it. Ultimately, the vaccine manufacturer withdrew it from the market citing poor demand.  Allen Steere, the man who discovered Lyme disease, also led one of the SmithKline Beecham (SKB) Lyme vaccine trials. He said, “the withdrawal of the SKB vaccine . . . represents the most painful event in our Lyme disease history . . . the vaccine was really withdrawn because of fear and lawsuits, not because of scientific findings”  Some advocates are attempting to rekindle efforts to make a vaccine for Lyme disease available again while others are opposed to the idea.
Tick prevention is our best strategy to prevent Lyme disease. Without a tick bite you cannot get Lyme disease. In fact, even if an Ixodes tick bites you, it takes at least 24-48 hours of attachment to transmit the bacteria into your body. The National Institutes of Health suggest that you follow their fashion advice and tuck in your shirt into your light colored pants, tuck your pants into your socks and then put tape around the bottom.  I’ve never seen this method utilized in a public place but I’m sure you will end up on the “People of Wal-Mart” site if you try it. The CDC recommends pyrethrins on your clothing and DEET on your skin and clothing to repel ticks.  The EPA also has a nice online tool. Check yourself everyday for ticks during peak months. Deer ticks are tiny so take some time and inspect your nooks and crannies. The nymph stage, the second smallest tick in this picture, is the one that usually infects people. Again, don’t forget about your dog. While he can’t give you Lyme disease, he is also susceptible to it. Ask your veterinarian which flea and tick preventative is right for your pets.
Lyme disease is no longer just a Lyme, Connecticut problem. If it is not yet in your backyard, it could be soon. Lyme disease can have lifelong, debilitating consequences. Arm yourself with information and your body with tick protection. We are not defenseless. Protect yourself. Protect your dog. Please.
 NIH Website http://www.niaid.nih.gov/topics/lymedisease/understanding/pages/intro.aspx
 Littman MP. Lyme nephritis. J Vet Emerg Crit Care (San Antonio). 2013 Mar-Apr;23(2):163-73
 Smith BG, Cruz AI Jr, Milewski MD, Shapiro ED. Lyme disease and the orthopaedic implications of lyme arthritis. J Am Acad Orthop Surg. 2011 Feb;19(2):91-100
 Centers for Disease Control and Prevention www.CDC.gov
 National Science Foundation http://www.nsf.gov/news/special_reports/ecoinf/lyme.jsp
 Townsend, Tracy A., "Change One Thing, Change Everything: Understanding the Rhetorical Triangle" (2013). Rhetoric Unit. Paper 3.
 Ohio DNR http://www.ohiodnr.com/home_page/NewsReleases/tabid/18276/EntryId/3033/Acorn-Mast-Survey-Results-Show-Increases-for-White-Red-Oaks.aspx
 J M Lindenmayer, D Marshall, and A B Onderdonk. Dogs as sentinels for Lyme disease in Massachusetts. American Journal of Public Health November 1991: Vol. 81, No. 11, pp. 1448-1455.
 Olson, Canines as Sentinels for Lyme Disease in San Diego County, California, Journal of Veterinary Diagnostic Investigation March 2000 vol. 12 no. 2 126-129
 Faith D. Smith, Rachel Ballantyne, Eric R. Morgan, Richard Wall Estimating Lyme disease risk using pet dogs as sentinels Comparative Immunology, Microbiology and Infectious Diseases, Volume 35, Issue 2, March 2012, Pages 163–167
 Levy et al. Use of a C6 ELISA test to evaluate the efficacy of a whole-cell bacterin for the prevention of naturally transmitted canine Borrelia burgdorferi infection. Vet Ther. 2002 Winter;3(4):420-4
 Aronowitz RA. The rise and fall of the lyme disease vaccines: a cautionary tale for risk interventions in American medicine and public health. Milbank Q. 2012 Jun;90(2):250-77.
 Steere, A.C. 2006. Lyme Borreliosis in 2005, 30 Years after Initial Observations in Lyme Connecticut. Wien Klin Wochenschr 118(21–22):625–33.
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Pretty good, thanks.
I have no good link, but in my area in southern MI, I've heard the rumor that more coyotes means less foxes and that means more mice. Over the past decade more coyotes and less foxes seems anecdotally true at my place. I'm hoping for an owl and kestral increase but can't say I've observed it. More ticks this particular year is very clear in my area, but we aren't sure why - we had a hot, dry summer last year, but also a deer die-off from epizootic hemorrhagic disease (EHD). I've had more on me this year (about 6) than the sum of the previous 20 years.
PS: The avoidance of the touchy chronic Lyme story was obvious. Maybe that was a good idea.
Very well written. Another grad student in my program presented with a bulls-eye rash earlier this week, after spending the weekend in some dense foliage. The rash was almost identical to the reference above, albeit smaller. She's on her fourth day of twice a day doxycycline horse pills today, which will hopefully be the worse part of it all since it was caught early. Unfortunately, we're a minimally notifiable state and I'm not sure of the true accuracy reported via the CDC database. Interesting though, nonetheless.
Correction--The majority of people infected with Lyme--at least 60%--DO NOT get a bulls-eye rash, or even any rash. The famous Lyme pediatrician in CT, Dr. Jones, has said that only about 10% of his patients were ever aware of getting a rash. That said, if one knows they were bitten by a tick and they get any kind of a rash at all--not just bulls-eye--THEN THEY HAVE LYME and need to seek antibiotic treatment immediately.
Also, Dr. Willy Burgdorfer has said that about 5-10% of ticks that are carrying Lyme disease have a systemic infection and have the disease in their saliva and can transmit it as soon as they bite. “There is no safety window.” - See more at: http://lymedisease.org/news/touchedbylyme/kathy-white-cdc-phone.html#st…
Thanks for your attention to Lyme disease. Much of the article is well-researched and accurate, however, there are some misconceptions that should be addressed.
Though it's often touted that black legged "deer" ticks are the only vector of Lyme disease, years of published evidence strongly suggest that the lone star tick, Amblyomma americanum, transmits Lyme disease, too...traditional Lyme as well as two species of Borrelia burgdorferi which current tests are not geared to detect. Please see this recent press release about lone star ticks and Lyme disease: http://galymediseaseassoc.blogspot.com/
This is important because lone star ticks are widespread halfway across the USA and bite humans so frequently.
The rash may not occur at all in some patients and, if one does, it doesn't necessarily appear as a bull's eye or target at all - in fact, they are often only solid, red, expanding lesions.
Lyme disease appears mostly in only 13 states because those states are awarded the federal funding to track the disease. In other states without funding, national reporting guidelines were never used making it look as it there are no Lyme cases when, in fact, there are thousands. Simply ask Lyme disease organizations across the nation what they are witnessing. Many of us collect case data including positive tests and compatible case history in patients with no travel history.
In tracking dog cases, unfortunately, often times the C6 ELISA is used to do the testing. This test was shown unreliable in detecting Dr. Ed Masters' cases in Missouri long ago. A study done at Tulane (Embers) found this test unreliable in detecting infected monkeys, and a horse study done by Chang showed the test failed to detect a significant portion of cases. If regionally-specific tests were used or a whole cell Borrelia ELISA, more dogs would test positive in the southern United States.
Though Lyme disease was first recognized in Lyme, CT, that doesn't mean it started there and is expanding outward. More Lyme species and strains have been identified in the Southeastern USA than in any other region of the country. Scientists believe this indicates that the bacteria had to have been here first, giving it time to diversify into so many unique strains, prior to moving north. If tests were designed to detect various Lyme Borrelia strains in humans, we would probably be very surprised to find how widespread this disease really is, not only in the United States, but across the world.
In recent years, the CDC funded Yale $2.9 million dollars to produce a new Lyme disease risk map. The map showed little risk to those in the Southern USA. Those of us in the South were shocked considering the number of patients we know. Upon closer examination, it was discovered that the Yale scientists based their conclusions on only black legged ticks, and on testing only a total of NINE of these ticks from a few states in the Southeastern USA. Our tax dollars shouldn't be so wasted when so many are suffering and need answers.
If the goal is to truly determine human risk, why test ticks anyway? Test HUMANS using regionally specific Lyme strains.
Thank you again for your article. I hope you will please share the important information about lone star ticks and Lyme disease with your readers. They deserve to be warned that Lyme disease indeed may be very prevalent in their own back yards.
Georgia Lyme Disease Association