Discussion: Lyme disease positive ticks at NAOC

E-mail from NAOC meet director Shawn Forney today:

Hi,

Normally I dont get too worried about this stuff until they mentioned
Green Lakes S. P. Article from WSYR Radio. Just be aware if you were at
Green Lakes for NAOC event, etc.

-Shawn

From wsyr.com:

Health Commissioner Cynthia Morrow says around 60 percent of adult ticks
collected from Green Lakes over the summer tested positive for the
disease.
Wednesday, October 1, 2008

Cases of Lyme Disease are up in Onondaga County.

Doctor Cynthia Morrow at the Health Department says around 60 percent of
adult ticks collected from Green Lakes over the summer have tested
positive for the disease.

You can avoid bites by covering up -- especially when in wooded areas.

Morrow also recommends you closely check your body for ticks -- which
are quite small (as pictured above).

Symptoms of the disease are a "bull's eye" rash (three red rings) and
fatigue.

The rash typically shows up 10 days later.

60% is truly worrisome!

Is it still considered valid that ticks must be attached for a significant length of time (I heard 24 hours?) before Lyme disease is transmitted?

My intent is not to 'push the limit' but to allay concerns of someone who might have found a tick 1-2 hours after the event.

Under normal circumstances, the tick does not usually transmit the disease until after 24 hours when it releases from the host - in doing so it 'regurgitates' fluid into the host. Note however that the disease can be transmitted prior to that if the tick is not properly removed - ie if you end up squeezing the tick while removing it, it can put some of the infected blood into your system

I've heard 24-36 hours.

Not everyone gets the bullseye rash (or any rash).

My classic symptoms were a high fever with chills and muscle/joint aches approximately 2 weeks following exposure (thought the rash was poison ivy; didn't remember removing a tick; etc.). Because of where I'd been 2 weeks before I suspected ticks/Lyme, they tested for it, and gave me 3 weeks of antibiotic to fight infection. No ill effects.

Lots of places online to learn about the disease. Best prevention is checking yourself after you O!

I think it is tough to really check yourself; you can only really see 50% of your skin area, and those ticks are truly small.

When I got Lyme disease, it was the one night I failed to promptly shower after orienteering in a known Lyme-infected area. I never saw any ticks, attached or otherwise. When the rash developed several weeks later, it was shaped quite randomly...certainly no "bulls-eye." And I had no other symptoms. But the rash persisted for a couple of weeks, until I went to a dermatologist. She didn't have a clue what it might be, and I had to coach her toward the Lyme diagnosis. Lyme is tough to diagnose; apparently blood tests are wrong as much as they're right, so essentially worthless.

I took antibiotics for 2 weeks, the rash faded, and the skin over the rash peeled abundantly. And then it was gone. Who knows if I really had Lyme disease?

Given that only ~60% of folks get the classic bulls eye rash if bitten, the real key is flu/fever symptoms about 6 - 10 days after exposure. There have been many cases of folks being misdiagnosed so insist on a Lyme diseases test if you get the 6- 10 day fever and have been in the woods. After that typically a very cheap 1 month course of antibiotics usually takes care of it. If Lyme disease progresses then thats when things get nasty.

This discussion makes me want to give up orienteering and stick to something safer, like skydiving. There you can tell if you are sick when you stop breathing shortly after exposure... ;)

Skydiving is fine, unless you land in a bush loaded with ticks ...

Got it in 1995 at Annadel State Park in Santa Rosa, CA... and I wasn't even orienteering or out in the bush, mostly hiking on trails.

Saw the tick the next day, thought I had grown a mole in my groin, but on closer inspection, that kinda freaked me out. Had never had a tick in my life.

Didn't think much about it until I got a rash. No bullseye, just a broad, 9 inch or so diameter rash. Suspected lime since there was a tick and rash involved, went to Stanford Medical Center, got the limer titer test, which ended up being positive. Since it's a medical school they paraded quite a few students in there to check out the rash, given my consent.

Got the one month course of antibiotics. Never remember getting flu/feverlike symptoms.

There's lots of information on the web; one of the best reasonably-current summaries is from eMedicine. In the article EM stands for erythema migrans, the rash that is found in only ~two-thirds of the cases.

Note that:
- Lyme disease and syphilis have much in common, both transmitted by spirochetes, and both can involve the brain and nervous system.
- Untreated or undetected Lyme develops into "late disease" which can involve severe arthritis, beginning with the knees. So if you've been orienteering for a while, and are having problems with your knees, add undetected Lyme to your list of suspected causes.
- Blood tests for early stage Lyme can be difficult...only 1/3 of those infected test positive; and conversely many cases of false positives result in over-treatment, with the concern that antibiotics may be losing their effectiveness against the disease.
- Once infected with Lyme, despite eradication of the infection, blood tests become completely worthless to detect either cure, or repeat infection, since antibodies to the disease persist for many years.
- A Lyme vaccine was once available, but has been removed because of concerns about side-effects and whether it works at all.

USOF also has a link to the Lyme Disease Foundation website; click on "Faces of Lyme" for some personal stories...the USOF Lyme information link no longer works. But Evan Custer has written an excellent Lyme FAQ on the BAOC website directed toward west coast orienteers.

I've changed the USOF link on Lyme disease information and added a link to the CDC site for tick-borne diseases, since Lyme isn't the only one out there.

Here is DVOA land Lyme disease is somewhat common for us. Denny has had it twice from two different bites and neither of them was from orienteering; work and walking our dog. In both cases he had no symptons until about 3 months after the bite and the doctor determined this time frame. He developed severe joint pain and as there was no other cause he was tested for lyme and it was positive. The second time he actually had a small very painful lump on his wrist. So just be aware of the fact that you can totally skip the rash and flu symptoms and sometime down the road other symptoms could arise with no explanation, test for Lyme just to me sure.

I was bit by tick in late May. No rushes, bull eye, fever etc were developed. However, two months later test for lime disease was positive.
I took 4 weeks antibiotic treatment, currently I feel alright.
Question: HOW I'd know next time after a bite wether I need treatment or not since the test for lime disease would be positive for sure ?

SV, when Denny was checked for his second bite, our doctor told him that it was definitely a second bite. She could tell by the tithers that it was a second bite and not a reocurrance of the orginial case of lyme he had had 6 months before. Whether this is true or not I can't say, I can only go by what we were told by our doctor Thankfully he has not had a problem in a couple of years now.

According to the eMedicine article, a positive titer is only the first of two steps in diagnosing Lyme disease. By my reading, in order to be confirmed Lyme, you must test positive in both steps:

Serology should include a two-step process. First, perform enzyme-linked immunosorbent assay (ELISA) or immunofluorescent assay (IFA) and, if positive, go to the second step. This next step involves Western blot analysis against specific antigens. This step is not interpretable in the absence of a positive ELISA or IFA result. Most assays require immunoglobulin against at least 3 specific proteins (for immunoglobulin M [IgM]) or 5 specific proteins (for immunoglobulin G [IgG]) for results to be considered positive.

Were you bitten in a known Lyme area? Was the tick very small, about the size of the head of a pin? Larger "dog ticks" are not known to transmit Lyme. Did you have both steps of this blood testing process? If not, there is a chance that without a rash, you never had Lyme at all.

Apparently for financial reasons, clinics sometimes omit the second stage of this test, and just administer a course of antibiotics. For future concerns, you may wish to ensure that this test is properly, and fully conducted.

Clark, SE PA is definitely a lyme disease area. Very common. I know people who got it from a tick at their kids Baseball game, cutting the grass and just plain gardening. So for those of us running around in the woods orienteering weekly it is a common problem. I don't know that Denny had the 2 step testing but in both cases he had definite joint pain and the second time it was just one joint his wrist with a lump on it. He got the antitbiotics and within days he was feeling better. I know that he had blood tests done with the Doc in both cases because he had to wait for the results before starting the meds.

SV, after a bite, if you have found a tick attached for more than 24-36 hours, especially if it's engorged and has been feeding, and you've been out and about in the Northeast US, you should definitely ask for testing and treatment. If the doctor removes the tick himself a lab can test it directly; if you've removed it and it has dried up they can't do a thing with it.

If you don't know you've been bitten, though, just watch for any of the symptoms people have mentioned after being outdoors.

Once infected with Lyme, despite eradication of the infection, blood tests become completely worthless to detect either cure, or repeat infection, since antibodies to the disease persist for many years

I had I think eight or nine of the possible immunoglobulins (I think the doctor called them "bands") two months after the initial infection in 2005. In 2007, I had 5. Just this last week, there was only one band remaining. All three tests were by the same lab in North Carolina, I believe. It seems that the intensity of the immune system response can be used to judge the amount of time that has passed since the initial infection.

The symptoms of the initial infection can indeed be vague and just about anything. In my case, there was only general malaise and the blood pressure was uncommonly high following training; no rash. The "late disease" can also follow various scenarios. Neurological damage is characteristic of only 5% or so of the patients and arthritis-like damage, of over 60%, yet in my case I got the former and not the latter. It seems that neurological damage can be profound and progressing years after the initial infection.

If you orienteer/spend time outdoors in the U.S. Northeast, the Mid-Atlantic, and the Midwest, and want to know whether or not you have Lyme, you should probably convince your doctor to test you at least once a year (you or the doctor should make up a good reason to justify the tests to the HMO), but once you know you have Lyme and have had it for a while, it's not clear what you can do to lessen the damage.

Dear Miss Hoover, you have Lyme disease. We miss you. Kevin is biting me. Come back soon. Here's a drawing of a spirochete. Love Shep.