You need to know that Pennsylvania is one of the most lyme endemic states in the country (see CDC map below). As you can see by the chart Pennsylvanians are at significant risk for exposure to Lyme Disease according to CDC reporting statistics. However, Lyme Disease is difficult to diagnose and is often misdiagnosed as other conditions which means the actual incidence of infection is much higher than reported by the CDC.

New England is one of the most dangerous areas of the country to contract Lyme disease, according the Center for Disease Control’s Lyme disease statistics for 2007. The states with the highest reported incidents of Lyme disease cases per 100,000 population (in order from the highest) are Connecticut, Delaware, New Hampshire, Massachusetts, Maryland, Maine, New Jersey, Wisconsin, Pennsylvania and Minnesota.

What is Lyme Disease?

Lyme disease (LD) is an infection caused by Borrelia burgdorferi, a type of bacterium called a spirochete (pronounced spy-ro-keet) that is carried by deer ticks. An infected tick can transmit the spirochete to the humans and animals it bites. Untreated, the bacterium travels through the bloodstream, establishes itself in various body tissues, and can cause a number of symptoms, some of which are severe.

LD manifests itself as a multi-system inflammatory disease that affects the skin in its early, localized stage, and spreads to the joints, nervous system and, to a lesser extent, other organ systems in its later, disseminated stages. If diagnosed and treated early with antibiotics, LD is almost always readily cured. Generally, LD in its later stages can also be treated effectively, but because the rate of disease progression and individual response to treatment varies from one patient to the next, some patients may have symptoms that linger for months or even years following treatment. In rare instances, LD causes permanent damage.

The first symptom is usually an expanding rash(called erythema migrans, or EM, in medical terms) which is thought to occur in 80% to 90% of all LD cases. An EM rash generally has the following characteristics:

• Usually (but not always) radiates from the site of the tickbite

• Appears either as a solid red expanding rash or blotch, OR a central spot surrounded by clear skin that is in turn ringed by an expanding red rash (looks like a bull’s-eye)

• Appears an average of 1 to 2 weeks (range = 3 to 30 days) after disease transmission

• Has an average diameter of 5 to 6 inches

(range = 2 inches to 2 feet)

• Persists for about 3 to 5 weeks

• May or may not be warm to the touch

• Is usually not painful or itchy

Ticks will attach anywhere on the body, but prefer body creases such as the armpit, groin, back of the knee, and nape of the neck; rashes will therefore often appear in (but are not restricted to) these areas. Please note that multiple rashes may, in some cases, appear elsewhere on the body some time after the initial rash, or, in a few cases, in the absence of an initial rash.

Around the time the rash appears, other symptoms such as joint pains, chills, fever, and fatigue are common, but they may not seem serious enough to require medical attention. These symptoms may be brief, only to recur as a broader spectrum of symptoms as the disease progresses.

As the LD spirochete continues spreading through the body, a number of other symptoms including severe fatigue, a stiff, aching neck, and peripheral nervous system (PNS) involvement such as tingling or numbness in the extremities or facial palsy (paralysis) can occur.

The more severe, potentially debilitating symptoms of later-stage LD may occur weeks, months, or, in a few cases, years after a tick bite. These can include severe headaches, painful arthritis and swelling of joints, cardiac abnormalities, and central nervous system (CNS) involvement leading to cognitive (mental) disorders.

The following is a checklist of common symptoms seen in various stages of LD:

Localized Early (Acute) Stage:

• Solid red or bull’s-eye rash, usually at site of bite

• Swelling of lymph glands near tick bite

• Generalized achiness

• Headache

• Early Disseminated Stage:

• Two or more rashes not at site of bite

• Migrating pains in joints/tendons

• Headache

• Stiff, aching neck
• Facial palsy (facial paralysis similar to Bell’s palsy)

• Tingling or numbness in extremities

• Multiple enlarged lymph glands

• Abnormal pulse

• Sore throat

• Changes in vision

• Fever of 100 to 102 F

• Severe fatigue

Late Stage:

1. Arthritis (pain/swelling) of one or two large joints
2. Disabling neurological disorders (disorientation; confusion; dizziness; short-term memory loss; inability to concentrate, finish sentences or follow conversations; mental “fog”)
3. Numbness in arms/hands or legs/feet

Treatment:

Early treatment of LD (within the first few weeks after initial infection) is straightforward and almost always results in a full cure. Treatment begun after the first three weeks will also likely provide a cure, but the cure rate decreases the longer treatment is delayed.