Dr. Jeremy Diroff, veterinary internist at Veterinary Specialty Center of Delaware in New Castle, gets a kiss from Chester, who already has tested positive for Lyme disease.(Photo: Suchat Pederson, The (Wilmington, Del.) News Journal)
That doesn’t mean they are suffering from the disease, but it does mean they have been exposed to it at some time in their lives, Diroff said. Lyme disease — named for Lyme, Conn., where it first was identified — can be fatal if untreated in dogs though that is not common.
The disease can be treated easily with a course of antibiotics. But damage can occur when it is not diagnosed early, and a significant debate continues about how to treat the patients whose symptoms do not go away after standard treatments.
“It’s a tremendous public health problem,” said Paula Eggers, a registered nurse in the Delaware Division of Public Health’s Bureau of Epidemiology. “The mortality rate is very low, but with such a high incidence of cases, there is an urgent need for prevention.”
That doesn’t mean keeping the kids inside, and it doesn’t mean hunters or hikers should find other pursuits.
It does mean smarter preparation and follow-up.
“It’s time for more active interest in it,” said Dr. Paul Fawcett, head of immunology laboratories for Nemours/Alfred I. duPont Hospital for Children here. “At times, there is an over-reaction – and that’s as bad as ignoring it. But this should be something physicians and health care providers are familiar with.”
Raising awareness
Ronald Hamlen, a retired DuPont Co. scientist, said he became “deathly ill” from Lyme disease about 10 years ago. As he recovered, he studied the disease. He has served on area committees and task forces to promote awareness and responsible policy.
Hamlen, a resident of Cecil County, Md., is among those who believe many doctors and officials do not recognize the long-term effects of the disease and minimize its significance. He is an officer in the Lyme Disease Association of Southeastern Pennsylvania, which he says keeps a list of Lyme-savvy physicians in the area. Hamlen said no Delaware doctors are on that list.
Fawcett said a debate continues on how to treat Lyme disease. A small percentage of patients have lingering symptoms even after treatment, and some consider that to be chronic Lyme disease, a position he does not agree with.
“Our studies show they are no longer infected, but probably have had an out-of-control immune response” or may have another condition, he said.
Hamlen hopes the new CDC estimates trigger more significant medical attention to the problems Lyme poses and hopes more accurate testing will be adopted.
As it is now, he said, “people remain unprotected and — even worse — unaware.”
Concern for hunters
Hunter Steve Kendus thinks he wound up with four ticks on him last week because he didn’t take his usual precautions. Before he went into the woods to hang a deer stand, he sprayed insect repellant on himself but wore shorts and a T-shirt, not the long pants and long-sleeve gear he would wear when hunting.
“A lesson to be learned,” he said.
When he goes hunting, he will prepare by spraying the repellant permethrin on his clothes. After the hunt, he’ll do a thorough skin check to try to find any ticks that found their way up his pant leg, down his shirt collar or under his sleeve.
“ It’s my theory that humans are more sensitive than all dogs are to getting symptoms of Lyme. Most people who get bitten by an infected tick are going to get sick.â€
— Dr. Jeremy Diroff, veterinarian
“One of the dangers is that some ticks are so small they’re difficult to see, especially if you are checking yourself,” he said.
He applies repellants to the coats of his dogs, too — the short-haired Hungarian vizslas he favors — and checks them for hangers-on at the end of the day.
Kendus said he never has had a dog diagnosed with Lyme disease, but the Companion Animal Parasite Council lists Delaware among 25 states as high risk on its website, with an estimated 1 in 12 dogs testing positive.
Test results can be misleading — in humans and animals. And much detective work sometimes is necessary to reach a knowledgeable conclusion.
Diroff, the veterinarian, looks for clinical signs in dogs — lethargy, fever, swollen or painful joints, a stiff gait. If the dog responds to antibiotics, he’ll be pretty sure it was Lyme disease. Untreated Lyme disease can cause a serious kidney disease in a small number of dogs.
“It’s my theory that humans are more sensitive than all dogs are to getting symptoms of Lyme,” Diroff said. “Most people who get bitten by an infected tick are going to get sick.”
Cats can get the disease, Diroff said, but he has never seen such a case.
A tick’s life
Deer ticks have three life stages, said Brian Kunkel, a specialist in entomology and wildlife ecology for the University of Delaware’s Cooperative Extension Service.
In their smallest stage, they are about a millimeter in size, the size of a poppy seed. When full grown, they are only about the size of a sesame seed.
Kunkel said he often works in the field and he often pulls 15, 20 or 30 ticks off himself when he returns. He recommends light-colored clothes so ticks are easier to spot and tucking pant legs into shoes or boots. Long sleeves, secured with rubber bands, are another defensive measure.
Ticks have to be attached to a host human or animal for 24 hours or so before Lyme disease infection is likely, which is why it is so important to check the skin for ticks soon after outdoor excursions.
Keeping yards and grounds mowed and trimmed helps remove some favored haunts for ticks, Kunkel and others said.
But no one has found a fail-safe defense yet, so deer ticks wait, hanging on a leaf or a stem, their tiny legs extended toward any passing mammal and the banquet in its bloodstream.
Top Lyme disease states
In 2011, 96% of all Lyme disease cases were reported from 13 states. Here are the top states by instances of Lyme disease per 100,000 population for 2011, the most recent year available, compared with 2002 when the government began tracking the disease in depth.
State 2011 2002 1. Delaware 84.6 24.0 2. Vermont 76.0 6.0 3. New Hampshire 67.3 20.5 4. Maine 60.3 16.9 5. Connecticut 56.0 133.8 6. Wisconsin 42.2 20.0 7. New Jersey 38.5 27.4 8. Pennsylvania 37.2 32.3 9. Massachusetts 27.3 28.1 10. Minnesota 22.2 17.3 11. Maryland 16.1 13.5 12. New York 16.0 28.9 13. Virginia 9.3 3.6 Nationwide 7.8 8.2
Source: Centers for Disease Control and Prevention
Early symptoms
• Red, expanding bull’s-eye rash
• Fatigue, chills, fever, headache, muscle and joint aches and swollen lymph nodes
Prevention
• Wear insect repellant
• Check for ticks daily
• Shower soon after being outdoors
• Call your doctor if a tick bites you and you experience symptoms
Source: Centers for Disease Control and Prevention
Additional information
• American Lyme Disease Foundation
• Columbia University Lyme and Tick-Borne Diseases Research Center
• International Lyme and Associated Diseases Society
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