From: BITNET list server at TCUBVM (1.7f) Subject: File: "SCOUTS-L LYME-NET" To: Danny Schwendener Date: Thu, 24 Mar 1994 11:23:30 -0600 From: Steve Tobin Subject: Lyme Disease Background Scouters: The following two letters are reponses to inquiries to Marc Gabriel, editor of the Internet Lyme-Net Newsletter. These letters, along with the information presented in the LymeNet faq, should provide you with the background to effectively manage the Lyme Disease threat to your charges. Distributed with permission. Note: CDC = Center for Disease Control ============================================================================ Date: Mon, 21 Mar 1994 20:42:30 -0600 From: Marc Gabriel To: srtobin@mmm.com Subject: Re: Exposure risks of Lyme disease. Steve, > ----------------------- Message requiring your approval ------------------ > Sender: srtobin@mmm.com > Subject: Exposure risks of Lyme disease. > > ......... I have been led to believe Lyme disease was > pretty much under control through the use of antibiotics, and that I should > not be overly concened. I think this attitude is pretty widespread. From > what I have read in this newsletter, this is not the case. You should know at least this: When the "experts" and CDC officials talk with each other and speak at Lyme disease functions, they say one thing. When they speak to the media, they paint an entirely different picture. Why? There are many reasons, fiscal and political to consider (i.e. do you want your property value to go down? Do you want people to stay secluded? etc). What you should remember is that public health officials assume that the average American (and the mass media) are unable to understand what a "risk" is and how to react to it. The data suggest that, in a few years, LD may be known as one of the most extensive epidemics in 20th century North America, along with polio, AIDS and a few others. Recent research into Alzheimers and MS suggest that, at the very least, thousands of these patients are actually infected in Bb. Many "autoimmune" phenomena are also misdiagnosed. You can't go on TV and say that without generating widespread panic. So, they tell you there is "insufficient data" to make any conclusions. They are right, even though they are not being entirely honest. > I obviously should be concerned about this, but my questions are: > 1. How concerned should we be about risking infection? To the point > of staying home? Having routine 'tick inspection' line-ups? What is > a reasonable policy relative to the danger? Take "common sense" precautions (not usually intuative, though). Remove the tick properly. Make sure you know of a lab that will do tick testing (typically a PCR DNA test to see if the tick is infected). They can usually do this for about $30, and most parents will shell out these funds for a piece of mind. If positive, treat (see recommendations vol#1 issue #12). If not, wait. Let the parents know the kid has been infected. If the kid shows *any* signs of infection, hit the kid with a strong oral regimen to ensure that, if there was anything there, it'll be dead soon. This is the best scenario. There are many permutations that will complicate things. Line-ups seem like a great idea. At the very least, you'll make the kids aware of the danger. Prophylactic treatment is a hot topic. Most Lyme organizations strongly support it. Physicains and the CDC on hysteria patrol are against it. As a troop leader, you will develop over time a sense of when to recommend it. Hopefully, responses from your question will help develop this sense. Hope this helps. mcg ----------------------------------------------------------------------------- Date: Wed, 23 Mar 1994 21:12:51 -0600 From: Marc Gabriel To: srtobin@mmm.com Subject: Re: Exposure risks of Lyme disease. Steve, Thanks for asking. In order to put things in context, reprint my comments with the following post script: The most important thing to remember about Lyme disease is that rational risk assesment is key. There is no reason to stay secluded becuase of the threat of Lyme. However, when one ventures in "high risk" areas, neglects to take precautions and later becomes "mysteriously ill", your "index of suspicion" for LD should be raised. Here are some examples: 1. A child goes hiking and carefully checks for ticks. The child falls, pulling a muscle. The child is in pain for the next few days, and the pain "will not go away" for several days. Myalgias (muscle pains) are a common symptom of LD. Here, the index of suspicion would *not* be high, since the cause of the child's pain can be directly attributed to the fall. The odds of an injury *and* infection are relatively small (especially since the child checked for ticks), so attention should be directed to dealing with the pulled muscle. Given the odds, one should not get hysterical about the possiblity of LD. 2. An athletic boy goes hiking in an endemic area and neglects to check for ticks in a characteristic macho fasion (I learned the hard way this is not a great idea). The child may or may not remember ticks on his legs. If he does remember them he "brushed them off" (despite the fact that a few may have been embedded). One week later, for no reason, symptoms begin. Let's say, headaches, myalgias, irritability and uncharacteristic profound exhaustion. If there are no other reasons for these symptoms, your index of suspicion should be raised. The child's parents should then discuss with the family doctor the option of a 30 day course of antibiotics (they tend to be relatively inexpensive, in the $35 range for a month). The physican should then determine if that course was effective and if further treatment is in order. Note that I describe "difficult" cases, since no rash is found / remembered. Most descriptions tell you about the rosey scenarios where rashes show up promimently, patients are familiar with LD and physicians are well enough educated to treat promptly without stalling. This, unfortunately, is not the norm. Treatment should begin promptly after any EM (Lyme) rash is found, without regard to other factors. There is little / no disagreement on this point among experts. There are too many variables and unknowns to draw up a clear formula on when to treat and when not to. Hopefully, these cases will illustrate when your "index of suspicion" should be raised. mcg ------------------------------------------------------------------------ Marc C. Gabriel marc@cnj.digex.com mcg2@Lehigh.EDU VOICE: 908-789-7346 FAX: 908-789-0028 ------------------------------------------------------------------------ From LISTSERV@TCUBVM.IS.TCU.EDU Thu Jun 9 19:59:25 1994 Return-Path: Delivery-Date: Received: from dxmint.cern.ch by bernina.ethz.ch with SMTP inbound; Thu, 9 Jun 1994 19:58:41 +0200 Received: from cearn.cern.ch by dxmint.cern.ch (5.65/DEC-Ultrix/4.3) id AA26292; Thu, 9 Jun 1994 19:58:32 +0200 Message-Id: <9406091758.AA26292@dxmint.cern.ch> Received: from CEARN.CERN.CH by CEARN.cern.ch (IBM VM SMTP V2R2) with BSMTP id 8013; Tue, 06 Sep 94 19:55:53 SET Received: from TCUBVM.IS.TCU.EDU (NJE origin MAILER@TCUBVM) by CEARN.CERN.CH (LMail V1.2a/1.8a) with BSMTP id 6546; Thu, 9 Jun 1994 19:55:52 +0200 Received: from TCUBVM.IS.TCU.EDU (NJE origin LISTSERV@TCUBVM) by TCUBVM.IS.TCU.EDU (LMail V1.1d/1.7f) with BSMTP id 3344; Thu, 9 Jun 1994 12:49:32 -0600 Date: Thu, 9 Jun 1994 12:49:30 -0600 From: BITNET list server at TCUBVM (1.7f) Subject: File: "SCOUTS-L LYME-FAQ" To: Danny Schwendener Status: O Archive-name: LymeNet-L faq Archive-site: listserv@Lehigh.EDU Last-modified: 1993/04/25 =====----- Lyme Disease - General Information and FAQ -----===== Lyme disease is an illness caused by a spirochete bacteria, Borrelia burgdorferi, which is transmitted to animals and man through the bite of infected ticks. The disease is reported worldwide and throughout the United States. The states of New York, Massachusetts, Connecticut, Rhode Island and New Jersey account for the majority of cases in the United States. However, cases are reported from all geographic regions of the country. Different ticks are carriers in the different regions. Ixodes dammini (the deer tick) in the Northeast and midwest, Ixodes scapularis (the black-legged tick) in the South, Ixodes pacificus (the western black-legged tick) in the West and Amblyomma americanum (the lone star tick) found in several regions are all considered vectors. The is growing concern that Dermacentor variabilis (the American dog tick) may also be capable of transmitting the disease. Transmission by biting insects (flies, fleas, mosquitos) is speculated but appears to be quite rare. Not all ticks are infected. Infection rates in tick populations vary by tick species and geographic region from as few as two percent to 90 percent or more. THE DEER TICK Ixodes dammini is responsible for most of the cases of Lyme disease in the northeastern United States. These ticks are found in grassy areas (including lawns), and in brushy, shrubby and woodland sites, even on warm winter days. They prefer areas where some moisture is present. The tick has three life stages: larva, nymph and adult. Each stage takes a single blood meal. They feed on a variety of warm blooded animals including man, dogs, cats, horses and cows. The bite is painless so most victims do not know they have been bitten. The nymphal stage appears to be responsible for most Lyme disease cases. Both the larval stage (about the size of a grain of sand) and nymphal stage (about the size of a poppy seed) attach to a variety of small mammals, but prefer the white-footed mouse, the main reservoir of the Lyme disease bacteria. The adult ticks (about the size of a sesame seed) prefer to feed on white-tailed deer. The entire life cycle requires three separate hosts and takes about two years to complete. Larval and nymphal deer ticks also attach to birds. Indeed, birds may be a primary means by which the ticks (some infected) are spread from one area to another. Some species of birds also function as a reservoir of infection. LYME DISEASE SYMPTOMS IN MAN In about 50% of the cases a characteristic rash or lesion called erythema migrans is seen. It begins a few days to a few weeks after the bite of an infected tick. The rash generally looks like an expanding red ring. It is often described as looking like a bull's-eye with alternating light and dark rings. However, it can vary from a reddish blotchy appearance to red throughout. And can be confused with poison ivy, spider or insect bite, or ringworm. At about the same time that the rash develops, flu-like symptoms may appear with headache, sore throat, stiff neck, fever, muscle aches, fatigue and general malaise. Some people develop the flu-like illness without getting a rash. Seek prompt medical attention if any of these symptoms appear, especially after being bitten by a tick or visiting an area where Lyme disease is common. If possible document the presence of the rash by taking a picture because it may disappear before a physician can see it. A picture in this case is worth 10,000 words! If ignored, the early symptoms may disappear, but more serious problems can develop months to years later. The later symptoms of Lyme disease can be quite severe and chronic. Muscle pain and arthritis, usually of the large joints is common. Neurological symptoms include meningitis, numbness, tingling, and burning sensations in the extremities, Bell's palsy (loss of control of one or both sides of the face), severe pain and fatigue (often extreme and incapacitating) and depression. Heart, eye, respiratory and gastrointestinal problems can develop. Symptoms are often intermittent lasting from a few days to several months and sometimes years. Chronic Lyme disease, because of its diverse symptoms, mimics many other diseases and can be difficult to diagnose. TREATMENT Lyme disease is treated with antibiotics. Timely treatment increases chances of recovery and may lessen the severity of any later symptoms in both animals and man. The most effective treatment will be recommended by your physician or in the case of your animals by your veterinarian and will depend on the stage of the disease. Treatment for later stages is more difficult often requiring extended and repeated courses of antibiotic therapy. In animals and man treatment failures and relapses are reported. HOW TO AVOID TICK BITES When out of doors several precautions can minimize your chances of being bitten. * Tuck your pant legs into your socks and your shirt into your pants. * Wear light colored clothing. Dark ticks are more easily spotted against a light background. * Inspect clothes often for ticks. Have a companion inspect your back. * Apply repellents according to label instructions. Applying directly to clothing appears to be most effective. * Upon returning to the home remove clothing and wash or put it in the dryer for 30 minutes to kill any ticks. * When you get in from the field shower and inspect your body thoroughly. Especially check groin, navel, armpits, head and behind knees and ears. Have a companion check your back, or use a mirror. * Inspect children at least once daily for ticks. When in heavily infested areas inspect children every three to four hours. * When hiking stay in the middle of trails. Do not bushwhack. * Clear brush from around your premises and keep grassy areas mown. * Avoid plantings that especially attract deer and other animals. * Limit watering of lawns. * Judicious use of environmental insecticides to kill ticks may be necessary in some areas. LYME DISEASE IN DOMESTIC ANIMALS Lyme disease has been described in dogs, cats, horses cows and goats. Symptoms can include fever, lameness and soreness, listlessness, loss of appetite, swollen glands and joints. Heart, kidney, liver, eye and nervous system problems are also described in animals. Laminitis is reported in horses and cows, as are poor fertility, abortions and chronic weight loss. Temperament changes have been reported in dogs and horses. Untreated animals can develop chronic progressive arthritis. Symptoms can be intermittent and vary in intensity from mild to quite severe and can mimic many other conditions. If you suspect Lyme disease in your animals consult your veterinarian as soon as possible. WHERE TO FIND TICKS ON ANIMALS Ticks are most commonly found around the head and neck. They can also be found between the toes, on or in the ears, and in the armpit and groin areas. Because the ticks are so small, you must look very carefully. In animals the symptoms of illness may not develop for several weeks or months following tick bite. If you travel into tick infested areas with your animals, it is possible to bring home on the animals ticks that can infest your premises. If animals in your area develop Lyme disease it should alert you that you are also at risk. TICK CONTROL ON ANIMALS * As much as possible keep animals out of tick habitat. * Check animals daily for ticks and remove any found promptly. * Dogs and cats can be brushed as soon as they come in. Brush over a light colored surface so any ticks removed can be seen and discarded. * The most effective method to protect animals from infection and to keep those that travel from bringing ticks home is the regular use of tick repellent and control products. Permethrin, sold under many brand names, is very effective for tick control. Veterinary assistance is important in selecting safe and effective tick control products and designing a control program. HOW TO REMOVE ATTACHED TICKS FROM PEOPLE AND ANIMALS Prompt removal of ticks decreases the chances of getting Lyme disease. The proper and easiest method is to grasp the tick with fine tweezers, as near the skin as you can, and gently pull it straight out. Be careful not to squeeze the tick when removing it which could result in more bacteria being injected. Do not try to remove the tick with your fingers or attempt to remove with lighted cigarettes, matches, nail polish, or vaseline. Once removed save the tick for identification. Accurate identification becomes very important if you or your animals develop disease symptoms. Proof of tick bite and the kind of tick doing the biting is especially important to document in areas where Lyme disease is not considered prevalent and doctor suspicion is low. In most areas, ticks can be submitted for identification through local or state health department offices. Many physicians and veterinarians will also submit ticks. Put the tick in a tightly closed container with a small amount of alcohol (rubbing alcohol will do). Mark it with your name, address and phone number, date collected, host collected from (animal or man) and recent travel history. NOTES * The diagnosis of Lyme disease must generally be made on the basis of clinical signs and by ruling out other possible diseases. * Animal ownership does not directly increase a person's risk of Lyme disease. However, allowing your animals to roam in tick habitat or venturing into tick habitat with your animals does increase your risk of exposure to ticks. * Lyme disease is not considered to be contagious between people or directly from animals to man. * Although some deaths have been attributed to Lyme disease, it is not generally considered to be fatal. * Once an animal or person has apparently recovered from the disease it appears to be possible to be reinfected. * Blood testing is available for animals and man. A positive test can be diagnostic when appropriate symptoms are present. However, it is possible to have a negative test during the course of the disease or following antibiotic therapy and still have Lyme disease. A negative test following treatment does not indicate cure. * Miscarriage, premature births, still births, birth defects and transplacental infection of the fetus have been reported in animals and man. * Vaccination for dogs is now available. Consult your veterinarian for advice about your dog's need for vaccination. A vaccine for people appears to be several years away. FOR ADDITIONAL INFORMATION * State and local health departments * Your veterinarian or family physician * Local Lyme Disease support and informational groups can be found in many areas * Lyme Disease Foundation, Inc. P.O. Box 462 Tolland, Connecticut 06084 (203) 871-2900 (800) 886-LYME * The Lyme Disease Electronic Mail Network publishes the "LymeNet Newsletter" once every 10-15 days. The Newsletter contains timely news about the Lyme disease epidemic. Medical abstracts, treatment protocols, prevention information, and political happenings are all included. In addition, subscribers may ask questions to the patients, doctors and researchers on the net. To subscribe, send a memo to Internet address: listserv@Lehigh.EDU In the first line of the message, write: subscribe LymeNet-L Brochure by: Lloyd E. Miller, DVM....Troy, New York April 1993