Lyme Disease is often misdiagnosed

By Martin J. Kafina, M.D., F.A.C.P., F.A.C.R.

It's often missed and misdiagnosed. You can get it without knowing or remembering it, and if untreated or improperly treated it can cause serious problems years after you first contract it. There's no vaccine for it.

It's Lyme disease, and Massachusetts residents are considered at high risk for getting it. Figures from the state Department of Public Health show that the incidence of Lyme disease in the Commonwealth has increased five-fold since the early 1990s. The Bay State, in fact, ranked seventh among the states in the number of reported cases of Lyme disease from 1994-2003, according to the Centers for Disease Control.

Lyme disease, first described by the Rheumatology Group at Yale New Haven Hospital in the late 1970s, is caused by bacteria called a spirochete. It's carried and transmitted by various kinds of ticks (the deer tick is most prominent in our region), which can spread the disease to humans and animals.

The disease is contracted when the tick bites and leaves the bacteria in the skin. In most cases, the disease is characterized by a red circular rash appearing several days after the tick bites. Flu-like symptoms, including fever, muscle and joint pain, may also occur. If not treated early, Lyme disease can lead to problems with the nervous system, heart, bones and joints, and can result in severe debilitation.

Fortunately, awareness of this disease is growing. Last October the legislature's Public Health Committee heard from hundreds of patients, doctors, rheumatologists, and infectious disease experts on the need for more education and preventive efforts. Patients recounted their stories about being misdiagnosed and the disease's debilitating effects; physicians testified about the tricky nature of diagnosis, saying people can suffer from symptoms that may or may not be caused by the infection or develop symptoms weeks or months after being infected.

Tick season begins with the warmer months, and because ticks are carried by deer, mice, birds, and other small animals that can appear in your backyard, now's the time to remind ourselves about the disease, what can be done to protect you and your family, and what to do if you suspect you have it. This is especially important for those who live in or near wooded areas, spend time outdoors, or engage in such activities as hiking.

The Infectious Disease Society of America (IDSA) says the best approach to Lyme disease is that old tried and true prescription: prevention. If you're in an area susceptible to ticks (woods, overgrown grass or bushes), wear protective clothing -- long pants (tuck into socks as an added safeguard), long-sleeve shirts, and hats -- and use tick repellents. After exposure, inspect your entire body and scalp.

If you discover you've been bitten, promptly take precautionary steps. Carefully remove the tick with tweezers. Next, call your health care provider to see if you need to start treatment. Lyme disease caught early is treatable, and delayed recognition or diagnosis or inadequate treatment is dangerous and can lead to serious complications. The prescribed treatment is usually a regimen of antibiotics for two to three weeks. Finally, monitor the affected area closely for up to 30 days for signs of illness - the tell-tale red rash at the site of the bite.

Children who live or play often in tick-prone areas should receive special attention. Many don't remember if or when they might have been bitten, find it hard to describe exactly how they're feeling, and may still appear well and active after infection.

Be cautious if you share your living space with animals. Lyme disease has been known to affect various animals, including dogs and cats. Pets should be inspected daily, and if a tick is discovered (most commonly found around the head and neck), contact your veterinarian.

It's important to be vigilant about Lyme disease, because while symptoms may appear within days of the tick bite, symptoms may also be delayed for weeks, months, or even years in some cases.

As warm weather approaches and with Massachusetts a high-risk area for Lyme disease, each of us should learn more about this disease. Visit the Centers for Disease Control (www.cdc.gov) and The Lyme Disease Association (www.lymediseaseassociation.org) for more information on symptoms, diagnosis, transmission, and prevention.

Martin J. Kafina, M.D., F.A.C.P., F.A.C.R., is a clinical instructor in medicine at Harvard Medical School at Beth Israel Deaconess Medical Center and specializes in the private practice of rheumatology at Emerson Hospital in Concord. Physician Focus is a public service of the Massachusetts Medical Society. Readers should use their own judgment when seeking medical care and consult with their physician for treatment. Send comments to PhysicianFocus@mms.org.