[Hubbardbrookisefield] Fwd: A couple of comments on Lyme disease

Thu Jun 18 14:14:27 EDT 2015

Hi all, we are sharing this important information on Lyme disease. Sorry if this is a double post! Be vigilant! I have had Lyme disease and it is not fun!

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Begin forwarded message:

From: "Bailey, Scott -FS" <swbailey at fs.fed.us<mailto:swbailey at fs.fed.us>>
Date: June 18, 2015 at 7:24:20 AM PDT
To: "Burchsted, Denise" <dburchsted at keene.edu<mailto:dburchsted at keene.edu>>
Cc: "gwilson at hbresearchfoundation.org<mailto:gwilson at hbresearchfoundation.org>" <gwilson at hbresearchfoundation.org<mailto:gwilson at hbresearchfoundation.org>>, Mark Green <mbgreen at plymouth.edu<mailto:mbgreen at plymouth.edu>>, "Bailey, Amey -FS" <ameybailey at fs.fed.us<mailto:ameybailey at fs.fed.us>>, "Rustad, Lindsey -FS" <lrustad at fs.fed.us<mailto:lrustad at fs.fed.us>>
Subject: Re: A couple of comments on Lyme disease

Denise, thanks for sharing this. I have less experience with this and appreciate your insight. However, my opinion matches your - that a bite combined with symptoms warrants immediate treatment rather than waiting for a diagnosis.

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On Jun 18, 2015, at 10:09 AM, "Burchsted, Denise" <dburchsted at keene.edu<mailto:dburchsted at keene.edu>> wrote:

Hi Geoff:

After spending some time thinking about Kyle's heath yesterday, I'd really like to mention a couple of things that I know about Lyme disease in the context of the REUs.

For quick background: I don't have enough fingers & toes to count the number of friends, family, and colleagues who had / have Lyme disease. Most cases have resolved just fine. Some have not. It seems important to share what I have learned from where the disease is ubiquitous (my Dad's family is from the town next to Lyme, CT, and I have lived much of my adult life less than 50 miles from Lyme).

- I would strongly encourage anyone at Hubbard Brook who finds an engorged deer tick to obtain prophylactic antibiotics within 72 hours. This follows IDSA and State of NH recommendations: http://cid.oxfordjournals.org/content/43/9/1089.full.pdf+html and http://www.medscape.com/viewarticle/825419#vp_1 .

- The bullseye rash is a red herring. It is outstanding for identifying cases when it develops (i.e., true positive), but its absence is more likely than not (i.e., many many false negatives). Even where it commonly appears, 1/4 to 1/3 of cases never develop the bullseye rash. In my experience, with >20 cases I know of, I can only think of one that had a bullseye rash. Homogenous redness and swelling is more common (including my own case), but that is still not present even in the majority of cases in my experience. Perhaps that is because generalized redness and swelling around a tick bite seems unremarkable and most do not think of it. I see now that that the observation of more homogenous vs bullseye rashes has ben documented for endemic areas: http://annals.org/article.aspx?articleid=715176

- Anyone who has removed an engorged deer tick should be watched closely for flu-like fatigue, joint pain, fever, painful headaches, or odd neurological symptoms. Kyle's symptoms yesterday fit the bill perfectly, which is why I had asked if he had gotten a tick bite. I am baffled why he was attempting to work yesterday (I sent him home after we got out to the field site): he should have been asking for assessment of whether he has Lyme. I would be willing to spend some time educating the other REUs on what I know about the symptoms, if that would be helpful. I will be around for the next three weeks.

- In places where these cases are still early (like central NH), it is common for medical practictioners to not recognize symptoms and to err on the side of diagnosis-caution. I am troubled that Kyle was apparently sent home with instructions to wait for a week to get back the test results. In CT, someone who looked like him with his tick bite history would walk out of the office with a prescription to be filled, with the understanding that s/he would stop taking the abx if the test came back negative.

- I suspect that the standard blood test will include the other tick-borne diseases in NH (anaplasmosis, babesiosis), but it would be good to confirm that. Compared with Lyme disease, they are less common but present nonetheless. Anaplasmosis in particular is far worse than Lyme, based on my experience with the three people I know who had it. They all say that their doctor literally saved their lives.

With apologies for the length of this, but obviously this is something that I feel strongly about, and I feel that I need to bring it up. Again, I am willing to provide more information to the group if that would be useful. And would you keep me updated on how Kyle is doing?

  - Denise

Update on Lyme Disease and Other Tick-borne Diseases: An Alert for New Hampshire Clinicians
New Hampshire continues to have one of the highest rates of Lyme disease in the nation. The New Hampshire Division of Public Health Services provides recommendations for healthcare providers.
Read more...<http://www.medscape.com/viewarticle/825419#vp_1>

--
Denise Burchsted, PE, PhD
Assistant Professor of Environmental Studies
mail: 229 Main Street MS 2001; Keene State College; Keene, NH 03435-2001
office: (603) 358-2176; Putnam Science Center room 236
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