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Throughout the year, Massachusetts residents are faced with guarding against a number of infectious
diseases. Seasonal flu, swine flu, West Nile virus, and Eastern Equine Encephalitis are all threats to our public
and personal health. Lyme disease can be one of the most problematic.
According to the Centers for Disease Control,
Lyme disease is the most commonly reported vectorborne disease in the United States, and 93 percent of cases occur in just 10 states.
Massachusetts is one of those states, with the fifth highest incidence of the
disease. (A vectorborne disease is one that is transmitted to humans
or other animals by an insect or other arthropod-type animal. One
example: mosquitoes, which transmit West Nile virus.)
The disease has the potential to cause serious
health problems, and that’s why “early detection is of paramount
importance,” says Martin Kafina, M.D., a rheumatologist at Emerson Hospital in Concord and a specialist in Lyme disease.
But Dr. Kafina, who is also an instructor at Harvard Medical School, offers some good news. “Caught early, Lyme disease is curable,”
he says.
Dr. Kafina presented a wealth of information on
Lyme disease, detailing its causes, symptoms, potential effects, and
treatments, on the February edition of the Massachusetts Medical
Society’s Physician Focus television program, hosted by Bruce Karlin, M.D., a
primary care physician who practices in Worcester.
When first contracted, Dr. Kafina explained, the
disease initially presents flu-like symptoms, with accompanying
fatigue, fever, headache and sore muscles and joints. But if missed,
misdiagnosed, or left unattended, the disease can move into secondary
and tertiary stages, ultimately causing serious problems to joints,
the nervous system, and even the heart.
Lyme disease was first outlined in 1977 by
epidemiologists at Yale University, following an investigation of an outbreak of arthritis among a dozen
or so children in Lyme, Connecticut. The disease is transmitted by ticks, some only the size of a pencil
point. These ticks carry what is called a spirochete – a microbe or
bacteria identified as Borrelia
burgdorferi – that infects humans.
The disease is transmitted by the tick, which
latches on to humans for a blood meal. As it feeds itself, the tick regurgitates the spirochete – or
germ – into the human’s blood stream, infecting the person. If
undetected, the tick may feed itself for 24-48 hours. Removing the
tick before or within that time period will usually prevent the
infection from occurring.
The signature mark of early infection is a rash,
appearing anytime between 10 to 20 days after the bite as a red circle
and taking the shape of a “bulls-eye” with a fleshy clearing in
the middle. “If you see the rash,” says Dr. Kafina, “you’ve
been inoculated with the spirochete. Call your doctor.” The
disease is treated with a regimen of antibiotics.
While Dr. Kafina says the human immune system is
highly effective in responding to disease -- “The spirochete has to
get past a raft of protections our body has to do damage.” -- early
detection is critically important.
So is pinpoint identification of the disease.
“It’s also important not to confuse Lyme disease with other
conditions such as fibromyalgia or Lupus, which can present similar
symptoms,” Dr. Kafina said. Testing
for Lyme disease, which can include a physical exam and blood test,
can have objective findings, he said.
Lyme disease can be contracted throughout the
year, when the temperature is above freezing and ticks are seeking
their blood meal. But ticks are most active in warm weather and
present the biggest risk then. For those who spend a lot of time
outdoors or live in tick-infested areas, vigilance is the key.
The number of confirmed cases of the disease is
climbing rapidly in the state: from 1999 through 2008, the incidence
of Lyme disease in Massachusetts quadrupled, from just under 1,000 cases to nearly 4,000. Nationally,
the latest statistics from the CDC indicate that the number of cases
reported have more than doubled from 1998 through 2006.
No vaccine to prevent the disease currently
exists, so the best prevention is protection – wearing long-sleeve
shirts and pants, using a repellent with DEET according to
instructions, and – most important -- performing a “tick check”
on yourself after being in tick-infested areas. And for animal lovers,
know that animals can also get Lyme disease, so if you have pets or
share space with animals, check them daily as well.
Text:
MMS/Richard Gulla
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