Pediatricians see summer spike in Lyme disease
This photo shows a deer tick under a microscope. (Photo courtesy of the Associated Press)
Dr. Howard Topol
Summertime means we’re spending time in the great outdoors and that brings the chance of being bitten by a tick.
Doctors are stressing the importance of protecting you and your family from Lyme disease. In 2020, 91% of all Lyme disease cases occurred in just 15 states, and Pennsylvania reported more cases than any other state. Lyme disease also disproportionately affects children, as they spend more time outdoors during summer break.
Lyme disease is caused by the bacterium Borrelia burgdorferi, which is transmitted to humans through the bite of infected blacklegged ticks. Lyme disease is one of the most common reportable infectious diseases in Pennsylvania. The U.S. Centers for Disease Control (CDC) says the actual number of Lyme disease cases may be nearly 10 times the reported number. That means Pennsylvania may have as many as 100,000 cases a year, or roughly 1 case for every 100 Pennsylvanians.
“Lyme disease is pretty common in the Western Pennsylvania area. The incidence has increased over the last 20 to 30 years,” said Dr. Howard Topol, a pediatrician with Allegheny Health Network (AHN). “We’re seeing more cases, and the tick season is usually between April and October. The incidence is way higher in June and July. That’s when we see about 50% of the cases.”
Lyme disease usually presents with a rash that starts small and increases in size to around 2 to 3 inches in diameter at the site of a tick bite. “A lot of times, kids don’t even notice that they’re bitten, or we never actually see the tick bite,” says Topol. “But about three to 30 days afterwards, you develop that expanding rash.” Topol says roughly half of pediatric Lyme disease cases he sees in his office show up in June and July.
While the bullseye-shaped rash is the most common symptom, there are other clues to what’s happening. Topol says sometimes patients don’t go through the first stage of rash, or if it’s left untreated, he sees two more phases. “Some of the things that we see in the early disseminated part of Lyme is Bell’s Palsy,” he said. “Sometimes you can see heart involvement. You can get eye involvement, or it can present like a viral meningitis.”
Late findings often present in the wintertime if Lyme is in the body for at least six months after a tick bite in spring or summer. “It takes a while for the symptoms to manifest, and then usually that would be like an arthritis,” says Topol. “Usually, one joint becomes swollen. It’s not as painful as it looks. A lot of times, you’ll see a kid walk into the office with a really swollen knee but it’s not very painful.” Flu-like symptoms can also be common, such as low-grade fever, joint aches and pains and feeling rundown along with neck pain.
If kids have been playing outside – especially in wooded areas – do a tick check all over the body, recommends Topol. “Ticks like warm areas like the armpits and the groin. For kids who have longer hair, you need to separate all the hair since they can hide on the scalp. Behind the ears is a common place as well.”
If you do find a tick, Topol recommends using tweezers to pull it off, then calling your pediatrician right away. There are blood tests for Lyme disease, but it takes a few weeks for antibodies to build enough to show up in the testing.
“A lot of times if we see the rash in the early stages, we will treat without doing any testing if it’s obvious that it is Lyme disease,” Topol says. “We might give one dose to prevent the transmission, so it’s a good idea to always call your pediatrician. For all stages, we treat with antibiotics – most commonly amoxicillin or doxycycline. The length differs based on the stage of onset.” He adds the good news is that if you get proper treatment, it will take care of the infection and not progress to the next stage.
Prevention is key, and the best protection is to use bug repellent any time you go into the woods. “You can use bug spray that contains DEET up to 50%,” Topol said. “The amount of DEET that’s in there kind of gives you a sense of how long you’ll be protected, but concentrations of DEET over 50% don’t give you any added benefit.”
When you get home, do a tick check and take a shower. If you wash the tick off before it gets attached or engorged, it may help with prevention.
“This shouldn’t be a reason not to go outside and hike and have fun as long as you are taking the proper precautions,” Topol added. “The good thing about this is if you treat it early, we can minimize any complications and kids can get better.”