In the last three to five years, the state has seen a steady increase in the number of newly diagnosed Lyme disease cases, but 2018 broke that trend.
Nate Wardle with the Pennsylvania Department of Health said the number of Lyme disease cases diagnosed in 2018 went down from previous years. In 2017 there were 11,900 new cases and in 2018, there were 10,208 new cases.
Lyme disease is an infection caused by the spirochete bacteria Borrelia burgdorferi. It is transmitted through the bite of an infected black-legged tick.
Dr. Richard Conn, a primary care physician in Connellsville, said the tick-borne illness seems to originate from the most northern states and have continued a slow migration southward over the years.
“In this area, these are primarily deer ticks,” said Conn. “Symptoms usually won’t start until after seven to 14 days, but can be up to 30 days after the initial tick bite. A typical infection results in fever, headache, and fatigue, which can often be mistaken for cold or flu symptoms.”
Some patients will also develop the classic “bullseye” rash, and if left untreated, the second stage of the infection can then spread to the joints, heart, and nervous system. “Thankfully, the more serious problems that Lyme disease can cause are relatively rare,” said Conn. “Lyme carditis (the heart infection), only happens in about one percent of cases of Lyme disease, and only nine deaths from Lyme carditis have been reported since 1985.
“Neurologic symptoms, which can include numbness, weakness, facial paralysis mimicking Bell’s palsy, visual problems, and meningitis symptoms, are also relatively infrequent,” he added. “Other rare neurologic problems may appear weeks, months or years after a tick bite and include decreased concentration, irritability, memory and sleep disorders, and nerve damage in the arms and legs.”
In 13 years of practice, Conn said his office has seen about 50 cases of confirmed Lyme disease, with a dramatic increase in the last three to five years.
One of the reasons the disease can be difficult to diagnose, he said, is because Lyme symptoms mimic other common diseases like the common cold, the flu, or arthritis.
“Those common diseases almost always have to be considered and ruled out first,” said Conn. “The secondary symptoms can also mimic diseases like multiple sclerosis, Bell’s palsy, or other forms of cardiomyopathy. And because the deer tick is so small, many people do not realize that they have been bitten.”
If a patient is suspected of having Lyme disease, a Lyme antibody test is administered, but Conn said it has a significant number of false positives, which is why another test, known as the Western Blot, is done as a confirmatory test.
“Western Blot is the gold standard in testing for Lyme,” he said. “It allow us to see if the antibodies that were found in the patient’s system react with antigens (proteins that cause an immune response) from the Lyme spirochete.
“But some of these proteins share similarities with other bacteria, and antibodies made against those bacteria will cross-react,” Conn added. “This is the source of most false positives.”
For a Western Blot to be considered positive, the patient’s antibodies need to react with several Lyme antigen bands on the blot. For most labs, that number is five to 10 of the 12 possible bands.
If someone is bitten by a deer tick, the Centers for Disease Control recommends a single dose of antibiotics to reduce the risk of contracting Lyme disease if the tick is from an area with a high risk for Lyme (including Pennsylvania and West Virginia).
If the tick has been attached for more than 36 hours, treatment should be started within 72 hours of tick removal. If someone has the bullseye rash, treatment is started without testing. Finally, if someone tests positive by Western Blot for Lyme, antibiotics are started.
The best way to prevent tick bites is to realize that ticks can be found anywhere there is a grassy area, said Wardle.
“So, ticks aren’t just found in rural, wooded areas, but nearly anywhere,” he added. “The ticks that carry Lyme disease have been found in every county in the state.
Brian Hair, director of emergency services at Monongahela Valley Hospital, said the biggest thing in dealing with Lyme disease is prevention.
“Ticks are very prevalent in our area and people need to be vigilant about it,” he said. “Wear long pants and long sleeves if you can and wear insect repellent that has DEET.
“Products that have 20 percent DEET in them have been found to be safe, and they’re effective in preventing ticks and mosquitoes from biting,” he added.
Wardle said it is also important to shower quickly after being outdoors to help wash off any possible ticks, and to put clothes in the dryer on high heat.
“Make sure you check yourself and your children after being outside, even if it’s just in your yard,” Hair added. “Tick-borne diseases aren’t going to go away any time soon.”