February 5th, 2012
Econintersect: The geographic extent of Lyme disease has been largely determined up to now by tracking the diagnosis records from doctors. That has been less than satisfactory because the disease is very hard to diagnose by laboratory tests and clinical diagnosis is often subjective. Some medical experts maintain the disease is over diagnosed and other that it is under diagnosed. A report appearing in the February issue of the American Journal of Tropical Medicine and Hygiene gives results from a better means of defining the extent of Lyme disease: capture and test the black-legged deer ticks (pictured, click for larger image) that transmit the disease. Researchers associated with Yale University spent three years traveling around the eastern and mid-western U.S. collecting ticks on sheets dragged through the woods.
The ticks were tested for the spirochete that produces Lyme disease in humans and some other animals and generally it was found about 1 in 5 carried the infectious agent. The range of the ticks in the east and upper Midwest was greater than had been previously assumed and there were indications that the range might be extending although more testing in future years will be needed to confirm that. The following map is from the journal article and shows all the testing areas across the eastern U.S into the Great Plains and to the Gulf of Mexico.
Another version of the map was published by the Raleigh News Observer on February 4:
Information about Lyme disease can be obtained from ILADS (International Lyme and Associated Diseases Society).
Editor’s note: This editor has been infected with the Lyme spirochete since at least the mid-1980s. After several years of progressive symptoms (chronic stiff neck, grossly swollen and deformed fingers, knee pain, disturbed sleep and periods of difficulty concentrating) treatment (several months of oral antibiotics) was administered on the basis of a clinical diagnosis and all symptoms were resolved. Blood tests for Lyme disease at the time were negative. One confirmatory observation that Lyme disease was in fact the likely culprit: at the end of the third week of treatment I broke out in a full body rash which persisted for about 6-7 days. This was what is known as the Herxheimer reaction.
The course of that first treatment, which started at the end of 1988, was four months. It took three months to completely resolve all symptoms and a fourth month of “polishing off” treatment was administered. Since 1989 there have been five re-occurrences of Lyme disease. In the third re-occurrence (1997) there were severe neurological symptoms with intense pain and atrophy of more than 75% of the right quadriceps in about three months. I didn’t realize that Lyme disease was involved and did not seek treatment until I was severely affected. That time there was finally a positive blood titer for the spirochete. The doctor said it was the highest titer he had ever seen up to that time.
The fourth re-occurrence was in 2003 and I sought treatment when the early neurological symptoms and leg pain started to return. The treatment was successfully completed in two months. In early 2005 I moved from the Hudson Valley (a Lyme hotspot) to the central Piedmont in North Carolina. According to the research map I am more than 200 miles from the nearest potential exposure risk. But in the spring of 2010 I had a re-occurrence of the same neurological symptoms with leg pain which I did not have treated as quickly as I should have and suffered excruciating pain for several weeks during the period of delayed treatment and the first 2-3 weeks of antibiotics.
It was interesting that when I did seek treatment I went to an urgent care facility, recounted my history, waited while the physician check the CDC (Center for Disease Control) online information and decided to give me the requested prescription (30 days). I then went to my regular doctor a couple of weeks later to get his review and to get the next 30 day prescription. After a serious discussion I convinced him that my long experience history gave a high probability that my diagnosis was correct. He had been reticent to prescribe another 30 days because (1) I had no evidence of having a precursor tick bite, (2) the standard CDC guideline for treatment is 30 days of antibiotics as soon as possible (definitely within 6 months) of a tick bite and (3) the CDC does not recognize that a chronic infection can exist. And a chronic infection is what I clearly had to have with recurring symptoms five years after the last exposure to an infection risk area.
My advice to anyone who is exposed to a possible Lyme disease infection is to find a doctor who is a member of ILADS. The possibility of being treated improperly by anyone else is simply too great.
New map pinpoints Lyme disease risk areas (Holly Ramer - Associated Press, Raleigh News Observer, February 4, 2012)
Human Risk of Infection with Borrelia burgdorferi, the Lyme Disease Agent, in Eastern United States (Maria A. Diuk-Wasser and 15 co-authors, American Journal of Tropical Medicine and Hygeine 2012 vol. 86 no. 2 320-327)