June 20, 2018
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Bangor pediatricians offer tips on Lyme disease

James Gathany | CDC
James Gathany | CDC
In this 2007 photo released by the Centers for Disease Control and Prevention, the trademark bull's-eye rash of Lyme disease appears on woman's arm.


Lyme disease has been in the news a lot recently, and many of the parents of our patients at EMMC Pediatric Medicine ask us about it. It’s an important health issue and we’re glad people are asking questions and becoming educated about the disease.

We have found, however, that there are misconceptions about Lyme disease. As pediatricians, it’s our goal to make sure the community has the most up-to-date, medically accurate information.

Within the first month, Lyme disease is usually characterized by the classic bull’s-eye rash, fever, muscle aches and sometimes joint pain. It is easily treated by a course of antibiotics and the infection itself does not have long-term effects. Rarely, after several weeks, some people will have multiple bull’s-eye rashes, swollen joints, headache and fatigue. Again, this stage is easily treated by a somewhat longer course of antibiotics and almost never causes any further problems.

If Lyme disease goes untreated for months or years, patients may develop a form of the disease characterized by on-and-off arthritis and, rarely, numbness. Even with this late form of the disease, the recommended antibiotic course is four weeks long. In rare cases, symptoms may persist, and a consultation with an infectious disease specialist is necessary. There is no evidence that taking antibiotics for a longer period of time is effective in treating the late onset form of the disease.

Lyme disease is becoming more common, but the risk of any one person contracting the disease remains low. There were more than 1,375 confirmed and probable cases of Lyme disease reported in Maine in 2013. To put this in perspective, that is 103.6 potential Lyme disease diagnoses per 100,000 members of the population.

Lyme disease cannot spread from person to person; it can only be contracted from a tick bite. A tick needs to be attached for a minimum of 24 hours to be able to transmit the disease, and often doesn’t transmit the disease until it has been attached for 36 hours. At that point, it is quite engorged. If the tick is not engorged, the risk of Lyme disease is almost zero.

Prevention is truly the best medicine when it comes to Lyme disease. We advise parents to apply an EPA-approved insect repellant (like DEET) on their child’s skin, check their child’s body once a day after being outside and have their child shower after coming inside. If you find a tick, remove it with a tick spoon or a pair of tweezers, grabbing the neck as close to the skin as possible and gently pulling out. It’s OK if the head breaks off. Removal of the body removes the risk.

Parents often call us to ask how Lyme disease is diagnosed and if they should have their child come in for a test. An accurate diagnosis always requires an office visit and examination, not just a lab test. It is generally not helpful to test people who do not have clinical signs of the disease. When symptoms are present, proper diagnosis is important.

Vague symptoms like fatigue, belly pain and low energy may be misdiagnosed as Lyme disease, and some people may get extended antibiotic therapy when they don’t need it. When this happens, the patient may not be getting the proper treatment for their disease. We encourage parents of children who have been bitten by a tick to call their pediatrician and determine the appropriate next steps for care.

It is not necessary to send the tick to a lab for testing, as most labs will only identify the type of tick and will not determine if it carries the germ that causes Lyme disease. The results of such a test do not affect the recommended treatment approach.

There are some people, mostly adults, who experience continued symptoms after appropriate antibiotic treatment for Lyme disease. Although this is often called chronic Lyme disease, a better term for it is post-treatment Lyme disease syndrome. These symptoms may last months but resolve with time. If symptoms persist, it is important to see a doctor to determine the true reason behind the symptoms and begin appropriate treatment.

If you have questions, please contact your doctor or an infectious disease specialist or check the CDC website for detailed, scientifically proven information. Remember that there are many sources of health information out there, and seek out information that comes from reputable sources.

The most important thing to remember is that summers in Maine are beautiful, and time spent outside should not be limited by fear of a disease that is not very common and is usually easy to treat. Taking the proper precautions is the best approach to preventing Lyme disease, and seeking medical care promptly if symptoms arise will result in the proper treatment with full recovery.

Contributed by pediatricians at EMMC Pediatric Medicine in Bangor: Dr. Amy Barrett, Dr. Melissa Burch, Dr. Scott Clough, Dr. Annie Powers, Dr. Michael Ross, Dr. Colette Sabbagh, Dr. Chelsea Swandal, and family nurse practitioner Kersten Noyes.

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