Lyme disease is nothing to take lightly, as
Women’s National Basketball Association (WNBA) rookie stand-out Elena Delle
Donne demonstrates with a recurrence of the sometimes stubborn condition that
has her sidelined indefinitely.
by John B. Tyburski,
PhD, MPH
Youth
Fitness Advisory Board
Copyright © 2014
Youth Fitness Council, LLC. All rights reserved.
Last week
the Chicago Sky announced that guard/forward Elena Delle Donne returned to her
home in Delaware to seek continued treatment for recurrent Lyme disease. The
WNBA rookie of the year has already missed five games in June but scored 13
points in a recent loss to Connecticut. Now she is sidelined with no
speculation as to when she may return, according to team officials.
“It’s
extremely frustrating for her, obviously physically, but it takes a mental toll
as well,” Sky coach Pokey Chatman told The Associated Press. “She tries to
be-stoic about everything. But I told her, this thing is real and you are doing
the right thing by dealing with it.”
The 6-foot-5
Delle Donne, known in the league and among her fans as “EDD,” had an exemplary
college career at Delaware, despite missing play on three separate occasions
because of Lyme disease. This season, she averaged 21.2 points per game with
the Sky.
In North
America, Lyme disease is caused by spirochete bacteria (Borrelia burgdorferi)
transmitted from small mammals to humans by ticks, mainly deer ticks. The name
“Lyme” was coined from two towns in Connecticut, Lyme and Old Lyme, in which a number
of cases of the disease were recorded in 1975 before pathological agent and
vector information were discovered. It was in 1978 that investigators
determined that ticks are the vector or transmitter for the disease, but it was
not until 1981 that the bacteria that cause Lyme infection were isolated by
entomologist Willy Burgdorfer, the namesake of B. burgdorferi.
Ticks
acquire the spirochete bacteria from biting and feeding on the blood of
infected small mammals, most often the white-footed mouse. The infected ticks
can then transmit the bacteria to new hosts during subsequent blood feedings.
It can take less than 24 hours for a tick to infect a human or other animal
host. Interestingly, deer ticks cannot acquire the bacteria from deer, even
infected deer. However, deer serve as highly mobile dispersion agents for
infected ticks, exhibiting a strong propensity for invading highly populated
human population centers, especially under the dark cloak of night.
According to
the
U.S. Centers for Disease Control and Prevention,
over 30,000 new cases of Lyme disease are recorded each year. It is the most
commonly reported vector-borne illness in the U.S., but it does not occur
uniformly through the country. Cases reported in 2012 in only thirteen states
accounted for about 95 percent of all cases for that year. Lyme disease is
concentrated in the northeast (Virginia, Maryland, Pennsylvania, Delaware, New
Jersey, New York, Connecticut, Massachusetts, Vermont, New Hampshire, and
Maine) and in the northcentral (Minnesota and Wisconsin) U.S. In 2012, it was
the 7
th most common
Nationally Notifiable disease.
The
symptoms of Lyme disease vary
depending on time after infection. Within three to 30 days after an infecting tick
bite, approximately 70 to 80 percent of patients will exhibit an expanding red
rash called erythema migrans (EM). This is the “bull’s-eye rash” often
associated with Lyme disease. This rash may or may not form around the
infecting bite wound. During this period, infected individuals may also
experience fatigue, headache, fever, chills, muscle and joint aches, and
swollen lymph nodes. A few different antibiotics are commonly prescribed at
this stage of illness.
Early disseminated stage (days to
weeks post-tick bite)
Untreated,
the infection may spread from the site of the bite to other parts of the body,
producing an array of specific symptoms that may come and go, including:
- Additional EM lesions in other areas
of the body
- Facial or Bell’s palsy (loss of muscle
tone on one or both sides of the face)
- Severe headaches and neck stiffness
due to meningitis (inflammation of the spinal cord)
- Pain and swelling in the large joints
(such as knees)
- Shooting pains that may interfere with
sleep
- Heart palpitations and dizziness due
to changes in heartbeat
Many of
these symptoms will resolve over a period of weeks to months, even without
treatment. However, lack of treatment can result in additional complications
lasting years.
When left
untreated, the infection may spread to distant parts of the body and manifest
in additional EM rashes, pain and swelling in the large joints, facial palsy,
severe headaches and neck stiffness from meningitis, heart palpitations from
carditis, and dizziness as a result of irregular heartbeat. This early
disseminated stage is usually observed days or weeks following an infecting
tick bite. Intermittent arthritis with severe joint pain and swelling, shooting
pain, numbness or tingling in hands or feet, and interruptions of short-term
memory may occur in late disseminated stage, which is typically months to years
after the infecting tick bite.
Even with
early detection and proper treatment with antibiotics, about ten to 20 percent
of patients may experience what is called Post-treatment Lyme disease syndrome,
or PTLDS. This chronic condition can last months to years and manifests as
muscle and joint pains, cognitive defects, sleep disturbances, or fatigue. No
evidence has been found for persistent presence of B. burgdorferi in
these patients and some investigation suggests an autoimmunity component, but
not much is really known about the cause or causes of PTLDS.
Are children at risk for Lyme
disease?
Yes, of
course. In fact, approximately 25 percent of all documented Lyme disease cases
involve children. The CDC reports that boys of ages five to 19 years exhibit
the most cases at three times the average rate for all other age and gender
groups. Like with any adverse health condition, Lyme disease in children brings
issues unique to these young patients.
According to
the non-profit corporation
LymeDisease.org,
special consideration must be given to recognizing Lyme disease risk and
infection in children. For one, a very important challenge regarding Lyme
disease in children is achieving accurate and timely diagnosis because children
have less experience and ability to communicate about what it means to feel
“normal” as well as “ill.” What is more, the symptoms of early localized Lyme
disease mimic and may be mistakenly attributed to other, more common illnesses.
It is difficult to assess changes in these symptoms, especially worsening
trends. Finally, a very long list of symptoms has been assembled from numerous
pediatric case reports, indicating that properly diagnosing Lyme disease in
children can be extraordinarily challenging. The reader is referred to the
organization’s
pediatric Lyme disease resource for details.
A
comprehensive guide to Lyme disease is available for download from the CDC. Families
residing in the states mentioned earlier should review this and other resources
periodically and be always vigilant in checking for ticks and monitoring for
symptoms. The CDC also makes available a number of
communication tool kits for
specific groups, including parents and adult leaders and coaches. As with most
diseases, early detection is a key determinant in preventing Lyme disease from
becoming a chronic condition.
Minimize the Risks
As they say,
“prevention is the best medicine.” For parents and adult leaders in area with
high Lyme disease incidence, preventing tick bites in children should be a top
priority.
- Learn to
recognize ticks in their various life stages.
- If possible,
avoid tick-infested areas such as deep grass and dense forests where large
populations of deer are observed.
- Clothe
children in light-colored clothing that makes ticks easier to spot and covers
as much of the body as possible.
- Use
DEET-containing insect repellent on exposed skin and spray permethrin solution
onto clothing.
- Secure both
wrist and ankle cuffs to prevent ticks from gaining access to bare skin through
these openings.
- Thoroughly
inspect for ticks after being outdoors.
- Inspect any
bedding or seating areas for ticks.
- Remove ticks
immediately; they may be killed by immersing in rubbing alcohol.
In short, be
informed, aware, and diligent in preventing tick bites to prevent Lyme disease.
Use EDD’s hiatus from WNBA play as a wake-up call to how serious this illness
can be for the active child.
Treatments
Patients
treated with appropriate antibiotics in the early stages of Lyme disease
usually recover rapidly and completely. Antibiotics commonly used for oral
treatment include doxycycline, amoxicillin, or cefuroxime axetil. Patients with
certain neurological or cardiac forms of illness may require intravenous
treatment with drugs such as ceftriaxone or penicillin.
Approximately
10-20% of patients (particularly those who were diagnosed later), following
appropriate antibiotic treatment, may have persistent or recurrent symptoms and
are considered to have Post-treatment Lyme disease syndrome (PTLDS). The
National Institutes of Health (NIH) has funded several studies on the treatment
of Lyme disease which show that most patients recover when treated with a few
weeks of antibiotics taken by mouth. For details on research into what is
sometimes referred to as “chronic Lyme disease” and long-term treatment trials
sponsored by NIH, visit the
NIH Lyme Disease web site.
