The Common and Serious Problem of Lyme Disease

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.

First published at Youth Fitness Council on July 6, 2014

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.

For detailed recommendations on treatment, consult the 2006 Guidelines for treatment developed by the Infectious Diseases Society of America. Additional information on prolonged treatment for Lyme disease is also available.