Posted by Dr Joe on March 4, 2019 · Leave a Comment
Lyme disease has gotten a bad name. Originally described in Connecticut and New York, on the coast, near the town of Old Lyme, it was found to be carried by the deer tick (the vector), a far less common tick than the tree or dog tick. It now has also been found in most parts of the country and cannot be transmitted from person to person. The deer tick is very small, about the size of the head of a pin, and as opposed to a wood (dog) tick will not engorge with the blood of other mammals, so it is often times very difficult to see when scanning the skin. This tick must remain attached and feeding for 24 to 48 hours before it is capable of transmitting disease. Only about 5% of tick bites with the deer tick in an endemic area will result in Lyme disease in the human. Ticks and tick bites are far more common during the summer months so that is when your powers of observation need to be finely tuned. You should carefully examine your children at least twice a day for the presence of any tick attached to your child’s skin. Be sure to look in those places not easy to observe such as the scalp, between the fingers and toes, and in the pubic and the perineal areas (between the genital area and the anus).
When found, these ticks should be removed from the skin by applying a tweezer to the mouth parts firmly very close to the skin, and with firm steady traction (not sudden and jerky) pull the tick from the skin. You may leave some dark mouth parts in skin; don’t try to remove them but cleanse the area well with soap and water and treat as you would for any abrasion or cut. Those mouth parts may very well come out on their own or may remain and not cause a problem. Of course these areas can become secondarily infected ( as any cut or abrasion might) with bacteria and that would result in redness, swelling, warmth over the area and pain or tenderness Since ticks actually breathe very infrequently the idea of smothering them with petroleum jelly or other thick substance would not be practical. Do not try to burn them off with a heated pin or freshly lit match head as the only thing you will probably burn is your child’s skin.
If the disease is transmitted to your child (let me point this out again, this is rare) a mild illness with feverinitially might occur in some, this is more likely not the case however, and chronic long term vague illness is also not necessarily what you will see. The rash of Lyme’s disease also does not occur in all cases and is fairly 
characteristic: initially a reddened bump that subsequently clears in the middle leaving a red ring that slowly and inexorably enlarges. Sometimes there is more than one ring and other times that ring may enlarge significantly to cover entire body parts and extend to others. As a result, it is sometimes difficult to recognize this as a ring. There are blood tests that can detect the presence of Lyme disease but these might not be positive for several weeks. Treatment is easily accomplished through the use of an antibiotic for 21 – 28 days and there is time to begin treatment, up to a week to 10 days without fear of the disease progressing. The antibiotics used are common to everyone generally without side effects: Amoxicillin for young children and doxycycline (a form of tetracycline) for children 8-10 years and older.
This is a diagnoses made usually on clinical grounds; that is as a result of your child’s doctor’s experience in light of a certain constellation of signs and symptoms. Checking the tick for the presence of Lyme disease (if you have the tick) is not recommended and neither is preventive treatment if living in a high density tick area. There are reports of “chronic Lyme disease” and the treatment of such a suspected occurrence is not clear- probably the services of a specialist (infectious disease) should be sought.
Summary– Lyme disease is not very common even though you may hear of cases in your area. If you are concerned after a tick bite take your child to his/her doctor and he/she will make the diagnosis and suggest treatment if necessary. Check your child twice a day for the presence of any ticks and remove as described above. There is plenty of time to begin treatment and the antibiotics used are well tolerated; once treated it is not recommended to repeat lab work if done originally, and it can be assumed that the illness is gone and will not leave long lasting problems.
