Tuesday, March 28, 2023

Since children play outside, especially with pets it is understandable that 25% of cases of lyme disease involve the pediatric age group. In fact, boys between the ages of 5-19 years are infected three times as much as other age groups. Lyme Disease is transmitted when a tick (deer or mice) feeds on an infected host then passes the bacteria by feeding on humans. Humans, mostly children, are exposed when playing in grass and when exposed to pets who are exposed to the outdoors.

The disease takes its name from Lyme and Old Lyme, Connecticut where cases of children with similar symptoms were described in 1977. The disease was first called Lyme arthritis. Lyme disease is a bacterial infection which affects multiple organs and can vary in clinical presentation. It is caused by the bacteria Borrelia Burgderoferi and transmitted by ticks. The ticks are unfortunately very small, the size of a pinhead and frequently go unnoticed. The initial symptoms may easily mask an unspecified viral infection and diagnosis may be delayed with possible serious consequences. Lyme Disease is the most frequent tick-borne disease in the Northern Hemisphere.

The disease can be described in three phases: Early localized infection, early disseminated infection, and late disseminated. A rash is present only in 70-80% of infected people and may not be the classic “bull’s eye rash,” also known as Erythema Chronicum Migrans (ECM). This rash generally appears 3 to 30 days after a tick bite. It may be itchy, dark red, and warm but generally is not painful. Within days to weeks after the bite the bacteria spreads through the bloodstream. The presentation at this point may be rashes in areas not associated with the initial bite, fever, fatigue, facial nerve palsy (paralysis of half the face), neck stiffness, severe headaches, and joint pain. The late disseminated phase may progress if the patient is untreated. This is characterized by severe neurological symptoms such as shooting pains of arms and legs, difficulty in concentrating, severe headaches, impairment of sensory and motor function. In its late stages, walking may be difficult or impossible. Cognition may be impaired as well.

Treatment of Lyme Disease is with antibiotics which in the early stages are very effective. The challenge to parents and health care providers is making a diagnosis. Frequently, tick bites are not detected and the rash is either absent or not typical so easily mistaken for a viral rash. The delay in diagnosis may lead to a more serious and controversial phase which is chronic lyme.

Aside from medical school and residency, most of my knowledge came from my grandmother: prevention is far better than treating once a disease has already occurred. So, “tick check” in children is a great idea. The tick has to usually be imbedded in the skin for 24 hours before the bacteria can be transmitted. A rash needs to be examined no matter how well you think you can describe it over the phone and children who have fever, fatigue, and joint pain should be examined and tests done to see if Lyme Disease is the cause.

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