by Kathy Meyer
Virginia Governor’s Task Force on Lyme Disease 2010-13 and
Co-leader, Parents of Children with Lyme Support Network, DC Metro Area
“…The physician cannot rely on a laboratory test or clinical finding at the time of the bite to definitely rule in or rule out Lyme Disease infection, so must use clinical judgment as to whether to use antibiotic prophylaxis. Testing the tick itself for the presence of the spirochete, even with PCR technology, is helpful but not 100% reliable.
An established infection by B. burgdorferi [the bacteria that causes Lyme] can have serious, long-standing, or permanent, and painful medical consequences, and be expensive to treat. Since the likelihood of harm arising from prophylactically applied anti-spirochetal antibiotics [taking antibiotics to kill potential infection] is low, and since treatment is inexpensive and painless, it follows that the risk benefit ratio favors tick bite prophylaxis.”
-Dr. Joseph Burrascano, the longest-treating physician for Lyme in the U.S.
As the weather warms, there is justifiable panic in the question, “I just found a TICK on me, so what do I DO?!”
The only important question is, “Was the tick embedded?” If it is dug in and starting to exchange bodily fluids, just like with unprotected sex and STDs, it may have given you a disease. You can determine if the tick has started to suck your blood if the body of the tick is at all “puffy” or rounded. (If the tick is fully flat and pulls off with ease, it is not a problem.)
What to do next? I’m not qualified to give medical advice, but I’m grateful for the experienced Lyme specialists who have published their opinions. “I definitely advise treating tick bites. Waiting for symptoms is unwise,” says Dr. Steven Phillips in the Huffington Post. He says he starts treatment “within hours of the tick-bite.”
URGENT CARE AFTER TICK BITES:
When you find an embedded tick, suspect a Lyme rash (not everyone gets a rash, and it may not look like a bull’s-eye, but more like a spider bite.), and/or have flu-like symptoms after tick exposure (especially in summer months), and if you are not under the care of a Lyme-literate doctor (LLMD), go to your local Urgent Care or Emergency Room and request a full course of antibiotics ASAP.
Testing for Lyme is typically negative in the first several weeks after a tick-bite. Antibodies take time to form.
Remember, ticks carry MANY diseases in addition to Lyme, some only recently identified and some not yet identified, and waiting for any test results to start antibiotics can place you at risk for losing your best window to prevent chronic tick-borne disease.
TREATMENT AFTER A TICK BITE:
As Dr. Burrascano notes above, a doctor can’t rely on any testing or symptoms when it comes to a tick bite, and speed is crucial to prevent disease. He recommends the following:
TICK BITES – (Anecdotally, as little as four hours of attachment can transmit pathogens.) The risk of transmission is greater if the tick is engorged, or of it was removed improperly allowing the tick’s contents to spill into the bite wound. High-risk bites are treated as follows (remember the possibility of co-infection):
1) Adults: Oral therapy for 28 days. Consider Doxycycline first in early Lyme due to concern for Ehrlichia co-infections. Doxycyline 200 mg bid with food
2) Pregnancy: Amoxicillin 1000 mg q6h for 6 weeks. Test for Babesia, Bartonella and Ehrlichia. Alternative: Cefuroxime axetil 1000 mg q12h for 6 weeks.
3) Young Children: Oral therapy for 28 days. Amoxicillin 50 mg/kg/day divided into q8h doses.
See Dr. Burrascano’s complete guidelines on the treatment of Lyme and Other Tick-borne Diseases: http://lymenet.org/BurrGuide200810.pdf
NOTE: Although the CDC sometimes permits use of a single dose of doxycycline, the International Lyme and Associated Diseases Society (ILADS) disagrees. Their guidelines…”placed a high value on preventing disease… not causing the abrogation of the immune response.” Therefore, “Clinicians should not use a single 200 mg dose of doxycycline for Lyme disease prophylaxis.” www.tandfonline.com/doi/full/10.1586/14787210.2014.940900
REMOVE ATTACHED TICKS IMMEDIATELY:
- Use fine-tipped tweezers or shield your fingers with a tissue, paper towel, or rubber gloves, when removing the tick; otherwise infectious agents may enter through mucous membranes and breaks in the skin. DO NOT use petroleum jelly, a hot match, nail polish, or other products.
- Grasp the tick as close to the skin surface as possible and pull upward with steady, even pressure.
- DO NOT twist or jerk the tick; this may cause the mouthparts to break off and remain in the skin.
- DO NOT squeeze, crush, or puncture the body of the tick because its fluids may contain infectious organisms.
- After removing the tick, disinfect the bite site and wash your hands with soap and water.
- Reference: https://www.fairfaxcounty.gov/health/fightthebite/ticks
The best scenario of all is no tick bites.
- Avoid direct contact with ticks. Avoid wooded and bushy areas with high grass and leaf litter and walk in the center of trails. Learn how to maintain a tick free yard.
- Use a repellent containing DEET. Repellents with DEET can be applied to exposed skin to help repel ticks. Follow the label instructions. (**Consumer Reports has also identified Repel with lemon eucalyptus or Sawyer with 20% picaridin as acceptable repellents. Other essential oils or mixtures do not seem to provide repellency except briefly, according to the CR testing.)
- Wear long, loose-fitting, light-colored clothing. Wear long-sleeved shirts and long pants. Tuck your pants into your socks and your shirt into your pants so ticks don’t have easy access to your skin. It’s easier to see ticks when they are crawling on light-colored clothes.
- Use permethrin on clothing. Permethrin kills ticks and there are formulations to treat your clothes sold at sporting goods stores. Follow the instructions on the label. (Pre-treated clothing is available from many labels now and is effective through many washes.) Permethrin-treated clothing is far more effective than just repellents on skin because permethrin kills.
- Check for ticks. While outside, take breaks to check yourself for ticks. Bathe or shower as soon as possible after coming indoors (preferably within two hours) to wash off and more easily find ticks that are crawling on you. Do a thorough check at the end of the day; use a mirror or have someone help you check the hard-to-see places on your body.
- Examine gear and pets. Ticks can ride into the home on clothing and pets, then attach to a person later, so carefully examine animals, coats and backpacks. Dry clothes on high for 30 min BEFORE washing to kill any ticks you may not see.
FOR FURTHER INFORMATION:
Governor’s Task Force on Lyme Disease in VA 2010-13
Parents of Children with Lyme Support Network for DC Metro Area
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