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The much smaller nymphal tick, that is about the size of a medical conditions have been noted to be caused or associat-
poppy seed, is responsible for about 95% of cases of Lyme ed with Lyme disease in peer reviewed medical journals. Early
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and is most active from mid-May through late August in Con- detection and treatment can help prevent the late manifesta-
necticut. tions of Lyme which are often severe and difficult to treat.
Nymphal ticks feed for 4 days while adult ticks feed for
5-7 days. The rate of transmission of Lyme from the bite of an What are the symptoms of Lyme in Children?
infected tick increases over time. Transmission over the first 48
hours is about 12%; however it increases dramatically to 75% Children under the age of 15 account for 25% of reported
at 72 hours and 94% at 96 hours. In the Northeast, as many as cases of Lyme disease. In addition to the symptoms mentioned
70% of ticks may be infected with Lyme and 50% of ticks may above, many children experience abrupt behavioral changes,
carry other tick-borne illnesses. uncharacteristic outbursts, rapidly declining grades and trou-
ble tolerating their normal environment. This sometimes leads
What are the Signs and Symptoms of Lyme Disease? to them being misdiagnosed with autism or ADHD. Other
common symptoms include abdominal pain, nausea, vomit-
A red rash with central clearing (bull’s eye), called ery- ing and digestive difficulties.
thema migrans (EM), is diagnostic of Lyme disease. Studies
show that 40-69% of people have the classic EM rash; how- How is the diagnosis of Lyme made?
ever, physicians report that this rate may be as low as 10%.
This rash may not occur at the bite site. Patients may pres- Lyme disease is a clinical diagnosis based upon the symp-
ent with multiple EM rashes or other types of rashes. Fifty to toms a patient is experiencing. It is important for physicians
seventy-five percent of those infected with Lyme disease do to consider if a patient lives in a Lyme endemic area, such as
not remember having had a tick bite. Connecticut, or has a history of tick bite. An EM rash in Con-
Lyme is a complex, multi-system disease that has the po- necticut is diagnostic of Lyme disease and laboratory testing
tential to affect every organ system in the body. The most com- is not necessary to support the diagnosis. Symptoms consis-
mon symptoms of acute Lyme disease include flu-like symp- tent with Lyme disease in a patient without an EM rash are
toms, migratory joint and muscle pains, fatigue, headache, also diagnostic of Lyme. In cases where the diagnosis is not
cognitive dysfunction (often called brain fog) and migratory clear or symptoms have been present for a prolonged period
paresthesias (a numb or tingly feeling). Some patients experi- of time, laboratory tests may be helpful in supporting a diag-
ence sound and light sensitivity as well as eye pain. nosis. Many physicians diagnose Lyme using the criteria set
Lyme has been called “The New Great Imitator” because forth in the CDC surveillance case definition of Lyme disease,
it can present with a myriad of symptoms that mimic other including a two step laboratory testing strategy: an antibody
disorders (Historically, Syphilis was the first “great imitator”). screen followed by a confirmatory Western blot. These tests
Patients may be misdiagnosed with conditions including de- are known to miss 20-50% of patients who have Lyme disease.
pression, anxiety, migraine headaches, fibromyalgia, chronic On its website, the CDC states, “This surveillance case defini-
fatigue syndrome and multiple sclerosis. tion was developed for national reporting of Lyme disease; it
Severe cases of Lyme can cause heart block (a blockage in is not intended to be used in clinical diagnosis.”
the heart’s electrical system), meningitis (inflammation of the Due to inaccuracies in currently available laboratory tests,
covering of the brain and spinal cord) or encephalitis (inflam- physicians must rely on in-depth patient interviews, physical
mation of the brain itself), amongst other problems. Over 350 exam and clinical judgement in order to diagnose Lyme disease.
October 2009
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