Pediatric Lyme Disease
L
yme disease is the most common vector-borne disease in the United States. It is transmitted to humans by the bite of an infected Ixodes scapularis tick. This tick is better known
by its common name the blacklegged or deer tick. Lyme disease is caused by the bacterial spirochete Borrelia burgdorferi. Cases of Lyme have been reported in all 50 states. Summer is the peak time for people to get deer tick bites. Since symptoms may not show themselves for 1-3 months or more after transmission, it’s important to keep Lyme in mind year round. The deer tick can be found active during all months of the
year, however, peak incidence of Lyme transmission occurs dur- ing the summer months. Adult deer tick activity peaks in early spring and again in mid-fall. Adult ticks account for transmission of about 5% of reported cases of Lyme disease. The much smaller nymphal tick, which is about the size of a poppy seed, is respon- sible for about 95% of cases of Lyme and is most active from mid-May through late August in Connecticut. However, I’ve per- sonally seen nymphs active as late as October. 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 infected tick increases over time. Transmission over the first 48 hours is about 12%, however it increases dramatically to 75% at 72 hours and 94% at 96 hours. The Centers for Disease Control and Prevention (CDC) has
indicated that reported cases of Lyme disease are about 10% of actual cases that meet their surveillance criteria. This means that up to 90% of cases that meet these criteria are not being reported. Currently, over 20,000 cases of Lyme disease are being reported each year in the United States. If unreported cases are as preva- lent as suspected, then there are likely over 200,000 new cases per year. This would mean that each year 5 times more people would contract Lyme than HIV/AIDS. Lyme disease has reached epidemic proportions in the North- eastern states, including Connecticut. In 2008, the CT statewide
incidence of Lyme disease was 114 cases per 100,000 people, with some counties reaching a rate of 250 cases per 100,000. If CDC estimates are correct that would mean that approximately 1 in 100 people in CT become infected with Lyme disease each year. Approximately 25% of people who become infected with Lyme are children.
Children and Lyme Disease
Children are more likely than adults to have both exposure
and infection because they are outside playing on the ground. Playing on the swing set that is near the tree line. Hugging the family pet. At times children are resistant to wearing the proper clothing and insect repellent that can help protect them from tick bites. I must admit it is not very cool to walk around in white pants tucked into your white knee-high socks. They also tend not to be very compliant with tick checks. Lyme disease is most com- mon in 5-9 year old children (boys > girls) and young men.
Symptoms of Lyme Disease
Lyme is a complex, multi-system disease that has the po-
tential to affect every organ system in the body. The most com- mon symptoms of acute Lyme disease include flu-like symptoms, migratory joint and muscle pains, fatigue, headache, cognitive dysfunction (often called brain fog) and migratory paresthesias (a numb or tingly feeling). Some patients experience sound and light sensitivity as well as eye pain. Diagnosis and treatment of Lyme disease in children is often quite difficult because its symp- toms are often insidious and subtle. The manifestations of Lyme disease in the pediatric population are unique and unfortunately often go over looked. The diagnosis of Lyme disease requires a physician to review
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your child’s entire health history and perform a comprehensive physical exam. Lyme is a multi-system disease whose symp- toms often present subtly. Children may report they feel ok, but
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