flu-like symptoms (1:47). If left untreated,the disease spreads to other parts of the body,and often results in more joint, tendon and musclepain, partial facial paralysis, and heartpalpitations (8:11). Chronic symptoms can developif the disease goes untreated for months or years,and leads to severe arthritis and neurologicalproblems (5:29).
The best way to arrive at orexclude a diagnosis of Lyme disease is to examinethree aspects of the patient. The first is todetermine if the patient exhibits any of the abovesymptoms.The second is discover whether or notthe patient is at a high risk of contracting thedisease. This factor takes into account theenvironment in which the patient lives, works, orenjoys his recreational activities.
It may alsoinclude whether or not the patient has a pet thatmay have brought the ticks into the house (16:41).The third factor to consider before diagnosingLyme disease is to perform laboratory tests. TheSecond National Conference on Serologic Diagnosisof Lyme Disease recommends a two-test approach todetermine an active disease or a previousinfection. A physician should perform a sensitiveenzyme immunoassay (EIA) or immunofluorescentassay (IFA). If a patient tests positive on an EIAor IFA then the physician should follow up with astandardized Western immunoblot (15:937).In itsearly stages Lyme disease can easily be treated.Clinical studies have shown that a ten day tothree week course of antibiotics is nearly 95percent effective in eliminating the disease(14:1015). Amoxicillin and doxycycline are the twomost prescribed antibiotics.
They replaced theearlier treatments of penicillin and tetracyclinebecause they are more easily absorbed by theintestinal tract and require less frequent dosing(9:1). Erythromycin, which is less effective thanpenicillin or tetracycline, is now only used inthe treatment of young children, pregnant ornursing women, and those people allergic topenicillins (2:166). If left untreated and allowedto progress to a later stage, Lyme disease mayrequire to be treated with intravenousantibiotics.
The success rate at this stage dropssignificantly and often patients will continue toexperience chronic symptoms (2:167).It isimportant to be aware if you live in or aretraveling to a high risk area. Ticks thrive inwooded, bushy, grassy habitats, and particularlyin shady and moist areas. Measures to prevent Lymedisease include wearing long sleeves and pantswhen outdoors, tucking pants into socks, and usingrepellents –permethrin (sold as Permanoe) onclothing, and diethyltoluamide (DEET) on exposedareas of skin.
The most important means ofprevention is a complete inspection of the body atthe end of every day spent outdoors. A tick mustbe attached to the body for a minimum of 24 hoursin order to transmit the disease; therefore if atick is found upon inspection it is not too lateto prevent the disease from being transmitted. Ifa tick is discovered embedded in the skin itshould be removed immediately by grasping the bodywith a pair of fine tipped tweezers and pullinggently until the tick comes out (4:31).In 1995(the last complete year for which figures areavailable), there 11,603 cases of Lyme diseasereported in the United States by 43 states and theDistrict of Columbia.
The overall incidence of thedisease was 4.4 per 100,000 people. This was thesecond highest annual number reported since thedisease was first tracked in 1982, however it wasan 11% decrease from the 13, 043 cases reported in1994 (10:274).
Despite the national decrease, theincidence of Lyme disease in New Jersey hasincreased steadily since 1992, from 688 cases to1,704 in 1995 (6:T-3). An overall incidence of21.1 per 100,000 people was reported (10:274).Hunterdon County leads the state and is secondamong the 3,300 counties in the nation in thenumber of cases per 100,000 residents. In 1995,Hunterdon reported 565 cases.Morris County wassecond in the state reporting 232 cases (6:T-3).FACTORS CONTRIBUTING TO THE HIGH INCIDENCE OF LYMEDISEASE IN NEW JERSEY The three main factorscontributing to the incidence in New Jersey arethe amount of deer present in the state, anincreased interaction between people and deer, andan increase in the number of physicians diagnosingand reporting Lyme disease. The number of deer inNew Jersey continues to grow every year (17:41).
This population explosion means that there aremore deer for the ticks to feed on and infect.This directly relates to the increase ininteraction between people and deer. As peoplemove into more wooded areas, they are more likelyto come in contact with deer and their habitats.This provides an opportunity for the ticks toattach themselves to clothing or be found inhouseholds (13:37). The third factor can beattributed to an increase in awareness amongdoctors to diagnose Lyme disease. After asubstantial amount of media attention given toLyme disease in the late 1980s and early 1990s,physicians suddenly began diagnosing the diseasein more patients. As an awareness of the symptomsand risk factors of Lyme disease increased,physicians were better able to make a moreaccurate diagnosis.They were now diagnosing Lymedisease in patients that had previously beenuntreated (3).
It is inevitable that the cases ofLyme disease will continue to increase in NewJersey until more people become aware of theseriousness of the disease. In recent years, themedia has been instrumental in providing thepublic with pertinent information concerning thesymptoms and risk factors involved in the disease.At present, there is no vaccine protecting humansagainst Lyme disease. The best way to protectoneself against contracting Lyme disease is toprevent a tick from having the opportunity totransmit the infection. Bibliography: 1.Accerrano, Anthony. Tick, tick.
Sports Afield.Aug. 1996. 44-47. 2. Barbour, Alan G., M.D.
LymeDisease.Baltimore: Johns Hopkins UniversityPress, 1996. 3.
Fernandez, Bob. New Jersey CountySuffering from 2nd Highest Rate of Lyme Disease.Tribune News Service. 28 Aug. 1994.4. Gubler,Diane J.
, et al. A Field Guide to Animal-borneInfections. Patient Care. 15 Oct. 1994.
23-37. 5.Hearn, Wayne. Lyme Disease Back With a Few NewTicks, er, Tricks. American Medical News. 22 Jul.
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11. Miller, Sue.Lyme Disease Update. Country Journal.Jul.-Aug.1994. 8.
12. Murray, Polly. The Widening Circle.New York: St. Martins Press, 1996.13.
Nelson,Peter. Deer Watch. National Wildlife. Oct.
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Pfister, Hans- Walter, et al.Lyme Borreliosis: Basic Science and ClinicalAspects. The Lancet.
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15.Recommendations for test performance andinterpretation from the Second National Conferenceon Serologic Diagnosis of Lyme Disease. TheJournal of the American Medical Association. 27Sept. 1995.
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A Quick Lookat Lyme Disease. Nursing. Aug. 1994.
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