It’s summertime and people are hiking and camping throughout New England. Today’s teaching conference at MGH/Brigham was given by Dr. Howard Heller regarding tick-borne illnesses. He focused on Lyme Disease because it is the most common tick-borne illness in our region. Howard emphasized that while Lyme is hyperendmic in coastal Massachusetts (Cape Cod, Martha’s Vineyard, Nantucket), the Berkshires in Western Mass are also hyperendemic. And Lyme is actually found throughout the region, and patients can get infected even in well-off enclaves like Cambridge and Newton. A few other points he made:
- The manifestations of Lyme are protean. During tick season, be sure to consider Lyme even without a clear tick exposure when patients present with a febrile illness, rash of any sort, meningitis, Bell’s Palsy, etc.
- Ticks are tiny and are often missed even when people are doing those tick checks. If there’s a rash in an area of the body where ticks are likely to come into contact (popliteal fossa, etc), consider Lyme, even if the rash isn’t a classic bullseye (erythema migrans). Be sure to undress the patient and do a complete dermatologic exam.
- Diagnosis of Lyme is made by serology and should be sent to a reliable laboratory
- Follow the IDSA guidelines (and American Academy of Neurology guidelines for CNS Lyme)
- Be sure to test for anaplasma/babesia, as those diseases frequently co-exist with Lyme and require different treatment.
The main question I have coming out of this lecture is about the epidemiology of Lyme and the other tick-borne diseases. It is believed that changes in land management practices have contributed to the rise in Lyme. But what can be done to reduce the incidence of all of these tick-borne illnesses?