15 Useful Facts About Lyme Disease

Stringer/Getty Images
Stringer/Getty Images

As summer nears and you spend more time outdoors in one of the many beautiful natural spots in the United States, be sure to dress for the season—tick season, that is. Some experts say 2017 may be an especially tick-infested year. Deer ticks (Ixodes scapularis) carry a bacteria that causes Lyme disease, an infection from a bacterium that coils waiting in their insect bodies. Lyme-carrying deer ticks are especially prevalent in the upper East Coast, the upper Midwest, northern California, and the Oregon coast. While not every tick carries the bacteria that lead to infection—and some carry other pathogens—it’s best to take precautions to prevent bites, and seek medical attention if you have been bitten. The infection can cause long-lasting damage if not treated early. Here are 15 facts you need to know about Lyme disease.

1. LYME DISEASE IS CAUSED BY COILED BACTERIA.

Lyme disease is caused by the bacterium Borrelia burgdorferi, a spirochete, or tightly coiled bacterium that looks like a tiny spring under a microscope. Spirochetes are very simple, slow-replicating bacteria that require a mammalian or avian host to survive. According to Timothy Sellati, chair of the infectious diseases department at Southern Research, a nonprofit research institution in Birmingham, Alabama, “It takes on the order of 18–20 hours for a single spirochete to divide into two.” That’s incredibly slow, compared to other bacteria like E. coli, which can replicate every 20 minutes. Because Borrelia replicates so slowly, and they don’t reach high numbers, “They do not show up easily in a blood test,” Sellati says.

2. TICKS PREFER A LONG MEAL.

Sellati explains that ticks are very different feeders from mosquitoes, which he calls “hit-and-run feeders.” Ticks will feed over a period of three to five days before they become fully engorged. Female ticks generally only take three “blood meals,” he says, in the duration of their lifespan. They take one blood meal after hatching from their egg into the larval stage, another after they molt into their nymphal stage—the stage where they are most likely to bite you—and a final “big meal” in preparation for laying thousands of eggs. Adult male ticks generally don’t feed, he says.

3. THEY ARE A VIRULENT DISEASE VECTOR …

When an infected tick bites a human, the waiting spirochetes—which live essentially dormant in the tick’s gut until environmental cues such as changes in temperature and oxygen availability awaken them—travel from the tick’s gut to its saliva glands. “From the saliva glands they can literally be spat into the bloodstream that the tick is feeding on,” Sellati says. Once they enter the bloodstream, spirochetes travel to various body tissues, because if they stay too long in the bloodstream, they’ll get killed by their host's immune system. “Once it gets away from site of inoculation, it shows a bias toward joints, heart, central nervous system,” Sellati says.

4. … WHICH LEADS TO INFLAMMATION.

“The bacteria has components that are very effective at eliciting an inflammatory response,” Sellati explains. While Borrelia don’t produce toxins like other bacteria, they do incite inflammation in sensitive parts of the body such as the joints, heart, and brain. “That inflammatory response is important to help kill and clear the spirochetes, but it causes collateral damage as well.”

5. INFECTIONS MAY BEGIN WITH A BULL'S-EYE.

The first symptom to look for in about 80 to 90 percent of Lyme cases is a telltale rash of an infected tick bite, called an erythema migrans (EM) rash, which looks a lot like a red bull's-eye, and usually appears at the site of a tick bite within seven to 14 days, according to the American Lyme Disease Foundation. However, the rash does not appear in every instance of Lyme disease, so if you’re bitten, you should visit a doctor immediately. You may also experience flu-like symptoms or joint pains in the first month after the bite.

6. DON'T WAIT TO GET TREATMENT.

If you don't see the tick bite, and don't treat early symptoms, the spirochetes continue to spread throughout your body and can cause more severe symptoms, including fatigue, stiff or aching neck, tingling or numbness in your extremities, and even paralysis of your face. Even more debilitating symptoms of later-stage Lyme disease can include severe headaches, painful arthritis and swelling of joints, cardiac abnormalities, and central nervous system debilitations leading to cognitive disorders.

7. IF CAUGHT EARLY, IT'S USUALLY HIGHLY TREATABLE …

When the disease is caught in its early stages, and treated with antibiotics, it’s curable, Sellati says. Even later stages of the disease can be treated, but the longer an infection goes untreated, the more severe the symptoms and damage can become.

8. … BUT SOME PATIENTS EXPERIENCE SYMPTOMS FOR MUCH LONGER.

Scientists are not entirely sure why a subset of patients have recurrent symptoms of the illness in the months and even years following treatment, known as post-treatment Lyme disease syndrome. “It’s not clear if there is a persistence of live replicating bacteria in some immune privileged niche where they’re protected from exposure to antibiotics,” Sellati says, or if it’s simply the subsequent inflammation stirred up in the body that refuses to go back to normal. “What drives that is not entirely clear.”

9. YOUR GENETICS MAY DICTATE YOUR TREATMENT.

Sellati’s lab has been exploring whether genetics plays a role in who recovers after treatment and who doesn’t. “We have some evidence that your genetic makeup can actually predispose you to developing post-treatment Lyme disease syndrome," Sellati says, and adds it will require more research. They believe they might be able to isolate genetic markers that will tell doctors if antibiotics alone will work, or if the patient might need additional treatment.

10. FEAR THE ENGORGED TICK (BUT DON'T PANIC).

The good news is, even if a tick bites you, if it isn’t yet fully engorged on your blood, chances are good it hasn’t been there long enough to transmit the spirochetes that lead to infection. However, it’s always better to be safe, and pay attention to any symptoms that occur thereafter. “The sooner you can remove a tick from your body, whether it’s feeding or not, the better. If the tick is feeding for less than 24 hours, the likelihood of being infected with Borellia is significantly reduced,” Sellati says.

11. AREAS WITH MICE HAVE MORE LYME DISEASE.

Wherever you find mice and deer you’re very likely to find ticks as well. In fact, Sellati says, mice in all forms—but especially the white-footed mouse—are what infectious researchers call a “maintenance reservoir.” Sellati says. “They maintain the bacteria in the wild so that new ticks can acquire it.” Since spirochetes tend to stay in the bloodstream of mice much longer than they do in humans, that’s how ticks have such an endless supply of the bacteria. “If you got rid of all the mice in the world, you would either come very close to or significantly reduce the population of Borellia in the environment. You’d have a significant decrease in Lyme,” he emphasizes.

12. YOU CAN TAKE SIMPLE STEPS TO PROTECT YOURSELF.

Wear clothes with the most coverage possible. Spray yourself with anti-tick sprays. But no matter what, always do a tick check after you return from the outdoors just to be safe. And if you start to feel any of the symptoms mentioned earlier within a month of a tick bite, don’t wait to visit your doctor.

13. CHECK YOUR CREVICES.

Ticks are not opposed to biting you wherever they can reach, but they have a preference for your warm, moist crevices, such as armpits, backs of the knee, groin, base of the head, and nape of your neck.

14. SKIP SOME OF THOSE "TIPS" FOR REMOVING TICKS THAT YOU'VE HEARD ABOUT.

No matter how many YouTube tutorials you’ve watched, Sellati recommends that you do not use heat, like a match or a lighter, to burn a tick off. The same goes for “goops” such as petroleum jelly, alcohol, or hand sanitizer. Since the spirochetes are transmitted through tick saliva, Sellati warns, “If you try to do those things, you’re only going to piss the tick off, and a pissed-off tick spits a lot, and you're more likely to get more bacteria into your bloodstream.”

15. INSTEAD, USE SLOW, STEADY PRESSURE—AND SOME TWEEZERS.

Take a small pair of forceps or tweezers, Sellati instructs, and gently grasp the tick as close to the skin’s surface as possible, “then pull the tick straight up slowly, which pulls the mouth part out of the skin, and then just dab the area with alcohol to disinfect.” A tick’s mouthparts are like tiny barbed hooks, designed to pierce the skin and stay there. “Then they have secretions that cement the mouthparts to the skin, because they have to feed over a long time and they don’t want to be knocked off while they sit and sip.”

A Generic EpiPen Coming in Early 2019 Could Save You Money

Brand-name EpiPens at a Congressional hearing on the escalating cost of the drug in 2016
Brand-name EpiPens at a Congressional hearing on the escalating cost of the drug in 2016
Alex Wong/Getty Images

For an incredibly common, life-saving medication, EpiPens (epinephrine auto-injectors) are surprisingly difficult for many consumers to get ahold of. Their cost has skyrocketed in recent years from less than $100 for a pack of two to more than $600. They’ve gotten so expensive that some EMTs have resorted to using syringes to manually administer epinephrine rather than purchasing the standard auto-injectors, which are almost exclusively made by the pharmaceutical company Mylan. Generic options have been slow to come to market, but according to Business Insider, a recently approved EpiPen rival is coming in the first few months of 2019, and it could save consumers a significant chunk of change.

The drug’s developers have had an unusually hard time getting the new EpiPen alternative, called Symjepi, onto store shelves. The drug was approved in 2017, but the company, Adamis Pharmaceuticals, had trouble finding investors. Now, Novartis, the Swiss-based pharmaceutical giant that manufactures drugs like Ritalin, is releasing the drug through its Sandoz division (perhaps most famous for it role in discovering LSD in the 1930s).

Symjepi will cost $250 out-of-pocket for a pack of two doses. That’s 16.6 percent less than the Mylan-authorized generic EpiPen or Teva’s generic EpiPen, which both sell for $300. It differs a bit from its rivals, though, in that it’s a pre-filled, single-dose syringe rather than a spring-loaded auto-injector. Auto-injectors are plastic, pen-like devices that keep the needle shielded until the moment of injection, and are specifically designed to help make it easier for untrained (even squeamish) people to use in an emergency. With this version, patients will need to remove a needle cap and inject the needle. Just like the EpiPen, though, it’s designed to be injected in the upper thigh, through clothing if necessary.

If you have health insurance, the difference in cost may not matter as much for you as a consumer, depending on your plan. (I personally picked up a two-pack of Mylan-authorized generic Epipens at CVS recently for $0, using a manufacturer’s Epipen coupon to knock down what would have been a $10 copay.) But it will matter considerably for those with high-deductible plans and to insurers, which, when faced with high costs, eventually pass those costs on to the consumer either through higher co-pays or higher premiums. It also affects agencies that buy EpiPens for emergency use, like local fire departments. And since EpiPens expire after just a year, the costs add up.

However, there’s currently a shortage of EpiPens on the market, according to the FDA, making it more important than ever to have other epinephrine drugs available to those at risk for serious allergic reactions.

[h/t Business Insider]

Brain-Eating Amoeba Kills Seattle Woman Who Used Tap Water in Her Neti Pot

CDC/Dr. Govinda S. Visvesvara, Wikimedia Commons // Public domain
CDC/Dr. Govinda S. Visvesvara, Wikimedia Commons // Public domain

If you use a neti pot to clear out your sinuses, there's one important rule you should always follow: Don't fill it with tap water. Doing so could land you a sinus infection, or worse, a potentially fatal disease caused by a brain-eating amoeba. Although the latter scenario is exceptionally rare, a 69-year-old woman in Seattle died from doing just that, The Seattle Times reports. Experts are also warning that these infections could become more common as temperatures in the northern hemisphere continue to rise.

Physicians at Seattle's Swedish Medical Center initially thought the woman had a brain tumor. She was brought into the emergency room following a seizure, and a CT scan of her brain seemed to reveal a tumor-like mass. The only other known symptom she had was a red sore on her nose, which was previously misdiagnosed as rosacea. When surgeons operated on her the following day, they noticed that "a section of her brain about the size of a golf ball was bloody mush," neurosurgeon Dr. Charles Cobbs told The Seattle Times. "There were these amoeba[e] all over the place just eating brain cells. We didn't have any clue what was going on, but when we got the actual tissue we could see it was the amoeba."

She died a month later of an infection called granulomatous amoebic encephalitis (GAE), according to a recent case report published in the International Journal of Infectious Diseases. The disease is caused by a single-celled amoeba called Balamuthia mandrillaris, and it's extremely deadly. Of the 109 cases between 1974 and 2016, 90 percent were fatal.

According to the FDA, some bacteria and amoebae in tap water are safe to swallow because acid in the stomach kills them. However, when they enter the nasal cavity, they can stay alive for long periods of time and travel up to the brain, where they start eating their way through tissue and cells. Another brain-eating amoeba called Naegleria fowleri can cause a similar disease, except it acts faster and can cause death in just a few days. Although it's also rare, it's usually found in warm freshwater, and infections start by getting contaminated water up one's nose while swimming or by using a nose irrigation device filled with tap water.

Dr. Cynthia Maree, an infectious disease doctor at the Swedish Medical Center, said the changing environment could facilitate the spread of these infections. "I think we are going to see a lot more infections that we see south (move) north, as we have a warming of our environment," Maree says. Researchers say these amoebae are still little-understood. Future studies would need to be conducted to learn more about the risk factors involved.

[h/t The Seattle Times]

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