Report: Lyme disease is on the rise

A new report from the Atlanta-based Centers for Disease Control and Prevention (CDC) says there were more cases of Lyme disease in 2000 than in any previous reporting year.1 Lyme disease is the leading cause of vector-borne infectious disease in the United States, says Carrie McCoy, PhD, MSPH, RN, CEN, an associate professor of nursing at Northern Kentucky University in Highland Heights. "Over 17,000 cases are reported annually, but it is believed that the disease is significantly underreported," McCoy adds.

Here are effective ways to manage Lyme disease:

• Know which patients are at risk. The highest rates were reported in children under age 15 and adults 30 and older, says McCoy. Lyme disease is caused by infected ticks found in temperate regions with relatively high humidity, she adds. The states with the highest reported annual incidence of Lyme disease are Connecticut, Rhode Island, New York, New Jersey, Delaware, and Pennsylvania, says McCoy. Lyme disease is most commonly transmitted to humans in May to July, she adds.

Ticks crawl onto humans when they brush against vegetation, explains McCoy. "Ticks can attach to the body anywhere, but most often attach on more hidden parts of the body such as the groin, armpit, scalp, and where clothing is tight," she explains. Anyone who comes into contact with wooded, brushy, and grassy places is at highest risk for the disease, says McCoy. "In backyards, exposure to ticks is greatest in the woods and garden fringe areas, but ticks can be carried to lawns and gardens by animals," she notes.

• Know symptoms to watch for. Symptoms of Lyme disease vary, but the most common are a red, slowly expanding rash that looks like a bull’s eye, and flulike symptoms such as fatigue, fever, headache, muscle aches, and joint pain, says McCoy. "Unfortunately, although common, the rash is seen in only 60%-80% of cases," she notes. She explains that symptoms usually appear within seven to 14 days, but may appear as early as three days and as late as 30 days after exposure. "Some infected individuals do not exhibit symptoms, or develop nonspecific symptoms such as fever, headache, fatigue, and myalgia," adds McCoy.

Untreated Lyme disease may lead to intermittent episodes of swelling and pain in the large joints; neurologic abnormalities including aseptic meningitis, facial palsy, radiculoneuritis, and encephalitis; and cardiac problems including heart block, myopericarditis, and cardiomegaly, she warns. "These later manifestations may appear in some patients without a history of the earlier manifestations of the disease," McCoy adds. "In some patients, Lyme disease morbidity may be severe, chronic, and disabling."

• Know latest diagnosis and treatment interventions. Diagnosis is based primarily on clinical findings, according to McCoy. However, serologic testing may give you supportive diagnostic information in patients with endemic exposure and objective clinical findings that suggest later stage disseminated Lyme disease, she notes. "Unfortunately, an episode of Lyme disease does not confer immunity," she says. "Once treated, it is possible for a person to be reinfected at a later date."

Early disease is treated with three weeks of doxycycline, or amoxicillin, says McCoy. She adds that cefuroxime, axetil, or erythromycin are alternatives for patients allergic to penicillin, or those who cannot take tetracyclines. "Later disease is treated with intravenous ceftriaxone or penicillin for a month or more," she says.

Because antibodies often persist for months or years following a treated or untreated infection, seroreactivity alone cannot be used as a marker for active disease, McCoy cautions. "False negative results also are not uncommon," she adds.


1. Centers for Disease Control and Prevention. Lyme disease — United States, 2000. MMWR 2002; 51:29-31.


For more information, contact: Carrie McCoy, PhD, MSPH, RN, CEN, Associate Professor of Nursing, Northern Kentucky University, Highland Heights, KY 41099. Telephone: (859) 572-6541. E-mail: mccoy@NKU.EDU.