Bull's eye! Lyme disease awareness
In the 1970s, the deer tick was named Ixodes dammini (now named Ixodes scapularis) after my father, so when I browse the stacks of medical libraries, articles like yours on Lyme disease (LD) pique my interest ("Targeting Lyme Disease," May 2013).* The timing is apt, as May and June are the peak months for new cases of LD and other diseases carried by the deer tick. At this time of year, the nymphal form is miniscule but is also a voracious feeder. Although deer ticks are found throughout the year in most of the United States, they're easier to spot in fall and winter when they're much larger.
The pathognomonic rash is erythema migrans with its target-like pattern; however, the initial lesion can also look blotchy, cellulitic, and boil-like. The rash must attain at least 5 cm in diameter, as noted, and persist for at least a few days. Some patients have a local allergic reaction to the tick's salival proteins.1-3
The testing and criteria for diagnosis is controversial. Often, even with the classic rash and typical constitutional symptoms, the early serology can be negative.2 Antibiotics are quite effective early on, but public education and prevention, as reviewed quite thoroughly in this article, are key for detecting LD.
Your article on Lyme disease was right on target! Two years ago, I noticed a deer tick attached to my skin after walking through deep woods in northern Illinois. Using a pair of tweezers, I tried to grasp the tick as close to the skin's surface as possible. However, in the process of removing the tick, I accidentally squeezed its body. I immediately went to the ED with the tick.
In the ED, I was informed that I was overreacting. I had only a small bite mark on my skin from the tick and no other discerning signs or symptoms. I was assured that LD treatment wasn't indicated in our geographic location, so I was sent home.
Less than 48 hours later, I developed a red, target-like rash at the site of the tick bite. I returned to the ED and this time I was given oral antibiotics. Now, nearly 2 years later, I'm asymptomatic. In my case, I fully believe it was a "stitch in time."
-TRISTRAM C. DAMMIN, MD, FACEP
Danvers, Mass.
-ALFRED J. HOLLAND JR.
Glen Ellyn, Ill.
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