02/13/2019
By Gabrielle L. Wheeler
Cayuga Medical Center in Ithaca provides rapid results for suspected Lyme disease cases
Between 2016 and 2017, the total number of reported cases of Lyme disease in the U.S. increased by 9 percent, reports the Centers for Disease Control and Prevention. That means that either more people contracted the disease, or more cases were caught and confirmed. At Cayuga Medical Center, the latter is becoming reality thanks to same-day results from its new ELISA laboratory testing equipment.
How is Lyme disease transmitted?
New York State had 3,602 confirmed positive and 1,653 probable cases of Lyme disease in 2017, according to the CDC. In the Finger Lakes Region, the prevalent type of Lyme disease is caused by the bacteria, Borellia burgdorferi. Blacklegged ticks, also referred to as deer ticks, contract Lyme disease by feeding off an infected host animal, most commonly a rodent or bird. Then, when the infected deer tick bites a person, the bacteria may be transmitted into the person’s skin.
It is also important to note that not every tick carries Lyme disease, and transmission is unlikely if the tick is removed before it becomes engorged (within 16 to 48 hours of attachment).
But if the disease is transmitted, it triggers an inflammatory response that often results in a red bullseye rash. But not every person who becomes infected will develop the same symptoms. In fact, Lyme disease often displays with general symptoms that can lead to misdiagnoses.
Testing for Lyme
Laboratory testing analyzes immune system response, in other words, the level of antibodies produced to ward off the bacterial infection. However, during the first few weeks of infection, testing is considered inaccurate. “I always tell people we don’t rely on the blood test in the first two to three weeks of symptoms,” says infectious disease specialist Douglas MacQueen, MD, medical director for the Antimicrobial Stewardship and Infection Prevention Programs at Cayuga Medical Center in Ithaca. “Instead, we consider factors such as: does the person spend time outdoors where there are deer ticks? And, do their symptoms match up with an early Lyme infection? If that’s the case, we treat them for Lyme.”
Testing begins with an enzyme-linked immunosorbent assay (ELISA) test, explains Dr. MacQueen. “If the ELISA screening test and then the confirmatory test tells us this person is producing IgM antibodies or IgG antibodies – or both – it can help me decide how recent the infection was and what will be the best type of antibiotics for the patient.”
In the confirmatory Western Blot test, IgM antibodies will be present within two to three weeks of having a bacterial infection, while IgG antibodies are present between four to six weeks of initial infection.
At any given medical center, getting results from the tests can take anywhere from a few days to up to four weeks, depending on the lab being used. The delay significantly impacts how soon patients with a positive test can be treated. However, Cayuga Medical Center’s new onsite ELISA laboratory testing equipment can give patients piece of mind within an hour, and the opportunity to begin treatment immediately.
Preventing Lyme Disease
While testing and treatment for Lyme disease have significantly improved over the past few decades, Dr. MacQueen notes that prevention is still the best option. “My bottom line for people is keep taking advantage of the outdoors here but just take a few steps to be cautious about it,” he says.
Ticks like to hang out on leaves no more than 18 to 24 inches off the ground and then grab onto passersby as they brush against the leaves. Once they are on a body, they climb upward searching for a warm, dark hiding place to attach onto. Ticks can be so surreptitious that in many cases of confirmed Lyme disease, patients say they never found the tick attached
to them.
Recommendations by Dr. MacQueen and the CDC on how to prevent Lyme disease include the following.
• Use insect repellant. The CDC recommends visiting epa.gov/insect-repellents for a list of repellants recommended by the Environmental Protection Agency including DEET or oil of lemon eucalyptus.
• Treat clothing and gear with products containing 0.5 percent permethrin.
• Tuck in shirts and pantlegs while out in the woods.
• Stay on maintained trails.
• Do a thorough tick check every day, including behind the ears, around the belt buckle, and in the groin and armpits.
• Remember to check pets.
• Remove ticks promptly and completely, such as with a Tick Twister O’TOM®.
• Seek medical help if you develop a round, red rash or other symptoms of Lyme disease.
Once ticks are removed, squish them or stick them to a piece of tape so they can’t get away and continue to be a threat, suggests Dr. MacQueen.
As someone who enjoys spending time outdoors, he doesn’t want to scare people indoors. “I think the important thing is to remember it’s a great area to do things outdoors in, and I encourage people to continue to do that, despite these ticks.”
For more information on Lyme disease, please visit the CDC’s website at
cdc.gov/lyme/index.html
Case Studies
How Lyme disease is treated depends on how early it is caught. If a Lyme infection is caught within the first few weeks, it is possible to effectively treat with antibiotics. Symptoms of early acute Lyme disease may include the bulls-eye rash, fever, chills, persistent and noticeable fatigue, a pounding headache, and muscle and joint aches, among others.
Sheri Bone of Dingmans Ferry, Pennsylvania – previously of the Finger Lakes Region — lives and works in the woods. When she developed unusual and persistent nausea, she sought medical treatment. “The doctor wanted me to have complete blood work done, so I had to wait three weeks,” Bone reports. “She said it takes about two weeks for the Lyme test to come back and she wanted to rule out anything else before putting me on antibiotics.”
With a confirmed diagnosis, Bone was treated with a 28-day cycle of doxycycline. Her symptoms have not returned.
However, if Lyme disease is not diagnosed and treated at early onset, persistent and hard-to-treat symptoms may occur in what the CDC refers to as post-treatment Lyme disease syndrome. Jennifer Maloney of Dundee was diagnosed with Lyme disease in 2016, but her doctors believe she may have had it for much longer than that – at least 10 years. “I had brain fog, muscle and joint pain, deep bone pain, headaches, my eyesight kept getting worse and I ended up with cataracts, and I had the worst fatigue,” says Maloney.
She was treated with antibiotics for two years and now takes tinctures to treat her myriad of symptoms which include a rash, shortness of breath, heart palpitations, sleep impairment, and memory loss, among others. Maloney also suffers from coinfections that were transmitted by the tick she never saw, and continues to seek treatment for Lyme disease.
The Cayuga Medical Center
101 Dates Drive, Ithaca, NY 14850.
Phone: 607-274-4011
cayugamed.org/cmcindex.cfm
