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Blood testing is done in two steps. An enzyme screen (EIA or IFA) is done first, and if it is positive, then a Western Blot is done. A Western Blot that is a true positive is never preceded by a negative screen, and conversely a positive screen does not always signify Lyme disease and must be confirmed with a Western Blot.
It is important to realize that fatigue, muscle pain, and headache alone — without a rash, arthritis, or Bell’s palsy — seldom indicate Lyme disease in a person not engaged in outdoor activity during tick season. A blood test done in response to these symptoms alone has little predictive value.
How do you treat Lyme disease?
The preferred treatment for early Lyme disease is a 14- to 21-day course of the antibiotic doxycycline for children over the age of 8, and a similar course of amoxicillin or cephalosporin for children ages 8 and under. If symptoms of early-disseminated disease are present, 28 days of treatment is indicated. Late disease is treated with 14 to 28 days of intravenous therapy.
Some doctors will prescribe a single dose of doxycycline for children over 12 who have been bitten by an engorged tick. This protocol is not universally followed and may not be effective. Testing of an engorged tick has poor predictive value and is not encouraged.
How can I avoid Lyme disease?
The best way to avoid Lyme disease is to avoid those places that are infested with ticks. But often that’s not possible. If you’re camping or hiking, cover arms and legs, wear a hat, pull back long hair, and wear closed shoes. Tuck pants legs into your boots, and wear light-colored clothes so ticks can be more easily spotted. Have your child stay on cleared paths rather than in deep woods or tall grass.
At home, safeguard your yard by clearing brush, leaves, and tall grass. Ask a licensed professional pest control expert about further steps you can take.
The insecticide Deet can be used in concentrations of less than 30 percent, but it must be reapplied frequently and washed off at night. Another insecticide, Permethrin, can be sprayed on clothing and is good for 10 to 15 washings.
Remember, Lyme disease is a treatable condition if caught early. Be careful, take precautions, and check for ticks when you’ve been in an area where ticks might live, but don’t let the threat of these little creatures undermine your outdoor fun.
Fern Perlman, M.D. has been in practice with Bay Street Pediatrics in Westport for over 30 years. She is a senior attending at Norwalk Hospital and an Associate Clinical Professor of Pediatrics at New York Medical College. She and her husband have lived and raised four children in Westport.
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