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Saturday, December 24, 2005

Be on the lookout for Lyme disease

Maryland Community Newspapers Online
On a November day last year, Patty Belke’s 6-year-old son Jared came back from playing in the autumn leaves.

The family, who lives in Good Hope Estates, often made trips to the nearby Maydale Nature Center in Cloverly, but for Jared, this trip ended differently.

Patty Belke found a tick embedded on Jared’s back. The tiny bloodsucking insect had not yet swollen from feeding, and was roughly the size of a poppy seed. After its removal, the family thought no more of it.

Within two weeks, however, Jared had strange symptoms. His hands and feet felt tingly and painful, and other troubles soon followed.

‘‘[Normally,] we knew our child was very coordinated and highly intelligent,” Patty Belke said. ‘‘Within a couple of months, he had involuntary body movements, he was clearing his throat a lot ... he became oversensitive to light.”

The Belke family didn’t know it, but Jared had Lyme disease. The illness is prevalent in suburban and rural areas, where the deer that carry the diseased ticks can be found. A rash shaped like a bull’s-eye often results from the tick bite, but the rash does not occur in all cases.

The bacteria are sophisticated enough to bypass the immune system, and varied enough to manifest more than 100 symptoms. The disease’s variable nature makes it difficult for doctors to diagnose because it can mimic other illnesses.

‘‘Part of the misconception is if you have it, you’ll definitely get the bull’s-eye rash,” Patty Belke said, adding that her son did not develop the rash. ‘‘My son was tested twice by local doctors — both blood tests came back negative.”

Finally, the family contacted a California-based clinic that specialized in tick-borne diseases, and this led to a successful diagnosis.

Such problems are common for Lyme, according to Dr. Leila Zackrison, a Fairfax, Va., rheumatologist who specializes in identifying Lyme.

‘‘It is a bacterium, but it prefers living inside the cell” of infected tissues, she said. ‘‘It is genetically very sophisticated ... it can change the genes and the proteins at will, so it’s very hard for the immune system to detect it.”

Most people who suffer may not recall being bitten by a tick. Winter infections can be harder to diagnose because the symptoms match many cold-weather illnesses.

‘‘The usual season is June through the fall ... but there are late ones, especially if it’s been not so cold,” she said.

Lyme disease manifests itself by attacking three areas. If it affects the muscular-skeletal system, patients feel joint pains and muscle aches. If it attacks the nervous system, patients can suffer from tics and twitches, as well as paralysis in some cases. This variant also can lead to behavioral symptoms, such as depression, said Dr. Raphael Stricker, president of the International Lyme and Associated Disease Society.

Stricker said a strain of the bacteria has arisen along the East Coast that can target the cardiac system, leading to heart arrhythmia. Other symptoms include joint pains that can disappear and reappear, and also hallucinatory experiences such as hearing music.

The earlier Lyme is diagnosed, the easier the treatment, which consists mostly of antibiotics. More serious or chronic infections can lead to hospital stays and intravenous treatment, but Stricker said even a non-hospitalizing infection can be debilitating.

‘‘You still get chronic symptoms, like inflammation, which can be disabling — people have lost their jobs and livelihoods because of this,” he said.

The best approach is prevention, according to Zackrison. Homeowners should try to limit the number of deer that come into their yard, by putting up fences, for example. Parents should spray themselves and children with repellent, and should check for ticks after going out. Children are more likely to get ticks in their hair, ears, neck and armpits, while taller adults are more likely to get bites on their legs or groin. ‘‘If you’re on a property, make sure you clear the hedges, and don’t let underbrush or leaves accumulate,” she said.

If you do get a tick on you, it does not mean you automatically have Lyme disease, according to Marilyn Piety, manager of special projects of the Montgomery County Department of Health and Human Services. In her work with the communicable diseases program, Piety has learned that tick bites often take days to transfer the bacteria to victims.

‘‘The tick has to be on for a while — at least 48 hours — to give you Lyme disease,” she said. Further complicating the matter, adult ticks are not the only type that can transmit the disease. Younger ticks, known as nymphs, are equally to blame and much harder to see — sometimes as small as 2 mm across, Piety said.

For Montgomery County, which is less rural, the number of Lyme disease cases is relatively low compared to other Maryland counties, and Lyme cases have decreased each year since 2000.

In 2004, the Maryland Department of Health and Mental Hygiene’s Epidemiology and Disease Control Program reported 38 cases for the county, compared to 117 in Frederick County and 63 in Prince George’s. In 2003, Montgomery County reported 49 cases.

Jared Belke’s parents are thankful that his school notified them about his behavior changes. They found a specialist in Connecticut to treat him.

A year later, Jared’s symptoms are much milder, and he is taking antibiotics. Patty Belke said the medical costs have ranged from $10 to $100 per month, but that she had heard of acute cases costing up to $1,000 monthly.

The Belkes now use bug repellent and check themselves for ticks after each excursion. Jared still loves to play in the leaves, but he’s more careful, going in only up to his knees.

‘‘Every once in a while, he’d say, ‘I don’t like ticks — why do there have to be ticks?’ ” Patty Belke said. ‘‘But he takes the medicine and does what he has to do and he’s pretty positive through the whole thing.”

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