Recognizing And Treating Insect Bites And Stings In Athletes
- Volume 17 - Issue 8 - August 2004
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Diagnosing And Treating Lyme Disease
Lyme disease is a multi-systemic condition that involves the skin, nervous system, joints and heart. It is caused by a tick born spirochete, Borrelia burgdorferi. The principal vector is the deer tick Ixodes scapularis. This malady is named for Lyme, Conn., where the first cases were reported in children. Lyme disease is now recognized on six continents and in at least 20 countries. It equally affects both sexes and people of all ages.
The clinical picture is one of headache, stiff neck, myalgia and fever. Lyme disease has three primary stages.
Stage 1 (flu-like stage) is the early infection phase with erythema chronicum migrans (85 percent of cases) at the site of the tick bite. Stage 2 (the cardiac and neurological stage) is the disseminated infection phase with characteristic signs and symptoms in the cutaneous system, nervous system and musculoskeletal sites. Stage 3 (chronic arthritis and neurological syndrome stage) is the late persistent infection phase with severe progressive arthritis, chronic encephalomyelitis, chronic fatigue syndrome, ataxic gait, spastic paresis and polyradiculopathy.
One frequently makes the diagnosis solely on the knowledge that the individual was bitten by a tick and subsequently developed a skin lesion in the general area. The skin lesion, erythema chronicum migrans, is therefore the characteristic finding in Lyme disease. The skin lesion begins as a small vesicle or papule at the tick bite site that slowly enlarges and forms an erythematous ring or oval with a gradually clearing central area. Over the next few days, the erythematous lesion expands rapidly away from the bite area to form a single or double, broad, round-to-oval area of erythema. During the early stage with the skin lesion present, patients may develop fever and minor constitutional symptoms. The lesions usually disappear within four weeks of the infection.
When treating Lyme disease and erythema chronicum migrans, the key is early administration of oral doxicycline for three weeks. Amoxicillin is recommended for younger children and for pregnant or lactating women. When treating patients who are allergic to the penicillins, using erythromycin for 30 days is recommended.
Athletes can best prevent tick bites by wearing protective socks and boots with pant cuffs tucked into the socks while they are outdoors in tick country. They should also inspect all skin areas regularly for ticks and treat their socks and other outer clothing with repellents such as permethrin.
Dr. Caselli is an Adjunct Professor in the Department of Orthopedic Services at the New York College of Podiatric Medicine. He is also a staff podiatrist at the VA Hudson Valley Health Care System and a Fellow of the American College of Sports Medicine.
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