… flu-like symptoms (1:47). If left untreated,
the disease spreads to other parts of the body,
and often results in more joint, tendon and muscle
pain, partial facial paralysis, and heart
palpitations (8:11). Chronic symptoms can develop
if the disease goes untreated for months or years,
and leads to severe arthritis and neurological
problems (5:29). The best way to arrive at or
exclude a diagnosis of Lyme disease is to examine
three aspects of the patient. The first is to
determine if the patient exhibits any of the above
The second is discover whether or not
the patient is at a high risk of contracting the
disease. This factor takes into account the
environment in which the patient lives, works, or
enjoys his recreational activities. It may also
include whether or not the patient has a pet that
may have brought the ticks into the house (16:41).
The third factor to consider before diagnosing
Lyme disease is to perform laboratory tests. The
Second National Conference on Serologic Diagnosis
of Lyme Disease recommends a two-test approach to
determine an active disease or a previous
infection. A physician should perform a sensitive
enzyme immunoassay (EIA) or immunofluorescent
assay (IFA). If a patient tests positive on an EIA
or IFA then the physician should follow up with a
standardized Western immunoblot (15:937).
early stages Lyme disease can easily be treated.
Clinical studies have shown that a ten day to
three week course of antibiotics is nearly 95
percent effective in eliminating the disease
(14:1015). Amoxicillin and doxycycline are the two
most prescribed antibiotics. They replaced the
earlier treatments of penicillin and tetracycline
because they are more easily absorbed by the
intestinal tract and require less frequent dosing
(9:1). Erythromycin, which is less effective than
penicillin or tetracycline, is now only used in
the treatment of young children, pregnant or
nursing women, and those people allergic to
penicillins (2:166). If left untreated and allowed
to progress to a later stage, Lyme disease may
require to be treated with intravenous
antibiotics. The success rate at this stage drops
significantly and often patients will continue to
experience chronic symptoms (2:167).
important to be aware if you live in or are
traveling to a high risk area. Ticks thrive in
wooded, bushy, grassy habitats, and particularly
in shady and moist areas. Measures to prevent Lyme
disease include wearing long sleeves and pants
when outdoors, tucking pants into socks, and using
repellents –permethrin (sold as Permanoe) on
clothing, and diethyltoluamide (DEET) on exposed
areas of skin. The most important means of
prevention is a complete inspection of the body at
the end of every day spent outdoors. A tick must
be attached to the body for a minimum of 24 hours
in order to transmit the disease; therefore if a
tick is found upon inspection it is not too late
to prevent the disease from being transmitted. If
a tick is discovered embedded in the skin it
should be removed immediately by grasping the body
with a pair of fine tipped tweezers and pulling
gently until the tick comes out (4:31).
(the last complete year for which figures are
available), there 11,603 cases of Lyme disease
reported in the United States by 43 states and the
District of Columbia. The overall incidence of the
disease was 4.4 per 100,000 people. This was the
second highest annual number reported since the
disease was first tracked in 1982, however it was
an 11% decrease from the 13, 043 cases reported in
1994 (10:274). Despite the national decrease, the
incidence of Lyme disease in New Jersey has
increased steadily since 1992, from 688 cases to
1,704 in 1995 (6:T-3). An overall incidence of
21.1 per 100,000 people was reported (10:274).
Hunterdon County leads the state and is second
among the 3,300 counties in the nation in the
number of cases per 100,000 residents. In 1995,
Hunterdon reported 565 cases.
Morris County was
second in the state reporting 232 cases (6:T-3).
FACTORS CONTRIBUTING TO THE HIGH INCIDENCE OF LYME
DISEASE IN NEW JERSEY The three main factors
contributing to the incidence in New Jersey are
the amount of deer present in the state, an
increased interaction between people and deer, and
an increase in the number of physicians diagnosing
and reporting Lyme disease. The number of deer in
New Jersey continues to grow every year (17:41).
This population explosion means that there are
more deer for the ticks to feed on and infect.
This directly relates to the increase in
interaction between people and deer. As people
move into more wooded areas, they are more likely
to come in contact with deer and their habitats.
This provides an opportunity for the ticks to
attach themselves to clothing or be found in
households (13:37). The third factor can be
attributed to an increase in awareness among
doctors to diagnose Lyme disease. After a
substantial amount of media attention given to
Lyme disease in the late 1980s and early 1990s,
physicians suddenly began diagnosing the disease
in more patients. As an awareness of the symptoms
and risk factors of Lyme disease increased,
physicians were better able to make a more
They were now diagnosing Lyme
disease in patients that had previously been
untreated (3). It is inevitable that the cases of
Lyme disease will continue to increase in New
Jersey until more people become aware of the
seriousness of the disease. In recent years, the
media has been instrumental in providing the
public with pertinent information concerning the
symptoms and risk factors involved in the disease.
At present, there is no vaccine protecting humans
against Lyme disease. The best way to protect
oneself against contracting Lyme disease is to
prevent a tick from having the opportunity to
transmit the infection. Bibliography: 1.
Accerrano, Anthony. Tick, tick.
Aug. 1996. 44-47. 2. Barbour, Alan G., M.D. Lyme
Baltimore: Johns Hopkins University
Press, 1996. 3. Fernandez, Bob. New Jersey County
Suffering from 2nd Highest Rate of Lyme Disease.
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Diane J., et al. A Field Guide to Animal-borne
Infections. Patient Care. 15 Oct. 1994.
Hearn, Wayne. Lyme Disease Back With a Few New
Ticks, er, Tricks. American Medical News. 22 Jul.
6. Its Tick Time. The Record. 23 Jun.
1996. T-3. 7.
Lang, Denise, and Derrick DeSilva,
Jr., M.D. Coping With Lyme Disease. New York:
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Lyme Disease Update. Country Journal.
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Peter. Deer Watch. National Wildlife. Oct.-Nov.
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Lyme Borreliosis: Basic Science and Clinical
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Stewart, Kay B. A Quick Look
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Phil. The Bambi Boom. Scholastic Update. 16 Apr.