Tick disease forum helps fill in the gaps
By Dr. Judith Fisher - May 4, 2006
At the end of a long work week, Island physicians and other health-care providers gathered in the Mansion House Friday evening to hear a panel of experts discuss their latest research and current understanding of tick-borne diseases, including Lyme disease, erlichiosis, and babesiosis.
For many of those who have been on the clinical front lines in communities such as Martha's Vineyard, where tick-borne diseases tend to be more prevalent, the evening may have provided no surprises, but it was an opportunity to fill in any gaps in understanding.
The panelists were Dr. Sam Donta, a specialist in infectious diseases; Sam Telford 3rd, associate professor of infectious diseases at the Tufts University School of Veterinary Medicine; Dr. Robert Kalish, a rheumatologist at Tufts-New England Medical Center; Dr. John Halperin, clinical professor of neurology, New York University School of Medicine; and Dr. Peter Krause, director of infectious diseases at Connecticut Children's Medical Center.
They spoke about tick-borne diseases that might affect summer inhabitants of Martha's Vineyard; the cause and available tests for tick disease; babesiosis and Lyme co-infections; tick immunity and its role in prevention of tick-borne infections; arguments for and against the condition know as chronic Lyme disease; Lyme arthritis and its prevention; and neuroborreliosis guidelines.
The Island health-care providers listened attentively throughout the presentations and followed up with questions and discussion. One participant asked about antibiotic resistance to Lyme, while another raised a more difficult subject, asking what to do with the patient who comes in with vague symptoms, no history of a tick bite, but self-diagnoses the illness as Lyme disease.
Lyme disease was discovered in the early 1980s in the community of Lyme, Connecticut, when the mothers of the many children diagnosed with juvenile rheumatoid arthritis urged their health-care providers to look more closely at their cases. At the time, I was practicing in Hunterdon County, New Jersey, another rural area, and a Lyme-endemic area. In those days, physicians were diagnosing and treating patients not knowing the full extent of the disease. We did suppose that Lyme disease must be similar to syphilis, as spiral-shaped bacteria called "spirochetes" cause both diseases.
Prior to accepting a job at Martha's Vineyard Hospital, I lived and worked in Philadelphia. It had been many years since I was confronted with Lyme disease and never the other three tick-borne illnesses.
Although I had tested patients with fevers who had returned from endemic areas for tick diseases, all of these patients were diagnosed with other illnesses. Last fall, I began to read up on Lyme disease, tularemia, babesiosis, and erlichiosis. I realized that more than one disease might be carried by the same tick, making it important to suspect and look for more than one tick-borne disease in a given individual.
The summer season and tick-borne illness it brings frightens many of the inhabitants of Martha's Vineyard. As always, knowledge is power. Many facts shared Friday night are invaluable when faced with the summer tick crisis on the Vineyard.
Most important is that 97 percent of individuals bitten by a tick in an endemic area do not get Lyme disease. On the other hand, if a nymph deer tick bites and is found filled with blood (engorged), the chances of passing one of the tick-borne diseases is highest, and a one-time dose of antibiotics could be used as a preventive measure. So far, there have been no reported cases of antibiotic resistance to Lyme disease, babesiosis, or erlichiosis.
A non-clinical solution to the problem of tick-borne diseases was also provided in the example of Great Island, a private island community off Hyannis. There, the incidence of tick-borne illness was dramatically reduced when the island's deer population was killed off.
Unfortunately, despite all that we know, there are still some unknowns about Lyme disease, and there are areas of disagreement: for example, whether an individual who has been fully treated with appropriate antibiotics can have what is known as chronic Lyme disease, a condition for which there is no concrete medical evidence for its existence.
By the end of the evening, both the presenters and attendees filed out of the Mansion House having had an opportunity to share some of what researchers and physicians have learned and still do not know about Lyme disease, erlichiosis, and babesiosis.
When faced with an ill patient, the health-care provider must use the art as well as the science of medicine to effectively diagnose and treat a tick-borne disease. Ultimately, the prevention of tick bites is the best medicine.
Dr. Judith Fisher is a family physician at Martha's Vineyard Hospital. A 1978 graduate of the University of Pennsylvania Medical School, she has an extensive medical and academic background in community health care and family medicine. Beginning this month, Dr. Fisher will contribute a new online column aimed at addressing readers' concerns and issues surrounding community health. It will be published monthly and only on mvtimes.com. Readers may address inquiries to Dr. Fisher at doctor@mvtimes.com, or to Dr. Fisher, c/o The Martha's Vineyard Times, P.O. Box 518, Vineyard Haven MA 02568.
