By Alex LaTrenta, Greenwich Academy class of 2020
The first in a series of articles about the prevention, recognition, and treatment of public health threats in Greenwich.
One warm autumn day after my family had moved from Manhattan, my three year old brother rushed outside to frolic in a leaf pile when my mother noticed the target-shaped red rash on the back of his arm that heralded Lyme disease. After antibiotics he fully recovered but only because my mom recognized the first warning sign and acted immediately. While she did recognize this symptom, she had not realized how simply playing in the grass and leaves in our backyard could endanger us and thus had never taken preventive measures against Lyme disease.
Between 2007 and 2017 more than 30,000 cases of Lyme have been reported in CT and likely ten times that number have gone undiagnosed or resolved on their own. It’s no surprise that the disease is named after the CT town Lyme where it was discovered in 1975.
Lyme disease begins with the bite of the female black-legged tick which drinks the blood of rodents infected with a corkscrew-shaped spirochete bacterium Borrelia burgdorferi. These ticks the size of sesame seeds live on the abundant white tailed deer but cannot jump, fly, or drop from trees and instead pass to animals or humans from grass or bushes.
Lyme disease is not contagious; only the bite of an infected black-legged tick which has been attached for at least 36-48 hours can transmit the disease to humans or dogs. As warm autumn temperatures continue to draw people outside, the risk remains because deer ticks thrive in mild fall and winter weather. The best strategy to prevent this common disease still remains avoidance of tick bites through vigilance and caution.
When walking in wooded areas and fields, wear clothing that protects against ticks and allows for their easy detection such as light-colored long pants, socks, and closed shoes. When hiking, try to find wide, dirt trails like the ones in Mianus River Park and avoid trekking off into the leafy debris on the side of the trail.
Infectious disease expert Dr. Ralph Cipriani, an Internist with Glenville Medical Concierge Care, recommends giving yourself “a tick check, especially if you’re having a picnic, lying in the grass, hiking, fishing, boating, hunting, golfing even, or any other outdoor activity. You should try to cover up exposed skin, wear insect repellent, and do a survey for ticks when you get home.”
One can spray clothing (but not skin) with tick repellent containing 0.5% permethrin or spray skin with insecticide containing approximately 30% DEET. While some natural repellents including lemon eucalyptus oil and citronella repel mosquitos, Connecticut’s Tick Management Handbook declares that most plant-oil based repellents do not provide adequate protection from ticks.
As soon as you return indoors, you should shower within 2 hours because ticks require several hours to become fully attached. While ticks attach on your legs and feet, they often climb up your body to hide in warm creases like the neck, armpit, groin, belly button, behind the ears or between the toes.
You can also protect your backyard from ticks by removing leaf litter, tall grasses, and shrubs. Mowing the lawn frequently can force ticks out of your backyard and keep the family safe. Also fencing your yard to protect from pesky deer and spraying grass with pesticides can reduce tick populations.
If you see a tick on you, don’t panic; just remove the tick as soon as possible. In order to infect you with Lyme, ticks must be attached to you for 36 to 48 hours or more. Only prompt removal of the tick will lower the chances of infection—do not wait for it to detach.
Do not use folklore treatments like nail polish, petroleum jelly or matches to detach the tick. Before and after removing the tick, clean the affected skin with rubbing alcohol or soap. Use tweezers to grab the tick and pull upward in slow steady motion—no twisting or jerking. If the head breaks off in the skin remove it with tweezers if possible or apply a small amount of ointment and let it heal. Place the tick in a sealed plastic bag or container but do not attach it to tape.
Dr. Yvette Ghannam, bacteriologist with the Greenwich Health Department Laboratory, suggested bringing the tick to the Greenwich Town Hall from Monday-Friday from 8:00am to 3:00pm so that they can perform PCR-DNA analysis to determine whether the tick is infected with Lyme. The test is performed within 10 days and results can be obtained by phone or mail for a fee of $68 (cash or check only).
Dr. Ghannam said that in Greenwich the percentage of ticks found to carry the bacterium B. burgdorferi is around 25-28% of those tested which is similar to the percentages positive/present found at the Connecticut Agricultural Station. If the tick is not infected, antibiotics can be avoided.
If you or a loved one does get a tick bite, the classic target or bulls-eye rash can be the first symptom in up to 80% of Lyme infections. This rash appears several days after infection and can grow, but is rarely itchy or painful and can come and go. Dr. Cipriani said, “If a rash is the size of a tennis ball or larger, red, ring-like, round or ovoid, then see your doctor.” In those cases without the telltale rash, you may have a flu like illness with symptoms of fatigue, stiff neck, fever, and headache but no cough or stuffy nose.
Lyme is often a clinical diagnosis as blood tests for antibodies against the bacteria are only helpful weeks after infection when the human body produces an immune response in the form of antibodies. Dr. Cipriani observes “If I have a suspicion that someone has Lyme even if the test is negative, I will treat them and then do a follow up blood test in a month to see if that’s changed. Sometimes you end up treating when you didn’t really need to, but it’s better to treat at the appropriate time than to play catch up. The longer it goes untreated, the higher the chance you will have chronic Lyme symptoms.” There is no effective and reliable vaccine against Lyme disease. Unlike measles, having Lyme disease once does not confer immunity, and you can get Lyme disease over and over.
If untreated, Lyme disease the bacteria multiply in the area next to bite, and then diffuse through skin and blood to other body systems up to year after receiving the bite. Manifestations of second stage Lyme disease include damage to the joints, heart, and brain/spinal cord.
When ignored, Lyme disease is not only painful and damaging to your health but can interfere with work or school due to fatigue. That is why all of Greenwich residents need to do their best to prevent tick bites in the first place before any damage has been done.
All of the following information has been obtained from the Connecticut Tick Management Handbook, Connecticut Public Health records, the CDC, or Lyme disease experts such as bacteriologist Yvette Ghannam from the Greenwich Health Department Laboratory or infectious disease specialist Dr. Ralph Cipriani from the Glenville Medical Group.