By Robert A. Dracker, MD
Among the many health challenges facing children today is the very real threat of contracting Lyme disease. Nearly 30% of the estimated 476,000 people in the U.S. each year who are diagnosed and treated for this disease are ages 0-19. It is no wonder then that the prevalence of Lyme disease among children has rightfully been called “an epidemic within a pandemic.”
Lyme disease has also been called “the great imitator” and there is justification for that moniker as well. That’s because its presentation can mimic varied disease entities, including those of infectious, rheumatologic, neurologic and cardiovascular origin. In children in particular, its presentation is extremely variable and often includes symptoms as commonplace as headache, stiff neck, aches and pains in muscles and joints, low fever, chills, malaise, and even loss of appetite. Compounding the challenge is that symptoms can occur differently in each child and even the most common symptom – a ring-shaped rash that looks like a bulls-eye with pink in the center and a darker red ring around it – does not occur in every case. Because of this, Lyme disease is not always considered in an initial diagnosis. But it should be.
Children are especially vulnerable to all tick-borne diseases because children are physically low to the ground and that’s where ticks are found. Children, for the most part, are more engaged on a regular basis than are adults in outside activities – they play in leaves, roll on grass, and cuddle with pets, all of which increase their exposure to ticks. The most common of all tick-born diseases in the United States is Lyme disease which, if not properly diagnosed and treated, can be a very real threat to a child’s health and well-being. If left untreated, the bacteria that causes Lyme disease can attack many systems of a child’s body, including the skin, heart, nerves, and joints.
Parents need to be vigilant and physicians need to be attuned to the threat of Lyme disease. The impediment is that unlike a mosquito bite where people know immediately if they have been bitten, deer ticks that may carry Lyme disease are tiny—the size of a poppy seed—and more often than not most children and their parents never remember being bitten or notice a tick bite at all. But these bites need only 36-48 hours to transmit disease and start to do their damage.
If and when children start experiencing signs and symptoms suggestive of Lyme disease, it is important to test immediately. Although adults tend to have more systemic symptoms and children tend to have more associated symptoms (fevers, body aches and fatigue) the methodology for testing is the same. It should be simple, reliable, and have high sensitivity and specificity for the disease.
The best test we have found is the Sofia® 2 Lyme FIA by Quidel. This revolutionary test provides the patient, parents and physician with indicative results within 15 minutes, as opposed to days, which has historically been the norm (and during which time organisms can spread and become systemic). It can be performed in the privacy of a doctor’s office or local clinic and it is the only test that can get results from a simple finger prick of blood. Such in-office testing affords diagnostic accuracy and supports early treatment.
With appropriate antibiotic treatment, most people with Lyme disease recover completely; but the key (as with all disease) is catching it early. In fact, even if the initial screening test is negative, we often test again in 1-2 weeks if clinical indicated. And if in doubt, we treat as if Lyme disease is present, as the consequences of not treating are far greater than treating if there is suspicion of Lyme disease and if the child presents with a characteristic rash or other symptoms or if we suspect there may have been tick exposure.
Fortunately, testing for Lyme disease has increased in the evaluation of core chronic signs in children including headache, fatigue, non-specific rashes, myalgias and arthralgias. In fact, it is encouraging that testing for Lyme disease is increasingly being considered for acute illnesses when other diagnostic tests are performed, even in cases which lack the classic Lyme signs or symptoms. Our hope is that this practice of increased testing continues, that parents and children remain vigilant and that physicians’ curiosity about Lyme disease becomes a normal part of any patient visit.
Robert A. Dracker, M.D., medical director at Summerwood Pediatrics and Infusacare Medical Services in Liverpool, New York.