infectious diseases
Lyme Disease
Prevention of Lyme Disease
Precautions against tick bites ( see Tick Bite Prevention ) should be taken by people in endemic areas. Deer tick nymphs, which attack humans, are small and difficult to see. Once attached to the skin, they gorge on blood for days. Transmission of Preventing tick access to skin includes Staying on paths and trails Tucking trousers into boots or socks Wearing long-sleeved shirts Applying repellents withdiethyltoluamide(DEET) to skin surfaces DEET should be used cautiously in very young children because toxic reactions have been reported.Permethrinon clothing effectively kills ticks. Frequent searches for ticks, particularly in hairy areas and on children, are essential in endemic areas. Engorged ticks should be removed with care and not crushed between the fingers because crushing the tick may result in disease transmission. The tick’s body should not be grasped or squeezed. Gradual traction on the head with a small forceps dislodges the tick. The point of attachment should be swabbed with alcohol. Petroleum jelly, alcohol, lit matches, and other irritants are not effective ways to remove ticks and should not be used. (See How To Remove a Tick .) No practical means are available to rid entire areas of ticks, but tick populations may be reduced in endemic areas by controlling small-animal populations. 200 mg has been shown to reduce the likelihood of Lyme disease after a deer tick bite, routine antibiotic prophylaxis to prevent Lyme disease after a recognized tick bite is not recommended. Patients with a known tick bite can easily be instructed to monitor the bite site and seek care if rash or other symptoms occur; the diagnostic dilemma of Lyme is most prominent when there is no history of tick bite. According to the 2020 Infectious Diseases Society of America (IDSA) guidelines, antibiotic prophylaxis should be offered only when all the following circumstances exist ( Prevention reference ): The attached tick can be reliably identified as an adult or nymphalI. scapularistick. The tick is estimated to have been attached ≥ 36 hours (based on degree of engorgement of the tick with blood or time of exposure). Prophylaxis can be started within 72 hours of tick removal. (See How To Remove a Tick .) Patients live in or have visited an area where ≥ 20% of these ticks are infected withB. burgdorferi(generally only in parts of New England, parts of the mid-Atlantic states, and parts of Minnesota and Wisconsin). Doxycyclineis not contraindicated; it is contraindicated only in pregnant or lactating women, children < 8 years of age, and people who have had an allergic reaction to atetracyclineantibiotic. 1.Lantos PM, Rumbaugh J, Bockenstedt LK, et al: Clinical practice guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the prevention, diagnosis and treatment of Lyme disease.Clin Infect Dis72(1):e1–e48, 2021. doi: 10.1093/cid/ciaa1215 