July 09--NANTUCKET -- Don't expect a blood test to distinguish between a summer flu and a newly incubated case of Lyme disease, a Johns Hopkins researcher said yesterday during a conference at Nantucket High School.
The patient takes time to develop antibodies to infection, so physicians must use their clinical judgment in deciding whether to prescribe antibiotics for Lyme disease, said Dr. John Aucott, president and founder of the Lyme Disease Research Foundation of Maryland.
Doctors should take into consideration symptoms such as fever, fatigue and muscle aches and note whether the patient lives in a deer-tick habitat, he said.
"Testing is not the way early diagnosis of Lyme is made," he said.
More than 200 people gathered for a free expert panel on Lyme disease and other tick-borne illnesses, such as babesiosis.
"Everybody in the room has known someone with Lyme disease," Aucott said. "It's very important we catch the disease early and treat it then."
If untreated or under treated, Lyme patients may develop Bell's palsy, heart problems, arthritis and even neurological problems, he said.
Nantucket is ground zero in Massachusetts for tick-borne illness. In 2008, according to information collected by Dr. Timothy J. Lepore, medical director of the Nantucket Cottage Hospital medical staff, there were 312 local cases of Lyme disease, 69 cases of babesiosis, and 18 cases of ehrlichiosis, also known as anaplasmosis.
"Nantucket's got a problem," said Lepore, who blamed much of it on the island's population of 2,500 deer, which provide a host and a meal for the adult deer tick.
Deer ticks infect people by biting them and injecting bacteria into their blood.
Many people don't even know they've been bitten, given the tiny size of the deer tick, particularly in its nymphal stage in spring and early summer.
Sam R. Telford, associate professor of infectious diseases at Cummings School of Veterinary Medicine at Tufts University, passed around a vial of poppy-seed-sized deer ticks, whose features could only be made out with a magnifying glass.
"If you find one tick on yourself, look for another," Telford said.
In most cases of Lyme disease, afflicted patients get a rash that can look like a bull's-eye or a red round spider bite.
"Anything round, red, oval -- think Lyme disease at this time of year," Aucott said. He said that too often patients without the rash or a positive Lyme test are told they have a summer flu, even though they don't have sniffles.
"Misdiagnosis is fairly common," he said. In his home state of Maryland, where Lyme is now spreading, patients may be treated with the wrong antibiotics such as cipromycin.
Local physicians are getting better at making clinical diagnoses, said Brenda Boleyn, head of the Cape and Islands Lyme Disease Task Force in a phone interview. But "in many cases they reach for that test too soon."
Not only do antibodies take a while to develop, she said, but some people's antibody reaction is too weak to ever produce a measurable response.
"It's just a question of how sure you want to be," said Dr. Alan Sugar, head of infectious diseases at Cape Cod Hospital in Hyannis.
If a patient has fever, muscle aches and fatigue, "it's absolutely OK to go ahead and treat," he said. "It's not necessary to do a lot of blood tests."
A stuffy nose, sore throat and earache are not symptoms of Lyme disease, however, Sugar said.
"We have no idea" of the true incidence of Lyme disease, said Dr. Malcolm W. MacNab, chairman of the Nantucket Tick-borne Disease Committee. "We know it's underreported."
A type of illness also caused by the deer tick and known as babesiosis is even more underreported, said Dr. Peter J. Krause, senior research scientist at the Yale School of Public Health at Yale University.
Babesiosis, which used to be known as "Nantucket fever," has a mortality rate of 3 percent to 20 percent and is especially dangerous for elderly people or those without a spleen, he said.
"The island has unfortunately been a longtime national leader in infection caused by tick bites," said Jim Lentowski, executive director of the Nantucket Conservation Foundation.
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