Lyme Disease: The Forgotten Vector-Borne Disease of North Carolina By Katherine S. Adams, William J. Taylor, Peter Ahiawodzi, and Mark Moore
of the 230 cases of Lyme disease in 2016 were recorded in Wake County. (1) The number of cases in Wake County is quite disturbing as it is one of the fastest growing areas in the nation and second-most populous county in North Carolina with approximately 1,025,000 residents. (7) Symptoms
Background Transmitted by blacklegged ticks (species: Ixodes Scapularis; family: Ixodidae), Lyme disease is a multisystem bacterial infection caused by the spiral-shaped bacterium, Borrelia burgdorferi. It is important to note that blacklegged ticks are commonly referred to as “deer ticks.” First documented in 1975 as childhood arthritis, Lyme disease received its name from the small town of Lyme, Connecticut. According to the Centers for Disease Control and Prevention (CDC), Lyme disease is the most commonly reported vector-borne illness in the United States and was the fifth most common nationally notifiable disease in 2014. (1) Even though the majority of cases are reported in the northeast and north central states, in recent years, the geographical magnitude of disease has expanded raising the prospect of Lyme disease becoming endemic in the southeast. (2)
Recent research suggests that regions across the United States where Lyme disease was previously uncommon are now experiencing a growth in blacklegged tick populations (Appendix A). (3) Ominously, people living in these newly affected areas may be unaware of the associated health risks and appropriate prevention techniques since they previously had no reason to worry. (3) Data from the CDC indicates the state of North Carolina is experiencing a drastic increase in the number of Lyme disease cases per year (Appendix B). (1) For surveillance purposes, five counties within the state were classified as endemic for Lyme disease in 2015: Alleghany, Haywood, Guilford, Wilkes and Wake. (4,5) For a county to be classified as endemic there must be at least two confirmed cases of Lyme disease acquired within the county or a population of infected blacklegged ticks must have been previously documented within the county. (6) According to the CDC, 27
North Carolina Pharmacist
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Symptoms of Lyme disease resemble other common illnesses, thus making diagnosing arduous; however, there is one characteristic symptom associated with Lyme disease, the “bull’s eye” rash (erythema migrans). Located at the site of attachment, the small circle grows over time reaching the dimension of a penny or larger. Other symptoms that often co-occur with the rash include: fatigue, chills, fever, headache, lymphadenopathy, neck stiffness, myalgia, and arthralgia. (8) Lyme disease has three clinical stages: early-localized, earlydisseminated, and late Lyme disease. Early symptoms usually occur 3 to 30 days following the tick bite. The rash, erythema migrans (EM), is characterized within the first stage of early-localized Lyme disease. (9) Multiple EM, as well as cardiac and neurological findings, are often observed in the early-disseminated stage of the illness. Cardiac findings include carditis with second-or third-degree heart block, while neurologic findings include cranial neuritis, lymphocytic meningitis, or mo-
Volume 99 Number 3 Summer 2018
