Ft. Worth Star-Telegram, January 14, 1999

Tick talk: Lyme disease is on the upswing - nationwide and in Texas. A new vaccine and greater awareness of the symptoms can help combat the debilitating illness. Here's what you need to know.
By Carolyn Poirot
Star-Telegram Staff Writer


The desperation in Jacqueline Smith's voice is undeniable.

"I'm dying of Lyme disease, chronic, reoccurring neurological Lyme disease, and people keep saying Lyme disease is not a problem in this part of the country," says the Fort Worth resident, 42. "I've suffered from this since 1985, and it's about to put me in a nursing home. We've had a damn old vaccine for dogs for years, and nothing for humans."

It's the country's most common tick-borne illness, a multistage, multisystem disease transmitted from animals to humans and caused by infection with a spiral-shaped bacterium known as `Borrelia burgdorferi.' If the disease progresses and the bacteria invade the brain and spinal cord, infecting the central nervous system, it can cause severe anxiety, insomnia, memory loss, moodiness and depression, hallucinations, panic attacks, paranoia, manic depression, seizures and even dementia, according to the American Lyme Disease Foundation.

While most people associate the disease with the Northeastern part of the country where it was first diagnosed just over two decades ago, cases have now been confirmed in every state except Montana, and new cases continue to develop at a rate of about 10,000 a year.

Texas now counts 2,000 probable cases, 725 confirmed.

Officially disabled by chronic Lyme disease, Smith counts herself among nearly 100,000 cases that have been reported to the Centers for Disease Control and Prevention. She has home health nursing care, can no longer walk without a cane, and depends primarily on a three-wheeled cart to get around.

Although Smith's case is extreme, doctors and scientists say that most of the time Lyme disease is both preventable and curable. Public awareness of what the disease is and how it spreads is part of the solution. And on Dec. 21, the Food and Drug Administration approved LYMErix as safe and effective. It's the first human vaccine against the disease.

Confusing symptoms

Smith's Lyme disease was diagnosed in 1990 after she had endured numerous blood tests, a spinal tap and a ferocious series of medical problems.

She had been treated for fatigue, headaches, weight loss, joint pains, fever, irritable bowel syndrome, irregular heartbeat and other nonspecific symptoms since late 1985.

She believes she contracted the disease while she was working as a nurse and caring for a patient known to have Lyme disease. Although most health officials maintain that the disease is spread to humans only through tick bites, Smith says she got it through a needle stick. She says her daughter, who also has been found to have Lyme disease, contracted it through maternal-fetal transmission.

The needle stick came in August 1985, two months before Smith's first symptoms hit.

"First you feel like you've got the flu, but it stays on you longer, then it goes into remission, then it comes back worse than ever," Smith says.

Last February, she ended up at Parkland Memorial Hospital in Dallas, hallucinating. The diagnosis was psychosis.

"They tried to put me in the mental ward, but then, thank God, they did a spinal tap that showed I had an infection of the brain and needed IV antibiotics again. It's a common late manifestation when you have neurological involvement with Lyme," she says. "It is the most horrible thing I have ever experienced, like you are in a deep fog on a merry-go-round, going faster and faster. It's terrifying."

Most cases of Lyme disease are not nearly as severe as Smith's. The disease can usually be treated successfully with four to six weeks of intensive antibiotics -- though it can be difficult to diagnose.

Onset is commonly associated with a characteristic target-shaped skin rash known as "erythema migrans," which can vary in size, but is most often about 2 inches across. The rash is often accompanied by flulike symptoms including headache, fever, fatigue, joint aches, muscle aches and a stiff neck.

Texas outbreak

The first cases of Lyme disease in Texas -- nine of them -- were reported in 1986, says Julie Rawlings, epidemiologist with the Texas Department of Health. The next year, the number jumped to 33. In 1992, the state had a high of 113 new cases. In 1997, the most recent year for which there are complete records available, 60 cases were reported to the Texas Department of Health. There were 97 cases the year before.

"The number of new cases in Texas has been down in the last year, but it has mostly to do with the drought," Rawlings said recently.

Rawlings says all it would take is a wet year for the ticks to get happy and prolific, and she doesn't want to provide a false sense of security by saying the numbers are going down.

Experts blame the fast-emerging disease, in part, on the quickly growing deer, mice and tick populations and on migratory birds, which often carry tiny ticks hundreds of miles before the ticks fall off, looking for their next blood meal.

"Land-use patterns are a major factor," says Dr. Richard Falco, an entomologist with Calder Vector Ecology Research Laboratory at Fordham University and research consultant for the American Lyme Disease Foundation.

He studies ticks and teaches in the infectious disease department at Fordham.

"The reason there is so much more Lyme disease now is probably because land-use practices have changed," Falco says. "Here in New York, we used to be pretty much agricultural, but now the forests that were cleared for farming have started coming back. The deer populations have increased, and the mouse populations -- and especially the tick populations."

The weather plays some role along with the mass production of acorns and with biological factors, including the number of hosts, predators and parasites, Falco says.

To reduce the tick population, Falco recommends insecticide in residential environments in places where ticks are prevalent.

"We recommend spraying on your own property," he says. "Probably 70 percent of the Lyme disease here in Westchester County is acquired right in our own back yards. Insecticides are one weapon, as is the new vaccine," he says.

For those traveling -- or hunting -- in areas where ticks are found, experts also suggest taking personal precautions. "Dress appropriately, with long pants and shirt tucked in, use a repellent spray, check for ticks and remove them promptly," says Dr. Michael Caldwell, commissioner of health for Dutchess County, New York. "If you remove any tick within 24 hours of attachment, it will greatly reduce the risk of tick-borne disease. You need to pull them straight out with a point tweezers."

Most people do not even know they have been bitten by a tick unless they find one on their body. The tick emits a little anesthetic from its mouthpiece, numbing the area when it attaches, according to Caldwell.

From bad to worse

If left undetected and untreated, the Lyme bacterial infection can cause irregular heart rhythms and spread to the joints. When the disease infects the brain and spinal cord, it can be devastating. Even after Lyme disease is cured, some victims continue to suffer certain symptoms, especially arthritis and neurological problems, says Caldwell, whose county lies about 100 miles north of New York City.

Dutchess County has more Lyme disease for its population (270,000) than any other place in the country, with about 1,800 new cases each year.

Caldwell was principal investigator for clinical trials of the new vaccine, developed by SmithKline Beecham pharmaceuticals.

"We have a lot of deer and white-footed mice, both carriers of Lyme," Caldwell notes. "About half the ticks we test carry the Lyme bacterium."

The bacterium is not as common in Texas, but Lyme disease is the most common tick-borne disease in the state, Rawlings says. She estimates that about 2 percent of the ticks found here carry the bacterium.

"The vaccine will protect only against Lyme disease, but 90 percent of tick-borne disease is now Lyme," Caldwell says.

Three doses of the vaccine are recommended for the most effective protection, with the second given one month after the first and the third one at 12 months. The efficacy rate is 79 percent protection after three injections.

"Clearly, three doses provide the best protection, but two provide some protection. I recommend starting sooner than later. You can reduce the risk by 50 percent with just two doses," Caldwell says.

"We believe Lyme disease is both preventable and curable, but infection often is not protective. Even after you've had it, you are at risk of getting it again, so the vaccine would be beneficial for anyone living in or working in or visiting an area where there are a lot of ticks," he says.

For Fort Worth's Smith, the vaccine comes too late. Still, the former nurse hails its significance.

"I hope doctors will prescribe the vaccine now that we finally have one," she says. "I know veterinarians who won't give their own dogs the Lyme vaccine for dogs and cats because they say Lyme disease is not a big enough problem around here," Smith says.

Smith knows just what a problem it can be.

New Lyme vaccine has implications for curing arthritis In the beginning it was referred to as "Lyme arthritis." Lyme disease originally was described in 1975 by medical researchers evaluating an outbreak of juvenile rheumatoid arthritis in and around Lyme County, Conn. There is, in fact, some belief that bacteria may be a common trigger in many forms of arthritis. Like genes or being overweight, bacteria might be one factor in the development of the disease, according to the Arthritis Foundation, which was also involved in the development of the new vaccine. "This is a very exciting and positive outcome," says Brian Butcher, vice president for research and professional education. "We at the Arthritis Foundation are very excited, because this is an ultimate outcome of the many years of research support in Lyme disease that we have provided." In addition to preventing further cases of Lyme disease, the vaccine may provide a model for addressing other types of arthritis where there are preliminary indications for bacterial triggers, Butcher says, including rhuematoid arthritis, lupus and ankylosing spondylitis, a kind of arthritis that affects the spine. Checking for ticks Heading for the great outdoors? The Arthritis Foundation recommends taking personal precautions to avoid the risk of tick bites. Among them: Conduct detailed tick checks at the end of each day (to remove any tick before it can transmit disease), wear light clothes (so ticks will be visible), tuck pant cuffs into socks (so ticks cannot gain access to the skin) and properly use insect repellents that contain the chemical insecticide DEET. For free brochures and additional information on Lyme disease, call the Arthritis Foundation at (800) 283-7800. Research on Lyme disease Researchers across the country are taking some novel approaches to try to stop ticks and Lyme disease on their march across the country. Lizards may be protecting some areas of the country, including parts of Texas, from Lyme disease. The small Western fence lizard, a favorite feeding host for the Western black-legged tick that carries Lyme disease, has a protein in its blood that kills the Lyme bacteria as the tick sucks, harming neither the tick nor the lizard. "Lizards are doing humanity a great service here in the west," says Dr. Robert Lane of the College of Natural Resources at the University of California at Berkeley, who reported on the lizards last year in the `Journal of Parasitology.' "The infection rates are diluted out west and down south because you have a host that acts as a dead end for transmission," says Dr. Richard Falco, a medical entomologist at Fordham University and scientific consultant for the American Lyme Disease Foundation. He is looking for a similar biological agent to help control Lyme disease in colder parts of the country, where the lizards cannot survive. "We are looking at nematodes and fungi that might appeal to the ticks and work similarly," Falco said when contacted by phone last week. Falco is also participating in a U.S. Department of Agriculture project that started in Kerrville several years ago and involves applying insecticides to paint rollers around troughs that are supplied with corn to attract deer. As the deer reach their heads into the feeders to eat the corn, they rub their necks against the rollers and self-apply the insecticide, which is approved by the Food and Drug Administration. It kills the ticks but does not harm the deer, Falco says. Also, researchers at the University of Massachusetts at Amherst are studying how parasitic wasps can be used as tiny guided missiles to kill ticks. The wasps use a sharp appendage to lay eggs within the ticks. Their offspring hatch inside the ticks and kill them.