Tick-borne disease that struck a star shows importance of vigilance, prevention

As fans follow the health of singer and actor Justin Timberlake, his illness serves as a reminder of the importance of trying to prevent and treat tick-borne diseases. Timberlake has Lyme disease, which almost a half-million Americans are diagnosed with and treated for each year. That’s according to the Centers for Disease Control and Prevention, which says some of them may have been misdiagnosed.

Timberlake doesn’t seem to have any doubt about his condition, which he said has caused nerve pain, fatigue and other symptoms. He believes his diagnosis came well after he was infected.

Bottom line: It’s not something anyone wants to get, celebrity or not. So here, with the help of infectious diseases specialist Stephen Thacker, M.D., of MUSC Children’s Health, we take a look at:

• What causes Lyme disease.
• Its impact in South Carolina.
• Its symptoms.
• Treatment
• Prevention.

Cause of Lyme disease

Thacker said Lyme disease is usually spread through the bites of blacklegged ticks, also known as deer ticks. “It's the most common tick-based illness that’s diagnosed in the U.S.,” Thacker said.

“Most cases, though, are where these ticks live most, which is in the Northeast, Mid-Atlantic and upper Midwest regions. And we're seeing increases in the number of tick bites and where these ticks might live, with the longer and more warm seasons that we're experiencing. Peak transmission typically is during the warmer months, May through September, because this is when ticks are most active.”

Impact on South Carolina

Blacklegged/deer ticks are active in South Carolina, although not in the numbers seen north of the state. The South Carolina Department of Public Health lists them among the six types of ticks that live in the state, all of which can carry diseases.

 

As for Lyme disease case numbers, those are lower here than in some other states as well. According to World Population Review, a website that features data and analysis, South Carolina had about 760 reported cases of Lyme disease from 2000 to 2020. That’s a small number compared with Pennsylvania, the top Lyme disease state, which had more than 134,000 reported cases during that period.

That doesn’t mean people don’t show up in the Lowcountry with tick-borne infections. They just tend to have been on the move. “Most of the patients that we see with Lyme disease are folks who got it through traveling,” Thacker said.

But he added this about the larger picture when it comes to ticks. “When you just look at emergency department encounters across the U.S., we're seeing the highest rate of patients showing up with concerns about tick bites in the last five years. And we've seen that trend steadily increase year over year. It's probably driven by longer summers, warmer average temperatures. With that, we are seeing expansion of where we find different types of ticks.”

Symptoms of Lyme disease

Thacker said most people who get a tick bite don’t get sick. But for those who do get Lyme disease, there are some symptoms to watch for. 

“They show up typically in the range of anywhere from three days to three weeks-plus after a tick bite. Folks might see the development of a rash called erythema migrans, also called a bull's-eye rash. And we see that in about 75% of cases.”

Other early symptoms include:

• Fever.
• Chills.
• Headache.
• Tiredness.
• Muscle and joint aches.
• Swollen lymph nodes.

Thacker said it’s important to try to catch Lyme disease early. “What we know is that early treatment prevents progression to more serious complications.”

Those complications include joint infection, heart problems and trouble with the nervous system, Thacker said. 

As for what some people call chronic Lyme disease, Thacker said a more accurate term is post-treatment Lyme disease syndrome. “It can cause myriad symptoms from fatigue to headaches to joint complaints. But this is different from active infection, and the symptoms typically improve with time and supportive care, but symptoms can persist sometimes over many months.”

Treatment

But the need for that long-term care is avoidable for most people if Lyme disease is caught early. “The treatment is timely and correct antibiotics. The most common option is a medicine called doxycycline.”

Other antibiotic options include amoxicillin and cefuroxime axetil. Factors that affect which antibiotics doctors prescribe include patients’ symptoms, age, allergies and whether they’re pregnant. 

Prevention

Thacker encouraged people to try to avoid tick bites. “The best thing to do is when you're going to be in areas that are wooded or have high grass, make sure that you’re using approved insect repellents. Oftentimes, they contain things like DEET or picaridin or permethrin,” he said.

 

“We really encourage folks to be tick smart and wear long pants and long-sleeve shirts when they're in these areas if they can. It's always good to tuck your pants into your socks when you're hiking. Might not look the coolest, but it's a good way to prevent ticks from latching on as you're moving through high-risk areas.”

He focused on pants because ticks can hang out in ankle- to knee-high grass and bite people’s legs. “But they can also be in trees. We can get tick bites on a variety of locations on the body.” Thacker said.

With more than a month left of prime tick season, and the reminder that Justin Timberlake gave everyone of what Lyme disease can do, Thacker said it’s worth being vigilant. “Probably one of the most important things is performing daily tick checks on yourself, your children and your pets if they're coming with you on outdoor activities.”