Lyme Disease, a Continuing Concern in Ohio

Source: Ohio Department of Health

Lyme disease is spread by the blacklegged tick, Ixodes scapularis. The blacklegged tick was first established in Ohio in 2010. Since then, this tick’s range has expanded in Ohio, and Lyme disease has dramatically increased and continues to significantly impact Ohioans.

Over the past 14 years, there has been a 48-fold increase in Lyme disease cases reported in Ohio.

1. Consider tickborne diseases, including Lyme disease, as a differential diagnosis when evaluating patients with febrile illness, with or without a rash. Many tickborne diseases present with non-specific clinical signs such as fever, headache, fatigue, and muscle aches. Some, but not all, tickborne diseases may present with a rash that can vary in presentation. For more information on symptoms of tickborne diseases, visit CDC’s Tickborne Diseases Symptoms website.
2. Familiarize yourself with the laboratory tests available to diagnose tickborne illness.
   • Lyme disease:
     • Testing involves two steps and can be done with the same blood sample.
       1. Standard two-tier test (STTT): a positive or equivocal first-tier screening assay, often an enzyme immunoassay (EIA) or immunofluorescence assay (IFA) for immunoglobulin M (IgM), immunoglobulin G (IgG), or a combination of immunoglobulins, followed by a concordant positive IgM or IgG immunoblot interpreted according to established criteria.
       2. Modified two-tier test (MTTT): positive or equivocal first-tier screen, followed by a different, sequential positive or equivocal EIA in lieu of an immunoblot as a second-tier test.
     • The IgM Western blot usually is positive a few days to a few weeks after illness onset. The IgG Western blot should be positive around four weeks after symptom onset.
   • Anaplasmosis, ehrlichiosis, and spotted fever group rickettsiosis:
     • Perform PCR from whole blood specimens collected during the acute state of illness, or IFA testing of at least two serum samples collected two to four weeks apart during acute and convalescent phases.
     • Note: Serologic sensitivity is poor in the early stages of infection. If serology is negative in patients with possible early infection, repeat serology three to four weeks later may demonstrate seroconversion.
   • Babesiosis:
     • Diagnosis can be made by examination of thick and thin blood smears stained with Giemsa or IFA testing.
   • Powassan virus:
     • Contact the ODH Zoonotic Disease Program at 614.995.5599 to arrange for testing by CDC.
3. Promptly report suspected cases of tickborne infections to the local health department where the patient resides.

Treatment for Tickborne Illnesses
If anaplasmosis, ehrlichiosis, Lyme disease, or spotted fever group rickettsiosis is suspected, treat all patients, including children, promptly with doxycycline. Do not delay therapy pending diagnosis, as anaplasmosis, ehrlichiosis, and spotted fever group rickettsioses are potentially fatal.

Babesiosis should be treated with Atovaquone PLUS azithromycin or Clindamycin PLUS quinine.

There is no medication to treat Powassan virus infection; provide supportive care.

Additional information on treatment of tickborne diseases can be found at CDC’s Tickborne Diseases website.