News

Probable Cases of Lyme Disease in N.C. Quadruple

Michael Todd

09/02/2015

Aug. 31--Lyme disease is rare in North Carolina, but it's difficult to diagnose.

For example, when the state tallied 173 cases of Lyme disease in 2013, it also recorded 48,417 cases of chlamydia, according to the communicable disease section of N.C. Department of Health and Human Services. By comparison, chlamydia outnumbered many municipal populations that year in the Old North State.

Despite those proportions, difficult and delayed diagnoses reduce chances for relief in cases of Lyme disease with lingering symptoms, for which federal guidelines offer few solutions.

State Epidemiologist Megan Davies in a memo April 1 petitioned doctors to consider Lyme disease during patient visits. N.C. Division of Public Health (NCPH) each year tallies cases of Lyme disease in North Carolina. The infection is among many diseases that doctors report to local health departments.

NCPH "would like to ensure that health care providers consider the possibility of (Lyme disease) when appropriate," Davies wrote. "The diagnosis of (Lyme disease) should be based on a combination of symptoms, physical findings, the possibility of exposure to infected ticks and laboratory results."

Camp Lejeune and Air Station New River's wooded swaths are suitable tick ecosystems. But base public health officials also recognize challenges -- and obstacles -- in the diagnosis of Lyme disease.

"The symptoms of Lyme disease are typically intermittent and very general: fatigue, fever, headache, mildly stiff neck, arthralgia or myalgia," said Raymond Applewhite, spokesman for Naval Hospital Camp Lejeune. "In addition, laboratory blood tests are helpful only if used correctly and performed with validated methods."

Applewhite also said lab tests are discouraged for patients without symptoms of Lyme disease.

"As it is important to correctly diagnose Lyme disease when a patient has it, it is just as important to avoid misdiagnosis and treatment of Lyme disease when the true cause of the illness is something else," he said.

When to treat

Centers for Disease Control and Prevention guidelines -- followed by many hospitals, including Naval Hospital Camp Lejeune -- recommend antibiotics for early stages of Lyme disease. But antibiotics are discouraged months and years later, according to CDC.gov.

Patients treated early with appropriate antibiotics "usually recover rapidly and completely," Applewhite said. "However, treatment is only recommended for those with signs and symptoms of Lyme disease who have had a positive lab test."

Other obstacles also can prevent an infected patient from receiving antibiotics.

Applewhite said at Naval Hospital Camp Lejeune, patients receive prophylactic antibiotics "if all of the following:"

The attached tick can be "reliably identified as an adult or nymphal I. scapularis tick that is estimated to have been attached for over 36 hours."
"Prophylaxis can be started within 72 hours of the time that the tick was removed."
"Ecologic information indicates that the local rate of infection of these ticks with B. burgdorferi, (which the CDC indicate is the bacterium transmitted in Lyme disease infections) is greater than 20 percent," Applewhite said.

--The antibiotic doxycycline is not "contraindicated," or suggested not to be used, he added.

Probable cases rise

Applewhite's reference to Lyme disease symptoms as "intermittent" adequately describes Daniel Le Duc's condition in recent months. The Sneads Ferry resident's wavering symptoms began June 2014 and were diagnosed as Lyme disease in August of this year.

Le Duc's grandfather, Bruce Turci, reached out to The Daily News after a recent story on vector-borne illnesses. Turci wrote about the conflicting information that his grandson faced regarding the prevalence of Lyme disease in North Carolina.

Le Duc "has been told that Lyme disease doesn't exist in North Carolina," Turci said of his grandson's medical journey. "There is Lyme disease in North Carolina and there is Lyme disease in Onslow County."

From 2000-2005, Onslow County had 55 cases of confirmed Lyme disease, according to NCPH.

In addition, the Directorate for Public Health aboard Camp Lejeune also has documented 43 cases of Lyme disease in from 2011-2015:

10 cases in 2011
15 cases in 2012
Nine cases in 2013
Two cases in 2014
And seven cases so far in 2015, Applewhite said

It is unclear whether those infections were contracted locally, however.

Since 2008, Lyme disease has been reported in 80 of North Carolina's 100 counties, according to information from NCPH. In 2013, North Carolina reported 173 cases of the disease; in 2014, the state had 172 reported cases, according to NCPH. Of those, most were "probable cases" and few were "confirmed cases," according to NCPH.

To have a confirmed case, Lyme disease must be documented by "objective clinical data" and lab tests, said Dr. Carl Williams, who helps NCPH with the state's annual survey of Lyme disease. A probable case requires only a lab test, he added.

Williams said confirmed cases are "stable" at roughly 25 cases of Lyme disease annually in the Tar Heel State.

"Lyme disease is by no means common" in North Carolina, he said.

He said there are many more cases of tick-borne Rocky Mountain spotted fever in the state, which has about 400-500 cases per year.

Davies' memo cites a more than 400-percent increase in North Carolina's probable cases -- from 31 in 2008 to 144 in 2014. Williams said he "can't explain why" there has been such an increase.