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Lyme or Horrible Bug Bite????

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Posted 6/20/2012 6:01 PM (GMT 0)
Just got back from my derm as I wanted her to look at an expanding rash on my hip. It started 10 days ago as a small red bite. I never felt anything bite me. Within two days it expanded in size to a 1 1/2 x 1 inch red oval shaped inflamed spot. It was slightly itchy. I was alarmed by the size the spot was becoming so I went to my GP and she said it was a bite but wasn't sure what kind of bite. I was given a Rx for Keflex for seven days and a steroid cream and told to follow up if it didn't go away. The spot was never hot or sore at all.

Over the next few days the initial swelling on the bite subsided but the large oval spot was still there. It was still very red but again never hot or sore. Approx one week after the initial bite a rash had started to surround the oval spot. Minor itching but no pain or soreness. The steroid cream did not help.

I made an appt with my derm and she said she wasn't sure what bit me but took a biopsy to rule out cellulitis. (To be honest, it does not resemble cellulitis in any way.) I asked her if she thought it could be a tick and she said "Oh absolutely not. Tick bites that produce Lyme disease always have a bullseye ring around them."

I have read that Lyme disease rash is not always a bullseye pattern. Is this true? I have never had a bite react like this. Its not getting any better and now for the last five days I have had a headache every day. It comes and goes and feels like there is a horrible pressure in my head. I rarely get headaches so this is unusual for me. I'm not sure what to think. I don't want to have Lyme disease but if there is a chance I would like to be tested for it so I know. Any input would be appreciated. Thanks!
Posted 6/20/2012 11:38 PM (GMT 0)
Please read this and/or print it off for your doctor:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2698836/

BMC Infect Dis. 2009; 9: 79.

Published online 2009 June 1. doi: 10.1186/1471-2334-9-79

PMCID: PMC2698836

Diagnostic challenges of early Lyme disease: Lessons from a community case series



You are absolutely right, and your dermatologist is mistaken. The rash does not have to have a bull's eye pattern.

Sorry for the short reply, but I wanted to share this valuable resource with you.

If your dermatologist is unwilling, your GP might consider prescribing a course of doxycycline (as long as you aren't pregnant) if you go back to her with your expanded rash and additional symptoms. Although most doctors hate patients who walk in with printed articles from the internet, doing this could save you a lot of needless suffering. It is intended for doctors, so don't worry if you don't understand all of it.

The rash and headache should be enough for you to get treated. The dermatologist's biopsy may well be inconclusive and could needlessly delay your treatment.

The Lyme titer (e.g. ELISA) blood test won't be meaningful for at least the first few weeks until your body produces enough antibodies to be measured.

I sure hope you don't have Lyme disease, but if you do, early treatment is VERY important to avoid potential complications down the road.

All the best,

Rita
Posted 6/21/2012 12:32 AM (GMT 0)
p.s. Be sure to take a photo of your rash. You may need it in the future.
Posted 6/21/2012 3:38 AM (GMT 0)
Rita,

Thank you for this information. I am going to print it and seek another opinion.

I am wondering if the biopsy would show Lyme disease if that were the case? And you are right.....I certainly don't want to wait a few weeks if there is even a slight possibility.

I also took photos of the bite/rash since this started.

Thank you again.

sfgirl
Posted 6/21/2012 5:15 AM (GMT 0)
sfgirl,

You're most welcome, and I'm so glad you've been taking photos.

This is probably even more information than you need right now, but you do seem interested in knowing the facts, so I’m going to share a couple of more links with you.

Even if your dermatologist ordered the right test to check for Lyme disease in your rash, it looks like you would have only a 50% chance of the result being accurate according to this published article. Aside from that, lots of things can interfere with skin biopsy results, as you can see below. That’s probably why most experienced doctors skip the biopsy altogether:


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC153420/

Clin Microbiol. 2002 February; 40(2): 319–324.
doi: 10.1128/JCM.40.2.319-324.2002
PMCID: PMC153420

Laboratory Testing for Lyme Disease: Possibilities and Practicalities

“Culture isolation of B. burgdorferi sensu lato from clinical specimens remains the “gold standard” for diagnosis and is most commonly attempted with skin biopsy or cutaneous lavage specimens from EM lesions and blood from patients with early-disseminated disease. Positive culture rates of nearly 90% for secondary EM lesions, 50% for primary EM lesions, ...”

and

“The histopathology of LD is not specific and is most useful for excluding other diseases. Biopsy specimens from of EM lesions show edema, mucin deposition, and a perivascular infiltrate of macrophages, lymphocytes, and occasional plasma cells within the superficial and deep dermis (17). Acute cellulitis due to secondary bacterial infection and allergic reaction to the tick bite can obscure these features and complicate interpretation.”


One other thing I forgot to mention earlier is that being prescribed Keflex soon after your rash appeared could potentially interfere with any Lyme disease test results in the future, but I don’t want to confuse or stress you out, so I’ll leave it at that for now. Just tuck that detail away in the back of your mind for the moment, and do your best to get that second opinion as soon as possible.

http://www.hcplive.com/publications/Resident-and-Staff/2007/2007-06/2007-06_01

"Lyme Disease: Current Guidelines

Published Online: Wednesday, July 7, 2007

Lyme borreliosis is the most frequent tick-transmitted disease in the United States. The wide spectrum of clinical manifestations of Lyme disease in the 3 stages of infection include early disease, early disseminated disease, and late (or chronic) disease. Serologic testing should begin with ELISA. If this test is reactive, immunoblot assay is indicated. Identification of the etiologic agent by culture or polymerase chain reaction should be confined to specific indications, such as neurologic and arthritic symptoms, and to specialized laboratories. Several antibiotics are effective against Lyme disease. Empiric treatment of patients with erythema migrans is recommended, without serologic testing. The diagnosis remains a challenge in the absence of skin lesions. Lyme disease can have debilitating effects if left untreated; early treatment can prevent systemic infection.
...

Treatment

Doxycycline may be effective when used for 10 days, but up to 21 days of treatment may be required. For doxycycline and amoxicillin, the therapeutic course ranges from 14 to 21 days. There is no evidence that a longer treatment course offers any benefits.1 Doxycycline is relatively contraindicated in women who are pregnant or lactating and in children younger than 8 years. Thus, one of the other 2 agents should be used in these patient populations. When one of the 3 first-line agents is not tolerated or is contraindicated, an oral macrolide antibiotic can be used, such as erythromycin (Ery-Tab, PCE Dispertab; adult dosage?500 mg 4 times daily for 14-21 days). Agents that should not be used to treat Lyme disease include first-generation cephalosporins, such as cephalexin (Keflex), and sulfonamides.1"


Take care,

Rita
Posted 6/21/2012 2:18 PM (GMT 0)
Rita,

You have been beyond helpful.

Since you obviously know a great deal about Lyme disease, I was hoping to ask you one more question. I read, on several websites, that a tick must be attached for 36 hours before it will pass the bacteria to you. I never saw what bit me and I doubt that a tick would have been attached for that long without me knowing it. It was right on my hip, about an inch under my belt line and I feel I would have seen it or felt it there.

Is is true regarding the length of time a tick needs to be attached before you can get Lyme disease?

Thanks again,

sfgirl
Posted 6/21/2012 2:48 PM (GMT 0)
When my son was infected, he had what we thought was a mosquito bite, a bad one.

I took him to his pediatrician because he managed to break his finger on our fishing trip and went ahead and showed him the bite.. Yup.. mosquito. No meds required.

It was a nasty looking bite.

1 year later..... he was so ill, he missed most of the 10th grade. Tested positive for lyme and babesia... LLMD believes from a mosquito.

From now on, if any of us are bit to that degree.. i will insist on 21 days of doxy.

Momtomonsters

Posted 6/21/2012 6:25 PM (GMT 0)
Hi again, sfgirl,

Current wisdom is that it takes only 24 hours (and possibly less) for a tick to transmit Lyme disease.  There isn't universal agreement on this, so you'll see various points of view being expressed on the internet (and elsewhere).  The longer a tick is attached, the greater the chance of being infected.

The nymphal ticks that usually infect people do so because they are so tiny and usually cannot be felt.  That's said, it IS possible that your rash is something other than Lyme disease, however as momtomonsters has pointed out, almost anyone who has (or has had) Lyme disease would be looking for 21 days of doxy just to play it safe.   Trust me, it can be a devastating illness if left untreated or only partially treated.

Gotta go, but I'll check in later.

Hope this helps a bit.

Rita

Posted 6/22/2012 12:32 AM (GMT 0)
sfgirl,

I hope all of this information isn't too overwhelming, but there's one more link I'd like you (or your doctor) to take a look at. It shows examples of rashes other than the classic bull's eye -- which may only occur 9% of the time. Identifying rashes isn't easy, so I don't envy the doctors who are supposed to distinguish one from another. Lots of illnesses cause rashes, and this is part of the diagnostic challenge. I wish it were more straightforward, but unfortunately it isn't. Again, not every rash is caused by Lyme disease, but those that are need to be identified by a medical professional and then treated as soon as possible.

http://jdc.jefferson.edu/cgi/viewcontent.cgi?article=1007&context=fmfp&sei-redir=1&referer=http%3A%2F%2Fwww.google.ca%2Furl%3Fsa%3Dt%26rct%3Dj%26q%3Dkeflex%2520%252B%2520lyme%26source%3Dweb%26cd%3D1%26ved%3D0CFUQFjAA%26url%3Dhttp%253A%252F%252Fjdc.jefferson.edu%252Fcgi%252Fviewcontent.cgi%253Farticle%253D1007%2526context%253Dfmfp%26ei%3DlLziT-OuEOq_0QHmy_n5Aw%26usg%3DAFQjCNFUw9406b6x7VprBRVxjhoVXC3w4w#search=%22keflex%20%2B%20lyme%22

Please let us know how you make out.

Rita
Posted 6/22/2012 3:52 AM (GMT 0)
Just one more tidbit:

http://wwwnc.cdc.gov/eid/article/11/1/04-0303_article.htm

"From a third to three fourths of patients with Lyme disease cannot recall having been bitten by a tick (6,34–36). "


I know it's hard to believe, but plenty of people simply don't notice even an attached tick. That must be true given the location some rashes shown in published articles. The nymphal ticks can be as tiny as a poppyseed or the smallest freckle on your body. More than a few people have mistaken them for a speck of dirt.
Posted 6/22/2012 3:54 AM (GMT 0)
Thank you again for all of your information.

I have been doing quite a bit of reading the last few days. I feel a bit more educated and better able to ask the right questions.

I can't get in to see my GP until next Tuesday. I have the printouts that you suggested and a few others I found.
As I said before, I certainly hope this is NOT Lyme but I don't want to let it go if there is even a slight chance.

My headache is still present although not as bad but my jaw has been quite stiff and sore. I have Hashimotos so I have quite a bit of muscle and joint pain
already but never jaw issues.

Again, thank you. I will keep you posted.

sfgirl
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