Either you, a family member, or friend have contracted Lyme disease, the most common North American tick-borne illness. It is hard to believe that a tick the size of a poppy seed can transmit an infection, if undetected or undiagnosed in a timely fashion, can lead to long term complications. I diagnose approximately 200 cases of Lyme disease annually at Southampton Urgent Medical Care, P.C. and am acutely aware of Lyme disease’s clinical presentation. The information below, although technical at times, will provide pertinent information. Remember your 28 year old friend who received a pacemaker for ‘heart block’ ? He probably had Lyme myocarditis; if a health care professional entertained this diagnosis, the patient would have been treated effectively with intravenous antibiotics.

Lyme disease is an infection endemic to Eastern Long Island carried by the vector deer tick, and the Lone-star tick. The medical term for the infecting agent is spirochete bacterium Borrelia burgdorferi. Residents and visitors to the Hamptons must be vigilant regarding the symptoms and signs of Lyme disease in order to eradicate the infection, and prevent long term illness.

LYME DISEASE DIAGNOSIS is divided into 3 stages:

1. Primary, or Early localized: characteristic symptoms include fever, chills, myalgias (muscle aches), arthralgias (joint aches), malaise, fatigue, and swollen glands. In other words, think Lyme disease if you develop ‘summer flu’ symptons regardless of a history of a tick bite.

A Lyme rash, also called Erythma migrans, will accompany these symptoms 50- 80% of the time, and commonly manifests a ‘bullseye’ in appearance on the skin.

2. Early disseminated: disease is caused by the spread of the bacteria through the bloodstream resulting in multiple Lyme rash, arthritis, myocarditis, and Neuroborreliosis. Lyme arthritis typically involves the knee (although other joints may be infected) and causes pain and swelling. Lyme myocarditis may present with dizziness, vertigo, lightheadedness, and palpitations due to heart block. Neuroborreliosis (Lyme disease of the central nervous system) may present with Bell’s palsy (facial droop and numbness), meningitis (fever, headache, photophobia, vomiting, and neck pain), encephalitis (fever, headache, cognitive impairment, personality changes and depression) and polyneuropathy (peripheral pain, numbness, tingling and weakness).

3. Late, or Chronic persistent:
also referred to as post-Lyme disease syndrome, presents with ongoing symptons as elucidated above, even though the patient has completed antibiotic therapy. This may represent an autoimmune reaction and not active infection. Chronic antibiotic therapy is not indicated for this stage.
LYME DISEASE TREATMENT is antibiotic therapy. If a patient hosts an engorged tick for 24 hours or more, a prophylactic dose of Doxycycline 200mg. is indicated. Primary Lyme disease, Lyme arthritis, and Lyme disease induced Bell’s palsy is treated for 2-3 weeks with doxycycline, amoxicillin, or cefuroxime. Lyme meningitis and myocarditis requires 3 weeks of intravenous Rocephin. Failed therapy might indicate the presence of a tick- borne illness coinfection, e.g. Babesiosis, Ehrlichioses, or Bartonella.

PREVENTION IS THE BEST POLICY. Vigilance is key. Wear protective light colored clothing so that ticks are visible, use insect repellant, and remove the tick with a fine tooth tweezer at the head.

Lyme disease is also known as “The Great Imitator.” It is diagnosed clinically, and may mimic other illnesses such as multiple sclerosis, rheumatoid arthritis, fibromyalgia, chronic fatigue syndrome, etc. The ELISA and Western Blot blood test aid the diagnosis, but are not indicated for patients with the pathognomonic Lyme rash, or classic ‘summer flu’ symptoms. I administer blood tests for the other tick- borne illnesses if a coinfection is suspected.

*Have a medical question you want to ask Dr. Kot?  Email drkot@kdhamptons.com and look for his upcoming Q + A posts!

*If you need urgent care, visit us at:
Southampton Urgent Medical Care (SUMC)
609 Hampton Road
Southampton, NY
631.204.9600 phone