Locations of Lyme disease cases

Locations of Lyme disease cases (Courtesy of the CDC / August 20, 2014)

Robin Ann Wolfender was infected with Lyme disease in 1979, when she was a 19-year-old summer camp counselor at Catoctin Mountain Park in Thurmont. Just five years earlier, the tick-borne disease had been named for the Connecticut town where children were developing odd target-shaped rashes and arthritis. Two more years would pass before researchers would link the symptoms to ticks that latched on to human bodies, secreting poisons as they consumed blood.

Wolfender, now 54, developed a fever of 105. It took a week for the fever to break, she says, and 11 years for doctors to diagnose her worsening health as Lyme disease.

Today, the Westminster resident walks with crutches, has difficulty with balance, tires quickly, and sometimes has difficulty turning her thoughts into words. "It's in every organ," says Wolfender, who leads a Lyme disease education and support group in Central Maryland. "Heart, lungs, brains, muscles and joints."

Compared with many states, Maryland is a hotbed of Lyme disease. And with cool and comfortable temperatures in the region inspiring more people to get out and enjoy nature, it's a good idea to heed strategies for avoiding the illness.

Thirteen states, including Maryland, are responsible for 95 percent of reported Lyme disease cases in the United States, according to the Centers for Disease Control. Between 20,000 and 30,000 new cases were reported nationwide each year between 2003 and 2012, the CDC says. In Maryland, confirmed cases have increased nearly every year, from 691 in 2003 to 1,113 in 2012.

But the actual numbers of Lyme disease cases may be 10 times as high, according to the CDC, which a year ago said it's likely that 300,000 Americans each year develop the disease.

"I like to get away from the absolute numbers and say there is plenty of Lyme disease in Maryland," says Katherine Feldman, state public health veterinarian and chief of the state's Center for Zoonotic and Vector-Borne Disease. A key reason for the underreporting is that Lyme disease symptoms such as aches and fatigue can apply to so many illnesses. Even the tell-tale bull's-eye rash does not appear in every case, or it may be hidden by hair.

The test for diagnosing Lyme disease won't register signs of the disease until a month has passed.

Lyme disease is caused by the Borrelia burgdorferi parasite. Symptoms include aches, fatigue and swollen joints. If treated with antibiotics, the cure rate is high. But if it is not treated right away, Lyme disease can be permanent and debilitating. Some people develop facial palsy, and about 1 percent of people with Lyme disease develop Lyme carditis, in which the disease infiltrates the tissues of the heart, causing chest pain, dizziness, and shortness of breath, says the CDC.

The scientific name for the ticks that carry Lyme disease is Ixodes scapularis, but most people know them as deer ticks. Deer ticks live from spring to fall and thrive in moisture, says Feldman, so the Eastern Shore and areas around rivers and streams are of particular concern. They climb up blades of grass, and wait for a human, deer or other animal to walk by. Then they latch on for a blood meal.

Keeping ticks at bay

The best way to prevent Lyme disease is to avoid getting bitten by a tick in the first place. Second-best is to remove the tick before it spews its poison. But if you've been bitten, and the tick is engorged, the next step is going to a doctor for antibiotics.

To make property inhospitable to ticks, keep the lawn mowed, clear away brush and trim tree branches so sunlight can penetrate, says Feldman. Lucy Barnes, director of the Lyme Disease Education and Support Groups of Maryland, suggests creating borders between lawns and surrounding brush, using mulch that has been sprayed with Permanone insect repellent.

Make sure your dogs and cats have a tick preventive, and check them for ticks. "Not only can your dog get Lyme disease, but your dog can bring ticks into your environment," says Feldman.

When venturing into areas likely to be infested with ticks, wear long pants and tuck them into socks, says Feldman. Choose long sleeved-shirts and opt for light-colored clothing, so it's easier to spot ticks that have landed on you. She also recommends spraying insect repellent on clothing.

After spending time outdoors, shower immediately, then do a head-to-toe tick check, paying particular attention to warm spots such as the backs of knees, crooks of elbows, behind the ears, in hair, under breasts, and in genital areas. Wash and dry your clothes — the heat from the dryer will kill the ticks, says Feldman.

The CDC says the tick must be attached for 36 to 48 hours to transmit Lyme disease, so if you check for ticks daily and you see a tick that's latched on, you can remove it without getting sick.

"Take fine-tipped tweezers, get as close to your skin as possible, keeping tweezers parallel to your skin, and apply firm, steady pressure with those tweezers, pulling the tick 90 degrees away from your body," says Feldman. "It should pop out." Then wash the area with antibacterial soap, she advises.

If the tick is still flat when it's removed, that's "a good indication it has not had a blood meal," says Feldman, who adds: "Personally, I make a note in my calendar when I've been bitten by a tick."

If the tick is swollen, put it in a plastic baggie, and take it — and yourself — to a doctor, says Feldman. There's no point in testing you for the disease, because the test won't be effective for several weeks after a tick bite, but the doctor might prescribe a single dose of the antibiotic doxycycline as a preventative measure, she says.

For most people infected with Lyme disease, the tell-tale sign is not the tick (which more often than not is never discovered), but the symptoms, which typically begin about a week after the bite, and get worse over time, says the CDC. About 75 percent of people with Lyme disease develop rashes, which are warm to the touch but not painful. In most cases, treatment with antibiotics over two to four weeks will cure the disease.

Lyme disease can be frightening, says Barnes, but "we want people to enjoy the outdoors."

For more information, see the CDC website at cdc.gov/lyme, or visit the Maryland Department of Mental Health and Hygiene site at dhmh.maryland.gov.