Appalachian Trail Hikers’ Ability to Recognize Lyme Disease

[Tom Murphy]

From VFTT:



Link to Article

http://doi.org/10.1016/j.wem.2013.09.009

Abstract

Background
Lyme disease is the most common vector-borne infectious disease in North America. With nearly 2,500 Appalachian Trail (AT) hikers entering the endemic area for as long as 6 months, exposure to the disease is likely. The characteristic exanthem of erythema migrans (EM) should be a trigger for seeking medical treatment, and its recognition in this relatively isolated environment is important.

Objective
The purpose of this study was to determine the ability of AT hikers to identify EM, the exanthem of Lyme disease.

Methods
Hikers were administered a photographic stimulus in this Internal Review Board-approved pilot study. Historical hiking data, basic demographics, and self-reported treatment and diagnosis were collected.

Results
In all, 379 responses were collected by 4 researchers at 3 geographically separate locations at or proximate to the AT from June 2011 to May 2012. Fifty-four percent of respondents (206 of 379) were able to recognize the photographs of EM/Lyme disease; 46% could not. Of those who did recognize EM, 23 (6%) had seen it either on themselves or on another hiker while on the AT. A total of 37 hikers stated that they had been diagnosed with Lyme disease while hiking, and of these, 89% were treated with antibiotics. Thirteen of these 37 hikers (35%) diagnosed with Lyme disease had visualized an embedded tick. Nine percent of all respondents reported they had been diagnosed with Lyme disease by a healthcare practitioner, whether from EM, symptomatology, or by titer.

Conclusions
This study suggests that hikers are poorly able to recognize the characteristic exanthem of Lyme disease but have a high exposure risk.

[4eyedbuzzard]

37 hikers contracting Lyme out of 379 respondents is pretty scary actually. A 10% chance of getting Lyme is pretty high. It would be interesting to know more about the individual hiker's preventative measures - use of topical repellents (DEET), permethrin treatment of clothing, frequent inspection, etc, and to what degree these behaviors and measures effect the rate.

But, goes to show, many of us have always said ticks are the most dangerous thing on the AT, not bears or giardia.

[Don H]

I got it in MA and I used Permethrin on my clothes every 4 weeks from May until I got to NH.

[Tom Murphy]

characteristic exanthem of erythema migrans - THE CLASSIC BULL'S-EYE RASH

https://www.google.com/search?q=characteristic+exanthem+of+erythema+migra ns&safe=active&rls=com.microsoft:en-us:IE-SearchBox&source=lnms&tbm=isch&sa=X&ei=ls7eUqPjH-_ksATXsYAI&ved=0CAkQ_AUoAQ&biw=1920&bih=912

http://en.wikipedia.org/wiki/Erythema_chronicum_migrans

[4shot]

37 hikers contracting Lyme out of 379 respondents is pretty scary actually. A 10% chance of getting Lyme is pretty high. It would be interesting to know more about the individual hiker's preventative measures - use of topical repellents (DEET), permethrin treatment of clothing, frequent inspection, etc, and to what degree these behaviors and measures effect the rate.

But, goes to show, many of us have always said ticks are the most dangerous thing on the AT, not bears or giardia.

I contracted Lyme's on the AT. The initial stage I just chalked it up to a stomach virus as I did not see the "red bullseye" although I had pulled plenty of ticks off of me. Stage 2 was the scary part - I was having severe aches in my joints (classic symptons). Fortunately I asked my doctor to run a Lyme's test and he did. His clinic had never seen (or diagnosed) a case of Lyme's before so he would not have thought to do so until maybe much further down the road. Moral of this story: if you hike the AT for 6 months or 6 minutes, familiarize yourself with this disease and its symptoms. There is a good chance that your doctor may not have seen it, especially if you do not live directly on the AT corridor. It is not a pleasant experience and can be life threatening if untreated (or even if treated during the latter stages).

[burger]

I am 90% positive that I had Lyme disease a couple of years ago (not on the AT but nearby--I work out in the woods). I didn't realize it until well after the fact, when I was talking with another hiker about his Lyme symptoms. On top of the usual fever, fatigue, etc., he reported a terrible cough that wouldn't go away. He tested positive for Lyme and was treated with antibiotics. I had a very similar experience, and after 2 weeks of nonstop coughing which kept me up half the night (plus the fevers, night sweats, etc.), I finally begged my doctor for antibiotics. I was better in 2 days.

A lot of online symptom lists for Lyme don't mention coughing, and that's why I didn't consider it sooner. But if you browse through published scientific papers, there are some reports of coughing in the early stages.

[Dogwood]

I don't know if I was one of those 379 respondents in this specific study but three times, twice on the AT(once in the town of Lyme NH, once at a TH), and once elsewhere, I filled out questionaires on my ability to recognize some of the symptoms associated with Lyme Disease. I answered questions and was shown various pictures, including the Bulls Eye Rash symptom. I was even told by those doing the studies this is what they were attempting to discern: If hikers are able to recognize the characteristic exanthem(fancy word for skin eruption, like a rash) of Lyme disease. Two of the study groups(located at a busy AT TH and in Lyme NH) were giving out insect repellents, which if I'm recalling correctly, were DEET or Permrethin or both. I'm noting in various studies that the Bulls Eye Rash MAY NOT occur as often as was previously assumed. So, I would use that symptom, erythema migrans rash, as only one possible indication of Lyme Disease exposure. In other words, while being able to recognize the Bulls Eye rash will prompt hikers/outdoors people to get medical treatment, lack of the Bulls Eye Rash, is not an indication that one has definitely avoided Lyme Disease after a tick bite. And, Lyme Disease is just one of several different tick vectored diseases AND those other diseases aren't associated with a Bulls Eye rash. I'm currently reading Healing Lyme Disease Coinfections by Stephen Buhner.

The erythema migrans rash(the so called Bulls Eye Rash symptom) is classically 5 to 6.8 cm in diameter, appearing as an annular homogenous erythema (59%), central erythema (30%), central clearing (9%), or centralpurpura (http://en.wikipedia.org/wiki/Purpura) (2%).[6] (http://en.wikipedia.org/wiki/Erythema_chronicum_migrans#cite_note-pmid17113969-6) Because of the "bull's-eye" description to describe the Lyme disease rash, the condition commonly called ringworm (http://en.wikipedia.org/wiki/Ringworm) is sometimes confused with Lyme disease.[6] (http://en.wikipedia.org/wiki/Erythema_chronicum_migrans#cite_note-pmid17113969-6)Uncommonly, EM may be less than 5 cm in diameter (http://en.wikipedia.org/wiki/Diameter).[7] (http://en.wikipedia.org/wiki/Erythema_chronicum_migrans#cite_note-7) Multiple painless EM rashes may occur, indicating disseminated infection.
The EM rash occurs, according to sources, in 80%[8] (http://en.wikipedia.org/wiki/Erythema_chronicum_migrans#cite_note-8) to 90%[9] (http://en.wikipedia.org/wiki/Erythema_chronicum_migrans#cite_note-9) of those infected with Borrelia. A systematic review (http://en.wikipedia.org/wiki/Systematic_review) of the medical literature[10] (http://en.wikipedia.org/wiki/Erythema_chronicum_migrans#cite_note-10) showed 80% of patients have an expanding EM rash, at the site of the tick bite,[11] (http://en.wikipedia.org/wiki/Erythema_chronicum_migrans#cite_note-pmid17579230-11) although some patients with EM do not recall a tick bite. In endemic areas of the United States, homogeneously red rashes are more frequent.[12] (http://en.wikipedia.org/wiki/Erythema_chronicum_migrans#cite_note-12)[13] (http://en.wikipedia.org/wiki/Erythema_chronicum_migrans#cite_note-pmid11982300-13)

***A significant group of practitioners disputes the generally accepted incidence (http://en.wikipedia.org/wiki/Incidence_(epidemiology)) of the rash, claiming it occurs in less than 50% of infections.[14] (http://en.wikipedia.org/wiki/Erythema_chronicum_migrans#cite_note-14)[15] (http://en.wikipedia.org/wiki/Erythema_chronicum_migrans#cite_note-15)

[FooFighter'12]

I got in NY. I didn't see the tick but came across a sore bump where it had been in my armpit. Didn't think much about it at the time, just chalked it up as a bug bite. Then I started feeling fatigued, sore, and had headaches. In CT, I noticed the bulls eye rash. Walking through MA, my body really started crashing on me. By the time I got to the VT border, I had three rashes. The one around the bite had expanded to about 10 inches in diameter. The other two were small, one on my chest and the other on my arm. By this time I was really struggling to do miles and decided to head into Bennington to get checked out. Three days into the 2 week prescription and I started feeling better.