Male: If you considered a tick bite high risk that you might want it treated with antibiotics, what will be in your head?
Female: For example, if I spend a week or a few weeks in upstate New York and I had an episode of fever or an unusual rash, I will definitely be very suspicious about that.
Male: But even more than just a tick bite, you will watch some symptoms, is that correct?
Female: Exactly.
Male: If you had three weeks after a tick bite, you would start worrying?
Female: Yes.
Male: Is it a certain type of rash you get?
Female: It is a very, very specific rash, although sometimes, it can present in different ways.
Male: But the classical look--
Female: A classic one is like a target—a huge, big target.
Male: Like a target.
Female: Yes.
Male: Like a bow and arrow target.
Female: Yes. And the way that we have to describe this is like a growing target. It is a very--
Male: It gets bigger.
Female: It is bigger over the time. It is red. It is very red and is rounded and it has this particular way that it behaves is it will stop growing over time, so you get it in the back or you get it in the leg or you get it in any part of your body and it will start to grow.
Male: If someone had to see a little tick in the skin and they brought it to the lab, and they know it, that does not even help you, does it because you do not know if it transferred it?
Female: Well, sometimes people can verify if a tick was infected or not, but it is not really worth it sometimes to know. You may need to take yourself and see what is going on.
Male: We watch for the symptoms of Lyme disease that you mentions is that target—obviously that is the hallmark.
Female: There are two different things—the rash and the fever and some vague symptoms like flu symptoms. Those kinds of symptoms are happening together and simultaneously with the tick bite. That will be like one or two weeks and the tick bite. So that will be like summer time kind of symptoms.
The later symptoms that will appear with Lyme disease and that is like secondary to a tick bite, will be arthritis. The arthritis needs to be treated aggressively and the arthritis needs to be treated longer than the symptoms that presents in the beginning.
Male: If you treated, not with—with a real bad case, what would you treat with and how long would you normally treat with.
Female: We are talking about arthritis?
Male: Some little target, not too much symptoms.
Female: If it is an acute Lyme with some rash and flu-like symptoms, I would treat it probably for two weeks.
Male: With?
Female: With amoxicillin.
Male: Okay. All the people, they seem to use things like--
Female: Doxycycline.
Male: Doxymicyin, something like that.
Female: No. In pediatrics, like at least less than ten years old or even less than 14, some people say I will advice them to take amoxicillin.
Male: Recently, we have heard that tetracycline could stain teeth?
Female: Exactly.
Male: Does that even make a little bit increased pressure in the head?
Female: We tend to avoid these antibiotics to kids for the side effects that we have proven and that is happening. The first is the changing colors in the teeth and these teeth are growing and they are not still mature enough and on the other hand, we definitely know that there are some other more serious effects, so doxycyline for adults or for at least teenagers.
Male: How long would you treat a case-two weeks or three weeks?
Female: Two weeks, maybe three weeks. I would say like two weeks sometimes for the initial Lyme disease should be enough. Arthritis is a different thing. Arthritis, we have to go for a good four weeks of antibiotics.
Male: Two weeks, not so bad, four weeks a bad case. Sometimes even longer?
Female: Yes.
Male: And if you were going to test for Lyme disease, you cannot test it at day of the bite because it is not going to show anything, is that correct?
Female: No.
Male: It has to be about three weeks.
Female: At least a few weeks until you will see some positive signs.
Male: And sometimes you do it twice, three weeks and a few months later because you could have missed it.
Female: Exactly.
Male: And what test would you recommend? What would be the right test for that?
Female: The more common one and is being used everywhere and is good enough is looking for antibodies against Lyme and it is straightforward antibodies against Lyme. This is not more than that.
Male: That is not too expensive?
Female: It is not too expensive.
Male: And this is western blot which is very expensive.
Female: Yes, and it is negative or positive, so this first one that I just mentioned is either positive or negative. If it is negative, it is reliable enough and we can be sure that there is no Lyme here. If it is positive, sometimes, it is not good enough because you can have false positives, so that means that if it is becoming positive, this is still a possibility that you do not have Lyme. So either that becomes positive, you have to confirm with a more sophisticated, more expensive test which is called Western blot. There is no need to do a western blot if the test is negative.
