Diagnosing Lyme Disease

Kristin Drew probably pulled hundreds of ticks from the dogs she groomed.

One of the ticks bit back: The Pierce Township woman was diagnosed with Lyme disease, a debilitating and sometimes fatal illness, in 2005.

She says she was bitten in 2000 and battled doctors and insurance companies until she finally got confirmation that her symptoms -- facial paralysis, swollen joints, fevers, flulike illness, memory loss and muscle weakness -- added up to what is Lyme disease.

Her daughter Lauren, now 5, was born with the disease, which is not uncommon when a mother has a bacteriological infection that has gone untreated. Mrs. Drew and her daughter used to go to Long Island, N.Y., for treatment, but now travel to Columbus to see a specialist.

Public health officials monitor the number of cases of Lyme disease reported every year. But in Ohio and Kentucky, where Lyme disease numbers remain relatively low, the question is: Where is the disease coming from?

In Ohio, only 11 deer ticks, the critters known to carry the disease, have been found, “and they were scattered all over the state,” said Robert Restifo, medical entomologist for the Ohio Department of Health.

And deer ticks apparently don't live in Kentucky, said Dr. Michael Auslander, state public health veterinarian and assistant director of the division of epidemiology for the Kentucky Department for Health Services.

Only about half of Kentucky's cases were acquired in the state, Dr. Auslander said, “and I'm skeptical of those because we don't have the tick that causes Lyme disease in Kentucky.”

Kentucky officials have never confirmed the tick's presence there, he said, “so if we don't have the ticks, how do we get it?”

In both states, residents can send in ticks they've managed to catch to be identified. Almost always, they're American dog ticks or lone star ticks, Mr. Restifo said. “The disease's presence is a bit of an enigma,” he said.

But every year, Lyme disease is reported in both states, although not a lot: In 2004, only 19 new cases were reported to the U.S. Centers for Disease Control and Prevention from Kentucky. Ohio logged 45 new cases last year and Indiana recorded 22 cases in 2005.

In contrast, Dutchess County, N.Y., located about 60 miles north of New York City, logged more than 1,300 new cases of Lyme Disease last year. In 2005, more than 1,500 new Lyme cases were reported in Dutchess County, the highest number of new cases in the nation.

The way cases are reported to the CDC can be an area of debate for Lyme patients, doctors and public health officials.

Mr. Restifo estimates that “only about half of the cases reported to the state are reported to the CDC because of the federal agency's diagnostic guidelines”.

So, depending on your point of view, the disease is either over- or under-diagnosed. Dr. George Deepe, an infectious disease specialist with the University of Cincinnati, thinks Lyme disease is over-diagnosed, “which will get me into trouble.”

Some patients, such as Mrs. Drew, think it's under-diagnosed, and often misdiagnosed. Health officials and Lyme disease patients say they have been diagnosed with multiple sclerosis, fibromyalgia, chronic fatigue syndrome, clinical depression and a host of other ailments before the real culprit could be identified.

Lyme Disease