Download A New Look At Lyme Disease

BROKER WORLD MAGAZINE
Impaired Risk Review…
ROBERT
GOLDSTONE
MD, FACE, FLMI, board certified internist and endocrinologist, is vice president and chief
medical officer for Pacific Life
and Pacific Life and An­nu­ity.
He has extensive brokerage and
life insurance experience, having been medical director at
both MetLife Brokerage and
Transamerica Occidental Life.
Goldstone is board certified in insurance medicine and
the inaugural recipient of the W.
John Elder Award for Insurance
Medicine Journalism Excellence.
He was also honored as a fellow of
the prestigious American College
of Endo­­­crinology and has written monthly for Broker World
since 1990.
Goldstone can be reached
by ­ telephone at 949-420-8390.
Email: bgoldstone@­pacific
life.com.
A New Look
At Lyme Disease
L
yme disease burst to the forefront of
infectious medicine when a number of
cases were identified in 1975 near the town
of Lyme, Connecticut (hence its name). In
1981 a specific tick carrying the Borrelia
burgdorferi bacteria was incriminated as
the causative agent, and since then it is
recognized that Lyme disease is the most
common tick-borne disease in the United
States and Europe.
At first a disease of exclusion—where
every other cause of arthritis and myalgia
symptoms was ruled out—testing has
now become sophisticated and specific in
looking for Lyme disease much earlier in
the process.
Lyme disease can affect multiple body
systems and produce a host of signs and
symptoms. It has been found that the disease is not exclusive to the Northeastern
United States and, in fact, can be acquired
just about anywhere in the United States.
Animals such as mice and deer can carry the
disease as a host until humans are infected
by a tick bite.
Lyme disease is tough to pinpoint early
in the process, as many of the clinical
symptoms early on are non-specific. The
serologic testing with the disease is inaccurate until later in the illness, and many
cases are missed when testing is ordered
and turns up negative early in the disease
process.
Reprinted from BROKER WORLD April 2011
Used with permission from Insurance Publications The Three Stages of
Lyme Disease Symptoms
There are basically three stages of Lyme
disease symptoms. In the first stage, flulike symptoms and a skin rash develop
along the site of the tick bite. The lesion
spreads like a small bull’s-eye in most cases,
but often recedes after a few weeks. During
this stage, symptoms are muscle aches,
headache and fatigue.
The second stage is a spread to the nervous system, with a picture that simulates
meningitis, with headache and neck stiffness. At times, involvement of the heart can
cause arrhythmias and heart block.
Stage three is a late, persistent infection,
with mainly musculoskeletal complaints,
arthritis and general disability. This can
become chronic and recurrent in 10 percent
or more cases.
Testing for Lyme disease requires finding
antibodies specific to Borrelia burgdorferi in
serological tests called IFA (indirect fluorescent antibody) or ELISA (enzyme-linked
immunosorbent assay). The testing isn’t
well standardized, though, and laboratories
may not be consistent in their testing and
results.
Many times suspected individuals are
diagnosed clinically, with a history of tick
bite and symptoms, and treatment is initiated even without a clear-cut laboratory
confirmation of the diagnosis.
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Thankfully, early suspicion and prevention, as well as more prompt treatment,
makes Lyme disease less of a long term
health threat. The usual recommendation
of avoiding tick infested areas, covering
exposed skin, and using topical tick repellent
is more stressed now in endemic areas.
Antibiotics are quite effective and shorten
the duration of the rash and prevent long
term complications. Doxycycline is the most
effective, but amoxicillin and cefuroxime
have also been shown to work effectively. As
long as the disease is caught early, long term
sequelae are generally avoided.
Most cases of treated Lyme disease
without complication are insured as if the
disease had been completely eradicated.
Appropriate therapy generally resolves
almost all of the symptoms within a month.
Those in whom the disease becomes chronic
and affects the heart or central nervous system can have significant disability and, in
“
T
here are three stages of Lyme Disease
symptoms: (1) Flu-like symptoms and a skin
rash develop along the site of the tick bite. (2) If it
spreads to the nervous system, symptoms simulate
meningitis—headache and neck stiffness. (3) A
late, persistent infection with musculoskeletal
complaints, arthritis and general disability.”
the case of the heart, even mortality.
Rather than wait for testing to confirm
the disease, many tick bite cases are treated
prophylactically with antibiotics, which
Reprinted from BROKER WORLD April 2011
Used with permission from Insurance Publications helps limit the disease spread and complications of later illness. Treated and eradicated
Lyme disease can qualify for best class
underwriting. ˛
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