Dr. Kevin Most: Tips To Avoid Heat Related Illness Like West Nile, Lyme Disease And Acute Flaccid Myelitis

Dr. Kevin Most

We discuss the effects of temperature on our body a few times a year, cold in the winter, heat in the summer, 160 degree swing. During the summer however the heat also allows for other illnesses that we need to be aware of. We will touch on a few and what you can do to minimize your chance of ending up with one of these.

 West Nile Virus-

 In 1999 we recognized the first cases of West Nile Virus in the country in New York. The illness itself was well known in Africa since the 1930’s. It was noted in  6 counties in and around New York, however it spread across the US to the West coast within 3 years, experts had thought this would take closer to 10 years. The reason for the rapid spread across the country is that the vector for this illness is a mosquito and believe it or not the mosquito bites a bird, the bird is infected and travels, another mosquito bites the bird, and  now that mosquito is able to spread to another bird or a human with its next bite. Because of this the illness was able to spread quickly across the country.

 Should we be concerned about West Nile? This is a tough one to answer, 80% of individuals who are infected by West Nile will actually have no or minimal symptoms. The healthy individual is able to control the infection and the immune system knocks it out quickly. Many of us have probably been infected and never knew it.

 The symptoms for West Nile vary from individual to individual. The symptoms include mainly  headache, body aches, joint pain, and fever in some cases. The symptoms are mild and resolve within a day or two, because of that most cases go unreported.  Some individuals may have weakness and fatigue that last for a few weeks but in most cases the symptoms resolve without any treatment.

 There is no specific treatment for West Nile, as it is caused by a virus. The treatment is supportive with medication for fever and aches.

 It is difficult to say what percentage of people will develop the severe cases of West Nile as most cases go unreported. We do know the risk of the severe cases goes up as we age and individuals over the age of 60 are at greater risk for the West Nile illness that can affect the brain and spinal cord. The severe illness has symptoms that include high fever, neck stiffness, seizures, vision loss and in some cases paralysis.

Those over the age of 60 are at greater risk as are others with weakened immune systems as well as those with heart disease, kidney disease or cancer.

Recovery from the severe illness may take months and unfortunately it has been known to cause death in some cases.

Individuals ask about a vaccine. The NIH has a clinical trial that is ongoing to test a vaccine for West Nile. The interesting thing is they are doing the clinical trial on individuals aged 18-50. Many wonder if the vaccine is needed for this group and if it will be needed at all as the question about lifelong immunity following an infection will be maintained. If 80% of people infected have no symptoms and it is shown that once infected you would have immunity will put the value of the vaccine in question. It will be interesting to see how the vaccine works and the acceptance of the vaccine. Many will ask do I need the vaccine? Have I already been infected in the past and had no symptoms that I recall but now have immunity, what value will the vaccine add. The vaccine is thru the first stage of approval

Lyme disease-

In 1975 a cluster of cases of arthritis were noted in Lyme, Connecticut and thus the name, Lyme Disease. Lyme disease is actually a generic term for an infection from a bacteria known as Borelli, that is caused by a tick bite.  This illness had been known for many years however the acknowledgement and media over these cases has certainly brought it to the attention of the public. It is somewhat common with close to 250,000 cases a year, many will go undiagnosed initially.

Although Lyme Disease has been noted in each state there is high concentration in the Northeast and upper Midwest. Wisconsin  and Minnesota have high rates in the Midwest where they see 5 times the number of cases that are seen in Illinois. Pennsylvania has the highest number of cases where they see 40x the number of cases we see here in Illinois. Anyone vacationing in a wooded area should be aware of what to look for, how to dress and how to prevent.

The illness is caused by a bite from a deer tick that had been infected. The initial symptoms will include fever , headache, muscle pain, joint pain and fatigue. Sound familiar? However in many cases this infection will also cause a very characteristic rash, called a bullseye rash.  This rash is seen in70-80% of the patients and looks like a bullseye. Another unique symptom is a facial droop that is seen in patients with Bell’s Palsy.

The ticks that transmit this rash are very small and not the typical big wood tick people often see. Prevention of Lyme disease include staying away from areas where deer ticks may live. If you do go thru a walk in the woods or in high grass, wearing appropriate clothes to minimize exposure is important. High boots, pants tucked in, Long sleeve shirts, the goal is to not give the tick access to your skin.  Also, the use of DEET is recommended as it is 85% effective at repelling the tick. The importance of checking for ticks after any potential exposure is important, and don’t forget to check your dog. Individuals should remove all clothing and shower and then do a complete skin exam. The ticks involved are very small and may look like a freckle so a good comprehensive exam is important for prevention.

It is important to identify patients who have Lyme disease as it can be treated with antibiotics and early detection and treatment may prevent the complications we see with untreated cases. Patients who note these symptoms should seek medical attention.  Especially if the patient has been in a setting where deer and deer ticks may live. The physician should have this in his mind when a patient shows up with these symptoms. Blood tests can be done to look for the bodies response to the bacteria by measuring antibodies. For individuals with advanced illness spinal fluid may need to be tested as well. Patients who are identified and placed on the antibiotic quickly will typically have a rapid and complete recovery.

Unfortunately some individuals will continue to have symptoms after treatment with antibiotics, this is termed chronic or persistent Lyme Disease. Chronic Lyme will be noted in 10-20 percent of those individuals who are treated and continue to have some symptoms. The most common persistent symptoms are fatigue, joint pain and muscle aches. These symptoms may last 6 months or longer. The majority of these patients will see symptoms resolve or lessen after 1 year

Acute Flaccid Myelitis

Just last week the CDC pushed out a notice to physicians to be aware of the potential for an increase in cases of Acute Flaccid Myelitis (AFM). You may remember we discussed this last year as there was an outbreak of AFM in the late summer and early fall.  There were 233 patients afflicted with AFM across 41 states last year. AFM has been noted to be seasonal with most cases occurring between August and October and we have seen increases of cases every 2 years since 2014. The pattern of the illness is a bit strange as it appears to spike every 2 years on the even years. This year the CDC has identified 11 confirmed cases from 8 states. Last year in Illinois we had 9 confirmed cases.

Pattern

2014- 120 cases in 34 states

2015- 22 cases in 17 states

2016- 149 cases in 40 states

2017- 35 cases in 16 states

2018 233 cases in 41 states

2019 11 cases in 8 states

Although the pattern shows we may be in a down cycle year, we know that viruses can mutate and can continue so vigilant monitoring and identification are key as we try to figure out the exact cause of AFM

The symptoms for this illness are sudden muscle weakness, loss of muscle tone and loss of reflexes. Other rarer symptoms are facial drooping, difficulty moving eyes, slurred speech and difficulty swallowing. The CDC is urging parents to bring their child to be seen by a medical professional if these symptoms are noted.

The exact cause of AFM is not known but there is high suspicion that it has a viral cause as most of the children affected had a viral upper respiratory illness prior to having the symptoms of AFM. As there is no known cause but possible association with URI, we would use the same precautions we use during flu season to protect the spread of any viral illness, wash your hands often, avoid contact with individuals who have colds, cough into your sleeve, keep sick children home.

There is no vaccine as we are still unsure of the exact cause. Treatment varies by the patient and the extent of the illness. Testing to diagnose this may be a MRI, nerve conduction studies on the muscles, lumbar puncture. Some of these tests are done to make sure the symptoms are not due to another cause that can and needs to be treated quickly. Treatment is often supportive and may include some medications as well as therapy. The extent of the illness varies in each individual.

The CDC website is a great resource for accurate information on this illness.

Poison Ivy-

Obviously the biggest thing to do for this is avoidance. Knowing what the leaves look like is important for any one going thru any outdoor activities. Knowing to look for the 3 leaf cluster plants is important. The leaf’s have an oil on them which is very irritating to the skin and causes a rash that is irritating and causes itching

Prevention and treatment- after an exposure remove clothes and wash your skin immediately with soap and water. The sooner you clean the skin the less time the oil has to interact with the skin You also should wash the clothes immediately. Look for any other things you may have touched as the oil is the issue. Poison Ivy does not spread, we spread it, by transferring the oil to other parts of our body by contact. It is very important to clean any objects or areas that may have come in contact with the oil.  Another concern is dogs that run thru a patch of poison ivy will have the oil on their coats, so be careful and wash them if you think they went thru poison ivy.

The rash may last up to a month in some people although the average time for the rash is 2-3 weeks. Treatment at home can include Calamine lotion or OTC cortisone cream.  Aveeno baths in cool water may be helpful. This is one rash where antihistamines will do little or no help in eliminating the itching. A few things to NOT USE, antihistamine creams, antibiotic creams and creams with benzocaine as they will may make the rash worse. Many feel that the medication Zanfel is a great soap that will help Poison Ivy quickly. It is one product that I recommend to patients.

Physicians may prescribe steroid creams that are stronger than the OTC creams or they may prescribe oral steroids to help decrease the inflammation.

This may be treated at home but know the symptoms that should trigger a physician appointment. These include a rash that is close to your eyes or mouth, fever over 100 degrees, pus or yellow scabs on the rash site, pain at the site that is increasing or a rash that is not improving

One thing patients must try not to do is itch the rash. Itching can cause a break in the skin and allow bacteria to get into the inflamed area and cause an infection

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