Georgia’s Lyme Disease Mystery Continues

With only 193 confirmed Georgia cases in nine years, many doctors aren't diagnosing patients with Lyme disease.

Rob Pavey | April 3, 2015

Todd Young gave little thought to the tiny tick he found burrowed into his scalp two years ago.

“It was at the back of my head, at the hairline,” the Cherokee County trapper and taxidermist recalled. “I just pulled it off. That’s what I always did.”

The tick, he figures, likely dropped onto his clothing as he worked outside his taxidermy shop in Canton in mid-April of 2013.

Three weeks later, when Young developed sudden aches, chills and a stubborn fever, it never occurred to him that his discomfort could be linked to Lyme disease—an ailment typically associated with the Northeast.

“I got really bad flu-like symptoms, with the fatigue,” he said. “But I knew it wasn’t flu season.”

He also noticed pus oozing from a simple scratch he had gotten from briars while hog hunting.

“That told me my immune system was down,” he said. “And then, two days later, when I stood up from bed, my knees cinched up with arthritis.”

As his condition worsened over the next few weeks, Lyme disease moved up the line as the suspected cause of his symptoms—but confirming such a diagnosis proved elusive.

“To this day, I test negative for Lyme disease,” said Young, who at 41 suffers from a debilitating, chronic and advanced case of an ailment long thought to be non-existent in the South.

As Young and his physicians soon learned, the scientific conclusions about Lyme disease in Georgia can be as murky as the Ocmulgee River after a thunderstorm.

According to the U.S. Centers for Disease Control, Lyme disease is caused by the bacterium Borrelia burgdorferi and transmitted to humans through the bite of infected blacklegged ticks.

In the South, however, where black-legged ticks rarely bite people, the common lone star tick is the species that typically preys on hunters, anglers and people spending time outdoors.

That species, according to the CDC, is “not known to transmit Lyme disease” but linked to a Lyme-like ailment known as “STARI,” or “southern tick-associated rash illness,” that can include the telltale “bull’s-eye” type rash seen in northeastern Lyme disease patients.

STARI can be mistaken for Lyme disease and is also difficult to track, said Dr. Jose Vazquez, a professor and chief of the Infectious Diseases Section at Georgia Regents University in Augusta, which houses the state’s largest medical school.

“What’s important to note is that the lone star tick is the most common in the Southeast—and the lone star tick can transmit STARI, which looks kind of like Lyme disease,” he said. “So if someone gets the bull’s-eye lesion on their leg, they believe they will get Lyme disease.”

Cases of STARI are not reported to the CDC under the mandatory guidelines that require reporting confirmed cases of Lyme disease, which is considered a greater health threat.

“STARI does produce the bull’s-eye and the fever, but it doesn’t become chronic like Lyme disease,” Vazquez said.

“Lyme has different phases, and Phase 1 is the bull’s-eye and fatigue. Phase 2 can affect the nervous system and heart, and phase 3 can affect the brain, producing paralysis and dementia and even cardiac abnormalities,” he said.

By comparison, STARI has just one phase, which typically goes away within a week, he said.

Although there is debate and disagreement over the presence and prevalence of Lyme disease in the South, even the CDC, which tracks cases in all 50 states, has confirmed cases here.

According to the agency’s database, which covers the period from 2004 to 2013, there were 193 confirmed cases in Georgia, along with 193 cases in South Carolina and 645 in Florida.

By comparison, there were tens of thousands of cases in the Northeast.

A possible explanation, the agency has said, could involve residents who traveled to the Northeast and were bitten by an infected tick—and diagnosed back in their home state.

In all likelihood, though, many cases are likely never confirmed or reported.

“You have to remember what is reported to CDC is probably an under estimation of what is actually occurring,” Vazquez said. “There are only a few cases documented to CDC each year.”

Most Georgians who see a rash form after a tick bite will likely find that it is STARI and not full-blown Lyme disease. But there are still no hard answers on the extent of Lyme disease in the South.

“As far as what we have here, we don’t really know,” Vazquez said. “There are a few cases, and the few that we know of, we aren’t sure where they are getting it.”

Lance Durden, a Lyme disease researcher and professor at Georgia Southern University’s biology department, said the debate over the existence of Lyme disease in Georgia is indeed contentious.

Despite CDC’s assertion that Lyme does not occur locally in Georgia, some of the newest studies have shown that the disease’s causative bacterium circulates in nature in Georgia in several species of native mammals, birds and ticks—none of which get sick from the infection.

“I talk to people in Georgia all the time who state they have had Lyme disease—mostly outdoors people, which is not surprising,” Durden said. “However, because many physicians in Georgia follow the CDC statement, they will not make a diagnosis of Lyme disease.”

Those providers may prescribe antibiotics, which often take care of the problem, but the cases never get recorded as Lyme disease, he said.

Patients like Todd Young agree that many Georgians who get Lyme disease are misdiagnosed because so few physicians think to look for the illness here.

Consequently, prompt treatment that can ward off the more serious phases of the ailment later is not always administered.

“There’s still a lot of things about Lyme disease that are still unknown,” Young said, noting that this month marks the two-year anniversary of the tick bite that changed his life forever.

“Being in my line of work, all my life I had a fear of catching Rocky Mountain spotted fever. When we were kids, it was a death sentence, and now they can cure it in two weeks,” he said.

The fallout from Lyme disease, however, will be permanent, with recurring symptoms that include blurred vision, slurred speech, extreme dizziness and tremors.

“At my stage they can’t cure it, but they can try to run it into remission and make it dormant,” he said. “But for the rest of my life, if a loved one dies or something traumatic happens, it can flare up again.”

Some of the newest studies seem to indicate there are many strains or variations of Lyme disease that are still unknown to science.

“Some are so mild you’ll never know you got it—your immune system will just kill it,” Young said. “Some are so severe there is no cure for it, and that is what I’ve got.”

The recurring symptoms have made his career as a taxidermist and trapper uncertain, but Young is spending some of his free time trying to educate Georgians about the disease and all the uncertainty that comes with it.

“There is an extreme lack of knowledge on this disease, especially in the South, and I’ve kind of started a campaign of telling everybody I can about it,” he said. “The first thing I tell them is I never had a bull’s-eye rash, and to this day I still test negative for Lyme disease.”

What do Georgia’s outdoorsmen and women need to know about the risks of Lyme disease?

Medical professionals like Dr. Vazquez stress the importance of using an effective insect repellent, preferably with deet as an ingredient.

“After that, probably the most important thing is, whenever you are outdoors, when you come in you should look—or have someone look at—your body head to toe to see if there are any ticks,” he said.

“If you find one, and you pull it off right away, you don’t have to worry about it. If you do it within 24 hours, the tick doesn’t have the ability to transmit disease most of the time.”

Young believes the best tool for tick bite victims is awareness.

“What I tell people is, when you get bitten by a tick, you need to pay attention to when it was, and pay close attention to your body over the next few weeks,” he said. “If you start feeling symptoms you aren’t supposed to have, get yourself to a doctor.”

If the symptoms are typical of Lyme disease, such as flu-like fatigue and arthritic pain, there is an even greater urgency to seek treatment immediately.

“That’s when you need to jump on it and not waste any more time,” he said. “It is also important to find a provider or doctor who is willing to diagnose Lyme disease symptomatically—because you have to remember: the tests are highly inaccurate.”

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