Willow Crawford is described by her mother, Bianca, as a very active, fearless, outgoing two-year-old who enjoys playing outdoors.  She is spunky, funny, and often appears to have the strength of a 10-year-old.  In May 2022, while putting Willow to bed, Bianca and her husband, Kevin, made a startling discovery.  They noticed she had tiny blisters on her back with a ring around it that made it look like a target or bullseye.  Unsure of what the rash might be, Bianca decided to mark the area and wait until morning to determine if the rash had spread.

“When I checked Willow in the morning, instead of a number of small blisters, there was one, very large blister.  I called Licking Memorial Pediatrics – Tamarack right away to schedule a visit with one of the providers there,” Bianca recalled.  “I had no idea what could have caused the rash.”  

Willow and her siblings are patients of Richard A. Baltisberger, M.D.  When he is not available, appointments are scheduled with the other providers at the location, including Hanaa Abdelmessih, M.D., Shelley A. Gittens, M.D., Jimisha Patel, M.D., Theressa M. Blanchard, APRN-CNP, Adrian Leibas, APRN-CNP, and Kelly R. Morrison, APRN-CNP.  Bianca says all of the providers have been involved in Willow’s care over the past several months. 

Upon examining the rash, the physician advised Bianca that Willow most likely had been bitten by a spider or a tick.  It was suggested to take blood samples for testing to determine if Willow had Lyme disease, which is caused by the bacterium Borrelia burgdorferi and transmitted to humans through the bite of infected blacklegged ticks – also known as deer ticks.  Typical symptoms include fever, headache, fatigue, and a characteristic skin rash called erythema migrans.  If left untreated, infection can spread to joints, the heart, and the nervous system. 

At the time, the test was inconclusive; however, Willow was prescribed an antibiotic.  After a week, Bianca found a red ring covering Willow’s entire back.  She also noticed that Willow appeared to be experiencing hallucinations.  “She would get out of bed and ask us to go get her Uncle Terry, who was not staying with us at the time.”  Bianca scheduled another appointment with Licking Memorial Pediatrics.  Willow’s blood was tested a second time, and Bianca was informed the results were positive for Lyme disease.  Antibodies can take several weeks to develop, so patients may first test negative soon after infection.  

“We were surprised when they told us the disease came from a tick,” Bianca remembered.  “We did not find a tick on Willow or the other children.  I was told that is not unusual because the tick will feed, then fall off when it is full.”

Also, most humans are infected through the bites of immature ticks calls nymphs.  Nymphs are tiny and difficult to see.  They are typically more active during the spring and summer months.  Adult ticks can also transmit Lyme disease bacteria, but they are much larger and more likely to be discovered and removed before transmitting the bacteria.  Adult blacklegged ticks are most active during the cooler months of the year.

After Willow completed the course of antibiotics prescribed, Bianca hoped the symptoms would subside.  Weeks later, Willow cut her foot and required stitches.  During the follow-up visit to have the stitches removed, Dr. Gittens noticed the familiar bullseye rash on Willow’s back.  

“Dr. Gittens was so kind and went out of her way to connect us with a Lyme disease specialist at Nationwide Children’s Hospital,” Bianca shared.  “She said she would call me as soon as she had the specialist’s information, which was just minutes after we left the office.”

The specialist explained that although most cases of Lyme disease can be cured with antibiotics, patients can sometimes have symptoms of pain, fatigue, or difficulty thinking that lasts for more than 6 months after completing treatment.  The condition is referred to as Post-Treatment Lyme Disease Syndrome (PTLDS).  Some experts believe that Borrelia burgdorferi can trigger an “auto-immune” response causing symptoms that last well after the infection itself is gone.  Patients with PTLDS usually improve over time, but it may take months to feel completely well.  It was recommended that Bianca closely monitor Willow’s symptoms and be aware of pain in the tendons, muscles, joints, and bones.

“Willow did have some episodes of leg pain.  She would hold her leg, or even scream because it hurt so bad,” Bianca said.
 
Follow-up appointments with the physicians have been scheduled, but determining whether or not the disease has been cured can be difficult.  Blood tests for Lyme disease could continue to return positive results because antibodies developed to fight the disease normally persist in the blood for months or even years after the infection is gone.  Bianca continues to monitor Willow’s health for flare-ups, but says Willow has, for the most part, returned to her happy, active self.  She has also been more vigilant about checking her other children, Isabella and Zachariah Dailey, and Jordyen, Paisley, and Westyn Crawford, after they have been outside playing.

Lyme disease cases are increasing in Ohio as the range of blacklegged tick populations continues to expand in the state and human encounters occur more frequently, particularly in the insect’s preferred forest habitats.  Reported cases have increased from approximately 67 cases in 2012 to 582 cases in 2021, according to the Ohio Department of Health.  Most cases go unreported.  Anyone who spends time outdoors can be at risk for Lyme disease.  The blacklegged tick is most often found in wooded, brushy areas, but can be found in tall grass and leaf litter around houses.  

Reducing exposure to ticks is the best prevention for Lyme disease.  The Centers for Disease Control and Prevention suggests using Environmental Protection Agency-registered insect repellents containing DEET, picaridin, essential oils including lemon or eucalyptus, para-menthane-diol, or 2-undecanone.
The American Academy of Pediatrics recommends that products with no more than 30 percent DEET be used on children two months of age and older.  Permethrin kills ticks on contact, but should only be used to treat clothing.  If using an aerosol spray on a child, ensure the child is holding their breath.  Do not apply repellent directly onto a child’s face.  Instead, place the repellent in your hands and carefully apply avoiding the eyes and mouth.  

Wearing long pants and shirts with long sleeves minimizes the amount of exposed skin.  Also, it is easier to detect a tick on light-colored clothing.  Shower as soon as possible after spending time outdoors, and check for ticks daily.  Ticks can hide under the armpits, behind the knees, in the hair, and in the groin.