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    It’s the time of year when, whether you’re a hiker, camper, or survivalist, you’ll be spending more time in the Great Outdoors.  During your off-grid adventures, you’ll be exposed to all sorts of critters that want a piece of you. In this case, we’re not talking about bears or mountain lions; we’re talking about ticks. As many tick-borne illnesses are treatable in the early stages, you must, as family medic, know how to quickly identify and treat these conditions.

    You may believe ticks are insects, but they are actually eight- legged arachnids related to scorpions and spiders. One species or another of this parasite is found just about everywhere in the U.S. and Southern Canada, and a number of species seem to be extending their range over time. For the first time, disease-carrying ticks have been found near beaches in California.

    The CDC identifies more than 15 diseases transmitted by ticks to humans. They include:

    • Lyme disease
    • Anaplasmosis
    • Tularemia
    • Babesiosis
    • Rocky Mountain Spotted Fever
    • Ehrlichosis
    • Relapsing Fever

    How Ticks Spread Disease

    Ticks make their living by biting the skin of a host and extracting a meal of blood. Unfortunately, they also transmit various disease-causing microbes to humans and animals through their infected saliva.

    Ticks have a life cycle that can last two-three years and includes egg, larva, juvenile (also called a “nymph”), and adult stages. For a larva to develop into a nymph or for a nymph to develop into an adult, a blood meal in needed. It appears that the nymphs cause the most cases of Lyme Disease. The CDC estimates that about 30% of all ticks carry disease in the Northeast and Upper Midwest.

    Ticks don’t jump like fleas do and they don’t fly like, well, flies. To pass along a disease to animals or humans, ticks must first find their hosts. How do they do this? By detecting smells, sensing body heat, or feeling vibrations with movement.

    Usually, ticks hang on grasses and bushes, holding on with their back pairs of legs and latching onto passersby with their front pair(s). The larvae (juveniles) like to live in leaf litter. In inhabited areas, they can be found in shaded woodpiles, leaf piles, or tall grass. When the tick latches onto its victim, its mouth parts pierce the skin and start extracting blood.

    Identifying A Tick Bite

    Without finding an actual tick attached and feeding, it’s hard to tell one insect bite from any other.  While there may be a small, red bump after the tick detaches, some experience a more expanded area of irritation and itching. The appearance of acute Lyme disease is a little different and will be discussed shortly.

    Given the risk for disease, a thorough examination of the entire body for ticks is warranted within two hours of returning from a day outdoors. This is most easily accomplished during a shower. Look behind the knees, in armpits, around the ears, hair, groin and even the belly button (navel). Be especially certain to examine dogs and children as well when they return from a day outdoors. Inspect clothing for ticks as well.

    TICK REMOVAL

    Grasp as low down on the head and pull straight up

    Once found, it’s important to remove the tick as soon as possible. it may be possible to just brush or wash it off if it hasn’t bitten you yet. If that doesn’t work, the simplest method is to use fine-tipped tweezers to grasp the bug as close to the skin’s surface as possible, and pull straight upward in an even manner. Twisting as you pull or pulling at an angle may cause the mouth parts to remain in the skin.

    After removal, thoroughly clean the wound area with soap and water or isopropyl (rubbing) alcohol and apply antibiotic ointment. Wash your hands afterwards. As an added precaution, launder clothing in hot water and dry in high heat. If all this is done soon after the bite occurs, infection is highly unlikely.

    There are other methods of tick removal, such as using specially-designed instruments, smothering it with petroleum jelly, or lighting it on fire. No method, however, is more effective that simply pulling it straight out.

    LYME DISEASE

    “bulls-eye rash” seen in many cases of Lyme

    The most well-known disease passed by ticks to humans is known as “Lyme disease”. Lyme disease was unknown until about 1975, where it was first diagnosed in the town of Old Lyme, Connecticut. Since then, Lyme has become the most common tick-borne illness in the Northern Hemisphere.

    Lyme Disease is caused by the corkscrew-shaped bacterium known as Borrelia burgdorferi. A new species, Borrelia mayonii, has recently been shown to also cause the disease. Both are carried by Ixodes scapularis, also known as the blacklegged or deer tick, in the northeastern and upper midwestern U.S. and the western blacklegged tick (Ixodes pacificus) along the Pacific coast. They are also responsible for transmitting Babesiosis, Anaplasmosis, and other infections.

    In settings where winters are milder and acorns abundant, the population of animals that ticks like to feed upon increases. These include mice, a favorite of baby ticks, and deer, popular targets for adults. The Centers for Disease Control and Prevention (CDC) are estimating 300,000 cases of Lyme Disease in humans per year (three times the number reported 20 years ago).

    Symptoms Of Acute Lyme Disease

    Sometimes, the presence of a tick on the body goes unnoticed. By itself, the bite wound is not medically significant; indeed, transmission of Lyme disease by a biting tick is rare in the first 24 hours. Once at least 24-48 hours have passed, Lyme bacteria is more likely to be passed to the host by the tick. Symptoms can become apparent anywhere from three days to a month afterwards. You will usually see:

    •             Rashes

    •             Fever and chills

    •             Muscle aches

    •             Fatigue

    •             Joint pain

    In about 70 per cent of patients, the rash occurs before the fever and starts as a bump with redness in the area of the bite. It often then develops into a red ring-like “bull’s-eye” that feels warm to the touch. Usually, very little pain or itching is associated. The pattern, which spreads over time, is called “erythema migrans” and may be enough to confirm the diagnosis. Alternatively, some may present with a spreading, crusty, splotchy area of redness, a red oval plaque, or a bluish rash.  Lyme Disease, however, may be missed or misdiagnosed if symptoms are mild or, especially, if the tick bite was missed by the examiner.

    Treatment of Lyme Disease

    When a bite from a blacklegged tick is newly identified, the use of antibiotics may prevent Lyme Disease. A single preventative dose of two 100 mg tablets of doxycycline may suffice.

    Once there is the presence of erythema migrans, rapid treatment can still result in a cure. Symptoms, however, may last for a time after treatment. Doxycycline 100 mg twice a day for 14-28 days is indicated, or in children (must be over 8 years old) 4mg/kg twice a day for 14-28 days (max of 100 mg. per dose) Avoid doxycycline in pregnant or breastfeeding women.

    Alternatively, Amoxicillin can be used in pregnant or breastfeeding women at dosages of 500 mg 3 times/day for 14-28 days. 50 mg/kg is the dose for children younger than eight years of age (maximum 500mg 3x/day). Azithromycin has been mentioned as a second alternative. Although less effective, it can be used in those allergic to Penicillin-family drugs. These antibiotics are usually available in non-prescription veterinary equivalents.

    Prevention Of Lyme And Other Tick-Borne Diseases

    An ounce of prevention is, they say, worth a pound of cure, and this old saying is particularly relevant when it comes to infections caused by tick bites. Whether you’re off the grid with your survival group or just on a camping trip, consider:

    •             Long pants and sleeves on the trail.

    •             Thick socks and high-top boots (tuck your pants into them).

    •             Walking in the center of trails to avoid brushing up against vegetation.

    •             Using insect repellants like DEET (20% or greater) on skin (oil of citronella or lemon eucalyptus are natural alternatives).

    •             Applying Permethrin 0.5% insecticide to clothing, hats, shoes, and camping gear 24-48 hours before using (proper application will even withstand laundering). It is not useful for application to skin, however.

    •             Thorough exams after a day outdoors, again, paying special attention to children and dogs.

    Although not technically associated with poor hygiene, ticks are often first detected while bathing. This means that failure to bathe may allow them to remain on the body and increase the chance of disease transmission. Be sure to enforce good hygiene in your group members.

    Symptoms Of Chronic Lyme Disease

    As Lyme disease is often missed in its early stages, some people progress to a late stage that results in a more diverse (and problematic) set of symptoms. These may occur months after the tick bite and include:

    •             Neck pain and stiffness

    •             Severe headaches

    •             Multiple rashes away from the site of the bite

    •             Joint pain and swelling in knees and other large joints

    •             Bell’s palsy (nerve damage that causes drooping on one side of the face)

    •             Heart problems such as irregular heartbeats

    •             Dizziness

    •             Shortness of breath

    •             Inflammation of the spinal cord (called “meningitis”)

    •             Shooting pains, numbness, or tingling in the hands, feet, or face

    •             Memory loss

    Many of the above symptoms may persist for long periods. As of yet, there is not a proven cure or vaccine for chronic or late-stage Lyme disease.

    ROCKY MOUNTAIN SPOTTED FEVER

    Carried by the Rocky Mountain wood tick or species of dog tick, infection with Rocky Mountain Spotted Fever features a red rash which usually develops about 3 days after fever begins. The rash may vary in appearance during the course of the disease from splotches to pinpoint dots. Almost all sufferers will get the rash, but it may appear later in the illness, making early diagnosis difficult. Left untreated, severe damage to blood vessels may require amputation of digits or limbs. Like Lyme disease, treatment with doxycycline at the very beginning gives the best results.

    EHRLICHIOSIS

    A bacterium, transmitted by the Lone Star tick, symptoms from infection usually present within 7-14 days after being bitten. The appearance of the rash sometimes follows a fever and ranges from spotty, flat or with raised areas, to multiple small purplish areas (called “petechiae”). Nausea, vomiting, and diarrhea may also occur. Like many other tick-borne diseases, early treatment with doxycycline may be effective.

    Other than the appearance of the rash, most other tick-borne diseases have a similar presentation. You can expect to see fever, chills, head and body aches, fatigue, and, sometimes, nausea and vomiting.

    Joe Alton MD

    Joe Alton MD

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