In our last article, we discussed general aspects of those tiny but problematic arachnids: ticks. Perhaps the most well-known disease transmitted by ticks is Lyme Disease.
Spring and Fall are seasons that ticks are commonly known to bite humans. 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, so common that May is officially Lyme Disease Awareness Month.
Lyme Disease is caused by the corkscrew-shaped bacterium known as Borrelia burgdorferi. Another species, Borrelia mayonii, has also been shown to also cause the disease. Both are carried by Ixodes scapularis, also known as the blacklegged or deer tick, in the East, upper Midwest, and all the way down south to Texas. The western blacklegged tick (Ixodes pacificus) can be found all along the Pacific coast. Ticks are responsible for more than Lyme disease; they’re 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 many tens of thousands of Lyme cases 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. Indeed, by itself the bite wound is not medically significant and transmission of Lyme disease by a biting tick is rare in the first 24 hours. Once at least 24-48 hours have passed, however, 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:
- Fever and chills
- Muscle aches
- 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. Alternatively, some may present with a spreading, crusty, splotchy area of redness, a red oval plaque, or a bluish rash. Skin tone may affect the appearance.
Usually, very little pain or itching is associated. This pattern, which spreads over time, is called “erythema migrans” and may be enough to confirm the diagnosis. 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 100mg tablets of doxycycline may suffice or 4.4m/kg for children of any age weighing less than 20 kg (about 45 pounds).g
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 100mg per dose) Avoid doxycycline in pregnant or breastfeeding women.
Alternatively, Amoxicillin can be used in pregnant or breastfeeding women at dosages of 500mg 3 times/day for 14-28 days. 50mg/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 still available, at the time of this writing, in non-prescription veterinary equivalents.
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 complex 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.
- 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. Treat the individual symptoms if possible.
OTHER TICK-BORNE ILLNESSES
In our last article, we listed 15 different diseases passed by tick bites. They included:
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: Caused by 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.
Babesiosis is a disease caused by parasites that infect red blood cells. Most U.S. cases are caused by Babesia microti and are transmitted by the same species of tick that harbors the organism that causes Lyme disease. Symptoms appear within several weeks but may recur months later. These can include fever and chills, night sweats, fatigue, and head, muscle, and joint pain. GI symptoms like nausea and vomiting, abdominal pain and appetite loss are also common, as is a dark appearance in the urine.
Other than the appearance of the rash, most other tick-borne diseases not mentioned above have a similar presentation. You can expect to see fever, chills, head and body aches, fatigue, and, sometimes, nausea and vomiting.
PREVENTION OF TICK BITES AND DISEASES THEY CAUSE
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. Although mentioned in our last article, preventive strategies bear repeating:
- Wear long pants and sleeves on the trail.
- Wear thick socks and high-top boots (tuck your pants into them).
- Walk in the center of trails to avoid brushing up against vegetation.
- Use insect repellants like DEET (20% or greater) on skin (oil of citronella or lemon eucalyptus are natural alternatives).
- Apply 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.
- Perform thorough exams after a day outdoors, again, paying special attention to children and dogs. Also, inspect backpacks and clothes.
So, beware of lions and tigers and bears (oh my!), but also make certain to have a plan against ticks.
Joe Alton MD
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