Because
ticks feed on all sorts of critters-rodents, foxes, bears, pets, deer, mice
etc.-they pick up and can transmit a wide variety of diseases. Hence the
nickname “nature’s dirty needle.” Just as being pricked by a dirty needle can transmit
disease, the same holds true for ticks.
As
if I needed a reminder, both my husband and I have had tick borne illnesses
this summer. While mine is most likely Lyme, my husband tested positive for borrelia miyamotoi.
Over
the course of being treated, I’ve talked to three different providers and each
one had their own ideas about how to deal with our various tick bites. The
provider that saw my husband, who at the time was having intermittent chills,
fever and headaches, thought it was viral but ordered a tick panel just to “take
that off the table.” His symptoms started appearing three weeks after the tick
had latched on but hadn’t started feeding.
In
my case, I developed some sort of rash but it didn’t look like anything we’d
seen on line and my initial reaction was a lot of nausea, again not a symptom
that I saw on the list.
My
over all response to this experience is there is a lot of information on-line,
some of it old and outdated, some of it wrong, and some just plain confusing. More importantly, there is a lot we don’t know
and medical providers are struggling to figure out how to deal with this
epidemic. That noted, there are some basic things we all need to pay attention
to.
Note
that as new information becomes available, this post will be updated.
It’s
a rare person that hasn’t heard of Lyme Disease, however, that’s just the tip
of the iceberg for tick borne diseases. Depending on where you live, they can
transmit Rocky Mountain spotted fever, anaplasmosis/ehrlichiosis, babesiosis,
tularemia, powassan virus and various other diseases. According to the Centers for Disease Control (CDC),
over the past two decades, seven new tick borne germs that can cause illness
have been identified in the US.
Thanks
to climate change, tick borne diseases are spreading and it’s not just the
black legged tick you need to be concerned about. The Lone Star tick now
appears in the Great Lakes and New England. A bite from this tick can create an
allergic reaction to red meat (beef, pork or venison) that can range from hives
to full anaphylactic shock.
There
are also new tick species being identified in the US, including the Asian long
horned tick can make people and animals seriously ill.
Because
the focus has been on Lyme Disease, which requires a tick to be attached 36-48
before the bacteria enters the blood stream, medical providers are having to
adjust their thinking as some diseases can be transmitted in minutes. In short,
if you have to take the tick out with
tweezers, it may have had sufficient time to transmit a disease.
STEER CLEAR OF TICKS
Know the Ticks in
Your Area:
Ticks can be found in every state so it’s important to check with your local
health department about the type of ticks in your area and what diseases they
may carry. Health departments all have tick prevention programs so be sure to
understand the specifics for your region.
Avoid areas with high grass,
leaf litter and walk in the center of trails when hiking. Compost piles can also be areas where ticks
gather. Spring and early summer are high risk times as ticks are in an earlier stage of their development, called
“nymphs.” Nymphs often carry heavier loads of disease-causing pathogens, and
are smaller and harder to spot.
Use products that contain permethrin to treat clothing and
gear, such as boots, pants, socks and tents or look for clothing pre-treated
with permethrin. Wear light colored clothing-ticks show up better-and tuck pant
legs in socks and shirts into pants. Gaiters can add an additional layer of
protection
Treat dogs for ticks. Dogs are very susceptible
to tick bites and to some tick borne diseases. They may also bring ticks into
your home. Talk to your veterinarian about the best tick prevention products
for your dog. In Vermont, many people are using the Seresto collar for dogs and
cats. However, if you have a pet that likes to swim, the collar loses its
effectiveness a lot sooner than the 8 months advertised.
Bathe or shower as soon as possible, within two hours, after coming indoors.
Conduct a full-body tick check daily using a hand-held or
full-length mirror to view all parts of your body upon returning from
tick-infested areas. “Hot” spots include armpits,
hair, ears and behind the ears, belly button, behind the knees, and groin. Parents should help
children check thoroughly for ticks. Remove any ticks right away. If you live
in a high tick area, it’s recommended to check twice a day.
Put dry clothes in a dryer on high heat for
10 minutes
to kill ticks after you come indoors. If the clothes are damp, dry thoroughly
and then tumble dry on high for 10 more minutes.
IF YOU FIND A TICK
The CDC recommends the following method for removing
a tick:
• Use
fine-tipped tweezers to grasp the tick as close to the skin’s surface as
possible.
• Pull
upward with steady, even pressure. Don’t twist or jerk the tick; this can cause
the mouth-parts to break off and remain in the skin. If this happens, remove
the mouth-parts with tweezers. If you are unable to remove the mouth easily
with clean tweezers, leave it alone and let the skin heal.
• After
removing the tick, thoroughly clean the bite area and your hands with rubbing
alcohol or soap and water.
Do not : Paint the tick with nail
polish or petroleum jelly or use heat to make the tick detach from the skin.
WHAT TO DO WITH THE TICK
• Never
crush a tick with your fingers. Dispose of a live tick by putting it in
alcohol, placing it in a sealed bag/container, wrapping it tightly in tape, or
flushing it down the toilet.
•
If you don’t know what type of tick it is, save it and show it to your medical
provider
•
Many states are asking that ticks be mailed to the health department so they
can determine what type of disease(s) are occurring among the ticks in your
area. Not all health departments have posted this information on-line so call
your medical provider and/or local health department for information.
I’VE BEEN BITTEN, CAN’T I
TAKE SOMETHING TO PREVENT GETTING SICK?
The
CDC does not recommend routinely taking antibiotics after tick bites.
The International Lyme and Associated Diseases Society (ILADS) recommends against
the use of a single dose doxycycline. It is impossible to state a meaningful success rate for the
prevention of Lyme disease by a single 200 mg dose of doxycycline because this
regimen is based on a single human trial that utilized an inadequate
observation period and an unvalidated surrogate end point. In animal studies,
the efficacy of single dose doxycycline was <50 nbsp="" span="">
In
high incidence areas of Lyme disease, the CDC makes the following
recommendation:
Single prophylactic dose of
doxycycline (200 mg for adults or 4.4 mg/kg for children of any age weighing
less than 45 kg) may be used to reduce the risk of acquiring Lyme disease after
the bite of a high risk tick bite. Benefits of prophylaxis may outweigh risks
when all of the following circumstances are present:
1. Doxycycline is not
contraindicated.
2. The attached tick can be
identified as an adult or nymphal I. scapularis tick.
3. The estimated time of
attachment is ≥36 h based on the degree of tick engorgement with blood or
likely time of exposure to the tick.
4. Prophylaxis can be
started within 72 h of tick removal.
Antibiotic
treatment following a tick bite is not recommended as a means to prevent
anaplasmosis, babesiosis, ehrlichiosis, Rocky Mountain spotted fever, or other
rickettsial diseases. There is no
evidence this practice is effective, and it may simply delay onset of disease.
Instead, persons who experience a tick bite should be alert for symptoms
suggestive of tick borne illness and consult a physician if fever, rash, or
other symptoms of concern develop.
ILADS recommendation for a person in an endemic area who discovers a feeding blacklegged
(deer) tick is “100–200 mg of doxycycline, twice daily for 20 days. Other
treatment options may be appropriate on an individualized basis.”
These are two reputable
organizations and while they don’t recommend prophylactic treatment, they do
acknowledge situations where it may be appropriate. However, they verge in the
course of what that treatment should be.
WATCH FOR SYMPTOMS
Contact
your provider if you develop any of these symptoms following a tick bite and/or
it’s tick season and you develop unexplained:
Headache
Muscle
pain
Joint
swelling and pain
Rash:
It doesn’t have to look like the “bull’s eye” rash. Also many people, including
children, never develop a rash
Fever
Fatigue
Chills
Nausea
Vomiting
Cough
Confusion
TICK TEST
A
“tick panel” tests for Lyme and other tick borne diseases. However, it takes 2-6
weeks to mount an immune response that would turn the test positive so it
generally doesn’t make sense to do the test right away. Because co-infection is
a growing concern, providers will use the tick panel if you symptoms are not
resolving.
The
CDC recommends treatment based on symptoms and a confirmed exposure to a tick.
If the symptoms remain after treatment, a tick panel can be done to determine
if you have a tick borne disease that’s not treated by doxycycline, the drug of
choice for Lyme Disease and other tick borne diseases.
With
more advanced tick panels, more cases of co-infection are being diagnosed.
TREATMENT
The
treatment for Lyme Disease commonly includes doxycycline,
amoxicillin or cefuroxime axetil. For anaplasmosis, ehrlichiosis and Rocky
Mountain spotted fever, dosycycline is the first line treatment. Combination
therapy with atovaquone and azithromycin is most commonly recommended
for treatment of mild to moderate babesiosis. Treatment is usually continued
for 7 to 10 days. A combination regimen of oral clindamycin and quinine
has also been proven effective, but the rate of adverse reactions is
significantly higher with this combination.
CAN I BECOME IMMUNE TO LYME DISEASE
Lyme disease, if not treated
promptly with antibiotics, can become a lingering problem for those infected.
But a study led
by researchers from the University of Pennsylvania has some brighter news: Once
infected with a particular strain of the disease-causing bacteria, humans
appear to develop immunity against that strain that can last six to nine years.
However, there are at least 16 different strains of the Lyme disease bacterium
have been shown to infect humans in the United States, so being bit by a tick
carrying a different strain of the disease is entirely possible.
