Health

Staying Safe from Ticks: What your family needs to know about Lyme disease

Tick on Leaf
PHOTO BY ISTOCK

The summer months are peak times for tick bites, but as early as March, when the weather was still quite cold, a tick landed on Gloria Wright. She had taken her dog Molly out for a walk along a wooded path. Along the way, Molly found something pungent to roll around in and needed a bath as soon as they got home.

“I ran some water, picked her up and plopped her into the bathtub to give her a bath,” she recalled. “I don’t know for sure, but I think that’s when the tick jumped from her to me.”

Gloria didn’t notice anything until the next morning. “I woke up and my neck itched a little bit,” she said, “And then when I scratched, I felt a little lump.” She called her doctor right away, pulled the tick off with tweezers and put it in a Ziploc bag, which she took to her appointment.

Because it was so early in the season, Wright didn’t wear the herbal repellent she usually puts on before going out, plus her dog is on an oral tick medication year-round. Even though she had removed the tick, her doctor found the mouth was still under her skin and, after cutting it out, gave her two doses of doxycycline.

“I took the antibiotic right away and have had no ill effects since, that I know of,” she said. “And I didn’t get the little bullseye,” referring to the concentric circular red rash that some Lyme disease victims develop after being bitten. Her doctor told her it could have been worse had she not discovered the tick so quickly.

According to the most recently available Centers for Disease Control and Prevention (CDC) data, New York was in the high Lyme disease incidence category, with 2,446 confirmed cases in 2018 and 1,192 probable ones. Dr. Heidi Puc, a local physician who is an expert in Lyme and related infectious disease treatment, said Lyme disease is especially prevalent in our area. “You can walk out your door and a tick can latch on,” she said, and in fact recently found a tick crawling on her own leg while doing yard work.

She said ticks like to hang out on grass blades, in borders between lawns and forests, woodpiles, stone walls, thick dense branches or anyplace that is shady and moist. When the disease was first diagnosed in Lyme, Connecticut in 1975, transmission was discovered in blacklegged or so-called deer ticks, so deer were the animals most associated with carrying them. In addition to deer and pets, though, ticks commonly hitch rides on small animals like chipmunks, mice and shrews. Birds can also carry ticks.

Symptoms of Lyme Disease

The bullseye rash Gloria mentioned is only one sign that a person may have contracted Lyme disease from a tick bite. Other symptoms include fever, chills, headache, fatigue, muscle and joint aches and swollen lymph nodes. According to the CDC, the rash occurs in approximately 70-80% of infected individuals.

Information from the Connecticut Department of Public Health shows that the first people reporting symptoms in the 1970s were thought to have uncommon types of arthritis. The bacterium that causes the illness, Borrelia burgdorferi, was discovered by scientist Willy Burgdorfer and named after him in 1982.

Puc said that there are “cousins” of the bacterium, including borrelia miyamotoi, which came from Japan, and tick-borne relapsing fever. Although Lyme is the most common disease spread by blood-feeding insects and arachnids, there are other illnesses and organisms that can be present in ticks. Co-infectors that can reside along with Lyme in the same tick include organisms like anaplasma, ehrlichiosis and babesiosis.

Different Medical Approaches to Treatment

There are two different medical approaches to Lyme disease treatment, represented by two different organizations, The Infectious Diseases Society of America (IDSA) and the International Lyme and Associated Diseases Society (ILADS). Both have published guidelines for diagnosis and treatment of Lyme and other tick-borne diseases, and their methods vary, such as length of time for antibiotic treatment.

Puc follows ILADS guidelines in her practice, Integrative Medicine of Central New York. She treats any case of tick attachment with antibiotics. “We treat for at least 20 days, so three weeks to four weeks, even up to six weeks is typical,” she explained. “ILADS data is that if one is treated with at least 20 days’ worth of dox y(doxycycline), there is an approximately 85- 90% chance that you can prevent Lyme disease from happening.”

In comparison, IDSA Lyme prevention guidelines recommend a single dose of doxycycline for adult patients (200 mg dose) and for children eight years old and older (4 mg up to 200 mg). Puc serves on the board of the Central New York Lyme and Tick-Borne Disease Alliance; in that organization, both approaches are discussed and evaluated.

Tick Labs

Months ago, you could send ticks to be examined at the Thangamani Lab at SUNY Upstate Medical School. However, Saravanan Thangamani, M.S., Ph.D., the lab’s principal investigator, said that his team’s free tick testing is on hold right now. The COVID-19 pandemic has disrupted medical supply chains and the lab cannot access the supplies at this time, including reagents, that they need to do the work.

Thangamani suggests that if you are bitten by a tick during their temporary closure, you should, as Gloria did, put the tick into a completely sealed plastic bag with a piece of moist tissue paper or paper towel and put it in a freezer until testing resumes. You can find instructions on how to mail the tick to the lab on their website, thangamani-lab.com/tick-submission-updates. Thangamani asks that you include as many details as possible with your submission, such as where the tick was acquired and where on the body you were bitten.

The CDC states that tick testing labs in general are not required to follow rigorous quality control standards used by clinical diagnostic laboratories, and that positive results showing the tick contained an infectious organism do not necessarily mean that you have been infected. It also warns that false negatives can occur, which Puc concurs is a problem. “There are many false negatives,” she said. “Even with tick testing, it’s not 100%”

Tickreport.com, which is a project of the University of Massachusetts Amherst’s College of Natural Sciences, accepts ticks for testing. The cost is $50 per tick, but they also have more comprehensive test packages available for up to $200.

Local Lyme Disease Resources

If you have found a tick embedded in your skin and are concerned about Lyme or other diseases, the first step is to call a medical professional. The CNY Lyme and Tick-Borne Disease Alliance has a list of local resources and links to infectious disease organizations on its Resources webpage: cnylymealliance.org/resources.

Tick Prevention

There are several ways you can help keep yourself tick-free. These prevention tips are recommended by Heidi Puc, MD, FACP, ABIHM.

  • If you’re going out for a hike or know you’re going to be among blades of grass or in wooded areas, try to wear as much clothing as possible: long sleeves, long pants which you can tuck into socks and closed shoes. Also cover your head whenever possible.
    • Be vigilant about wearing repellent. Many common brands of tick repellent contain DEET, which is a chemical not recommended for babies younger than two months old. Puc is leery about putting a chemical like DEET directly on the body, because it can be absorbed through the skin. However, when coupled with essential oils, it can be used in smaller quantities.
    • Essential oils that can be used as tick repellents include lavender, cedarwood, lemon eucalyptus, lemongrass, citronella, geranium and pennyroyal. Even used on its own, citronella can be effective. If you are using essential oils as tick repellent, be sure to reapply often.
    • After being outside, throw your clothes into the dryer on a very high setting for 10 or 15 minutes. Simply washing the clothes in a washing machine will not kill ticks.
    • Inspect your body after going out, paying close attention to areas like the groin area, behind the ears, armpits, the folds of your elbows and backs of the knees.
    • Inspect your pets who have been outside.

New Types of Dangerous Ticks Discovered in CNY

A tick that once was found only in the southern United States has made its way to New York. Dr. Saravanan Thangamani, director of the SUNY Center for Environmental Health and Medicine and Vector Biology Laboratories, and his team have identified four Lone Star ticks in Central New York since June 2019.

Lone Star ticks, so named for the white dots found on females’ backs that resemble the star on the Texas flag, are more aggressive than the common black-legged or deer tick. “We call it a hunter tick,” Thangamani said. “They like to walk on leaf litter or grasses and they are much faster because they have long legs. So, they are capable of actually chasing humans.”

Thangamani believes deer are the primary carriers of Lone Star ticks, but they can also latch onto both wild animals, like foxes, and domestic ones. Your pet dog could be bitten or transmit a Lone Star tick to humans.

The viruses Lone Star ticks carry are newly emerging as well. Two new tick-borne viruses that can pass into a person’s bloodstream from a Lone Star bite include the Heartland virus and the Bourbon virus, both of which were first identified in Kansas. The Heartland virus is related to a tick-borne virus discovered in China about a decade ago. “It’s a pretty dangerous, nasty virus, and because it is a close cousin of this virus, in small animals and in human cases, we have found this disease kind of mimics what is really happening with the other virus in China,” Thangamani said.

People who have been bitten by Lone Star ticks may experience fever, fatigue, decreased appetite, headache, nausea or diarrhea. Thangamani said that some also develop an allergy to red meat, a condition known as alpha-gal syndrome, which may also accompany hives, itching or scaly skin; swelling of body parts including lips, face, tongue and throat; shortness of breath; runny nose or sneezing; headaches; or abdominal pain.

Lone Star ticks and another type of emerging tick, the Asian Longhorn, appear to be most widespread in New York’s tri-state region. The Asian Longhorn, first discovered in New Jersey a few years ago, is prolific; the female can, without a male mate, lay about five to ten thousand eggs at a time. The Asian Longhorn has not been reported yet in upstate New York, but Thangamani said “it is just a matter of time that we will start to see this and other ticks that might cause dangerous diseases.”

Repellents that contain DEET or essential oils like lemon eucalyptus will protect you from the Lone Star tick. However, Thangamani stressed that you should always read the label on any tick repellent and find out how many hours of protection one spray will provide. He also suggests that you can keep a designated set of clothes for outdoor activities that can be sprayed with the insecticide permethrin. He uses this method and said that the permethrin will last through 100 machine washings, which would cover you for an entire season. Permethrin is available online and in stores that carry pesticides.

You can find more information on tick prevention and protective chemicals on the Center for Disease Control and Prevention’s website: cdc.gov/ticks.

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