The Dangers of Ticks

Rebecca Reece, MD

It is the season we have long been waiting for. Summer is here, giving us warm weather and longer days to spend time outdoors. But be warned. Whether it is the dunes on a beach, a hike in the woods, or your own backyard, ticks can be anywhere.

These tiny bugs are more than a nuisance to avoid. They often carry diseases. That’s a bite that can take the fun right out of your summer.

Here in southern New England, the most common tick-borne diseases are Lyme disease, anaplasmosis, and babesiosis. All three are carried by the deer tick (Ixodes scapularis), which is very prevalent in New England. Powassan virus and Borrelia miyamotoi are less common tick-borne diseases also carried by the deer tick. A separate tick-borne disease, ehrlichiosis, is carried by the Lone Star tick, which is not as common in our area.

Is it serious?

When a tick that carries a disease bites you, the severity of your illness may depend on different factors:

1. Immune system health. Those who are very young, elderly, or immunosuppressed can have a more severe case of disease. The symptoms of both anaplasma and babesia are very similar: fevers, chills, sometimes night sweats, fatigue, and body aches. Both diseases attack our blood cells, with anaplasma infecting our white blood cells, and babesia infecting our red blood cells. These infections can be mild in healthy individuals who are diagnosed early. However, if you have a suppressed immune system due to a health condition or a medication, it can be more severe. The level of infected cells can be quite high, and in some cases, can lead to kidney or liver damage, respiratory distress, and shock.

2. Stage of illness. The severity of disease also depends on how long you have been infected. This is especially true with Lyme disease. In most people, it is limited to the skin with a bulls-eye rash in the early stage. However, if you are not diagnosed and treated during that first stage, it progresses to second or third stage illness. In those stages, the infection can now involve the joints (arthritis), the brain (meningitis, Bells’ palsy, etc.), the heart (carditis), and so forth.

Increasing cases

The Centers for Disease Control and Prevention (CDC) report an increase in cases of tick-borne diseases over the last 10 years. This is likely the result of a combination of increased diagnosing and reporting by clinicians, as well as an actual increase in the prevalence of diseases.

We also know that the tick burden is on the rise and spreading to areas where Lyme (and others) were previously not endemic. As a result, the combination of more awareness, increased exposure to ticks, and growth in the host animal population, including both white-footed mouse and deer, are all causes for increased concern about tick-borne illnesses.

Are all ticks dangerous?

Not all ticks are dangerous. First, the majority of ticks, including the deer tick that is most common in our area, are not carrying disease. It has been reported from prior tick testing results that around 30 to 35 percent of deer ticks are carrying Lyme (borrelia burgdorferi), and even fewer are carrying babesia or anaplasmosis.

Second, even with a tick that is carrying one of these diseases, they do not always transmit these with their bites. Ticks must be fully embedded and engorged following their feeding to have been able to transmit these common diseases. The timing of this is estimated to be at least 24 to 36 hours of attachment.

Protect yourself

There are several strategies to help with tick bite prevention.

  • Insect repellent. Apply insect repellants containing DEET to exposed skin below the neck. Much like using sunscreen, reapply every few hours.
  • Permethrin. This is a repellent that is sprayed on clothing and shoes that will kill ticks on contact. It should not be sprayed on skin. Allow it to fully dry before wearing the treated clothing.
  • Tick checks. The most important prevention method is a full body and scalp “tick check.” Do this on yourself, children, and pets when coming inside. This allows you to find and remove ticks before they can fully attach and embed.
  • Showers. Shower immediately after being outdoors in a high-risk area as this allows for a full skin check. This can dislodge ticks before they are firmly attached.
  • Heat. Throw your clothes in the dryer. The dry heat can kill any ticks that might be on your clothing.

I have been bitten. What do I do?

If you are bitten by a tick, your next step depends on how long the tick was attached, and whether it is engorged, indicating it has had a blood meal.

If you find a tick on you that is not engorged or embedded, and you know it has not been there for at least 24 hours, there is no risk to you for common tick-borne disease transmission.

If you find an engorged tick, and the timeline is more than 24 hours, call your doctor. Your doctor can discuss with you the option of a prophylactic dose of antibiotic, such as doxycycline, to help prevent a Lyme infection. This preventive step is only for Lyme and has not been studied on other tick-borne diseases.

What to watch for

In the spring, summer, and early fall, watch for symptoms of “summer flu.” These include fever, chills, joint/muscle aches, headache/neck stiffness, or fatigue that are new. Other signs that are more specific for Lyme are a bulls-eye rash or expanding red circular rash, an acute swelling of the knee or other joint, with no corresponding trauma/injury, or facial palsy with drooping mouth or eyelid (Bells’ palsy).

Knowing how to protect yourself and what to watch for can help you stay active and enjoy this time of year outdoors. For more information, visit our website.

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