by Robert DaSilva, MD
The incidence of tick-borne infections in the United States has risen significantly within the past decade. The tick itself is not the cause of infections but the bacteria, virus, or parasite in the tick that is transmitted during a tick bite that causes the infection.
Lyme Disease, caused by a bacteria, Borellia burgdorferi, in the deer tick, represents 82 % of tick-borne diseases. Estimates are approximately 300,000 cases in the US in the past year. Tick season lasts from spring to fall in the North East. When you are walking your dog in a grassy area, camping in the woods or even gardening in your back yard you may come in contact with ticks. Ticks can sense the C02 in your breath and wait patiently clinging to the tips of high grasses and shrubs to latch on as you brush by. The Blacklegged Tick (Ixodes Scapularis or Deer Tick) is the most common host, and in some areas up to 50% of Deer ticks carry the Lyme bacteria. Diagnosis can be made by flu-like symptoms (fever, fatigue, headache, enlarged tender lymph nodes, chills, joint and muscle aches) associated with the hallmark Erythema Migrans rash that looks like a Bull’s Eye (red center surrounded by an outer red ring ). This rash is present in 80% of infected individuals and expands over the site of the bite and can appear on other places on the body. This rash can appear from 3 to 30 days after contact with the tick, but usually shows up within one to two weeks.
AVOID TICK BITES: Keep to the center of paths to avoid overgrown grass. It is advisable to wear light colored clothing so you can easily spot the ticks. Tuck your shirt in and overlap your pant legs with your socks. Spray your clothes and shoes with permethrin which can remain effective even after several washes. Apply a 10-35 % micro-encapsulated DEET containing insect repellent to exposed skin or after applying sun screen. You may need to re-apply after swimming or excessive sweating. DEET is safe to use in a child over two months old and even in pregnant women. It also has the added benefit of protection against mosquitoes, biting flies, chiggers, and fleas. As soon as you get home place your clothes on high heat in the dryer for at least 10 minutes to kill any stowaway ticks.
RECOGNIZE IT: The adult female Deer Tick has a tear dropped shaped reddish body, 8 dark legs, and a dark cape like shield on its back. The nymph is markedly smaller, brownish and has a similar pattern. The dog tick is much larger and has a brown oval shape. The tick needs to feed at least 2-3 days before the bacteria can be transmitted. Do a thorough check of your body, targeting areas that ticks prefer to feast on, like the neck, knees, arm pits, scalp, groin areas etc. Ticks can be difficult to see so shower as soon as you can to wash away the ticks that have not latched on yet. Check your pets for ticks also.
REMOVE IT COMPLETELY: To remove the whole tick, grab the tick with fine-tipped tweezers by the head as close to the skin as possible and gently pull upward. If the mouth parts break off use the tweezers to remove them. Avoid squeezing and allowing the tick to come in contact with your skin. Cleanse the area with soap and water, or alcohol.
WHAT TO DO: If you have visited an area endemic with Lyme Disease, seek medical attention as soon as you can after the noticing a tick bite. A single dose of an antibiotic can prevent transmission of Lyme if the tick has been attached 36-72 hours. Since the immune system antibody response varies from person to person, blood testing for Lyme disease is not reliable during the first one to two weeks. Treatment of early stage Lyme involves 2-3 weeks of antibiotics which can prevent later complications such as conduction signal problems leading to a slow heart rate, paralysis of the facial nerve (which innervates the face muscles), psychological problems (depression, anxiety etc.), and in later stages swelling and pain in the large joints such as the knee.
Although Lyme Disease is the most common infection, we must also consider other tick-borne illnesses, particularly if flu-like symptoms are present with or without a rash in those that have visited a tick ridden area. The precautions in preventing disease are the same regardless of the tick species or organism that it harbors: prevention of tick bites, early detection and removal of ticks, and prompt evaluation by a physician.