PM Pediatrics

Dr. Christina Johns
Senior Medical Advisor, PM Pediatrics

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Sick of Ticks

Ticks seem to be going viral.  (Get it!?!?!-)

What I mean by that is I’m fairly sure that ticks have been getting more news and social media coverage than Russia recently…lots of reporting, no?  All of this reporting runs the gamut, from how this summer will be a BRUTAL one for volume of ticks, to the variety of weird tick-borne illnesses, to how best to remove a tick, to natural ways to keep ticks away! Exhausting. And sometimes tragic — the two year old girl in Indiana who reportedly died from Rocky Mountain Spotted Fever as a result of a tick bite, is the embodiment of every parent’s worst nightmare. I can’t imagine what they must be going through right now. My goal with this blog is to help ensure that we are educated on ticks as best as possible. In my clinical practice, patients have lots of fears about these illnesses, so I thought it might be good to line them up side by side to compare them, understand them, have healthy respect for them, and manage our concerns about them.

Let’s start with the tick bite itself.

Ticks bite into skin and bury their heads into the skin layers. They feed on blood and ingest it. Sometimes the contents from the tick’s mouth, which can contain the various disease-causing germs, can get transmitted to the person or animal being bitten. It stands to reason that the longer the tick is attached, the higher likelihood that infectious organisms can be transmitted from the tick.

I’m guessing the most common tick borne illness we hear about is Lyme Disease, with Rocky Mountain Spotted Fever (RMSF) coming in at a close second. These are completely different diseases, with Lyme Disease being caused by the Borrelia family of bacteria. In North America, the most common type is Borrelia Burgdorferii (25 cent word) and is carried by the Ixodes ticks, or small deer ticks. Endemic areas include the northeast and mid-Atlantic areas of the USA. Contrast that with RMSF, which is carried by the Dermacentor tick and is caused by the Rickettsia Rickettsii bacteria. RMSF is more commonly found in the southeastern area of the USA, despite its name and being discovered in the Rocky Mountains.

So how are Lyme Disease and RMSF similar?

  1. Both are caused by tick bites
  2. Both cause fever and headache
  3. Both have distinctive red rashes that may or may NOT show up

Let’s stop right there for a moment. These two rashes are actually a bit different. While both rashes are red, the rash in Lyme Disease typically occurs over a week and up to several weeks after being infected with the bacteria, whereas in the rash in RMSF happens sooner — a few days to two weeks (outside window) after symptoms begin.  Additonally, the rash in RMSF often begins on the wrists and ankles.  In Lyme Disease the rash usually arises at the site of the tick bite and is described as looking like a “bull’s eye,” or red with central clearing. The 25 cent word for the rash is erythema migrans.

bullseye rash

How are Lyme Disease and RMSF different?

  1. RMSF is more rapidly progressive and can be more acutely serious.
  2. They often affect different body systems.

Although both diseases are diagnosed by a blood test, they may be treated differently and have unique complications. RMSF can have heart and kidney complications, and it has a higher fatality rate than Lyme Disease. Lyme is most commonly known for neurological complications, like facial nerve weakness and even meningitis. RMSF is generally more severe, and Lyme Disease can really run the illness gamut from fairly mild to quite serious. Both can be treated with the antibiotic doxycycline, but Lyme Disease is sometimes treated with amoxicillin.

Now onto the strange tick illnesses.

The first is called Tick Paralysis. This is exactly as it sounds: when a person is bitten by a specific dermacentor tick they become paralyzed until the tick is removed. This illness is NOT caused by a microscopic organism; rather it’s caused by a neurotoxin in the tick’s saliva that gets into the body. The paralysis typically starts in the lower extremities and ascends up the body. Weirdly, the entire body can become affected including the respiratory system, but once the tick is removed, symptoms typically resolve in a matter of hours to days, and most people recover completely. Less is known about this illness than other tick borne infections. I find tick paralysis odd to say the least. It’s been written about and is on many emergency medicine board exams, but I’ve never seen it in my almost 20 years (gah!) of clinical practice.

And finally! The really rare illness that supposedly is going to be more popular this year: Powassan Virus. Weather conditions this spring have been favorable to tick reproduction and survival, and so more ticks carrying this virus are circulating. According to the CDC, only about 75 cases have been reported over the past decade (www.cdc.gov). The infection occurs when an infected tick injects a human with the virus. The symptoms are similar to the other tick borne illnesses: fever, vomiting, headache, weakness, and sometimes confusion and neurological problems. Since this is a VIRAL infection and not a bacterial one, there is no specific treatment other than supportive care and hydration. Sounds like a real charmer, doesn’t it?

So there you have it.  Four tick-borne infections that can make you quite sick. Now what?

Prevention!

If seeing all these diseases described together doesn’t make you double down on doing tick checks nightly on yourself and your children, I don’t know what will. Everyone needs to stand with their arms out like a “T” and get the entire surface area of the body examined—especially skin folds, where ticks really like to live. Removing ticks as rapidly as possible decreases the chances you’ll get sick.

Also, using insect repellent and wearing long sleeves and pants while out in wooded areas are important components of prevention. I’d be remiss if I didn’t make a plug for this. Insect repellent with up to 30% DEET is safe even for babies as young as 2 months. Please be vigilant about using and reapplying it every few hours. Even though ticks are technically not insects, the repellent will still work!

grasp it as close to the skin as possible and pull it off firmly

I think we get the picture of these tick borne illnesses now:

  1. Prevent with insect repellent and clothing.
  2. Make a “T” tick checks!
  3. Remove ticks accurately and completely.
  4. Observe for signs of tick borne illness.
  5. Realize the timing of the various rashes.
  6. Understand if you live in an endemic area.

As hard as it is to find anything redeeming about these guys—they’re not cute, they don’t fly or do anything terribly intriguing— now we’ve got a sense of what we’re dealing with when we come into contact with them. We’ll handle what we need to. We always do.

 

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