Ticks are nasty little buggers.
By Dr. Mike Dostrow
“Doctors are men who prescribe medicine of which they know little to cure diseases of which they know less in human beings of which they know nothing.” -Voltaire (1694-1778)
Around mid-May, I receive a call from Jack Lunch asking me to write an article about Lyme disease. I respond by emphatically stating, “Jack, there is no Lyme disease west of the Rockies.” So he says, “Doc, I beg to differ with you, but there are quite a few people with Lyme disease right here in the Eastern Sierra.” After reprimanding him for having the audacity to question my clinical acumen, I told him I would look into it. Beware of absolutes and arrogance in medicine. Indeed, Aesculapius and Hippocrates would soon conspire to teach me this lesson rather poignantly.
Two weeks later my beloved wife came home from work with high fever, severe body aches and headache. As these are common symptoms of the flu I treated her appropriately prescribing rest, fluids and Tylenol for fever and body aches. After two days, as her fever waxed and waned but her headache progressed to severe and unrelenting, I became much more concerned. By day three, as her headache became the “worst in her life” and she was unresponsive to all my remedies, I decided that it would be prudent to visit our local E.R. to rule out a brain tumor or bleeding with a CAT scan. The good folks at Mammoth Hospital treated us well and complied with my request to image her brain, which was present and without obvious pathology. They controlled her pain with overpriced opiates and we went home where she got a well-deserved good night’s sleep.
Unfortunately, her symptoms only temporarily abated, and over the next two days her misery worsened. High fever, severe headache, weakness, nausea, muscle aches … a cornucopia of symptoms were cropping up seemingly by the hour. On day five of her illness, I had to descend to SoCal for an emergent business matter. When I called to check in on her, I knew by her voice that it was time to return to the hospital.
When I reached the fine physician on call, I said, “She has encephalitis [swelling of the brain]. I don’t know why, but she is not leaving until you know what’s wrong with her.” He said he would do his best. Several anxiety-ridden hours later, I received a call stating that my wife was afflicted with a rare condition known as relapsing fever, which is coincidentally a distant west coast relative of — you guessed it — Lyme disease.
Thus my story comes full circle. As payment to the gods of medicine and as penance, I must pen a primer on tick-borne diseases both for my review and the reader’s edification.
Ticks are a familiar nuisance to any traveler in the wilderness or inhabitant of rural areas. They have few natural predators and inhabit a variety of biomes. As vectors (communicators) of disease they are second only to mosquitoes worldwide (see my story “Of Mosquitoes and Men”). In the U.S., however, they transmit more disease than any other beastie. Ticks usually attach to their unsuspecting victim in grassy or wooded areas and immediately inject a variety of substances from anticoagulants to anesthetics in order to facilitate their blood meal. Inadvertently multiple pathogens can be introduced into the host. Bacteria, viruses, et. al. dwelling within the parasite itself can cause a great deal of problems for the person to whom they are attached. In the U.S., ticks cause a variety of disease but only a few are worthy of mention in this brief review. Bottom line: what is the tick’s conceivable purpose in the ecological scheme of things? Got me, but they sure are nasty little buggers.
The disease was at one time limited to the middle and upper portions of the east coast, but is now seen, albeit far less frequently, in California and other parts of the west coast. The disease is named after the town of Lyme, Conn., where a 1975 outbreak of juvenile arthritis was eventually linked to the bacteria Borrelia Burgdorferi. Transmitted by the deer tick Ixodes scapularis (dammini), this disease is now the most common tick-borne disease in the Northern Hemisphere.
Although the overall frequency is unknown it is estimated that approximately 10,000 cases of Lyme disease occur annually with 99% occurring in the northeast and Midwest and between the months of May to August.
Lyme disease is an affliction that affects multiple systems and occurs in three stages. Briefly, stage one involves a characteristic rash known as erythema migrans that very often resembles a target. This unusual rash occurs within one week of the initial tick bite and can last as long as a year if not treated. Stage two occurs when the bacteria starts invading the rest of the body causing a plethora of problems. Fever, fatigue, malaise, headache, and swollen, tender lymph nodes, are just a few of the symptoms that can be expected. This stage can also involve severe musculoskeletal, cardiovascular and nervous system manifestations and is often confused with other terrible multi-system disorders. After a year or so the third stage is characterized by debilitating arthritis and nervous system involvement.
Diagnosis of Lyme disease is difficult as it is not always visible in the blood and no test exists to make a definitive diagnosis. The initial rash can help in making the diagnosis. Treatment with antibiotic therapy can be effective at shortening the duration of Lyme disease but even with treatment long term symptoms can occur.
As its name implies relapsing fever causes a recurring high fever, which can be confused with other flu-like illnesses. Caused by a relative of the bacteria responsible for Lyme disease, relapsing fever is not as severe but can cause significant problems. Severe headache, weakness, chills, nausea and vomiting are common and make the diagnosis difficult. In fact, the only way to make the diagnosis is visualizing the bacteria in the blood under a microscope. That’s how the stellar folks at Mammoth Hospital made the diagnosis in my wife’s case!
The tick, which carries Borrellia hermsii is a soft tick of the species Ornithodorus. Unlike deer (hard) ticks, these buggers are virtually undetectable, feed briefly and at night and usually leave no signs of a bite. Incredibly, they can go many years without a blood meal — making them a formidable foe. This form of relapsing fever can have long-term musculoskeletal and cardiovascular sequelae, but is rarely fatal. Like Lyme disease, relapsing fever is treated with antibiotics but usually has less long term problems. The most fascinating aspect of relapsing fever is the bacteria’s ability to change its structure making it difficult for antibodies to mount a response and accounting for the recurring and relapsing nature of this disease. In Borg terms, “Resistance is futile!”
Other tick-borne illnesses exist, but will be listed for the sake of brevity and sanity. Rocky Mountain spotted fever, Eastern spotted fevers, Q fever, Colorado tick fever and Tularemia are just a few.
Some precautions you can take to avoid tick-borne illnesses: Wear protective clothing such as long pants (tucked into boots or socks), long sleeves and a hat in tick-prone areas. Insect repellents such as DEET and permethrin are effective deterrents, but permethrin is a better choice. Regularly inspect for ticks and remove them by grasping them closely to the skin with a tweezers, pulling with steady pressure without crushing or squeezing the body. Disinfect after removal. If bitten, keep the tick and seek the advice of your friendly neighborhood medical professional.
For more on ticks and the disease they carry visit www.CDC.gov.