Lyme Disease One of Four Tick-borne diseases that Plague New Englanders

EXETER – Warm weather enthusiasts migrate outdoors as summer approaches, but they do so with escalating odds of contracting Lyme disease and, as it turns out, other lesser-known tick-borne illnesses that can also make them sick.

“Concurrent diseases are going on that we aren’t talking about, that primary care physicians aren’t really screening for. And those are Babesiosis, Bartonellosis and Ehrlichiosis,” says Naturopathic Doctor Robyn Giard, owner of Starry Brook Natural Medicine in Exeter.

But Lyme disease remains a concern.

“We’ve really noticed an uptick in Lyme disease. We’re seeing new cases of Lyme this season already, which is really early,” Giard says, “and we’re going to see more cases over the summer.”

Migrating deer are spreading Lyme disease, Giard says, “bringing ticks back and forth all over the place. In fact, we’re seeing more ticks and more infection across the country more recently than we have in years.” Also implicated in spreading Lyme disease are an increasing human population and homes built in wooded areas.

Lyme disease is the most common “vector-borne” — that is, transmitted by insects or ticks — disease in the U.S., writes Alan Eaton, a University of New Hampshire Cooperative Extension entomologist, in his February 2011 publication titled “Biology and Management of Ticks in New Hampshire.” Lyme disease’s vector is the blacklegged tick, also known as the “deer tick,” New Hampshire’s second most common tick species.

Blacklegged ticks live throughout New Hampshire, Eaton says, but are most abundant in the southeastern part of the state. About 85 percent are found within 35 miles of the coast, a pattern that also occurs in Maine, Massachusetts, Connecticut, Rhode Island and New York.

Using the most recent complete data, the Centers for Disease Control and Prevention ranked New Hampshire third nationally in the number of Lyme disease cases reported per 100,000 people. Most N.H. cases are reported from Rockingham, Hillsborough and Strafford Counties, and in 2009, Rockingham County alone had 583 confirmed and probable cases of Lyme disease, the most in the state.

Lyme disease symptoms frequently begin with a characteristic red zone rash around the site of the bite. It usually appears three to 30 days after being bitten by an infected tick and slowly expands in size, and then fades.

The rash is often ring-shaped and warm to the touch. Fatigue, fever, headaches, stiffness and pain in muscles and joints often occur. Symptoms can appear from a few days to weeks after infection. If Lyme disease is left untreated, dizziness, irregular heartbeat, arthritis and nervous system disorders can follow after several months to years after infection. Arthritis, joint pain and swelling are common symptoms, especially knees, in untreated cases months or years later.

“Ticks tend to like dark, quiet places like the genital area, by the buttocks and in the hair,” Dr. Giard says. “So if you do go out for a hike, it’s important to have a friend or a partner go through your hair, look on your back, in back of your legs, and go about the front. Tick checks are very important.”

Ticks are often discovered after they have begun to feed. To remove a tick, use tweezers to firmly grasp it as close to its head as possible, and pull gently, using slow, steady pressure. Do not yank it or pull it sideways, since this could cause its head to break off inside the wound.

“If a tick is attached to your skin for less than 24 hours, your chance of getting Lyme disease is extremely small,” Eaton says. “But just to be safe, monitor your health closely after a tick bite and be alert for any signs and symptoms of tick-borne illness.”

Most cases of Lyme disease are contracted in June and July, Eaton says, and treatment is most successful in the early stages. Giard treats Lyme disease with the antibiotic doxycycline, and the course of treatment for a confirmed case is 21 days.

“But in our practice anybody who is bitten with a tick —even before the case is confirmed —  gets the short course, which is one to three days of doxycycline,” Giard says. “There’s some good data about treating prophylactically if someone’s been bitten by a tick because it takes a while for the pathogen to develop in the blood, and not everybody develops the bulls eye rash.”

For some patients who finish the 21-day course but may still exhibit Lyme disease symptomatology, Giard we’ll continue another 21-day course until the symptoms abate.

But Lyme disease is not always the correct diagnosis.

“A lot of people are aware of Lyme, but they’re not as aware of Babesiosis, Bartonellosis and Ehrlichiosis,” says Giard. “Those have a devastating effect on people, and we’re really concerned. So it’s very important that when people go to get tested that they ask to be tested for all those tick-borne diseases, which are at epidemic levels.”

Babesiosis is a human disease related to malaria parasites. It is associated with voles, chipmunks, mice and shrews. The white-footed mouse is the primary reservoir host. Human cases have been increasing in the Northeast since it was first recognized in the 1970s. The Blacklegged tick is the main vector. Most human cases occur during summer.

Symptoms range from mild to life-threatening, including fever, fatigue, chills, sweats, headache, and more. Severe symptoms are more likely in people who are immunosuppressed, have had their spleen removed, and/or are elderly. Onset of symptoms is one to six weeks after the tick bite.

Between 2005 and 2008, 17 cases of human Babesiosis were reported in New Hampshire, the majority in 2008, indicating this is an emerging disease in New Hampshire.

“When we test in our office, we’re testing Lyme as well as those other organisms to determine if someone has been infected by a tick-borne bite,” Dr. Giard says. “And I like saying ‘tick-borne bite’ because we’ve had patients come in whose symptomatology really points to Babesiosis rather than Lyme. We treat it as if we’re treating malaria.

“Babesiosis in particular is quite nasty,” Giard says, noting that it can enlarge the spleen and liver. Giard retests patients every six hours because of the way these organism shed their DNA. “So we’re pretty on top of that as far as monitoring our patients, and not just focus on Lyme disease.”

Bartonellosis can infect humans, mammals and a wide range of wild animals, according to lymedisease.org. Its bacteria are known to be carried by fleas, body lice and ticks. Scientists suspect that ticks are a source of infection in some human cases of Bartonellosis. Some people who recall being bitten by ticks have been co-infected with Lyme and Bartonella.

According to lymedisease.org, Bartonellosis is often mild, but in serious cases it can affect the whole body. Early signs are fever, fatigue, headache, poor appetite, and an unusual, streaked rash. Swollen glands are typical, especially around the head, neck and arms.

Erythromycin and doxycycline have been used successfully for standard Bartonellosis, but lymedisease.org suspects that tick-borne Bartonellosis is different and recommends levofloxacin or, for children under 18, azithromycin.

Ehrlichiosis is the name for several animal and human diseases. Victims usually report flu-like symptoms — headache, fever, muscle aches, fatigue — and sometimes gastro-intestinal symptoms or rash. Symptoms typically appear five to 10 days after being bitten by an infected tick. The lone star tick is the primary vector. Between 2003 and 2008, 15 cases of human Ehrlichiosis were reported in New Hampshire.

According to the CDC, Doxycycline is the first line treatment for adults and children of all ages and should be initiated immediately whenever Ehrlichiosis is
suspected.

But of course, the best bet to stay healthy is avoiding being bitten by a tick in the first place.

“We always make sure that we talk with our patients about future prevention. One of my favorite things is pantyhose, for men and women,” Giard says with a laugh but in all seriousness. “If you’re going to go out and mow the lawn, throw on some pantyhose, which is not the sexiest look. But it’s a neat barrier for ticks because once you peel the panty hose off, you’re peeling off the tick.”

Giard also cautions not to let the dog on the bed during summertime. Many dogs are treated with Frontline and other pesticides, and ticks will jump off the dog and onto people, the bed or couch. People should change their sheets weekly, looking for any blood spots on them, and vacuum under couch cushions.

Eaton advises to avoid tall grass and brushy areas, prime tick habitats. “If you do spend time in tick-infested areas, wear proper clothing. Wear good shoes — no sandals or bare feet — and long pants tucked into your socks. A long sleeved shirt with snug collar and cuffs will also offer protection, if it is tucked in at the waist. Light colored pants and shirts allow you to easily spot crawling ticks.”

Carefully reading and following label directions, treat socks, ankles, legs and pant legs with tick repellent for added protection.

There are other chemical-dependent methods for reducing exposure to disease-carrying ticks, says Tom Pray, founder Eliot-based Ecotech Pest Control Services. A degreed entomologist with over 25 years of industry experience, Pray helps homeowners beat back pest problems not just using traditional chemicals alone, but by managing the environment responsible for fostering that very infestation.

Pray’s Select TCS “tick  boxes” represent an optimal combination of effectiveness and minimal environmental impact. The tick boxes are the only other option besides spraying treatments with Pyrethroids proven to rid an area of ticks.

Designed to eliminate ticks before they become a threat, the Select tick box system involves a baited box that laces the backs of rodents with a safe treatment — the same chemical found in Frontline — targeting and killing the ticks at early stages of development.

“It’s the greenest solution out there by far,” says Pray. “Not only does it not involve spray; it’s more effective than spraying, because rodents run everywhere, and that means you hit a much broader area.”

The tick boxes are specifically designed to let in only mice and chipmunks without increasing their ranks and are harmless to anything but ticks.

Starry Brook Natural Medicine and Ecotech Pest Control Services are business partners of the Green Alliance, a union of local sustainable businesses promoting environmentally sound business practices and a green co-op offering discounted green products and services to its members. 

For more information about Starry Brook Natural Medicine, visit www.starrybrook.com. For Ecotech, visit www.ecotechpc.net. And for the Green Alliance, visit www.greenalliance.biz.