Ticks

Many species of ticks live and flourish in the woods and fields of upstate New York. In the warm weather ticks and humans are apt to bump into each other on a path or lawn. More annoying than finding a tick crawling up your pant leg is finding one firmly embedded in your skin.

Tick removal is simple and straightforward. It is important to avoid "upsetting" the tick as well as the human to which it is attached. To this end do NOT use alcohol, Vaseline, gasoline, nail polish, nail polish remover or above all, a match. Simply grasp the tick with tweezers as close to the skin as possible; pull gently and steadily until the tick comes out. Wash the area with soap and water. Redness at the site should resolve in a few days. If signs of skin infection develop (redness, warmth, pain, etc.), call your healthcare provider.

The ticks in our "neck of the woods" that cause human sickness are the American dog tick (Dermacentor variabilis), the black-legged deer tick (Ixodes scapularis), and the Lone Star tick (Amblyomma americanum). The dog tick can transmit Rocky Mountain Spotted Fever (RMSF); the deer tick is associated with babesiosis, anaplasmosis and Lyme disease; and the Lone Star tick with human monocytic ehrlichiosis (HME) and southern tick-associated rash illness (STARI). Additionally, many varieties of ticks (including dog ticks and Lone Star ticks) can cause tick paralysis.

Rocky Mountain Spotted Fever (RMSF)

Though we see an occasional case of RMSF in the northeast, the majority of cases occur in five states (North Carolina, Oklahoma, Arkansas, Tennessee, and Missouri). Symptoms begin 2-14 days after a tick bite and include fever, rash, headache, nausea, vomiting, abdominal pain, muscle pain and conjunctivitis ("pink-eye"). Rash is present in 90% of cases but may vary in time of onset, appearance, and location. RMSF is treated with doxycycline, a common antibiotic. Illness can be severe and may have lasting health effects if not treated promptly.

Babesiosis

Babesiosis is caused by a parasite that infects red blood cells. Most cases occur in coastal areas of the northeastern U.S. (Islands off of MA and RI, Long Island, etc.). Symptoms can take a few days to a few months to develop. They might include fever, chills, sweats, headache, body aches, nausea, and fatigue. Some individuals develop anemia. Treatment includes a two-drug regimen; an anti-malarial drug and azithromycin.

Anaplasmosis

Anaplasmosis is bacterial and is most frequently reported from the upper midwestern and northeastern United States. Symptoms usually occur within 1-2 weeks of a tick bite and include fever, headache, chills, nausea, abdominal pain, and muscle aches. Illness is more severe in immune-compromised individuals. Doxycycline is the treatment of choice.

Lyme Disease

Lyme disease is most prevalent in the northeastern and north-central U.S. It is more common in NY than other tick-borne illnesses. Like anaplasmosis, it is bacterial and usually responds well to doxycycline.

Symptoms begin 3-30 days after the tick bite and can include fever, headache, fatigue, muscle and joint pain, swollen lymph nodes and a rash. The rash occurs in 70-80% of cases and often resembles a target ("bulls-eye"). It usually starts at the bite site. If left untreated, infection can spread to joints, the heart, and the nervous system. Early treatment is usually successful. Unfortunately, a small percentage of people experience persistent symptoms even after being treated.

Deer ticks are very tiny (poppy-seed-sized) and may go unnoticed. Treatment for diseases spread by deer ticks should not hinge on the presence of a tick. Symptoms should be addressed in light of the season of the year, the prevalence of tick-borne diseases in the region and the activities of the patient (travel, hiking, hunting, living near a wooded area, etc.).

Human Monocytic Ehrlichiosis (HME)

According to the CDC, 70 Upstate New Yorkers were diagnosed with HME in 2009. HME is a general term for a group of illnesses caused by similar bacteria. It can be tricky to diagnose. Symptoms vary from person to person. They usually begin 1-2 weeks after a tick bite and include fever, chills, headache, muscle pain, fatigue, nausea, vomiting, diarrhea, "pink-eye" and rash. In severe cases, trouble breathing and bleeding disorders develop.

Many people (particularly adults) do not get a rash. In those who do, its appearance can vary. For these reasons, it is not possible to diagnose HME simply based on rash. Also complicating things is the fact that testing might appear negative at first. Providers must look to other lab work for clues; low platelets, low white blood cells, or elevated liver functions.

HME can be life threatening and quick treatment with doxycycline is needed. As with all tick-borne illnesses, season of the year and patient history are very important in deciding when to treat.

Southern Tick Associated Rash Illness (STARI)

This is admittedly a "weird one". The germ that causes STARI has not yet been identified. Symptoms begin a week after tick bite and are similar to Lyme disease; including the "bulls-eye" rash. It is easily mistaken for Lyme. Unlike LD, STARI has not been associated with long-term problems with the heart, nervous system, or joints. Symptoms go away promptly following antibiotic treatment.

Tick Paralysis

This rare condition is caused by a toxin ("poison") made by the tick. Paralysis begins 5-7 days after the tick attaches. The legs are affected first; an unsteady gait may be the first sign that something is wrong. Weakness moves upward and will eventually affect the muscles used to breathe. Once diagnosed, the cure is easy. Find and remove the tick. If tick paralysis is suspected, a thorough search for an attached tick(s) ensues; scalp, groin, ear canals, genitalia, nostrils are carefully checked. Once removed, toxin levels begin to drop and paralysis goes away.

Diseases caused by ticks can be avoided. Follow these tips to prevent exposure to ticks and the diseases they carry:
  • Walk on cleared trails (avoid brush, tall grass and leaf litter)
  • Minimize exposed skin (tuck in pant legs to socks)
  • Wear light colored clothing (easier to see dark ticks)
  • Check yourself, your loved ones, and your pets for ticks after being outdoors
  • Shower soon after being outdoors
  • Wear tick repellent
  • Create a "tick-free zone" around your home
  • Discourage deer from entering your yard
Sources and links:

Deer Tick