As people get out of the house and enjoy the summer weather, health care workers prepare to see more tick-bite-related issues.
A health advisory was recently issued by the state calling for a heightened clinical suspicion for tickborne diseases from April through September. As expected, with more people spending time outdoors, there is an increase in tick exposures during the spring and summer months.
The most commonly reported tickborne disease in the state is Lyme disease. In 2108, Pennsylvania ranked fourth nationally in Lyme disease incidence rate. Usually the disease is seen from May through September.
"Lyme disease is carried by a tick called Ixodes scapularis, known as the deer tick or sometimes blacklegged tick," said Dr. Debra Powell, chief of section of infectious disease at Reading Hospital. "Some of the ticks are very small, especially the nymphal larva ticks. You may not always notice them because they could be the size of a poppy seed at the smallest."
Deer ticks infected with the bacterium that causes Lyme disease, Borrelia burgodorferi, have been reported in all 67 of the state's counties.
For a tick to infect a person with a tickborne disease, it must not only bite the person but remain in place for about 24 hours.
Spotting and treating Lyme disease
Lyme disease can cause a variety of symptoms depending on the stage of infection, including fever, rash, facial paralysis and arthritis. Early symptoms can be fever, chills, headache, fatigue, muscle and joint aches, swollen lymph nodes and a rash called Erythema Migrans, which looks like a bullseye.
"Usually three to seven days after the tick bites the person, you get this classical Erythema Migrans rash," Powell said. "Then after that it may become more disseminated with multiple round rashes over the body. Later on you develop different symptoms such as swollen joints and the facial palsy. Some patients can even develop a heart arrhythmia or even meningitis."
If a patient visits a health care provider in the early stages of the disease with the bullseye rash, a blood test is not recommended to diagnose the disease. The blood test for Lyme disease is an antibody test, and the body can take weeks to produce the antibody.
"Our emergency room, urgent care centers and primary care doctors have been advised not to test (if an acute bullseye rash is present), to just go ahead and treat," Powell said. "We consider Lyme disease treatable once it's diagnosed. Once it's treated the organism is dead."
The course of treatment for those in the early stages of the disease is oral antibiotics. When treated in the early stages, people tend to recover quickly. For people with certain neurological and cardiac symptoms, intravenous antibiotics may be required.
If the disease is caught in the later stages, there may be some joint destruction. In those cases, additional treatment is required for the joint damage even after the person recovers from the disease.
"It's kind of like having termites in your house," Powell said. "They chew apart the wood, and you can kill them, but you still have the damage."
Once a person recovers from Lyme disease, it is still possible for them to become infected again. The antibodies created during the first infection do not prevent future infections.
"You can get it back again," Powell said. "You're not immune from that first case. You can get a second infection."
More than Lyme disease
Powell has seen an increase of people with Lyme disease in the area over the years. It is also not the only tickborne disease being reported annually in the state.
"When I first started here, we had some cases of Lyme disease, but not a lot," Powell said. "Now we are considered a fully endemic area for Lyme disease, in addition to a couple of other tickborne diseases people may not know about."
Two of those diseases, also carried by deer ticks, are anaplasmosis and babesiosis. According to Powell, 10 years ago there were no reports of babesiosis in this area, but now there are reports every spring and summer of the disease.
Early signs and symptoms of anaplasmosis include fever, chills, severe headaches, muscle aches, nausea, vomiting, diarrhea and loss of appetite. Many people with babesiosis are asymptomatic, but some people can experience flu-like symptoms. The parasite causing babesiosis infects red blood cells, which may cause anemia. Both diseases are treatable.
The best way to avoid getting a tickborne disease is to prevent being bitten.
"I think prevention is going to be key," Powell said. "I hate to say limit your outdoor exposure, but that's where you get exposed."
For those enjoying time in the outdoors, Powell recommends covering as much of the skin as possible with clothing and showering once returning home.
"If you can come in, disrobe and shower after working outside or hiking, etc., that will decrease the chance of you having a tick on you that would bite you for an extended period of time," she said. "If you don't do that, I would recommend that you would look over your skin surface to look for any ticks. And if you have small children and pets playing outside, do a skin exam for them as well."
If a tick is found and it is not embedded in the skin, the likelihood of the person getting a tickborne illness is almost zero. In the case of a tick being embedded in the skin, use a pair of tweezers, get as close to the skin surface as possible and then gently and consistently pull off the tick to avoid breaking off any of the mouth parts in the skin. Once the tick is disengaged from the skin, the tick should be discarded.
Studying tickborne diseases
The best way to learn about tickborne diseases and treatments is by performing clinical trials. Reading Hospital is currently taking part in two.
One of the trials is a post treatment Lyme disease study being done by Dr. John Aucott at Johns Hopkins University of Medicine, which examines the possibility of patients experiencing post-treatment Lyme disease. Reading Hospital has been participating in the ongoing trial for about three to four years.
The other trial focuses on babesiosis and is being done by Penn State Health Milton S. Hershey Medical Center and Penn State College of Medicine. Researchers are attempting to characterize patients with the bacterium, learn more about the strains being reported in the area and the clinical presentation and resolution of symptoms.
Treatment is based on evidence from clinical trials.
"It's the only way we're going to know what actually works and what the life cycle of the disease is," Powell said. "It's important for me as a physician to know what works."