June 14th, 2021

We are seeing more cases of tick exposure and potential infections over the past few weeks as everyone is heading out to the mountains and beaches for vacation and regular life. Every spring and summer, many children present to our clinic with tick bites and other insect issues. While most bites are benign, some are not. Being aware of the realities and risks of tick exposure will help us make good decisions regarding medical care needs. Ticks are little 8 legged creatures (Images) that live primarily on animals in the woods and then grab onto us when we come into contact with a plant or animal that they were waiting or "questing" on for a "sucker" to pass by.

Ticks can migrate via birds that can carry them miles away from their previous location. They travel with all kinds of animals, but seem to be on mice, deer, livestock and birds predominantly. Ticks feed only on blood and utilize special mouth adaptations to cut the skin and suck out the blood. They keep our blood from clotting by releasing anti coagulants into the blood as soon as they suck it out.

While the amount of blood that a given tick removes from us is minimal to almost undetectable, they have a nasty habit of leaving behind dangerous pathogenic microbes in our blood stream. Of note, the most troublesome tick borne illnesses are caused by a bacteria called Rickettsia which causes Rocky Mountain Spotted Fever as well as the Borrelia bacterium which causes Lyme disease. Tularemia, babesiosis, tick paralysis and ehrlichiosis are a few other diseases that are tick born in the United States. Read about each disease at www.cdc.gov and know the corresponding tick to each illness.

We do know that Lyme disease is firmly in the south! I grew up in the hotbed of Lyme disease in the Hudson Valley of New York. It appears that mouse overpopulation is making things worse. This overpopulation is a result of shrinking predator populations as forest space is reduced in urban and suburban areas. Mice are highly efficient transmitters of Lyme and are responsible for infecting the majority of ticks carrying Lyme in the Northeast. A mouse can have up to 100 ticks covering its ears and face.

Let us look at three major tick induced diseases.

Rocky Mountain spotted fever, RMSF, is a disease that is spread by the dog or wood tick and is notorious for being a bad player if left untreated without antibiotics. It can be deadly in short order. RMSF presents with fever, headache, body aches and maybe nausea/vomiting and a rash that is a later finding on days 4 through 7 but occasionally as early as 2 days. The rash is a purplish spotted rash on the palms, wrists, ankles and soles. The illness mimics many viral illnesses in the first few days making diagnosis tricky. In general, it is recommended to start antibiotics in the first few days when the suspicion changes from virus to possible RMSF. Take this illness seriously!

Lyme disease, on the other hand, is not deadly in the early stages. It is a tick borne illness spread by the black legged or deer tick that presents with a bullseye rash called erythema migrans within the first few weeks of a bite. The symptoms can progress over the subsequent months with inflammation that involves the joints, heart and neurological system. It is a serious disease with significant morbidity if not treated with antibiotics. Read up on this illness further to know when to seek medical attention. Using antibiotics for acute treatment is therapeutic and preventative of lyme induced chronic symptoms.

Alpha gal is a tick induced allergy to red meat, beef and pork, that is increasing in incidence. The Lone star tick and the black legged tick, found often in the southeastern US, are the known vectors of transmission of a sugar molecule called alpha gal or galactose alpha 1,3 galactose which induces an immune reaction in susceptible individuals leading to an allergy. This food allergy reaction can occur at any age and is an IgE mediated delayed hypersensitive reaction (hours after meat exposure) to the sugar oligosaccharide epitope alpha gal. (Crispell et. al. 2019) The reactions can be as mild as just hives or as severe as anaphylaxis requiring epinephrine for survival. Organ meats, beef, lamb, pork, dairy and gelatins can cause this reaction upon ingestion. To make things worse, alpha gal sufferers can react to certain drugs and vaccines because of animal based gelatin additives. (Stone et. al. 2019) Avoidance of meats and gelatins is the treatment of choice.

Prevention is the key to avoiding exposure to these creatures. Here are some tried and tested methods to keep your family free of insect borne disease.

Ideas:

1) Perform tick checks on your children daily after outdoor play. Check behind the ears, nape of the neck, groin, armpit and between the toes. Ticks, in general, need to be attached for roughly 24 - 36 hours to transmit the spirochete or pathogen that causes Lyme disease and Rocky Mountain Spotted fever. Remove them gently with tweezers by gently pulling and not squeezing. See this link for details.

2) Tick bites can leave an itchy bump. Kids will often scratch them open and leave a place for infection to occur. We are seeing a lot of MRSA (a resistant bacterial skin bacteria) abscesses from these bites. (see newsletter link on abscesses below) Prevent them by using insect repellents and long clothing. .

3) Treat all domesticated animals for ticks if they have them. Prevent tick issues by having your animals take flea and tick medicine.

4) Use topical products with DEET or oil of lemon eucalyptus 30% to prevent tick bites. (not for kids under 3 years old). See the EWG's website, link for details on insect repellants. It is an excellent source of information for safe chemical use.

5) Apply all repellents by hand to avoid inhalation by yourself or your child. (same with sunscreens. Aerosolized chemicals are no good and not intended for inhalation, period!)

6) Shower after outdoor activity. Especially, if repellents are used.

7) I like creams like calendula, aloe vera and cortisone for itching. Also, rubbing a moist tea bag on bites can help with itching and swelling. The tannins act like an astringent.

8) Keeping mice and deer away from your living area is a great prevention strategy. Having an outdoor cat, using fences to keep deer out and treating your domesticated animals for tick prevention are solid choices for your families health.

9) Treating your hiking clothing with 0.5% permethrin is an effective prevention strategy if you are going to be out for days.

10) Contact your provider if you think that you may have a tick related illness.

Stay tick free,

 

Dr. M

Borchers Journal of Autoimmunity Article
NPR Tick Article
Steinke J Allergy Clinical Immunology
Crispell Frontiers in Immunology
Stone J Allergy Clin Immunology in Practice
Abscess Newsletter