Last month we talked about some illnesses prevalent in the warmer months, including the childhood illnesses Fifth Disease and Hand-Foot-Mouth Disease. As we get outside more, folks will be camping, picnicking, and otherwise enjoying the outdoors with sporting events and other activities. Sooner or later, someone is going to find a tick on themselves or their pet and wonder about danger of illness and how to remove the tick.
Ticks are of the class of animals called arachnids, which includes spiders and mites. Ticks live by hematophagy (eating blood!), and they attach and feed on humans, other animals and even reptiles. Ticks comprise diverse families of hard- and soft-shelled species. We are most familiar with the hard-shelled variety that we find on ourselves or our animals (usually dogs).
Ticks are called vectors because they bring or “vector/aim” disease-causing bacteria to us. There are scores of mild and serious illnesses brought to us by ticks. A few diseases that you might have heard about include Lyme Disease, Rocky Mountain Spotted Fever, and maybe Q Fever, but included are other nasty diseases with scary names like Crimean Congo Hemorrhagic (bleeding) fever, tularemia, and tick-borne meningoencephalitis (brain infection). Discussion of all diseases transmitted by ticks is beyond the scope and space of this discussion, but we’ll discuss two here.
Lyme Disease – Bacteria called Borellia burgdorferi from the blacklegged tick cause Lyme Disease. The tick bites and attaches to human skin, and while the tick is filling up on our blood, the bacteria are being transmitted to our bloodstream. In essence, we feed them and in turn, they infect us with bacteria that cause headache, fever, and a classic rash called erythema migrans. Some redness may develop at the site of the tick bite, and this could be any exposed part of the body. The site redness may disappear over a couple of days, and this is reassuring. But sometimes the rash starts expanding in a generally circular fashion, with some internal areas clearing as the borders expand. This can leave a typical “bulls-eye” appearance. During the first 1-4 weeks, as the rash is appearing and expanding, other symptoms begin and include fever, tiredness, joint aches, and swollen lymph nodes. Of course, the best prevention is avoiding tick bites in the first place by wearing appropriate skin-covering clothing and using repellants, along with avoiding likely habitats. Once a tick has bitten, disease can often be prevented by early removal. Antibiotics used to treat early stages of Lyme Disease include doxycycline and amoxicillin. Most people treated in the early stages of the disease recover completely, but a few do not. Some unfortunate people are plagued for months with joint and muscle aches, even after treatment. The good news is that most people eventually recover.
Rocky Mountain Spotted Fever (RMSF) – Despite the name, RMSF occurs at a medium incidence in Indiana. It is caused by the bacterium Rickettsia rickettsii, and this bacterium is also brought to us by tick bites. The most common ticks are the American dog tick and the Rocky Mountain wood tick. Symptoms are similar to those of Lyme disease in that there can be fever, headache and muscle pain, but there can also be abdominal pain and vomiting with RMSF. There is also usually a rash, but this is different than the bulls-eye rash of Lyme disease. The rash of RMSF is complicated, but more diffuse than the target rash of Lyme disease. The rash usually appears within the first few days after a tick bite, but a few people never develop the rash at all. The rash starts out as flat, pink, non-itching spots on the wrist or ankles, but then spreads to the extremities and trunk. While the disease can be fatal, early treatment with doxycycline can be curative.
Besides preventing tick bites in the first place, early removal of an attached tick is highly advisable. You’ve probably already heard of several methods by family members and friends which are not likely professionally recommended. Don’t try to apply heat (e.g. matches) or covering with nail polish. The best advice is to remove the tick as soon as possible by grabbing it close to the skin with clean tweezers and pulling straight up with gentle pressure until it detaches. Don’t twist or jerk or the mouth parts may be left behind. If this happens, try to remove as best you can with the tweezers, and then clean the area and your hands thoroughly with soap and water or iodine.
Of course, if you feel badly and think you might have a tick-borne illness, consult your primary care provider as soon as possible. You do have one, right? Be safe, and enjoy summer!
Dr. Fleming is the Medical Director of The Jane Pauley Community Health Center (closely affiliated with Community Health Network). Ideas for this column can be e-mailed to Dr. Fleming at AskDrFleming@gmail.com. Or you can write your medical questions to Dr, Fleming at AskDrFleming, 8931 E. 30th Street, Indianapolis, IN 46218. On written correspondence, please include your name and city (names will not be published).