Beware Tiny Tick

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By Gary E. Barr

Special to the Rappahannock News

Mysterious, confusing, and diverse, it is a sickness that can cause several serious medical conditions. As Virginia residents hike and work outside during summer, Lyme Disease can be a serious consequence.

“I didn’t have any of the normal symptoms,” said Susan Morgan of Wytheville. “Rob [her husband] thought it was a spider bite. It was in a place on my back that would have been covered and we never saw the tick.”

Within a few days the small red spot grew to a circular target shape eight inches in diameter. Morgan had to take antibiotics for almost a month, but her Lyme Disease eventually cleared up.

Lyme Disease first appeared 100 years ago in Europe. Deer ticks (black-legged ticks) began causing the disease in Lyme, Connecticut in 1975. Since then it has spread and the number of Lyme Disease cases is increasing in Northern Virginia.

Dr. Lawrence R. Whitehurst, a physician at Culpeper Medical Associates, explained:

“In our practice we have had one case of serious Stage III Lyme Disease involving the central nervous system of a patient and one case of Lyme Cardiomyopathy or Lyme-induced heart disease. We have had many cases of Primary localized (Stage I) or Disseminated (Stage II) Lyme and a few cases of Lyme Arthritis.”

Whitehurst has been practicing medicine for 36 years, is Board Certified in Family Medicine, and is an Assistant Visiting Professor of Family Medicine at the University of Virginia.

“There has been a general increase in reported cases of Lyme Disease throughout Northern Virginia and the Tidewater area over the past 5 years,” said Whitehurst. This is directly related to the increase in white tail deer which are the natural host [of] the deer tick.”

In Virginia one of the biggest jumps in cases of Lyme Disease occurred between 2006 and 2007. Statewide there were 357 cases of Lyme Disease in 2006, 1,000 cases in 2007. Since then the Virginia rate has somewhat stabilized at approximately 1,000 cases per year.

Whitehurst pointed out that Lyme Disease is currently the most prevalent vector-borne disease in North America with foci of infection in a corridor running from Maine through Virginia, and in regions of Wisconsin, Michigan, Minnesota, and Northern California. Highly populated cities such as Boston, New York, Philadelphia, Washington, D.C., and the whole Tidewater metropolitan area of Virginia have seen marked increases in the disease.

“One reason for the dramatic rise in Lyme,” Whitehurst said, “is loss of the normal habitat for the deer along with elimination of the natural predator of the deer, the timber wolf. This has caused the deer to move from the mountain areas into farms and fields frequented by humans.”

“Another vector in the chain is the white-footed mouse and this rodent tends to be prevalent in areas of overcrowding [that have] slum conditions with poor sanitation. The tick itself can be found in high grass, weeds, shrubs and other forms of vegetation and it is attracted to warm-blooded mammals as it needs a ‘blood meal’ in each of its stages of life.”

If untreated, Lyme Disease can cause serious problems with joints, the heart, and the body’s nervous system. Facial palsy, partial paralysis of facial nerves, can result along with types of meningitis, nerve inflammations in the body’s limbs, encephalitis (brain swelling), and carditis (heart inflammation).

Whitehurst described why deer tick bites often go undetected.

“The nymph stage tick looks like the adult but it is smaller and only has six legs rather than the eight found in the adult tick. Over a third of active cases cannot remember the original tick bite, and it frequently goes unnoticed since it is usually painless. The nymph stage tick is most active in the late spring and early summer; the adult tick is most active in the summer and fall.”

“Exposure to the deer tick should be reported as soon as suspected. Before any rash has occurred, a single dose of an antibiotic, usually Doxycycline can prevent the illness. Once a spreading red lesion has appeared around a tick bite or multiple red spots resembling bulls-eyes have appeared, 14 to 21 days of an antibiotic are usually adequate to kill the infection.

According to Peter Warren, an Extension Agent in Albemarle County, less than half of deer ticks carry the disease and it’s even a smaller percentage of such ticks that can actually transmit the Lyme Disease to humans. As a result, getting bit by a deer tick doesn’t mean you get the disease.

However, Whitehurst warned:

“Once arthritis or inflammation of the heart has occurred, a 30-day course of antibiotics is usually necessary. In severe cases, two to four weeks of intravenous antibiotics may be necessary.”

“It is essential to identify and treat Lyme Disease in its early stages which are in the first six weeks after exposure, the sooner the better. After this time the organism may enter a latent phase which may last for weeks, months or years and then reappear suddenly as full blown Stage 3 disseminated Lyme Disease affecting multiple organ systems, the heart and the central nervous system. I have seen a case like this and it is difficult to treat at best and at worst may leave the patient with a post-Lyme syndrome that resembles Fibromyalgia or Chronic Fatigue Syndrome that lasts for years and is very resistant to treatment,” said Whitehurst.

No one seems quite sure of the many variables related to Lyme Disease and attempts to produce an effective vaccine for humans have been unsuccessful.

“This is a very important and emerging infection in Virginia,” said Dr. Keri Hall, Director of Epidemiology at the Virginia Department of Health. Hall added it’s likely that many cases of Lyme Disease still go undetected.

Can the disease spread from human to human? Whitehurst explains, “Lyme is not communicable between humans; it can only be caught from the deer tick, usually in the nymph stage.”

Why have experts been unable to develop a vaccine for Lyme Disease?

“The CDC [Center for Disease Control] is still actively pursuing a vaccine, but vaccine development is difficult because the infecting organism has very few proteins on its surface that can be used to synthesize an effective vaccine.”

Until then, Whitehurst and groups such as the American Red Cross advise: to wear a good insect repellent and to do a self-examination following any treks in areas with tall grasses and wooded areas. If people do this, the number of Lyme Disease victims will decrease.

Looking at Lyme Disease

What is Lyme disease?

Lyme disease is a tick-borne illness caused by infection with the bacteria Borrelia burgdorferi.

Who can get Lyme disease?

People of any age can get Lyme disease, particularly those who spend a significant amount of time in outdoor activities. It occurs most commonly during the late spring and early summer months, but can occur during the fall and winter. Dogs, cats and horses also can get Lyme disease.

How is Lyme disease spread?

The bacteria that cause Lyme disease are transmitted through the bites of infected ticks. In the Eastern U.S., the only tick known to spread Lyme disease is the black-legged tick (formerly called the “deer tick”). Spread of the Lyme disease bacteria from an infected tick to a person is not likely to occur unless the tick has been attached to the person’s body for at least 36 hours. Lyme disease is not known to be spread to humans from other insects or animals, or from one person to another.

What are the symptoms of Lyme disease?

Within days to weeks following an infectious tick bite, most patients (about 80 percenttt) develop a red rash called an erythema migrans (a.k.a., “EM” or “bull’s-eye” rash) around the bite site. This rash slowly expands (up to 12 inches in diameter and clears around the center, but does not itch. It is usually accompanied by general tiredness, fever, headache, stiff neck, muscle aches, and joint pains. If untreated or not properly treated, some patients may develop arthritis, neurological problems, and/or heart problems weeks to months later.

How soon after exposure do symptoms appear?

The EM rash may appear within 3-32 days (usually 1-2 weeks) after exposure. Some patients never have early symptoms of Lyme disease, but become sick with more severe symptoms from weeks to months after tick exposure.

How is Lyme disease diagnosed and treated?

The diagnosis of Lyme disease is based primarily on signs and symptoms of illness. Laboratory tests for Lyme disease may be done on a patient’s blood to help confirm the diagnosis. When Lyme disease is detected early, it is treated with oral antibiotics such as doxycycline or amoxicillin and treatment usually lasts for 10-21 days. In the later stages of Lyme disease, antibiotic treatment lasts longer, is more complicated, and patient response to treatment is slower.

Is there a vaccine for Lyme disease?

There is currently no vaccine for Lyme disease.

How can Lyme disease be prevented?

Avoid tick infested areas, such as tall grass and dense vegetation in forests and along forest margins. When in potential tick habitats, tick-specific repellants may be used according to manufacturer’s instructions, such as those containing DEET (up to 50 percent DEET for adults, and less than 30 percent DEET for children) and/or permethrin (apply permethrin to shoes and clothing only, not skin). Be sure to follow the label’s instructions when using any repellent. Wear light colored clothing so that ticks are easier to see and remove. Tuck pant legs into socks to prevent ticks from crawling up under the pants. Wear long-sleeved shirts buttoned at the wrists. Conduct tick checks on yourself, your children, and pets within a few hours of exposure to a tick infested area. Remove any attached ticks promptly by gripping the tick with tweezers as close to the skin as possible and using a gentle steady pulling action. Protect hands with gloves, cloth or tissue when removing ticks from people or animals.

Where can I get more information about Lyme disease?

More information about Lyme disease is available on the Virginia Department of Health website atwww.vdh.virginia.gov or through the Centers for Disease Control and Prevention website atwww.cdc.gov.

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