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We know very little about tick-borne diseases, and yet the effects of their devastation permeate every strata of society. Therefore, it should come as no surprise that we live amidst 907 species of ticks.
Dr. George Dempsey, who specializes in tick-borne diseases at his private practice at East Hampton Family Medicine and who is on the advisory panel of the Tick-Borne Disease Resource Center at Southampton Hospital, explains how complex these tick-borne diseases are and how complex our lives have become as a result.
“Ticks feed on mammals, birds and reptiles,” he said. “When attached to birds, they can survive submersion under water. They feed only on blood and can live longer without food or water than any other creature. They usually molt three times to become adults, acquiring bacteria, viruses, protozoa from one feed and transmitting to the next. As they can survive the winter, it is possible that they can have a lifespan of up to seven years. Ticks harbor a complexity of organisms we are only beginning to understand. The implications of their effect on humans, makes the specter of Lyme disease grow pale in comparison.”
That being said, there is a newly arrived tick player in the Hamptons, amblyomma americanum or the Lone Star tick. Among the diseases the Lone Star tick spreads is tularemia, (rabbit fever, ulcers, affects mammals and domestic animals) erhlichiosis, (bacteria that affects humans and mammals, symptoms appear 7 to 14 days after infection and is treated with antibiotics), STARI, (similar to Lyme disease) and the alpha-gal meat allergy, (severe allergic reaction to red meat).
The reason these new strains are cropping up everywhere is migration and aggression. Ticks simply hop a ride to a new location. Both deer/black legged ticks carrying Lyme disease and the Lone Star ticks aggressively seek out their prey. When the new strains of virus enter the body of a human being, they affect our DNA. In the case of viral infections, antibiotics are ineffective. Our immune systems must bear the brunt. And for anyone with a compromised or fragile immune system, that can be life-threatening. Complicating matters even further is that proper diagnostic tools are lagging sadly behind. Only proper funding will enable researchers to find better ways to diagnose and treat many new and complex strains of tick-borne diseases.
According to lymedisease.org, in a recent survey of more than 3,000 patients with chronic Lyme disease, it was found that more than 50 percent had coinfections, with 30 percent reporting two or more coinfections. The most common coinfections were Babesia (32 percent), Bartonella (28 percent), Ehrlichia (15 percent), Mycoplasma (15 percent), Rocky Mountain spotted fever (6 percent), Anaplasma (5 percent), and Tularemia (1 percent).
Among all these, the most common co-infection is Babesia, which is a malaria-like parasite that infects red blood cells. Babesia is found in 50 percent of Lyme sufferers, and can be transmitted from mother to unborn child, or through a contaminated blood transfusion. Unfortunately, most blood banks do not screen for Babesia. Since the late 1980s, the disease has spread dramatically. Cases have been reported as far as Europe, and Asia.
Babesiosis starts with a high fever and chills. As the infection progresses, it is accompanied by fatigue, headaches, drenching sweats, muscle aches, chest pain, hip pain and shortness of breath. But because tick-borne diseases mimic other diseases and are experts at hiding in the body, babesiosis can also be mild, allowing it to go undetected.
Two tests commonly used to diagnose Babesia are the PCR (polymerase chain reaction) test, which can detect Babesia DNA in the blood, and the Fluorescent In-Situ Hybridization (FISH) assay, which can detect the ribosomal RNA of Babesia in thin blood smears. Negative results do not rule out infection or prophylactic treatment.
Babesiosis is treated with a combination of anti-malarial drugs and antibiotics. Relapses can occur. And if you rely on medical insurance, as most of us do, they will pay for antibiotics, but unless you have a clear diagnosis of Babesia (and not just the symptoms) the chance that they will agree to pay for more costly and effective drugs like mepron, which run between $1,200 - $2,000 for a month’s supply, is unlikely.
The next most popular co-infection is Bartonella, which is primarily carried by cats, but is also carried by fleas, body lice and ticks. It causes cat-scratch disease, endocarditis, and several other serious diseases. You don’t have to own a cat to have been exposed to the disease. In addition, it can be passed from mother to unborn child and it can be chronic because it periodically cycles into red blood cells, where the virus is believed to remain protected.
Symptoms of bartonellosis include fever, fatigue, headache, poor appetite, swollen glands, and an unusual streaked rash that looks like stretch marks. There are also at times more neurological symptoms with Bartonella, like blurred vision, numbness in the extremities, memory loss, balance problems, headaches, ataxia (unsteady gait), and tremors. Bartonellosis can trigger psychiatric manifestations.
As in the case of babesiosis, standard blood tests and polymerase chain reaction (PCR) biopsy tests are inconclusive. Test results can also be fickle, testing negative one time and positive another. Fluoroquinolones and doxycycline are used as treatment which are at times successful in the treatment of bartonellosis.
Ehrlichiosis is a term that describes several different bacterial diseases, one of which is also called anaplasmosis. Some are transmitted by ixodes ticks and others by the Lone Star tick. The symptoms of ehrlichiosis and anaplasmosis are the same. Each is recognized by a sudden high fever, fatigue, muscle aches, and headaches. Paradoxically, the disease can be mild or life-threatening. Ehrlichia parasites multiply inside host cells. The treatment of choice for ehrlichiosis/anaplasmosis is doxycycline, with rifampin as backup in the event the doxycycline fails. In resistant cases, a combination antibiotic therapy may be necessary.
According to the Tick-Borne Disease Resource Center, also making an appearance on the East End of Long Island is the Powassan virus, which can create encephalitis and meningitis. Patients with Powassan virus may be asymptomatic or suffer severe neurologic reactions. Common symptoms may include fever, headache, vomiting, weakness, confusion, seizures, and memory loss. It is a viral disease rather than bacterial, and is different than neurological Lyme, which is caused by a spirochete and is treated with intravenous antibiotics. The symptoms for neurological Lyme appear to be to be extreme back/spinal pain, and shooting pains down the legs and arms, along with brain fog, and memory loss. According to Dr. Patricia Coyle at Stony Brook University Hospital, the definitive test for neurological Lyme is a spinal tap. Long-term neurologic problems can occur with both. There are no commercial diagnostic tests for the Powassan disease, nor is there specific treatment. There is however a definitive test for neurological Lyme (spinal tap) as well as a successful treatment (intravenous antibiotics).
And last, but not least, is the Lone-Star-tick-induced meat allergy known as alpha-gal. Southampton based immunologist and allergist Dr. Erin McGintee claims she has treated 325 cases of alpha-gal since the end of 2010. Allergy symptoms hit, not after having been bitten by the tick, but three to eight hours after ingesting red meat. Very often, the patient awakes in the middle of the night with an itchy skin rash, (90 percent complain of itchy rashes) and hives. The more seriously affected experience abdominal cramps, nausea, vomiting, chest tightness, wheezing and in the most extreme cases, anaphylactic shock.
Dr. McGintee recommends taking up to 100 mg. of benadryl for the itchiness. If more severe symptoms accompany the rash, immediately call an ambulance. There is no known treatment for alpha-gal, other than avoiding all red meat. There is no cure and there are no long-term accompanying side effects. If the patient is experiencing tiredness or other symptoms, there might be a co-infection present. There should be no lingering effects six to 12 hours after the onset of the initial attack, and she believes that sensitivity to meat decreases with time.
In the event you or a family member find a tick bite, please go to your physician or the emergency room right away. Symptoms of Lyme and its confections are: sudden high fever and chills, very low blood pressure, extreme fatigue, recurring headaches, night sweats, poor appetite, blurred vision, dizziness, numbness in the extremities, memory loss, balance problems, headaches, ataxia (unsteady gait), tremors, an unusual streaked rash that resembles stretch marks, swollen glands, Bell’s palsy, neurological symptoms, muscle aches and respiratory insufficiency (shortness of breath). Even sudden psychiatric manifestations like depression or overwhelming rage should be double-checked.
If you or a family member is experiencing one or some of the symptoms outlined in this article, call the Southampton Hospital tick hotline at 631-726-TICK.
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on Jul 21, 2016