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My turn: Tick diseases go beyond Lyme

  • FILE - This March 2002 file photo shows a deer tick under a microscope in the entomology lab at the University of Rhode Island in South Kingstown, R.I. The University of Massachusetts Laboratory of Medical Zoology in Amherst is stepping up efforts in May 2016, to test ticks that people find on themselves or their pets for diseases. The lab is partnering with about two dozen towns in the state to offer discounted tick testing that lab director Steve Rich said can help treatment of Lyme and other tick-borne diseases. (AP Photo/Victoria Arocho, File) Victoria Arocho

  • A sampling of ticks (dead) that can transmit Lyme's disease, with an engorged tick at bottom left. Dangerous ticks can be even smaller than these. KEVIN GUTTING KEVIN GUTTING

  • Courtesy Courtesy

  • Photo courtesy state Department of Public HealthA deer tick sits atop a leaf. http://www.mass.gov/eohhs/gov/departments/dph/programs/id/epidemiology/ticks/



For the Monitor
Thursday, June 30, 2016

I went out to the barn to feed one morning, and found my senior horse Iggy lying down with his legs straight out, stiff, and clearly in pain. He was fine the night before, and I could find no signs of injury. I called my veterinarian out for an emergency visit, thinking she’d be euthanizing him because he looked so bad. He struggled to get up when she arrived, and she ruled out the more common diagnoses such as colic. She drew blood, gave him IV fluids and painkillers, and left to run lab tests. The answer came a few hours later: anaplasmosis, a tick-borne disease. She returned daily to treat Iggy with IV antibiotics (oxytetracycline) for the next 10 days, and he made a complete recovery.

Anaplasmosis is a tick-borne disease that is on the rise in the United States, and especially here in New Hampshire. As with other tick-borne diseases, both humans and animals can get anaplasmosis, but it can’t be passed directly from animals to humans or vice versa – transmission requires a tick as an intermediate vector.

Anaplasmosis is caused by a bacterium known as Anaplasma phagocytophilum, and is transmitted primarily from the black-legged tick, commonly known as the deer tick. Some other tick species appear to be competent vectors as well. The symptoms are similar to Lyme disease, and include painful joints and stiffness, fever, lethargy, loss of appetite, vomiting and diarrhea. Low blood platelets are a common laboratory finding in dogs with anaplasmosis. In severe cases, neurological problems may exist.

My personal observation is that veterinarians here in New Hampshire are much more likely to recognize tick-borne diseases than their human-physician peers. One reason is because it’s standard veterinary protocol to run a heartworm test on all dogs at least once per year. The test most veterinary practices use is called 4Dx, which tests for heartworms and also for three tick-borne diseases: Lyme disease, anaplasmosis and ehrlicheosis. This test is inexpensive compared to testing humans for tick-borne diseases; most veterinary practices offer it for around $50. The results are available in-house within minutes, so there’s no need to send blood to an outside lab.

In the vast world of competitive dog sports, a 4Dx test is often the first thing many of us turn to when our dogs “just aren’t right.” I do competitive sheep herding, and have friends who compete in agility and many other sports. We try our best to keep our dogs fit, and notice right away if a dog starts to slow down, drop a bar on a jump, or is just not as keen to work. Catching a problem early yields the best chance of healing, so serious competitors will often call their veterinarian and ask for a 4Dx at the first sign of a problem.

Because dogs are at risk of contracting the same tick-borne diseases as humans, and because of the low cost and accessibility of this test, dogs are now considered sentinels for humans regarding the risk of tick-borne diseases. According to the Companion Animal Parasite Council, one in every 10 dogs tested in New Hampshire is positive for anaplasmosis. (It is worth noting that some dogs’ and other animals’ bodies are able to develop antibodies quickly and fight off the disease, so not all those who are exposed to the disease become sick.)

Unlike veterinarians, human physicians seem to be frighteningly unaware of how prevalent these diseases are becoming. Consider these human cases:

Case 1

My sister, Yvonne, discovered an attached tick one night. A week later, she came down with a fever, chills and was shaking so badly that she said she felt her bones would break. She went to the doctor and mentioned the tick bite, but was told it was likely a flu or virus, and was sent home and told to take ibuprofen and drink plenty of fluids.

Later that evening her symptoms worsened so she went to urgent care. She had a fever of 105, was given IV fluids, and the doctor there ordered lots of bloodwork – all non-remarkable. As with the previous doctor, Yvonne told the urgent care staff about the tick bite. Neither doctor even knew what tests to run; Yvonne says, “There were all sorts of panels they generalized about, and wide price ranges, all extreme, but neither place or doctor knew a protocol for tick-borne diseases. Importantly – their focus was always on Lyme disease, not other tick-borne diseases.”

After a week or so, her symptoms lessened but didn’t go away. She works for a veterinarian, so Yvonne is well aware that tick-borne diseases may have an acute phase – where symptoms are sudden and severe, then they sometimes have a chronic phase – where the disease can appear non-symptomatic but might actually start to cause other problems.

Yvonne went back to her primary care physician armed with printouts from the Centers for Disease Control website about tick-borne diseases, and asked the doctor if she’d comply with the CDC’s recommended treatment protocol. Fortunately her doctor agreed, and also referred her to an infectious disease specialist. By the time she got in to see the specialist she had completed the antibiotic treatment, so that altered the tests he could run, but ultimately he stated that it was most likely anaplasmosis. No further treatment was required since she had been given the CDC’s protocol.

Case 2

Last spring, my friend found a tick on her husband’s back the day before they left on vacation to Arizona. Mid-way into the trip, Roland came down with severe flu-like symptoms, including muscle aches and headache. He spent the vacation in their hotel room taking ibuprofen and drinking fluids. He visited his doctor when he returned and mentioned the tick bite, but his doctor said Roland had likely had a virus since he had, for the most part, recovered.

Roland still had some symptoms though, and went back to his doctor a week or so later, and like my sister, brought printouts from the CDC website, showing the symptoms for tick-borne diseases other than Lyme disease. His doctor agreed to test him, and sure enough, 10 days later the results came back: anaplasmosis. Roland was given a course of doxycycline and has made a complete recovery.

These two cases represent three different doctors who seemed unequipped to deal with tick-borne diseases, even though both patients knew they’d had a tick bite.

The CDC is pretty unequivocal in their recommendations. The quote below is from the their website: “Anaplasmosis, ehrlichiosis, and Rocky Mountain spotted fever are treated in the same manner with doxycycline. Clinical suspicion of any of these diseases is sufficient to begin treatment. Delay in treatment may result in severe illness and even death.”

My conclusions

Don’t stop going outside. The value of fresh air and nature are far too great to allow these eight-legged arachnids to scare us away. Keep grass low around your home and eliminate leaves and brush. Mice play a crucial role in the lifecycle of the deer tick, so consider products like “tick tubes,” which contain nesting materials soaked in permethrin, which kills ticks. (Remember, permethrin is harmful to good insects as well, though, so place tick tubes in spots where mice are likely to go but away from areas visited by essential pollinators like bees.)

If you’re going in the woods or in deep grass, wear long pants and pull your socks up over your pants.

You can purchase insect-repellent clothing or treat your clothes with permethrin. Use a full-length mirror to do a tick check every night before bed.

Educate yourself and be aware of the many varied signs of tick-borne diseases. Lack of a bulls-eye rash is meaningless, but for some reason, many people, including physicians, seem to think if you don’t have a rash it isn’t a tick-borne disease. Not true. Be aware that there are a number of tick-borne diseases found here in New Hampshire, not just Lyme disease. Finally, if you experience symptoms and go to a doctor, be your own, strong advocate.

(Danielle M. Eriksen lives in Weare.)