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Deer Ticks

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Deer ticks are widely known as the sole carrier of the bacteria that causes Lyme disease in humans. Stock photo
The lingering effects of Lyme can be debilitating

By David Dunaief, M.D.

Dr. David Dunaief

After a spring where we’ve spent more than our fair share of time indoors, summer’s heat is finally here. Many of us are taking advantage of the weather to enjoy day hikes and picnics along the shoreline or bike rides through wooded areas.

The summer’s heat also means that tick season is in full swing. This means we need to be aware of Borrelia burgdorferi, better known as the bacterium that causes Lyme disease. This bacterium is typically found in the deer tick, also known as the blacklegged tick.

What do deer ticks look like? They are small and can be as tiny as a pencil tip or the size of a period at the end of a sentence. The CDC.gov site is a great resource for tick images and other information related to Lyme disease.

If you have been bitten by a tick, you should remove it with forceps, tweezers or protected fingers (paper) as close to the skin as possible and pull slow and steady straight up. Do not crush or squeeze the tick; doing so may spread infectious disease (1). In a study, petroleum jelly, fingernail polish, a hot kitchen match and 70 percent isopropyl alcohol all failed to properly remove a tick. The National Institutes of Health recommend not removing a tick with oil (2).

When a tick is removed within 36 to 48 hours, the risk of infection is quite low (3). However, a patient can be given a prophylactic dose of the antibiotic doxycycline, one dose of 200 mg, if a bulls-eye rash — a red outer ring and red spot in the center — has not occurred, and it is within 72 hours of tick removal (4). Those who took doxycycline had significantly lower risk of developing the bulls-eye rash and thus Lyme disease; however, treatment with doxycycline did sometimes cause nausea.

Lyme Symptoms

Stock photo

There are three stages of Lyme disease: early stage, where the bacteria are localized; early disseminated disease, where the bacteria have spread throughout the body; and late stage disseminated disease. Symptoms for early localized stage and early disseminated disease include the bulls-eye rash, which occurs in about 80 percent of patients, with or without systemic symptoms of fatigue (54 percent), muscle pain and joint pain (44 percent), headache (42 percent), neck stiffness (35 percent), swollen glands (23 percent) and fever (16 percent) (5).

Early disseminated disease may cause neurological symptoms such as meningitis, cranial neuropathy (Bell’s palsy) and motor or sensory radiculoneuropathy (nerve roots of spinal cord). Late disseminated disease can cause Lyme arthritis (inflammation in the joints), heart problems, facial paralysis, impaired memory, numbness, pain and decreased concentration (2).

Lyme carditis is a rare complication affecting 1.1 percent of those with disseminated disease, but it can result in sudden cardiac death (6). If there are symptoms of chest pain, palpitations, light-headedness, shortness of breath or fainting, clinicians should suspect Lyme carditis.

Preventing Lyme

According to the Centers for Disease Control and Prevention, we should wear protective clothing, spray ourselves with insect repellent that includes at least 20 percent DEET and treat our yards (4). Always check your skin and hair for ticks after walking through a woody or tall grassy area. Many of us on Long Island have ticks in the yard, so remember to check your pets; even if treated, they can carry ticks into the house.

Diagnosing Lyme

Lyme disease often can be diagnosed within the clinical setting or with a blood test. When it comes to serologic or blood tests, the CDC recommends an ELISA test followed by a confirmatory Western blot test (3). However, testing immediately after being bitten by a tick is not useful, since the test will tend to be negative, regardless of infection or not (4). It takes about one to two weeks for IgM antibodies to appear and two to six weeks for IgG antibodies (5). These antibodies sometimes remain elevated even after successful treatment with antibiotics.

Does chronic Lyme disease exist?

There has been a debate about whether there is something called “chronic Lyme” disease. The research, unfortunately, has not shown consistent results that indicate that it exists. In one analysis, the authors note that the definition of chronic Lyme disease is obfuscated and that extended durations of antibiotics do not prevent or alleviate post-Lyme syndromes, according to several prospective trials (7).

The authors do recognize that there are prolonged neurologic symptoms in a subset population that may be debilitating even after the treatment of Lyme disease. These authors also suggest that there may be post-Lyme disease syndromes with joint pain, muscle pain, neck and back pain, fatigue and cognitive impairment.

Ultimately, the IDSA (Infectious Diseases Society of America) argues in favor of recognizing post-Lyme disease syndromes, while the ILADS (International Lyme and Associated Diseases Society) believes chronic Lyme exists.

Regardless, the lingering effects of Lyme can be debilitating. This may be as a result of systemic inflammation (8). Systemic inflammation and its symptoms can be improved significantly with dietary and other lifestyle modifications.

The CDC recommends that physicians look beyond Lyme for other possible diagnoses before diagnosing someone with chronic Lyme disease (9).

Prevention is key to helping stem Lyme disease. If this is not possible, treating prophylactically when pulling off a tick is an important step. Contact your physician as soon as you notice a tick. If you have a bulls-eye rash and it is early, then treatment of antibiotics for two to three weeks needs to be started right away. If it is prolonged and disseminated, then treatment should be for approximately three to four weeks with antibiotics. If it has affected the central nervous system, then IV antibiotics could be needed.

References:

(1) Pediatrics. 1985;75(6):997. (2) nlm.nih.gov. (3) cdc.gov. (4) Clin Infect Dis. 2008;47(2):188. (5) uptodate.com. (6) MMWR. 2014;63(43):982-983. (7) Expert Rev Anti Infect Ther. 2011;9(7):787-797. (8) J Infect Dis. 2009;199(9:1379-1388). (9) JAMA Intern Med. online Nov. 3, 2014.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.

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Deer tick. Stock photo

By Leah S. Dunaief

Leah Dunaief

Early Sunday morning, I had a close encounter with a tick. Now I know this is a bonanza season for ticks because we have had so much rain this past spring and there is lush greenery for the ticks to inhabit. Also, we have run articles cautioning readers about ticks and how the symptoms of Lyme disease so closely mimic those of COVID-19. I can advise you further that when you find a tick in bed with you that has already attached itself onto your person, you will experience shock and maybe even the creepy-crawlies.

Additionally, I could feel the lump, but because of its location, I could not see it. So since it was early and I was still more than half asleep, I tried to persuade myself that I could go back to sleep and we could deal with it later. But no, my brain was already on high alert and nudged me out of bed and to a full length mirror. 

Yep, it was a tick, tiny but unmistakable. Ech! What to do next? I have pulled them off my dogs many times over the years, but this one was smaller and out of reach. I googled “Tickssuck.org,” which told me not to slather it with Vaseline in order to smother it into releasing its hold on me, which I had done with the dogs. Instead it recommended getting tweezers, placing one tip under the head of the tick and carefully extract the beastie. Not wanting to wake the household, I found a smaller hand mirror, a pair of tweezers and a plastic bag to save the tick for diagnosis.

It was not pretty. I was in a convoluted position just to see the spot, and while one hand had to hold the mirror, the other could only fumble around with the tweezers. Somehow, after repeated stabs, I was able to yank the tick free, but I had left the head, the toxic part, still in my skin. I carefully, or so I thought, moved the tweezers toward the plastic bag only to have the tick slip out and fall onto the small bathroom rug at my feet. I uttered a not-so-nice word as I bent down to find the arachnid. After intense scrutiny, I could not find it. I carried the fluffy rug, carefully as you might imagine, out the front door and put it down in the sunlight. I saw nothing and was about to give up when I spied it and this time bagged it.

What did I do next? I sat down back inside my house and considered throwing up. Not a good idea in the living room. I considered going to a hospital emergency room but dismissed the thought in this time of real emergencies. I had the specimen, it was no longer attached, it would make a good story when everyone was awake, and I would wait until the beginning of the week to see a physician.

Monday morning, I tried to get an appointment. “When are you free in August?” I was asked sweetly by the receptionist. There ensued a lengthy exchange about 72 hours being critical for treatment, followed by a couple of phone calls back and forth throughout the day and finally a Tuesday slot. “Yes, it appears the head of the tick is still there, in the center of the red circle,” confirmed the physician who was good enough to squeeze me into his already overbooked schedule. “Would you like to wait until your body extrudes the head, which normally happens with a foreign substance in the skin, or would you like me to anesthetize the area and cut it out?” he asked. “Makes no difference.”

Well, it did make a difference to me, and I opted to wait. I left with two doxycycline and the warning to make sure the red spot doesn’t turn into a rash, to call immediately if it does for a full 21-day prescription, and an order for a blood test for Lyme after six weeks will have passed.

I share this with you to urge you every night to check yourself and your loved ones for ticks.

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Lyme disease starts with a circular rash where the ticks bite. Stock photo

By David Dunaief, M.D.

Dr. David Dunaief

Ah, summer is upon us. Unfortunately, this means that tick season is getting into full swing.Thus, it is good timing to talk about Borrelia burgdorferi, better known as the bacterium that causes Lyme disease. This bacterium is from the spirochete class and is typically found in the deer tick, also known as the blacklegged tick.

What do deer ticks look like? They are small and can be as tiny as a pencil tip or the size of a period at the end of a sentence. The CDC.gov site is a great resource for tick images and other information related to Lyme disease.

If you have been bitten by a tick, the first thing you should do is remove it with forceps, tweezers or protected fingers (paper) as close to the skin as possible and pull slow and steady straight up. Do not crush or squeeze the tick, for doing so may spread infectious disease (1). In a study, petroleum jelly, fingernail polish, a hot kitchen match and 70 percent isopropyl alcohol all failed to properly remove a tick. The National Institutes of Health recommend not removing a tick with oil (2).

When a tick is removed within 36 to 48 hours, the risk of infection is quite low (3). However, a patient can be given a prophylactic dose of the antibiotic doxycycline, one dose of 200 mg, if the erythema migrans, or bulls-eye rash — a red outer ring and red spot in the center — has not occurred, and it is within 72 hours of tick removal (4). Those who took doxycycline had significantly lower risk of developing the bulls-eye rash and thus Lyme disease; however, treatment with doxycycline did have higher incidence of nausea and vomiting than placebo.

What are the signs and symptoms of Lyme disease? There are three stages of Lyme disease: early stage, where the bacteria are localized; early disseminated disease, where the bacteria have spread throughout the body; and late stage disseminated disease. Symptoms for early localized stage and early disseminated disease include the bulls-eye rash, which occurs in about 80 percent of patients, with or without systemic symptoms of fatigue (54 percent), muscle pain and joint pain (44 percent), headache (42 percent), neck stiffness (35 percent), swollen glands (23 percent) and fever (16 percent) (5).

Early disseminated disease may cause neurological symptoms such as meningitis, cranial neuropathy (Bell’s palsy) and motor or sensory radiculoneuropathy (nerve roots of spinal cord). Late disseminated disease can cause Lyme arthritis (inflammation in the joints), heart problems, facial paralysis, impaired memory, numbness, pain and decreased concentration (2).

How do we prevent Lyme? According to the Centers for Disease Control and Prevention, we should wear protective clothing, spray ourselves with insect repellent that includes at least 20 percent DEET and treat our yards (3). Always check your skin and hair for ticks after walking through a woody or tall grassy area. Many of us on Long Island have ticks in the yard, so remember to check your pets; even if treated, they can carry ticks into the house.

Diagnosis of Lyme disease

Many times Lyme disease can be diagnosed within the clinical setting. When it comes to serologic or blood tests, the CDC recommends an ELISA test followed by a confirmatory Western blot test (3). However, testing immediately after being bitten by a tick is not useful, since the test will tend to be negative, regardless of infection or not (4). It takes about one to two weeks for IgM antibodies to appear and two to six weeks for IgG antibodies (5). These antibodies sometimes remain elevated even after successful treatment with antibiotics.

The cardiac impact

Lyme carditis is a rare complication affecting 1.1 percent of those with disseminated disease, but it can result in sudden cardiac death due to second- or third-degree atrioventricular (AV) node conduction (electrical) block. Among the 1.1 percent who had Lyme carditis, there were five sudden deaths (6). If there are symptoms of chest pain, palpitations, light-headedness, shortness of breath or fainting, then clinicians should suspect Lyme carditis.

Does chronic Lyme disease exist?

There has been a debate about whether there is something called “chronic Lyme” disease. The research, unfortunately, has not shown consistent results that indicate that it exists. In one analysis, the authors note that the definition of chronic Lyme disease is obfuscated and that extended durations of antibiotics do not prevent or alleviate post-Lyme syndromes, according to several prospective trials (7). The authors do admit that there are prolonged neurologic symptoms in a subset population that may be debilitating even after the treatment of Lyme disease. These authors also suggest that there may be post-Lyme disease syndromes with joint pain, muscle pain, neck and back pain, fatigue and cognitive impairment.

Ultimately, it comes down to the IDSA (Infectious Diseases Society of America) arguing against chronic Lyme but in favor of post-Lyme disease syndromes, while the ILADS (International Lyme and Associated Diseases Society) believes chronic Lyme exists.

Regardless, the lingering effects of Lyme can be debilitating. This may be as a result of systemic inflammation (8). Systemic inflammation and its symptoms can be improved significantly with dietary and other lifestyle modifications.

But to throw one more wrench in the mix, the CDC recommends that physicians look beyond Lyme for other possible diagnoses before diagnosing someone with chronic Lyme disease (9).

Prevention is key to helping stem Lyme disease. If this is not possible, treating prophylactically when pulling off a tick is an important step. Contact your physician as soon as you notice a tick. If you have a bulls-eye rash and it is early, then treatment for two to three weeks needs to be started right away. If it is prolonged and disseminated, then treatment should be for approximately three to four weeks with antibiotics. If it has affected the central nervous system, then IV antibiotics could be needed.

References:

(1) Pediatrics. 1985;75(6):997. (2) nlm.nih.gov. (3) cdc.gov. (4) Clin Infect Dis. 2008;47(2):188. (5) uptodate.com. (6) MMWR. 2014;63(43):982-983. (7) Expert Rev Anti Infect Ther. 2011;9(7):787-797. (8) J Infect Dis. 2009;199(9:1379-1388). (9) JAMA Intern Med. online Nov. 3, 2014.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.  

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A deer tick is a common type of tick on Long Island. Stock photo

As Long Islanders are warned about an uptick in Lyme disease, another tick-borne virus has emerged in Connecticut across the Long Island Sound.

Nearly 12 years ago, Eric Powers, a biologist and wildlife educator, noticed an increase in the tick population at Caleb Smith park in Smithtown, after pulling nearly 40 ticks off a group of his students.

Powers conducted a survey of the park and discovered the population of tick predators had decreased, as feral and outdoor house cats either chased them off or killed them.

“It’s becoming a huge nationwide issue with our wildlife,” Powers said during a phone interview. “Wherever people are letting their cats out, we’re seeing this disruption in ecosystem where these tick predators are gone.”

But what Powers did not find was the prevalence of a tick-borne virus, the Powassan virus, which recently appeared in Bridgeport and Branford in Connecticut.

Between 1971 and 2014, 20 cases of POW virus were reported in New York, according to the Cornell Cooperative Extension in Suffolk County. The Centers for Disease Control and Prevention reports the virus has been found in Maine, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Pennsylvania, Virginia and Wisconsin.

Like Lyme disease, the virus can cause long-term neurological problems if left untreated. But Long Island POW virus incidences remain low despite the increase in tick population, according to Daniel Gilrein, an entomologist at Cornell Cooperative Extension.

POW virus, which is related to the West Nile virus, was first identified in Powassan in Ontario, Canada, in 1958 after a young boy was bitten by an infected tick.

Little is known about how much the tick population has exactly increased on Long Island, but Tamson Yeh, pest management and turf specialist for the Cornell Cooperative Extension, said it is unlikely cats are contributing to the increase by eating tick predators like birds.

“Birds will eat ticks, but not all birds are insect eaters,” Yeh said in a phone interview.

She said the snow cover during the winter months served as insulation for the ticks hiding in the ground, which helped them survive during the colder weather.

Richard Kuri, president of R.J.K. Gardens, a St. James-based landscaping company, has not noticed an increase in tick population recently. Regardless, he and his men continue to wear long sleeves and use a variety of sprays to ward off bugs while on the job. Kuri also said people may use more natural remedies to deter ticks.

“There are people who apply peppermint oil and rosemary mix that will help,” Kuri said. “But none of them are cure-alls.”

He added that granular insecticides, like Dylox, help kill a variety of unwanted bugs including ticks carrying viruses like Powassan.

There are two strains of the virus, which are carried by woodchuck and deer ticks. Since only about 60 cases of POW virus were reported in the United States in the past 10 years, Yeh said the chance of encountering POW virus is unlikely since the virus is rare.

Symptoms of the virus include fever, headaches, vomiting, weakness, confusion, drowsiness, lethargy, partial paralysis, disorientation, loss of coordination, speech impairment, seizures, and memory loss. Other complications in infected hosts may possibly arise, such as encephalitis, inflammation of the brain and meningitis.

Powers said he hopes to reduce tick population on Long Island through his quail program. He encourages local teachers, who use chicks or ducklings to educate their students about the circle of life, to raise bobwhite quails. He said releasing these quails annually will not only help them adjust to the presence of cats, but also control the tick population.

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