Tick-Borne Illnesses: Symptoms, Removal, Prevention and When to Worry

Prevention Is the Best Medicine

BEFORE heading out on your next adventure to the outdoors, consider treating your clothing with permethrin, or buy pre-treated clothing. This is especially important if you plan on wading through tall grass, walking wooded trails, or essentially doing ANYTHING in known tick-prevalent areas.

Additionally, use insect repellent with DEET (always follow the label instructions) or a similarly effective product like picaridin or 2-undecanone.

Conduct a tick check when you complete your outdoor activities or whenever you stop for a rest in the field. Shower within two hours of getting home or to a rest station so equipped. A shower can wash any unattached ticks from your skin before they "dig in."

• Transmission usually requires 24 to 48 hours of tick attachment.
• It takes 3 to 30 days for symptoms to manifest.
• Characteristic bull's-eye rash (erythema migrans).
• Flu-like symptoms, body aches, extreme fatigue.
• If left untreated, it can cause facial paralysis and encephalopathy (a very severe headache with confusion).
• Lyme carditis affects your heart's conduction system, causing arrhythmias that could be fatal.
• The vast majority of Lyme disease cases can be treated with doxycycline or ceftriaxone antibiotics. But the earlier the disease is diagnosed and treated, the better the outcome.
• Some patients develop Post-Treatment Lyme Disease Syndrome, which causes lingering and sometimes permanent fatigue, joint pain, chronic arthritis, and a brain fog that never resolves.
• Prophylaxis: in some locations where Lyme disease is very prevalent, prevention measures may include a prophylactic dose of 200 mg doxycycline as a one-time dose.

Other Diseases Carried by Ticks

Rocky Mountain Spotted Fever

• Caused by the bacteria Rickettsia rickettsii.
• The MOST SEVERE of the tick-borne illnesses.
• High fevers, headaches, and a widespread flat rash that turns purple.
• Leads to organ damage, seizures, and necrotic (dying) limbs requiring amputation.
• Doxycycline is the GOLD STANDARD therapy but must be started within 5 days of symptoms for the best outcome.

Tularemia

• Caused by the bacteria Francisella tularensis.
• Mostly affects animals (rodents, rabbits, hares) but can easily spread to humans who touch them or are bitten by ticks carrying the disease. Can also occur from eating undercooked rabbit.
• Painful blisters on the skin, eyes, and mucous membranes. Pneumonic tularemia is a severe and very dangerous form of pneumonia.
• Lawnmower tularemia occurs when you accidentally run over an infected carcass with landscaping equipment and breathe in the bacteria.
• Doxycycline, ciprofloxacin, and aminoglycoside antibiotics are effective. Physicians and other healthcare providers beware: the standard first-line "broad-spectrum antibiotics" (vancomycin/pip-taz, cefepime) DO NOT WORK.

Babesiosis

• Caused by the microscopic parasite Babesia microti, carried by black-legged (deer) ticks. Similar to malaria.
• Symptoms occur weeks to months after exposure: flu-like symptoms, hemolytic anemia, and organ enlargement (splenomegaly, hepatomegaly). Not easy to diagnose.
• Requires atovaquone and azithromycin, typically a 7 to 10 day course. Severe cases may require exchange transfusion and have lifelong consequences.

Powassan Virus

• Transmitted by a virus of the Flavivirus family, similar to West Nile and Zika.
• Unlike bacteria, which generally require at least 24 hours of tick attachment, Powassan virus can be transmitted in as little as 15 to 30 minutes. Takes 1 week to 1 month to manifest.
• Symptoms resemble mosquito encephalitis (West Nile virus): fever, severe headaches, and vomiting. Severe disease is neuroinvasive, causing encephalitis (brain swelling) and meningitis, with confusion, difficulty speaking, partial paralysis, and seizures.
• There is no specific antiviral; severe cases require hospital care for supportive measures. Severe neuroinvasive disease carries a 10 to 15 percent fatality rate, and over 50 percent of survivors report long-term nervous-system problems like chronic headache, muscle wasting, partial paralysis, and memory loss.

Alpha-gal Syndrome

• Transmitted by the lone star tick.
• Alpha-gal molecules are picked up by the tick when it feeds on mammals (deer or dogs), then injected from tick saliva into human blood. The immune system flags the molecule as foreign and makes antibodies.
• Those antibodies cross-react to red meat the person eats, causing a spectrum of allergic symptoms up to anaphylaxis and death. Chicken and fish are still safe to eat.
• The CDC estimates as many as 450,000 Americans may have alpha-gal syndrome, and the reaction is often delayed — typically 2 to 6 hours after eating red meat — which is why it is so often missed.