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Sunday, June 1, 2014

Ticks!

We are getting a ton of phone calls every day because kids have had ticks and parents are worried, so I thought I'd run through the most important things: prevention of ticks, tick removal, and diseases from ticks.

Prevention is of utmost importance in most things, and tick bites are no different. If you are going to be in an area that is likely to have ticks (trees and tall grass), wear boots or tuck pants into socks, long sleeves, long pants, and hats. Use repellents that contain 20 - 30% DEET on exposed skin and clothing for protection that lasts up to several hours. Always follow product instructions. Parents should apply this product to their children, avoiding hands, eyes, and mouth. You can use products that contain permethrin on clothing - ones that come pre-treated may be protective longer. Treat clothing and gear, such as boots, pants, socks and tents with products containing 0.5% permethrin, following package directions. For more information on insect repellants and how to choose the best for your situation, visit this EPA page.

If you have been in areas where ticks are likely, check for ticks daily. If ticks are removed within 24 hours there is less chance of disease transmission. Pay careful attention to the head and ears, under arms, around the waist and between the legs, and in the belly button. (Don't forget to check your pets and any gear you might bring inside!) Bathe as soon as possible after coming inside. Tumble clothes in a dryer on high heat for an hour to kill remaining ticks. (Some research suggests that shorter drying times may also be effective, particularly if the clothing is not wet.)

If you find a tick, proper removal is important. I've heard wild stories about drowning ticks or burning them off. These things are dangerous- the chemicals or heat can burn your skin and could cause the tick to regurgitate back into the skin, increasing risk of disease transmission. The best method is to use a pair of thin-tipped tweezers to grab the tick as close as possible to the skin (not the belly of the tick!) and pull firmly but gently. 

photo source: Shutterstock

There are many tick - borne diseases, but only a few in our area. For a listing by geographic area, see this CDC page. The most common symptoms of diseases caused by ticks:
Body/muscle aches
Fever
Headaches
Fatigue
Joint pain
Rash
Stiff neck
Facial paralysis
Rashes are often characteristic of the disease and are used in the diagnosis. Many of these diseases don't rely on lab testing, but rather the risk of exposure and the symptoms. Most have treatments available, but every tick bite should not be treated to "prevent" because that would expose people to unnecessary antibiotics most of the time. To see the target rash typical of Lyme, Rocky Mountain Spotted Fever, tularemia, and more, visit this CDC page

Ticks in the Midwest carry these diseases:
  • Rocky Mountain Spotted Fever (RMSF): Symptoms include fever, headache, abdominal pain, vomiting, and muscle pain. A rash may also develop after a few days, but not in all people. RMSF can be a severe or even fatal illness if not treated in the first few days of symptoms. Doxycycline is the treatment of choice for adults and children of all ages, and is most effective if started before the fifth day of symptoms. Treatment should be started based on clinical diagnosis before the disease is confirmed by lab testing.

  • Tularemia: People can be infected with tularemia from contact with infected rabbits, hares, and rodents, tick and deer fly bites, ingestion of contaminated water, or inhalation of contaminated dusts. Symptoms vary depending upon the route of infection. 
  • Ulceroglandular or Glandular: This form comes from a tick or deer fly bite or after handing of an infected animal. A skin ulcer appears at the site where the organism entered the body in the ulceroglandular form. In both forms lymph nodes (glands) swell in the area of the exposure.  
  • Oculoglandular This form occurs when the bacteria enter through the eye. This can occur when a person is butchering an infected animal and touches his or her eyes. Symptoms include irritation and inflammation of eye and swelling of lymph glands in front of the ear.
  • Oropharyngeal This form results from eating or drinking contaminated food or water. People with orophyangeal tularemia may have sore throat, mouth ulcers, tonsillitis, and swelling of lymph glands in the neck.
  • Pneumonic This is the most serious form of tularemia and comes from inhaling contaminated air particles or if another form is untreated and spreads to the lungs. Symptoms include cough, chest pain, and difficulty breathing.

  • Heartland Virus: As a newly discovered virus, there are still a lot of unknowns, but it seems to be carried by ticks in Missouri and Tennessee. Symptoms include fever, extreme fatigue, headaches, muscle aches, diarrhea, loss of appetite, and upset stomach. There is no lab test for it yet. There is no known treatment, but most people recover.
Lyme disease is probably the most well known but most misunderstood tick disease. Ticks in our area don't commonly have Lyme disease, but it is the most commonly found tick-borne disease in the US. Symptoms vary based on time:
  • Early localized phase (3-30 days after bite): A target shaped rash in the area of the bite develops in about 70% of people with Lyme disease. A red mark at the site of the bite is normal, not a sign of infection, but if the area grows and looks like a bullseye, that is the erythema migrans rash that can be associated with Lyme disease. People might also have fever, chills, fatigue, headache, muscle and joint aches, and swollen lymph nodes.
  • Early disseminated phase (days to weeks after bite): The rash can spread to other parts of the body. A facial paralysis can occur. Severe headache, stiff neck, joint swelling and pain, dizziness, and heart flutters can occur. Most of these symptoms will eventually resolve without treatment, but further complications can develop.
  • Late disseminated phase (months to years after bite): Arthritis, numbness and tingling of hands and feet, pains, and short term memory problems may develop without treatment in earlier stages.
  • Lingering symptoms after treatment: About 10-20% of people will have symptoms months to years after treatment despite treatment. These include muscle and joint pains, sleep problems, fatigue, and cognitive problems. It is thought that this is an autoimmune problem resulting from the infection, and antibiotics do not help (and might worsen) symptoms at this point.
  • For more on Lyme disease please visit the CDC's comprehensive Lyme pages.