Diagnosis and Management of Tick-Borne Illnesses

During the summer months and in warm climates, people tend to spend more time outdoors hiking and camping. While these are both excellent extracurricular activities, they do put people at higher risk of developing one of the many tick-borne illnesses. Adventure-loving patients and their pets should check their skin, fur, and clothing for ticks after spending time outdoors, especially in grassy or wooded areas.

Lyme disease

Lyme disease is caused by borrelia bacteria, which can be transferred to humans through a tick bite. This bacterium is common in Midwest and the northeastern and mid-Atlantic states, Europe, and Canada.

A tick bite usually presents as a small mark on the body, like most other types of bug bites. Symptoms of Lyme disease may not appear for up to 30 days after being bitten by an infected tick. A patient’s first noticeable sign is usually a “bullseye” type rash, which may be raised.

Powassan virus

Powassan virus is a rare disease that occurs primarily in the Great Lakes Region between late spring to early fall, when ticks are most active. Since 2012, only 200 cases have been reported in the United States.

Powassan virus can cause serious diseases including meningitis and encephalitis. Symptoms include fever, confusion, seizures, and loss of coordination. The mortality rate for Powassan virus is about 10%, and 50% of infected patients will have long-term neurological symptoms.

There is no cure or vaccine for this virus, and only supportive care can be given to patients who are infected.

Rocky Mountain Spotted Fever (RMSF)

Rocky Mountain Spotted Fever typically presents with high fever, nausea and vomiting, eye inflammation, chills, and muscle pain. Most patients develop a rash or small bruises across their arms and legs 3-5 days after a bite.

Because RMSF has the highest mortality rate of all tickborne illnesses, experts recommend doxycycline treatment for all patients diagnosed with RMSF, including children and pregnant women. Late complications of this illness can include anemia, thrombocytopenia, severe clotting disorders, major organ failure, shock, and even death.

Studies show that a tick must attach to the host body for 4-6 hours to pass RMSF to a human. It cannot be spread from person to person.

Other common tick-borne illnesses

While Rocky Mountain Spotted Fever, Powassan Virus, and Lyme disease are the most well-known tick-borne illnesses, there are many others that healthcare providers and outdoor enthusiasts should be aware of.

Ehrlichiosis. Ehrlichiosis is a bacterial disease transmitted by the Lone Star tick and the blacklegged tick. Symptoms include nausea, headache, rash, and body aches. The treatment of choice is doxycycline.
Anaplasmosis. Anaplasmosis is caused by the bacteria Anaplasma phagocytophilum. Symptoms of nausea and body aches typically do not appear for 1-2 weeks after a tick bite.
Babesiosis. Ticks carry the parasite babesiosis. This parasite causes flu-like symptoms that can become severe if left untreated. A combination of Atovaquone, Azithromycin, Clindamycin, and Quinine typically treat this parasite.
Tularemia. Ticks, deer flies, rodents, rabbits, and hares spread the bacteria that causes Tularemia. The most severe symptom is usually high fevers, reaching as high as 104 degrees.
Colorado Tick Fever. Tick bites spread the virus that causes Colorado Tick Fever. There are no vaccinations available or treatments for people infected with this virus. Supportive care and prevention are the best tools against Colorado Tick Fever.

Prevention and management

For tick-borne illnesses, prevention is the best strategy. While antibiotics can treat many tick-borne illnesses, and many others resolve on their own, some infections can be serious and even deadly. Those living in or visiting areas with high rates of transmission should take extra precautions.

Prevention strategies for tick-borne illnesses

Strategies for preventing tick bites include:

Avoid thick brush and heavily wooded areas
Wear insect repellent and reapply as needed
Wear long sleeves and long pants when spending time in the woods
Tuck your trousers into your socks
Check your body and clothing for ticks after camping or visiting the outdoors
Check the pet’s fur for ticks
Treat clothing and gear with 0.5% permethrin

Tick removal

If you do discover a tick on you or the skin of your pet, you should remove it promptly. To remove a tick, follow these steps:

Use a clean pair of small tweezers to grab the tick as close to the skin’s surface as possible.
Pull the tick upward with steady, even pressure.
Do not jerk or wiggle the tweezers as you remove the tick
After you have removed the tick, clean the area and wash your hands with either rubbing alcohol or soap and water.
Keep the tick in the jar for diagnostic information in case of infection

After discovering a tick bite, patients should seek advice from their primary care physician. Since symptoms do not usually appear for 1-2 weeks after a tick bite, it is important to monitor closely for any rash, headache, nausea, or fever in the weeks following any tick bite.