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10 Tips for Preventing Tick-borne Diseases This Summer 07/07/2013

Posted by thetickthatbitme in Prevention, TBID Facts.
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6 comments

It’s officially questing season for ticks. Billions of blood-loving arachnids are looking for their next meal, and it could be you. This wouldn’t be such a problem if ticks didn’t carry so many life-disrupting (and sometimes fatal) diseases. Here are 10 tips for avoiding the bite and its potential consequences.

1. Don your armor. Ticks attach to your skin. The best way to prevent this is to keep skin covered and to wear clothing that is treated with a tick repellent (like permethrin or cedar oil). Long pants are a must; tuck them into your socks or boots. (I know it looks stupid, but if enough people do it, it will become cool–I promise. It’ll be like wearing UGG boots with a miniskirt.) I’d also recommend long sleeves and a hat (better for ticks to end up on your hat than on your scalp). Wearing light colored clothing makes it easier for you to spot ticks on you.

2. Avoid high-risk areas. Yes, this seems like a no-brainer, but many people mistakenly believe that you have to be hiking to pick up ticks. In order to avoid ticks, you have to understand that ticks can be carried by almost any mammal or bird—not just deer and mice. If you’re in a place where wildlife is found (even if that place is your backyard), there’s a chance that ticks will find you. In particular, you should avoid wooded areas, tall grasses, leaf piles, cabins that may be infested with mice or rats, and picnic areas (a.k.a. tick restaurants). Also, keep in mind that ticks are found on domestic animals, including dogs, cats, cattle, and horses (don’t even get me started on petting zoos—oh, hello Q fever…)

3. If you must enter the danger zone, use common sense and be vigilant. When hiking, stay in the middle of trails and keep your distance from wild animals—no feeding the squirrels, etc. If you’re an avid golfer, don’t go trudging into the rough to retrieve your ball. Your score may suffer, but your immune system will thank you. Don’t believe me? Read this.

4. After outdoor time, do a proper debriefing (pun intended). When you come back indoors, before you hug the kids, post pics to Instagram, do the dishes, WHATEVER, remove your armor and toss it in the dryer. (Yes, before you wash it.) Experts used to say that an hour on high heat was necessary to kill ticks on clothing, but it may take as little as five minutes on low. See this article about Jacqueline Flynn, a high school student who researched tick-cide by dryer. Once your armor is in the dryer, it’s shower time for you—but first, you need to do a naked tick check. (Enlist the help of a spouse or family member, and don’t be embarrassed. Monkeys do this all the time.) Remember, nymphal ticks can be as small as a poppy seed, so you need to look carefully. Don’t forget to check the scalp, armpits, backs of knees, and groin area.

5. Preserve the evidence. If you find any ticks, don’t squash them, burn them, or flush them down the toilet. If a tick is on you, it might have bitten you, and you need to have it identified and tested to see what you may be dealing with. If a tick is attached to you, remove it gently with tweezers and put it in a closed container like a prescription bottle. Then call your doctor’s office and tell them you have a tick you’d like identified and tested.

6. Protect the pack. Your dog or cat is vulnerable to tick exposure as well, and ticks can easily hitch a ride into your house on your pet. Treat your pet with a vet-recommended tick repellant and do a tick check every time he/she comes in from outside. Keep your pet out of danger zones (including woods, leaf piles, and dog parks) during the summer months (tick questing season). Also, it’s strongly recommended that pets have their own bed instead of sharing yours.

7. Take control of your yard. Regularly dispose of fallen leaves, and mow your lawn short to decrease the likelihood that ticks will hang out there. Dispose of temptations for rats, mice, other rodents, and deer (fallen fruit, dog droppings, trash, etc.). Move wood piles (a.k.a. rat habitats) away from your house, and make sure all outbuildings (sheds, garages) are free of mice, rats, and other critters. You may also want to try spraying your yard for ticks—you can go the chemical or natural route, depending on what you’re comfortable with. Lastly, remember that birds carry ticks, too, so don’t attract them to your yard with bird feeders and bird baths (a.k.a. disease breeding pools). If you want to bird-watch, invest in a good pair of binoculars.

8. Take control of your house. Mandate that all humans and animals entering your home following outdoor activities undergo proper tick-checking procedures. Educate family members about the danger zones and how to spot ticks. To avoid your home becoming a danger zone, make sure there are no unwanted houseguests in the attic, crawl space, or walls (including mice, squirrels, raccoons, feral cats, and birds).

9. Know what you’re looking for. There are many different types of ticks—deer ticks, dog ticks, lonestar ticks, soft-bodied ticks. Depending on where you live, you may have a few or all of these in your neighborhood. Technically, ticks are spiders—they have eight legs—but they look different from spiders in that their bodies are larger in proportion to their legs. If you see something on your body that looks like a tick, don’t waste time trying to identify whether or not it’s a tick—get your tweezers and remove it ASAP, get it into a container, and then worry about what kind it is. See this post for some up-close tick pics.

10. Know who to call. Make sure that your primary care physician and/or infectious disease specialist is on-board with your disease prevention plan. Ask about tick testing. Do you need an appointment to drop off a tick for testing? Can the lab your doctor uses provide containers for tick collection? Is your doctor willing to prophylax you (prescribe a short course of antibiotics within 48 hours) if you get a tick bite? If your doctor is not on board, you can appeal to him or her by sharing the research, or you can start shopping for a new doctor.

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Six Tick Misconceptions 07/05/2012

Posted by thetickthatbitme in Diagnosis, Prevention, TBI Facts.
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4 comments

I have a confession to make. I have a phobia of most creepy-crawly things–roaches, mosquitoes, spiders, and especially ticks. When I see pictures of any of these critters, my first instinct is to shield my eyes. Ick! But what I should be doing is taking notice, so that if a tick ever gets on me again, maybe I can identify that little jerk.

the tick cartoon

This tick I can stand to look at. (Image via templeofcartoonmojo.blogspot.com)

Today’s post is about the misconceptions that many people have about ticks. As I warn frequently, there’s a lot of misinformation about ticks and the diseases they spread in the mainstream media and on the Internet. Here are six big misconceptions.

#1: Only deer ticks transmit diseases.

Deer ticks (a.k.a. blacklegged ticks) carry a lot of pathogens, including those that cause Lyme disease, Anaplasmosis, Babesiosis, and Bartonellosis, but they’re not the only ones you need to worry about. Dog ticks (Dermacentor variabilis) and wood ticks (Dermacentor andersoni) carry Rocky Mountain spotted fever (Rickettsiosis), Tularemia, and the Colorado Tick Fever virus. The lone star tick (Ambylomma americanum) carries Ehrlichiosis and the pathogen that causes STARI; bites from this tick have also been linked to a delayed allergic reaction to red meat. Two other types of Rickettsiosis, Rickettsia parkeri and 364D Rickettsiosis can be transmitted by the Gulf Coast tick (Amblyomma maculatum) and the Pacific Coast tick (Dermacentor occidentalis), respectively. Q fever (Coxiella burnetii) can be transmitted by the brown dog tick (Rhipicephalus sanguineus), Rocky Mountain wood tick (Dermacentor andersoni), and the lone star tick (Amblyomma americanum). Last but not least, soft-bodied ticks like Ornithodoros hermsi, Ornithodoros parkeri, and Ornithodoros turicata transmit Relapsing Fever-causing species of Borrelia. These ticks can live up to ten years!

#2: Lyme disease is the most dangerous thing I can get from a tick.

Though life-threatening complications like myocarditis can occur in the later stages of Lyme disease, B. burgdorferi infection is rarely fatal in the first months of infection. Many patients survive years without being properly diagnosed and treated. By contrast, Rickettsiosis (Rocky Mountain spotted fever) can be fatal in the first 8 days of symptoms (which vary greatly from person to person and don’t always involve the spotted rash) if it goes untreated. Female tick saliva also contains a neurotoxin that can cause tick paralysis, which can be fatal if the tick is not found and removed.

#3: I can’t get sick unless the tick is attached 36-48 hours.

While the CDC claims this is true for Lyme disease, if the tick has bitten you, there’s always a chance that bacteria or a virus is already in your system. Even if the tick doesn’t infect you with bacteria or a virus, you are still at risk for tick paralysis (see #2). In the case of soft-bodied Ornithodoros ticks, which spread Relapsing Fever Borrelia, feeding may only take a few minutes, and then the tick falls off, often undetected. (You can read more about soft-bodied ticks here.)

#4: If I don’t go hiking or camping, I’m not going to get bitten by a tick.

While participation in these activities does put you at higher risk for tick exposure, ticks can hide out in plenty of other places besides the forest floor, including the leaf litter in your yard. Ticks can hitch a ride into your yard on any of the wildlife on which they feed, including deer, mice, squirrels, and birds. They can hitch a ride into your house on your dog or cat. And don’t forget other four-legged friends like horses and sheep. If you have mice in your house or attic, you probably also have ticks. To avoid exposure, you should limit your contact with leaf litter, tall grasses, wood piles, and bird feeders. When hiking, stay in the middle of trails, wear long pants tucked into your socks, and wear repellent. Avoid sleeping in cabins that may be infested with rodents (and thereby ticks). After spending time outdoors or with animals, do a thorough tick-check. (This requires getting naked.) And if you’re a fan of spelunking, know that ticks—particularly soft-bodied ones—can live in caves too.

#5: If I don’t have a rash or a fever, the tick that bit me didn’t give me a disease.

At least 20% of people infected with Borrelia burgdorferi (Lyme) don’t have the characteristic erythema chronicum migrans (bull’s-eye) rash (EM). People with other tick-borne illnesses may be asymptomatic or have other symptoms (like joint and muscle pain or fatigue) that may not directly suggest an infection. That’s why it’s important to keep track of all of your symptoms following a tick bite, and to save the tick for identification and testing. You should always make sure your doctor is aware of any tick bites or tick exposures you may have had—and be clear about what regions/countries you’ve visited and what animal exposure you’ve had.

#6: I can use soap or Vaseline to remove a tick, and afterwards I should burn it with a match.

The proper way to remove a tick is with tweezers, grabbing the tick close to the skin, and using a slow, steady motion to pull it out. Using soap or Vaseline will not help you get a better grip on the tick, and may increase the likelihood that you squeeze the tick, causing it to regurgitate bacteria and other pathogens into your skin. Once you remove the tick, you should store it in a secure container and bring it to your doctor’s office for identification and testing. If you do get sick, it will be helpful to know what kind of tick it is and what pathogens it’s carrying. Don’t destroy the evidence with a match! If for some reason you can’t save the tick (because you’re too busy spelunking), at the very least try to take a picture of it. You’ll probably need a zoom lens.

So how do I spot them?

I usually try to link to pictures of ticks instead of posting them on this site because seeing tick photos can be a bit traumatizing to those of us who have been sick with tick-borne infections. However, for the purpose of prevention education, I’ve included pictures of all the ticks mentioned in this post (that I could find) in the slideshow below. You can read about the geographic distribution of hard-bodied ticks in the U.S. here and the habitats of soft-bodied ticks here.

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Major Misnomer: 8 things you need to know about Rocky Mountain spotted fever 06/05/2012

Posted by thetickthatbitme in Diagnosis, TBI Facts, Treatment.
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The fact sheet for Rocky Mountain spotted fever (Rickettsia) is up today. Here’s the cliff notes version:

1. You don’t have to be in the Rocky Mountains to catch RMSF. There are four types of ticks in the U.S. that can transmit this bacteria to you: the American dog tick (Dermacentor variabilis), Rocky Mountain wood tick (Dermacentor andersoni), brown dog tick (Rhipicephalus sanguineus), and the Cayenne tick (Amblyomma cajennense). Cases of RMSF have been reported all over the U.S., and there have also been some in Canada. In 2008, all but 8 states reported cases of RMSF to the CDC.

2. Rocky Mountain spotted fever can be a deadly disease if not treated promptly. The national fatality rate is about 3%, but this rate is much higher in certain states like Arizona, where the fatality rate is 10%. This is likely due to delayed diagnosis.

3. Patients infected with the Rickettsia rickettsii bacteria that causes RMSF may experience any combination of the following symptoms: chills, confusion, fever, headache, muscle pain, rash, diarrhea, light sensitivity, hallucinations, loss of appetite, nausea, thirst, and vomiting. Though 90% of patients develop the spotted rash, this often comes late in the illness, so if other symptoms are present, you shouldn’t wait to get treated. Ten percent of patients never develop the rash.

Rocky Mountain spotted fever rash

Example of an early-stage rash in an RMSF patient. (Image via CDC.gov)

4. RMSF can be diagnosed with a blood antibody test called an IFA (indirect immunofluorescence assay), but this test is often negative in the first week or so of infection. If you are showing symptoms of RMSF, your doctor shouldn’t wait for blood test results before putting you on antibiotics, because the longer treatment is delayed, the higher the risk of fatality.

5. RMSF is treated with Doxycycline in both adults and children. The usual course is between 7 and 14 days. The CDC recommends treating for at least 3 days after fever subsides.

6. Another way to get RMSF is by squashing ticks that you find on your dog (or anywhere else) with your bare fingers. When you squish a tick, the bacteria inside it can come out and enter your body through your skin. When checking your pets for ticks, always wear gloves, and use tweezers for tick removal.

7. Although very rare, it is possible to get RMSF from a blood transfusion. If you experience symptoms of RMSF following a transfusion, see your doctor right away.

8. The symptoms of RMSF can mimic those of other TBIDs, like Ehrlichiosis and Anaplasmosis. Luckily, all three of these are treated with Doxycycline.

If you want to read more about RMSF, check out the fact sheet, which is full of links to additional information.

Ehrlichia: confusing cousins, the blood supply, and the new kid on the block 05/04/2012

Posted by thetickthatbitme in Diagnosis, TBI Facts.
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Ehrlichia…I just met a girl named Ehrlichia…and suddenly the sound…

Nope. Doesn’t quite work.

Paul Ehrlich

Paul Ehrlich (1854-1915). Image via Wikipedia.

Ehrlichia is actually named after German microbiologist Paul Ehrlich (1854-1915), who won the Nobel Prize in 1908. Here are some things you actually need to know about Ehrlichia:

1. Ehrlichia is transmitted through the bites of lonestar ticks and deer ticks. If you’ve had another infection carried by these ticks (like Lyme Disease), your doctor should have had you tested for Ehrlichia (or maybe you’ll be asking him/her to test you after reading this post?).

2. Symptoms of Ehrlichiosis include: fever, headache, chills, malaise, muscle pain, nausea / vomiting / diarrhea, confusion, conjunctival injection (red eyes), and rash (in up to 60% of children, less than 30% of adults). When it goes untreated (or improperly treated), complications can include breathing problems, bleeding disorders, and death (1.8% of cases).

3. Ehrlichia is effectively treated with doxycycline in both adults and children. The CDC recommends a 7-14 day course.

4. Your doctor shouldn’t wait for your test results to come back before prescribing you doxycycline. If your doctor thinks you might have Ehrlichiosis, he/she might order a PCR, a blood smear, or an IFA (antibody test). These tests can take a few weeks to come back, and in that time, you could get very, very sick. In addition, a negative result on any of these three tests does not rule out the possibility of infection. Often, in the first 7-10 days you are infected, you will test negative. For more information about these tests, take a look at the Ehrlichiosis fact sheet.

5. Ehrlichia can be easily misdiagnosed as one of two other infections. It’s a rickettisial disease, which means it’s in the same family with A. phagocytophilum and Rocky Mountain Spotted Fever (RMSF). Sometimes the rash patients get with Ehrlichia looks a lot like the rash patients get with RMSF.

6. It may be possible to contract an Ehrlichia infection through a blood transfusion. The CDC has not been very vocal about it, but it’s on their website. Fun fact: “Ehrlichia chaffeensis has been shown to survive for more than a week in refrigerated blood.” If you’ve had an Ehrlichia infection, it’s probably not a good idea for you to be a blood or organ donor.

7. There’s a newly identified species of Ehrlichia in Wisconsin and Minnesota. It doesn’t have a fancy species name yet, so scientists refer to it as Ehrlichia Wisconsin HM543746 or Ehrlichia muris-like (EML). This one is carried by deer ticks. If you live in one of these states and your doctor is not so hip to the new infectious disease research, he or she may have told you that you didn’t need to be tested for Ehrlichia because “we don’t have that here.” (I hate it when doctors say that!)Hopefully there will be a commercially-available, species-specific test for this soon. For now, my guess is that physicians in Wisconsin and Minnesota who suspect Ehrlichia infection are ordering tests for E. chaffeensis and E. ewingii.

Got an Ehrlichia story you’d like to share? Shoot me an e-mail.

Well, Babs, you’re trickier than I thought 05/01/2012

Posted by thetickthatbitme in Diagnosis, Peer-Reviewed, TBI Facts, Tick-Lit.
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Welcome to the second installment of Tick-Lit Tuesday, where I comb through PubMed so you don’t have to. Today’s topic: Babesia and Blood Transfusions. Now, I know I posted about Babesia in the blood supply just a few days ago, but an interesting study has since come to my attention (thanks, Dr. W), and the implications are a bit scary. Okay, get your popcorn and let’s begin.

The Issue:

blood donation

A blood donation pictogram. Image via Wikipedia.

It has been well-documented that the tick-borne protozoan parasite Babesia can be contracted through blood transfusions. Blood centers aren’t required to test donated blood for Babesia, but this may change in the future, as Babesia infections contracted through transfusions are on the rise. So if we were to test all donors for Babesia prior to donation, which tests should we rely on to detect this pesky parasite? Let’s look at the candidates.

IFA: IFA is an abbreviation for indirect fluorescent antibody test. This type of test can also be referred to as serologic (as in blood serum) testing. If you’ve had one of these tests for Babesia, it’s probably titled something like “WA1 IGG ANTIBODY IFA” (for B. duncani) or “BABESIA MICROTI ABS IGG/IGM” on your lab results. If you’ve had Babesia in the past and been treated for it, your antibody test might still read positive because your body is still making antibodies to the parasite. This is one of the reasons why most insurance companies refuse to pay for treatment for Babesia if your only positive test is the IFA. They think maybe you had a past infection that you got over, so you don’t need treatment. (The other reason they refuse to pay is that they’re jerks, to put it nicely.) I’ll talk more about why this is such a problem later in this post.

Babesia microti smear

A stained blood smear on which B. microti parasites are visible in red blood cells. (CDC Photo: DPDx). Via CDC.gov.

Smear: When we talk about a smear for Babesia, we mean a Giemsa-stained thin blood smear. This test involves looking at blood samples under a microscope to see if there are any parasites hanging around. The problem with this test is that Babesia can infect fewer than 1% of your circulating red blood cells, so it could take many, many smears before any Babesia show up under the microscope. For more information about that phenomenon, read this.

PCR: This stands for polymerase chain reaction. It’s basically a DNA test that tries to identify whether a gene associated with Babesia is present in the blood. PCR has been found to be “as sensitive and specific” as blood smears for Babesia (see this study), which is not saying much, considering the tendency of Babesia to go undetected with smears.

Hmmm, for whom shall I cast my ballot, the antibody test insurance companies don’t trust, the inaccurate smear, or the inaccurate PCR? Choices, choices…

Today’s question:

Can the donated blood of someone with a negative PCR and negative blood smear still be infected with Babesia and cause Babesia infection in transfusion recipients?

(Hint: This is a leading question.)

Let’s talk about a study published in the journal Transfusion in December of 2011 called “The third described case of transfusion-transmitted Babesia duncani.”

Here’s what happened:

In May 2008, a 59 year-old California resident (I’ll call him Cal) with sickle-cell disease had some red blood cell transfusions. Cal’s only risk factor for Babesia was the transfusions; he didn’t have any tick exposure. In September of 2008, Cal was diagnosed with a Babesia duncani (WA-1) infection. The parasites were visible on a blood smear, the indirect fluorescent antibody (IFA) test was positive, and the PCR was positive for the Babesia gene. This launched a transfusion investigation in which doctors tracked down 34 of the 38 blood donors whose blood could have infected Cal with Babesia. One donor, a 67-year-old California resident (who I’ll call Don) had a B. duncani titer of 1:4096 (on the IFA test). What does a titer of 1:4096 mean? Well, if the antibody test for B. duncani is negative, the titer will be < 1:256. That means that Don’s antibody test was positive.

What the article abstract doesn’t tell you, which the full article does, is that both Don’s PCR and blood smear were negative for Babesia. How did the researchers prove definitively that Don had Babesia in his blood? They injected the blood into Mongolian gerbils, and were later able to isolate the parasite from the gerbils. Conclusion: Even though Don showed no symptoms of Babesia and both his PCR and smear were negative, his donated blood caused Babesiosis in both Cal and the gerbils.

Here’s why the study’s findings are important:

1. Clearly, blood smears and PCRs are not good indicators of whether someone is infected with Babesia. Why insurance companies think these tests need to be positive before they’ll pay for treatment is a mystery to me. There are probably a lot of people out there who’ve had positive IFAs but negative smear and/or PCR who were then not treated for Babesia because either the doctor, the insurance company, or both said they didn’t have an infection.

2. As far as the blood donation goes, if we don’t start screening out donors with positive Babesia IFAs, we’re going to continue to contaminate the blood supply with Babesia. It should be as simple as that. Been bitten by a tick? No blood donation for you. Positive IFA? No blood donation for you.

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Four (surprising) places ticks hang out 04/30/2012

Posted by thetickthatbitme in Media, TBI Facts.
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Most people think you have to be hiking around in the woods to pick up a tick. In reality, ticks are a lot closer than you think. Here are four (possibly surprising) places where ticks hang out:

1. In your un-mown lawn. Ticks like to hide in vegetation to keep from drying out. Vegetation includes tall grasses, so don’t get lazy on the lawn upkeep!

2. In piles of fallen leaves. Yes, leaves are fun to jump in, and yes, the crunchy sound they make when you walk over them is lovely, but you (or your pet) could also be picking up ticks from leaf litter, so rake ’em up!

protect your yard mice

Ticks feed on and pick up diseases from mice. Image via tickencounter.org

3. Anywhere mice or other rodents live. This includes wood piles, rock walls, crawl spaces, ground covers, abandoned vehicles, garbage, bushes, and palm trees. Mice also like to eat fallen fruit, so if you have fruit trees, be sure to dispose of any fruit that falls. If you have mice or rats in your home, chances are you have ticks, too. Here’s a more detailed list of mouse hiding places and what you can do to keep them away from your yard and house.

4. On and underneath wooden picnic tables and benches. To me, this is the creepiest one, because I’ve been to countless kids’ birthdays and neighborhood get-togethers in the park, and the last thing on my mind was tick exposure. If you don’t believe me when I say the risk is real, here’s an article abstract for a study conducted by Kerry Padgett and Denise Bonilla from the California Department of Public Health.

grizzly bench tilden park

Park bench on Grizzly Peak, in the Berkeley Hills. Image via Wikimedia Commons. Credit: nickton.

They collected ticks (some of which tested positive for Borrelia) from various areas in Berkeley’s Tilden Regional Park and found as many on wood surfaces as in leaf litter. If you’re planning on a day in the park, I recommend long pants and repellent with Permethrin.

If you’re spending time outdoors, it’s a good idea to check yourself for ticks as soon as you come inside. The University of Rhode Island’s Tick Encounter Resource Center has a great multimedia tool, the Tick Bite Locator, which suggests common places to check for ticks. They also have images of a variety of disease-carrying ticks (although the soft-bodied ones are missing) at different life stages.

Got a dog and not sure how to check him/her for ticks? WordPress blog After Gadget has a detailed explanation of how to do a thorough tick-check.

Be careful out there, everyone!

Eight things you need to know about Anaplasmosis 04/25/2012

Posted by thetickthatbitme in Diagnosis, TBI Facts.
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A new fact sheet is up today for Anaplasmosis, otherwise known as Anaplasma phagocytophilum infection. Try saying that three times fast. This is one of the two TBIDs I’ve been unlucky enough to have, but I had never heard of it before my lab results came back with a positive antibody test for it. By the end of this post, you’ll know eight things you didn’t know before about Anaplasmosis.

A microcolony of A. phagocytophylum visible in a granulocyte (white blood cell) on a peripheral blood smear. Image via CDC.gov.

1. Anaplasmosis is spread by the same ticks that spread Borrelia burgdorferi (Lyme Disease). This means that people with Lyme can have a coinfection with Anaplasmosis (and some of them don’t know it).

2. The symptoms of an Anaplasma phagocytophilum infection are: fever, headache, muscle pain, malaise, chills, nausea / abdominal pain, cough, and confusion. Some people get all the symptoms; other people only get a few.

3. If you show symptoms of Anaplasmosis, your doctor shouldn’t wait for lab results to come back to begin treating you. The CDC recommends beginning treatment right away.

4. If you’ve been infected with Anaplasma phagocytophilum and you get tested within the first 7-10 days you are sick, the test might come back negative. This doesn’t mean you don’t have Anaplasmosis, and you’ll need to be tested again later.

5. The best way to treat Anaplasmosis is with the antibiotic Doxycycline. According to the CDC, other antibiotics should not be substituted because they increase the risk of fatality. If your doctor insists on treating your Anaplasmosis with something other than Doxycycline, it’s probably time to get a new doctor. For people with severe allergies to Doxycycline or for women who are pregnant, the drug Rifampin can be used to treat Anaplasmosis.

6. Anaplasmosis can be confused with other TBIDs in the rickettsia family like Rocky Mountain Spotted Fever (RMSF) and ehrlichiosis. These infections are also commonly treated with Doxycycline.

annual Anaplasmosis cases

Image via CDC.gov.

7. The number of cases of Anaplasmosis reported to the CDC has increased steadily since 1996. You can attribute this to climate change or not, but the trend suggests that this disease will be an increasingly more common problem in the future.

8. More than half of Anaplasmosis cases are reported in the spring and summer months. This is a no-brainer, since this is when tick populations thrive. To avoid infection, take steps to avoid tick exposure for both you and your pets.

Anaplasmosis by month

Image via CDC.gov.

Pink Deer and TBID Prevention 04/23/2012

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We all know (I hope) that an ever-increasing deer population means an ever-increasing tick population. We may not be able to stop the deer from multiplying (although I hear some are trying with bowhunting), but can we stop the ticks?

pink deer

Fairfax Wildlife Biologist Vicky Monroe displays the day-glo pink pesticide that will show up on deer and any other animal who visits the county’s new feeders. Image via The Washington Post.

A March 26 article in the Washington Post describes a study the Fairfax County (Virginia) Wildlife Biologist’s Office (in collaboration with the county’s Disease Carrying Insects Program) is undertaking in which deer are attracted to feeders with corn and simultaneously treated with permethrin, a tick-killing pesticide.  The twist? The pesticide has been dyed pink to allow for easier tracking of the deer. Fairfax County residents can expect to see not only pink deer, but also squirrels, raccoons, birds, and any other fauna that stop by for a snack.

How will this aid research on and prevention of tick-borne illness? Washington Post’s Tom Jackman explains:

On a couple of days every other month for the next three years, the pink deer will be harvested (or “killed,” in non-wildlife biologist terms) and autopsied. Deer organs will be tested and the remaining ticks will be sent to a lab for detailed analysis

Thus, the pink deer study will help the Fairfax County Wildlife Biologist’s office determine how effective the feeder-application of the pesticide is in killing disease-carrying ticks on the deer.

The study is costing the Fairfax County Health Department $380,000. For those in the county who have been affected by tick-borne infectious diseases (TBIDs), I’m sure this is not too high a price.

Would you support programs like this in your community? What is your county doing to control the vector population and prevent TBIDs?

This Season’s Ticking Bomb – WSJ.com 04/19/2012

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Looking forward to spring? I’ve really been enjoying the extra daylight and walks with my dog, Lucy, after dinner, and it was so nice on Easter to be able to wear a dress without my legs getting cold!

Lucy is ready for a walk.

Nice weather, however, comes at a price. An article published last month in the Wall Street Journal explains how warming weather will contribute to an increase in tick population (and likely an increase in the number of tick-borne infections) this spring. You can (and should) read the full article here.

Here’s an interesting tidbit about a study the Centers for Disease Control are doing:

The CDC is conducting the first study of its kind to determine whether spraying the yard for ticks can not only kill pests, but also reduce human disease. Participating households agreed to be randomly assigned a single spray with a common pesticide, bifenthrin, or one that contained water, without knowing which they would receive.

Paul Mead, chief of epidemiology and surveillance activity at CDC’s bacterial-illness branch, says preliminary results from about 1,500 households indicate that a spray reduced the tick population by 60%.

“But there was far less of a reduction in tick encounters and illness,” indicating that even a sharp drop in tick populations leaves infected ones behind. “We may have to completely wipe out ticks to get an effect on human illness,” he says. The CDC is enrolling households for a second arm of the study and expects final results late in the fall. Organic repellents such as Alaska cedar are also being tested in other studies.

The article includes an interactive graphic with some suggestions for how to avoid tick bites in your backyard:

  • Store firewood and bird feeders (birds carry ticks too!) away from the house.
  • Keep leaves raked and grass mown.
  • Restrict use of plants that may attract deer.
  • Keep pets away from wood (and woods) and use tick repellant.
  • Use decks, tile, and gravel close to the house.
  • Seal up any holes in stone walls that mice might want to nest in. (And make sure your house is rodent-free!)
  • Shower immediately after spending time outdoors in possibly tick-infested areas.
  • Wash and dry clothing worn for hiking or golfing at high temperatures.

I’ve been trying a natural, non-toxic flea and tick repellant on Lucy (and myself) that’s made from cedar oil.  What will you be doing this spring to avoid ticks (and thereby tick bites)?

My Story 04/18/2012

Posted by thetickthatbitme in Diagnosis, meta-blog, Treatment.
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Like many people who have suffered from tick-borne illnesses, I struggled with my symptoms for a long time before I got a diagnosis and effective treatment. At the time when I hypothesize I was infected—I say ‘hypothesize’ because I never discovered a tick or a tick bite, I never had a rash, and I never had a fever—I was already dealing with a number of medical problems that had begun in my early twenties. I’ll save all the gory details for another time, but my laundry list included irritable bowel syndrome (later diagnosed as an Entamoeba histolytica infection and treated with Metronidazole), a dysfunctional bladder (still unresolved), a spinal deformity (for which I underwent major surgery in 2010), and a ptosis in my right eye.

In the summer of 2009 I had finished graduate school and started my first professional teaching job. I’d been suffering from bladder and bowel issues for several years and had begun seeing an urologist and a neurologist who were trying to figure out if my problems were neurological, and if so, what to do about them. I spent the Fourth of July weekend in Yosemite National Park on a girls’ retreat with some friends from high school. We stayed in a yurt—with bunk beds—and hiked two or three trails a day for several days. I remember having a head cold that I picked up on the plane ride from Long Beach to Oakland and blowing my nose all night. I remember being eaten alive by mosquitoes one morning, despite having worn bug spray. I don’t remember any ticks, but I’m not much of an outdoor girl, and at the time, my tick-awareness was nonexistent. The kind of tick that bit me was likely a soft-bodied tick, the kind that fall off when they’re done, so it’s understandable that I never saw it. If there was a fever or a rash, I didn’t notice them because I was already sick and swollen with mosquito bites.

This is when I believe I was bitten, but there is really no way to know. According to CDC reports, the area of Southern California in which I live is known to be infested with ticks that carry Borrelia hermsii. I could have been bitten while walking my dog or sitting at a picnic table in the park.

After my Yosemite trip, I returned to LA and the neurologist, who referred me to a neurosurgeon. The surgeon, after ordering MRIs, concluded that I was cursed with a spinal column that was too long for my spinal cord, which was causing the cord to stretch like a rubber band and causing nerve damage that might account for the bladder and bowel problems. After much convincing (and much freaking out), I decided to undergo surgery to shorten my spine the following summer. At the time, I was under a lot of stress, trying to balance work, my teaching credential program, my relationship with my boyfriend, and routine doctor visits. If I was exhausted, I attributed it to this balancing act, not to the infection that was, unbeknownst to me, festering in my bloodstream.

The spine surgery was traumatic–nine hours face-down on the table, nine days in the hospital–but successful. My mobility was impaired for the first six months. I wore a hard brace until December and a corset until February. I was able to drive (and teach again) by September, and my life got back into full swing with student teaching, paid teaching, and two other part-time jobs. When I wasn’t working, I spent most of my time lying on my back in bed. I got an iPhone so I could be more productive in that position, and most of the time, friends who wanted to hang out came to me. After the first six months, when my surgeon said–according to imaging–that the bone had completely healed, I wondered why I was still so tired and achey all the time. I was having trouble getting up in the mornings, and I wasn’t making expected progress in cutting back on my pain medication. Maybe it was just stress, I reasoned. Maybe I was depressed. After all, at 25, my life hadn’t exactly panned out the way I’d planned it. Maybe it was part laziness. That was the conclusion of one of my mentor teachers. I had no real framework for understanding what was happening to me, so I just tried to push through it.

A little more than a year following my surgery, I went up to my parents’ house for a summer visit. I’d had the second of two eye surgeries in May to correct the ptosis, which so far has stuck–no more ptosis. (The surgeon attributed my ptosis to having worn hard contact lenses as a teenager.) School was out, and my back was doing all right, but I felt perpetually exhausted. I helped out at my dad’s medical practice for a week, and he ordered some blood tests for me. I didn’t find out the results until I got home to LA. Three little surprises: 1) Entamoeba histolytica, my parasitic souvenir from my time studying abroad in China; 2) Borrelia hermsii, from a tick I’d never seen evidence of; and 3) Anaplasma phagocytophilum, another tick-borne infection.

We treated the Entamoeba histolytica with a course of Metronidazole, an oral antibiotic and the Anaplasma phagocytophilum with three weeks of Doxycycline. The treatment for Borrelia hermsii was 42 days of intravenous Ceftriaxone therapy.

The treatment of tick-borne infections with IV antibiotics is controversial because research, professional guidelines, and doctors’ practices based on their experiences treating these diseases often contradict each other.

The CDC does not have specific guidelines for the treatment of Tick-borne Relapsing Fever (TBRF), the name of the illness caused by a Borrelia hermsii infection. Here’s what the CDC has to say about treatment procedures: “Experts generally recommend tetracycline 500 mg every 6 hours for 10 days as the preferred oral regimen for adults. Erythromycin, 500 mg (or 12.5 mg/kg) every 6 hours for 10 days is an effective alternative when tetracyclines are contraindicated. Parenteral therapy with ceftriaxone 2 grams per day for 10-14 days is preferred for patients with central nervous system involvement.”

You’ll notice that they only recommend one to two weeks of antibiotic therapy, in contrast to the six weeks of therapy that I received.

The Infectious Disease Society of America doesn’t have treatment guidelines for Borrelia hermsii, but they have guidelines for its Lyme Disease-causing cousin, Borrelia burgdorferi. They recommend treating what they term “Lyme arthritis” with Doxycycline, an oral antibiotic, for 28 days. Treatment suggested for “Late neurologic Lyme disease” is intravenous Ceftriaxone for 2-4 weeks.

Many of the patients that I met in clinic had tried oral antibiotics—sometimes for months at a time—with less than stellar results. Others had been given intravenous antibiotics on an inconsistent basis (for example, Monday through Friday, but not on the weekends). The patients I met who got better were ones who had had a minimum of 28 days of IV antibiotic therapy.

I can’t prove anyone wrong or right, and I am most certainly biased as a patient and a doctor’s daughter, but I can point you to facts and information that may help you in your own journey to health. So here is an abbreviated description of my experience being treated for Borrelia hermsii by an experienced infectious disease specialist:

I came to the clinic every day for 42 consecutive days, except for the day that I had gallbladder surgery. I know you must be thinking the Ceftriaxone caused my gall stones, but the stones were revealed to me by an ultrasound that was done in LA two weeks before I started treatment; they were probably brought on by a combination of heredity–my mother had hers out–and my weight loss following back surgery.

The doctor prepared the drug in a sterile hood. He used a butterfly needle (which is very small as needles go) in the top of my hand. It wasn’t very painful for me, and I’m not squeamish, so the process was not traumatic. Each day, the drug infused over about 45 minutes. The doctor said this method was better than an injection because it lowered the risk of adverse reaction. If I’d had any problems, they could have switched me to saline quickly.

The first two weeks were the most difficult. I was still extremely fatigued, and I began getting more arthralgias (aches and pains) in my wrists, hips, knees, and ankles. It was explained to me that Borrelia like to “hide” in joints, and my pain probably meant that the bacteria were dying. Knowing this, I could reluctantly accept the pain as a good sign.

In week three, I had my gallbladder out. My surgeon was very talented and did the laproscopic procedure, so it only took a few days for me to get back to normal. They gave me Ceftriaxone through IV in recovery, so I didn’t technically skip my infusion that day.

At the end of week four, I started to notice that I had more energy. I was working during the day, helping my dad, then coming home at night and doing my own work (I do freelance editing when I’m not teaching.). It was the first time in more than a year that I felt truly alert and productive.

Weeks five and six went by more quickly. I found myself laughing more, and even singing in the clinic. It helped that there was a piano there. For the first time, my back felt almost as good as it had before my surgery. And my mind…well, I’m sure you can tell how sharp I am based on my excellent writing skills.

For those who believe in more holistic treatment methods, I’ll note that a few other components played a role in my recovery:

1. Exercise: I joined the small pool where my mom takes arthritis water aerobics classes and went with her two to three times per week. The warm water made my joints feel better, and the exercises strengthened my muscles and improved my balance. Because the class is zero impact, I didn’t get sore like I would from walking the dog or playing a sport. The class I took was designed by the Arthritis Foundation and is offered at hundreds of facilities around the country. Though you could say I had a reactive arthritis, you don’t have to have arthritis to take the class. You do, however, need a doctor’s approval.

2. Diet: My doctor recommended a diet high in choline. Choline is an essential nutrient that is classified as the newest member of the B Vitamin family. It’s important because it is required for the proper transmission of nerve impulses from the brain through the central nervous system. You can find information about high-choline diets here.

3. Fun: During the six weeks of my treatment, I tried to find ways to relax and fun things to do. I attended a musical and several movies with friends. I read some “guilty pleasure” novels (you know, the kind with romance, vampires, etc.). I took walks on the beach with my family. I also benefited from the relaxed atmosphere of the infusion center. The doctor invited a piano player to entertain patients, and a few patients, including myself and a former opera singer, often sang along. There were a handful of regulars, like me, “doing time” for 28 days or more, and they became my friends. We swapped stories about doctors, work, and life. We gave each other nicknames and told each other jokes. My six weeks of treatment were filled with song and laughter. Could that have affected my prognosis? If I were a betting kind of woman, I’d bet on it.

I am still a work in progress. I’m back home in LA and feeling better than I’ve felt in a long time, but I’m not done with doctors. I’m determined to stay on top of everything from now on. Never again will I let one discouraging doctor visit interfere with my care.

I invite you to stay tuned and learn with me as I gather articles, resources, and stories from others.

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