Visits to the emergency room for tick bites are higher than normal across the US right now. In all regions except the South Central US, weekly rates of ER visits are the highest for this time of year since 2017. May was Lyme Disease Awareness Month but staying vigilant throughout this summer and fall will help your patients and their families protect themselves from tick bites and the serious diseases they can cause. The most common types of tickborne infections found in the MD region:
Tickborne infections have nearly doubled over the last two decades due to global warming which has led to a longer tick season and a migration of ticks into more northern terrain, and partly from increased testing and reporting. It is not uncommon to see ticks now nearly year-round. The CDC’s Tick Tracker has the latest tick bite data in your area.
TICKS OF INTEREST IN MARYLAND
While not every tick bite transmits disease, these ticks found in MD commonly bite humans:
PREVENTION
Most cases of Lyme and other tickborne infections are preventable either by consistent use of any of the following FDA and ISDA recommended products when adults or children are going into a tick habitat or by recognizing and removing ticks soon after attachment:
People can also spray permethrin on clothes and shoes to repel ticks. Note that permethrin is not safe for direct application on skin. Clothes and shoes should be allowed to air dry for at least 2-4 hours before use. Permethrin will continue to work for up to 6 weeks after application. Clothes can go through the washing machine 6 times before permethrin needs to be reapplied. As a bonus, all the above products also protect against mosquitoes.
Limit direct contact with ticks by avoiding wooded and brushy areas with high grass and leaf litter, walk in the center of trails, wear long pants and long sleeves, and tuck shirts into pants and pants into socks to keep ticks on the outside of clothing. Wearing light colored clothing will help spot ticks more easily. Ticks can be transferred to humans from contact with pets before the tick attaches.
AFTER POSSIBLE EXPOSURE
Patients should be instructed to check themselves and their children for ticks at least once each day if there is potential for exposure. Removal of ticks within 36 hours of attachment completely prevents Lyme transmission and likely significantly reduces other infections. Alpha-gal syndrome can likely be triggered soon after lone star ticks start to feed, but the probability increases the longer the tick is attached, and more saliva is transferred from tick to human. Cheap plastic tick removal devices are sold in pet stores and work well for people, as well as for dogs and cats. While tweezers also work well, the plastic tick removal devices are more likely to remove the tick intact, a critical step to preventing infection.
Signs and symptoms vary with each type of tickborne disease but are provided here in summary:
Lyme Disease Typical | Symptoms include fever, rash, facial paralysis, and arthritis. Symptoms may vary depending on stage of infection. Early signs and symptoms (3-30 days after tick bite) include fever, chills, headache, fatigue, muscle and joint aches, swollen lymph nodes, and an erythema migrans (EM) rash in 70-80% of infected patients that can expand over several days up to 12” and may resemble a bull’s eye.
Ehrlichiosis | Presents as an acute viral-like illness with fever, fatigue, general malaise, but unlike the flu or COVID, respiratory symptoms are non-existent or not prominent. Conjunctival infection and rash may also occur. Symptoms appear 1-2 weeks after a tick bite. The bacteria infect the white blood cells.
Anaplasmosis | Similar to Ehrlichiosis
Babesiosis | Symptoms, when they occur, usually appear 1 week to a few months after a tick bite. Some patients develop non-specific flu-like symptoms such as fever, chills, sweats, headaches, body aches, loss of appetite, nausea, or fatigue. Parasites infect and destroy red blood cells so hemolytic anemia is a concern. The disease is most severe for the elderly, immunocompromised, and those without a spleen.
Spotted Fever (Rocky Mountain Spotted Fever) | Symptoms begin 3-12 days after tick bite and may start with a sudden onset of fever and headache. A rash typically occurs 2-4 days after fever onset and is highly variable with some people never developing a rash. Other symptoms are nausea, vomiting, abdominal pain, body aches, and swelling around the eyes and back of the hands.
Alpha-gal Syndrome | Symptoms can range from mild to severe and some may be life threatening appearing 2-6 hours after exposure to products containing alpha-gal like red meat or dairy products. It can cause hives, nausea, stomach pain, breathing issues, and swelling.
TESTING
With known exposure, prompt treatment should occur, regardless of confirmed infection. Not every hospital lab may test for tickborne diseases so specimens may need to be sent to outside labs.
Lab diagnosis of Lyme disease relies on a blood test that detects antibodies to the Lyme bacteria. It can take several weeks for the immune system to make enough antibodies to be detected by the test.
The CDC recommends using antibody tests approved by the FDA that are two-tiered.
The University of Maryland has a tick identification service available.
Or, you may submit a picture of the tick to TickSpotters
Note: Testing ticks for Lyme or other infections is not recommended.
PUBLIC REPORTING: REQUIRED
Per COMAR, healthcare providers, hospitals, and lab directors are required to report diagnosed or suspected cases of Lyme disease to the Local Health Officer or Health Commissioner (Baltimore City) in the county where the provider cares for the person.
Consult MDH’s Public Health Reporting page for reporting instructions for Healthcare Providers and Lab Directors
CONTINUING EDUCATION
CDC currently offers an online CME Case Study Course on Clinical Assessment, Treatment, and Prevention of Lyme Disease for practitioners and other professionals. Free CEs are available.
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