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As spring approaches and the snow recedes, our thoughts may naturally drift to the great outdoors and all the fun exploring and activities to be had in the woods and hills. But lurking among those blades of grass and fallen leaves is an army of small brown insects that could spell trouble for some people.
In particular, a tiny brown insect called Ixodes scapularis could be waiting to make a meal of you. More commonly known as the deer tick or the brown legged tick, this hard-bodied insect that's about the size of a sesame seed is endemic to much of the United States. It can also be a carrier of a spirochete, a type of bacteria, called Borrelia burgdorferi. That's the bacterium that causes Lyme disease.
Lyme disease occurs when a tick that's carrying the bacteria bites you. Ticks feed on the blood of a host, and for the deer tick, its primary source of food is deer blood. But human blood works just fine too, if it's available.
It's also worth noting that in addition to Lyme disease, ticks can also carry other pathogens that can cause other diseases including:
-- Babesiosis. This illness is caused by a parasite that attacks the red blood cells and can lead to low blood pressure, anemia and kidney or liver problems.
-- Rocky Mountain spotted fever. Caused by a bacteria, this disease causes flu-like symptoms along with red eyes and a splotchy rash that starts on the ankles or wrists.
-- Tularemia. Also called rabbit fever, this bacterial disease causes skin ulcers, fever and swollen lymph nodes.
-- Anaplasmosis. This bacterial infection attacks white blood cells leading to flu-like symptoms.
-- Ehrlichiosis. This disease is similar to anaplasmosis, but is carried by the lone-star tick.
-- Powassan disease. Named for the Canadian town where it was first diagnosed, Powassan disease causes headaches, fever, vomiting and cognitive changes. Loss of coordination and seizures can also occur.
[READ: 6 Sneaky Signs of Lyme Disease.]
Symptoms of Lyme Disease
Infection with the bacterium that causes Lyme disease typically causes a very specific "expanding, non-painful rash around the area of the bite," says Dr. Andrew Schamess, an internal medicine physician at the Ohio State University Wexner Medical Center in Columbus.
"On dark skin it will usually look like a darker area than the surrounding skin with a red tinge. On light skin it will look red -- sometimes solid, sometimes skin-colored with a red rim, sometimes concentric circles," like a bull's-eye or target.
This is the characteristic bull's-eye ring rash that's considered the hallmark symptom of Lyme disease. "The medical word for the target lesion is 'erythema migrans'" Schamess says. And it's often a highly visible indication of Lyme infection.
As the infection takes hold in the body, it can trigger additional symptoms including:
-- Joint and muscle aches.
-- Stiff neck.
-- Loss of appetite.
-- Swollen glands.
If Lyme disease is left untreated, it can cause serious, chronic problems in several regions of the body, including:
-- The nervous system. Neuropathy, or weakness, numbness and pain in parts of the body, can develop. Meningitis, which causes headache and stiff neck, can also occur.
In addition, some people develop a chronic condition. Though this post-Lyme disease syndrome is uncommon, it can cause fatigue, muscle aches and cognitive impairment for years after the initial infection, Schamess says.
He adds that the symptoms of this so-called chronic Lyme disease (which he notes is a misnomer because there's no active infection) are non-specific and could be caused by more common conditions such as depression, fibromyalgia, autoimmune and neurologic disease. "Don't fixate on a particular condition you found on the internet. It's better to keep an open mind and work with your doctor on finding a cause."
Rising Cases of Lyme
The Centers for Disease Control and Prevention are concerned about the rise in Lyme disease cases in recent years, noting that "approximately 476,000 Americans are diagnosed and treated for Lyme disease each year."
That's a significant number of people, and there are a few reasons why cases are rising:
-- Climate change. The tick population is rising, and that's a consequence of climate change. "Shorter winters and warmer weather lengthen the breeding season of the Ixodes tick that carries Lyme disease," Schamess says. "It's one example of the ways that climate change is already affecting human health."
-- Expanded geographic range. The CDC notes that the geographic range of Lyme cases is expanding, which is also in part due to climate change. Warmer conditions have expanded the geographical range of the tick responsible for Lyme, and warmer winters mean fewer ticks die off, leading to a bigger population in the spring.
-- Suburban sprawl. Similarly, an increased range of humans has also contributed to the uptick in cases. Suburban sprawl has brought greater numbers of humans into formerly wooded areas where ticks live. Thus, the opportunities for contact have increased, leading to a jump in cases in recent years.
-- Increased awareness and testing. Increased awareness of Lyme disease and improved testing and identification of cases has also contributed to a rise in documented cases.
How to Stop the Spread of Lyme Disease
Climate change is a knotty problem to solve and many factors have contributed. Solving it won't be easy, and significant political will is going to be necessary to make the kind of substantial changes that would impact the range of the deer ticks that carry Lyme disease.
In the meantime, the CDC is working to develop better insect repellents. In August 2020, the EPA registered a newly discovered compound called nootkatone, which is found in grapefruit, Alaska yellow cedar trees and some herbs. It appears to repel ticks and mosquitoes, which can also be vectors of dangerous diseases such as malaria, Zika, West Nile virus and Eastern equine encephalitis. The CDC reports that commercial products containing nootkatone may be available by 2022.
Educational efforts are also underway to help people better understand the risk of contracting Lyme disease and how to lower the chances of picking up a tick that could be infected. The CDC's TickNET program is a collaborative public health initiative aimed at helping prevent tick-borne diseases.
Clinical trials are also currently being conducted to develop a safe and effective Lyme disease vaccine.
Preventing Lyme Infection
The most immediately effective way to try to lower rates of Lyme disease is to stop infection before it occurs. If you're someone who enjoys the great outdoors in any capacity, these common-sense tips may help you avoid ticks and becoming infected with Lyme disease:
-- Do a tick check every time you've been outdoors. Schamess says that "ticks are found in wooded areas, and areas with high grass or brush. Hiking and camping are common exposure situations." While it's quite possible to come into contact with a tick anytime you're outside, the CDC reports that an infected tick must remain attached to the host for 36 to 48 hours or more to transmit the bacterium that causes Lyme disease. After potential exposure, "take a shower and do a tick check while undressed. Parents should check their children for ticks." Removing a tick before it has an opportunity to attach is critical to avoiding infection.
-- Wear white socks. Ticks often gain access by crawling up the leg from the ground. White socks can make a dark brown tick easier to spot before it reaches your skin.
-- Wear long trousers and tuck them into your socks. When walking in areas where there could be ticks, it's best to wear long pants and tuck them into your socks to prevent access to the skin by enterprising ticks.
-- Wear long sleeves and a hat with a wide brim. These measures will also help prevent a potentially infected tick from finding a patch of skin it can attach to.
-- Consider pre-treating your clothing. A chemical called permethrin is an insecticide that kills ticks. Schamess says you can spray a solution of 0.5% permethrin on clothes, socks and footwear to help keep ticks off your stuff. A single treatment lasts through several washings.
-- Mind where and when you walk. "Stay out of tall grass and underbrush if possible," Schamess says. Lyme disease season is the spring and fall, so be especially careful then. And if you live in the Northeast, mid-Atlantic or Upper Midwest, know that your risk is higher, as those regions of the country have higher rates of infection. People who live in those areas should be especially careful anytime they head outdoors.
-- Wear insect repellent. Ticks don't like certain kinds of insect repellent and are more likely to drop off if they encounter a barrier of one of these products on your clothes and skin. The Environmental Protection Agency recommends selecting a product that contains DEET, p-Menthane-3,8-diol, picaridin, oil of lemon eucalyptus, citronella or IR 3535. All are compounds that have been registered with the EPA and can be found in a variety of commercially available insect repellent sprays and lotions.
-- Remove any ticks. If you find a tick on your or your child's body, remove it carefully. Schamess recommends using tweezers to "grasp the exposed portion and pull. The headpiece left in the skin will dissolve on its own." And despite what you may have heard, "there's no need to use heat, Vaseline or other tools for tick removal." Just wash the area with an antibacterial soap and dry lightly afterwards.
-- Save the tick. If you've harvested a tick from your skin, put it in a jar or a plastic bag and bring it with you to your doctor's appointment. Your doctor might want to check what type of tick it is.
-- Consider how long it might have been attached. After removing a tick, try to determine how long it may have been attached. If it's been on your body more than 72 hours and you live in an area with a lot of Lyme disease, your doctor may recommend a preventive dose of an antibiotic called doxycycline.
-- Get medical attention if you notice the tell-tale bull's-eye rash. The hallmark bull's-eye rash is "caused by the body's inflammatory response to the spirochete spreading within the skin," Schamess says. As this happens, you'll also likely develop a fever, swollen lymph nodes and muscle aches. If any of these symptoms arise, contact your health care provider right away.
-- Make sure you're up to date on your tetanus vaccine. The bacteria that causes tetanus is often found in soil in the same places where ticks can be found. The tetanus virus can gain entry to the body via any break in the skin, such as a tick bite.
-- Stay vigilant. Even if you don't recall having been bitten by a tick, it's still possible to have received a bite and develop Lyme disease. "If you or your child develop flu-like symptoms accompanied by a rash, it could be Lyme disease or another insect-borne illness. Contact your doctor for any flu-like syndrome with rash, even if you don't remember a tick bite," Schamess says.
Treatment Is Possible
Though Lyme disease can be a nasty illness, it's treatable, and best results occur when the illness is caught at the earliest stages, right after the bite has occurred.
"Most cases of Lyme disease are treated quite easily with oral antibiotics," Schamess says. Doxycycline is the most commonly used antibiotic, but amoxicillin and cefuroxime are also effective.
Schamess adds that "in about 15% of cases, the symptoms may get worse for a day or two on treatment before they get better. This is due to the immune response to the Lyme bacteria being killed off."
In more severe cases, such as when the nervous system or joints become involved, more intensive intravenous treatment may be required. Ceftriaxone is usually the antibiotic used as an IV infusion in these cases.