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It’s Not Just Lyme Disease You Have to Worry About

The Crimean Congo hemorrhagic fever was recently diagnosed in Spain. Yes, this is a relatively newly diagnosed viral tick-borne disease and it can be a mild flu-like illness or you can bleed out from your mouth, eyes and nose and die and of course there’s no treatment for it. So along with Lyme Disease and Babisiosis and Dengue and West Nile Virus and Swine Flu and Chikungunya you now have the Crimean Congo Hemorrhagic Fever to worry about. It’s not an issue in Central New York yet but with the rate of world traveling look for it to be in a theater near you soon.

Depending on where you live you have to contend not only with Lyme Disease. There are a host of tick borne diseases to worry about right in our own backyard.

This report comes from the New England Journal of Medicine July 13th 2017 and talked about an AUTOCHTHONOUS infection. I didn’t even know what that word meant so I had to look it up and it means that the infection didn’t come from a traveler it came from someone living in Spain who contracted the illness without traveling to the endemic area. You can rest easy, for now, regarding the Crimean Congo Hemorrhagic Fever but let’s not let your guard down because we have a whole lot of home grown tick borne diseases to contend with.

As reviewed in the Cleveland Clinic Journal Of Medicine Volume 84 July 2017 there are a host of tick borne diseases right in our own backyard to worry about. All that’s tricky is not Lyme. Depending on where you live you have to contend not only with Lyme Disease but also Anaplasmosis, Babesiosis, Ehrlichiosis, Rocky Mountain Spotted Fever and Tularemia. Looking at the maps that show where these tick borne diseases are found it doesn’t look like there is one state in the union that doesn’t have a problem with at least one of these vectors.

This bull’s-eye rash is also called erythema migrans is a rash caused by Lyme disease.

The names of the bugs alone are daunting … Rickettsia rickettsii is the bug that causes Rocky Mountain Spotted Fever and it’s carried by the tick Dermacentor variabilis … now there is a Rickettsia Parkeri infection as well but this virus is borne by the tick Amblyomma maculatum.

There is an illness called Human granulocytic anaplasmosis that is borne by the common tick Ixodes scapularis. Don’t forget about Human Monocytic Ehrlichiosis with the tick vector Amblyomma americanum … this same tick carries the pathogen Ehrlichia ewingii. So far the infection called Ehrlichia muris like agent is limited to Wisconsin and Minnesota but for how long?

Lets not forget Babesiosis which is also borne by Ixodes scapularis and this illness presents, as do all the others with fatigue, fever or malaise headache, myalgia or arthralgia, nausea, anorexia, and cough. In the laboratory all of these infections can cause leukopenia and thrombocytopenia, that is low white count and low platelets. You would think that an infection would cause an elevated white count but not in these cases. Let’s round out the list by mentioning tick borne relapsing fever which is caused by Borrelia hermsii which is born by ticks which so far now only involve the Pacific Coast in Northwest and Southwest regions. It causes (as the name applies) relapsing fever or headaches gastrointestinal symptoms arthralgias and myalgias. Almost all of these pathogens can be treated with doxycycline just like Lyme disease except for tickborne relapsing fever and this bug is treated with tetracycline this isn’t a virus this is a spirochete. There is something called Southern Tick Associated Rash illness but we don’t even know the pathogen although we think the vector is Amblyomma Americanum.

To avoid tick bites be sure to wear long pants and long sleeves and/or use a lot of DEET and check yourself when you come back inside.

Okay, let’s round out the list with Tularemia, Heartland virus infection and Powassan virus infection. The Powassan virus Is apparently an uncommon Flavivirus but it’s becoming more common right here in New York State. Tularemia at least you can treat with an antibiotic. The Heartland virus which is borne by the tick Amblyomma Americanum (most likely) is also for now only diagnosed in Missouri and Tennessee.

Bottom line is that “Tickborne illnesses should be considered in patients with known or potential tick exposure presenting with fever or vague constitutional symptoms in tick endemic regions. Given that tick bite history is commonly unknown, absence of a known tick bite does not exclude the diagnosis of the tick borne illness. Starting empiric antibiotic is usually wanted before the diagnosis of tick borne illnesses confirmed. Tick avoidance is the most common effective measure preventing tick borne infections.”

Hopefully all of this talk of ticks doesn’t make you afraid to go outdoors. Just wear long pants and long sleeves and/or use a lot of DEET and check yourself when you come back inside. If you do experience any illness that doesn’t have a good explanation … work with your doctor to check for other possibilities and don’t rest until you have an answer or get better. Until next month … get well … stay well.

Dr. Barry