A Tickler About Tick Season

Pennsylvania is a hotbed for ticks. According to surveillance data, our home is considered a “high incidence” state with some counties reporting as many as 300 cases per 100,000 people. Importantly as well, tick surveillance shows that around 25% or more ticks analyzed carry Lyme disease bacteria, and generally less than 5% carry other tick-related diseases such as anaplasmosis or babesiosis. 

Infectious diseases physician Jaan Naktin, MD, with LVPG Infectious Diseases–1255 Cedar Crest, and Lehigh Valley Health Network (LVHN), part of Jefferson Health, is keenly aware of this trend, and the increasing number of cases in the hospital. “Tick-related illnesses used to be here and there, now they occur regularly,” he says. “It’s important for people to know our region is an epicenter.”

People are often familiar with Lyme disease, caused by bacteria transmitted by black-legged ticks, also known as deer ticks. Anaplasmosis is also transmitted by deer ticks, with bacteria that have an appetite for human white blood cells. Babesiosis affects the red blood cells. Both these diseases can occur independently or concurrent with a Lyme infection.

All three tick-borne diseases have similar symptoms:

• They can cause fever, chills, fatigue, headache and muscle aches.
• Lyme disease can be associated (in about 70% of cases) with a rounded red rash often described as a “bullseye.” The symptoms can be subtle, so clinicians often opt for testing and treatment during the peak seasons of late spring and early summer.
• Anaplasmosis is associated with the same symptoms, perhaps higher fevers, but the lab abnormalities are different with characteristic low white blood cell and platelet counts.
• Babesiosis shows similar symptoms, but can also cause low red blood cell counts, low platelet counts and elevated liver function tests.

These diseases have symptoms that look like other conditions, so clinicians need to be suspicious. If there is no rash (in the case of Lyme disease), Dr. Naktin and the infectious diseases team use their experience to determine if blood tests are needed.

“The goal is early detection and treatment in the year the patient is infected,” Dr. Naktin says. “There are excellent tests that reveal presence of the organism in the blood, such as a Polymerase Chain Reaction (PCR) test, which can detect anaplasmosis, babesiosis and a less common disease called ehrlichiosis.”

The blood test will show antibodies produced by the body’s immune system. These can be missed if the test is taken too early when the antibody level is low. Therefore, if a patient’s test is negative, but they have symptoms, the team may do another test in four to six weeks and treat in the meantime if their suspicion is high. 

These tests are often done in conjunction with other blood tests that detect the body’s immunological reaction to the infection.

Initial treatment for all three tick-borne diseases is antibiotics. Doxycycline, frequently used for Lyme disease, is also effective against anaplasmosis and ehrlichiosis. Additional treatment may be necessary for babesiosis infection.

Considering there is no vaccine currently available for tick-borne diseases, the infectious disease team at LVHN agrees prevention as the best medicine.

“Use insect repellent, preferably with 30-40% DEET.” Dr. Naktin says, adding that treating your clothes with permethrin is also helpful. “Dress appropriately,” he says. “It may be difficult in the spring and summer to cover effectively and stay cool. But if you are spending time outside, make the time to strip down at the end of the day, take a shower and inspect your body for any attached ticks.”