An Uptick in Tick-Borne Diseases, and Not Just Lyme

Pennsylvania is a hotbed for ticks. According to data, the Northeast leads the country in tick-borne diseases. The number of cases of Lyme disease alone, which in Lehigh and Northampton counties have reached about 800 a year, have more than doubled in the last 20 years. Infectious diseases physician Jaan Naktin, MD, with LVPG Infectious Diseases–1255 Cedar Crest, is keenly aware of this trend.

“Cases of tick-related illness 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, transmitted by black-legged ticks, also known as deer ticks. However, two other diseases are becoming common in Pennsylvania. Anaplasmosis is transmitted by deer ticks carrying the bacteria Anaplasma phagocytophilum that reproduces in white blood cells. Babesiosis, caused by microscopic babesia microparasites, infects the red blood cells. Both these diseases can co-occur with a Lyme infection.

Anaplasmosis and babesiosis typically do not cause chronic disease, but in certain people, an infection of babesiosis can be severe. Lyme disease can have chronic stages with autoimmune issues after infection. Symptoms of all three diseases include fever, chills, fatigue, headache and muscle aches. Anaplasmosis and babesiosis can cause nausea, vomiting and diarrhea. Beyond that:

• Lyme disease can affect the brain, nervous system, heart and joints (if the disease goes undiagnosed for days or months).
• In severe cases, babesiosis can affect the heart, respiration and mental status and can cause renal failure and death.

Those little specks you find after a walk in the woods aren’t a different breed of tick. They are baby black-legged ticks. Their life cycle spans about two years and goes from egg to larva to nymph to adult. At each stage, they must feed off another organism – a mammal, bird, reptile or amphibian – to survive. This is where the ticks can pick up parasites, bacteria and viruses.

When it comes to Lyme disease, many people point their finger at deer, but Dr. Naktin says research doesn’t support that. “Deer are not good reservoirs for borrelia, the bacteria that cause Lyme disease,” he says. “However, if you check the blood of the white-legged mouse, it’s loaded with it.”

Called “the great masqueraders,” these diseases have symptoms that can be mistaken for other conditions. If there is no rash (in the case of Lyme disease), Dr. Naktin and the infectious diseases team at Lehigh Valley Health Network (LVHN) use their experience to determine an “index of suspicion.” If the index is significant, they order blood tests.

“Blood tests rely on detecting antibodies the body’s immune system makes. These can be missed if the test is taken too early when the antibody level is low,” he says. “Therefore, if a patient’s test is negative, but they have symptoms, we do another test in four to six weeks.” In the meantime, treatment can start (and usually does) if the index of suspicion is at least moderate on a scale of low to moderate to high.

Treatment for all three tick-borne diseases is antibiotics. In severe cases of babesiosis, patients may also be treated with antiprotozoals and antimalarial drugs. “The goal is early detection and treatment in the year the patient is infected,” Dr. Naktin says.

The future of treatment, at least for Lyme disease, is looking up with a new vaccine in development. There is also research into a pill that you take once a month. In the meantime, prevention is still the best medicine.

“Use insect repellent, preferably with DEET,” Dr. Naktin says. “Treat your clothes with permethrin and dress appropriately.” He says that means tucking pants into socks and making sure everything is covered. “Following the habits of PPL’s people who work on the electric lines and taping the seams  where your clothing meets is an excellent way to prevent tick bites.”