TICK-BORNE DISEASES
A single tick can transmit multiple infections at one time. The presence of multiple infections tends to further complicate diagnosis and treatments.
LYME DISEASE
Names: Borrelia burgdorferi, Borrelia mayonii, Borrelia afzelii, Borrelia garinii
Transmission: Blacklegged tick (Ixodes scapularis, Ixodes pacificus and Ixodes ricinus), can cross the placenta during pregnancy
Signs and Symptoms: Some cases see the classic bulls-eye rash (erythema migrans), flu-like symptoms, fever, chills leading to late-onset disease: arthritis, muscle aches, brain fog, facial palsies
Pathogenesis: B. burgdorferi starts off as a spirochete spreading through the lymphatic and circulatory systems. It can hide from the immune response by changing it’s “skin” and going to places that immune system isn’t as strong like bones, muscles, and brain tissues. Later onset infection, B. burgdorferi will change its shape and become a biofilm.
Treatment: Early on-set disease is treated with doxycycline, amoxicillin, cefuroxime axetil
Distribution: Across US and worldwide, highest in June and July.
ANAPLASMOSIS
Names: Anaplasma phagocytophilum
Transmission: Blacklegged tick (Ixodes scapularis and Ixodes pacificus), American Dog tick (Dermacentor variabilis), and blood transfusions.
Signs and Symptoms: Fever, chills, headaches, muscle aches, nausea, diarrhea, loss of appetite and this all leads to a weakened immune response.
Pathogenesis: A. phagocytophilum infect neutrophils and has variant surface proteins that also help it escape from your immune response.
Treatment: Doxycycline.
Distribution: New England accounts for about 90% of the cases of anaplasmosis yearly, and ticks are commonly found carrying anaplasmosis throughout US.
BABESIOSIS
Names: Babesia microti, B. divergens, B. duncani, and an unnamed agent called M01)
Transmission: Blacklegged tick (Ixodes scapularis, Ixodes pacificus), blood transfusions.
Signs and Symptoms: Usually asymptomatic; some develop flu-like symptoms and since Babesia parasites infect RBC it can cause hemolytic anemia.
Pathogenesis: A protozoan parasite that infects red blood cells
Treatment: Asymptomatic people do not require treatment. For ill patients a combination of atovaquone and azithromycin; clindamycin and quinine.
Distribution: Mainly in Northeast and upper Midwest.
ROCKY MOUNTAIN SPOTTED FEVER
Names: RMSF, Rickettsia rickettsii
Transmission: American Dog tick (Dermacentor variabilis), Rocky Mountain wood tick (Dermacentor andersoni), and Brown dog tick (Rhipicephalus sanguineus).
Signs and Symptoms: Fever and headache followed by a rash.
Treatment: Diagnosis in the early stages is difficult. A number of laboratory tests can confirm the diagnosis but treatment should be begun based on symptoms. Doxycycline is an approved antibiotic to use for treatment of RMSF.
Distribution: NH has reported cases of human’s having RMSF. But ticks only have known cases as far north as Rhode Island and more commonly associated with Southern states as far north as Maryland.
TULAREMIA
Name: Francisella tularensis)
Transmission: American Dog tick (Dermacentor variabilis), Rocky Mountain wood tick (Dermacentor andersoni), and Lone star tick (Amblyomma americanum), Deer fly (Chrysops spp.), contact with an infected animal (and consumption of contaminated water and inhalation of contaminated dust contaminated by a dead infected animal).
Signs and Symptoms: Fever, skin ulcers, and enlarged lymph nodes leading to pneumonic symptoms including cough, chest pain and difficult breathing.
Pathogenesis: F. tularensis can live inside and outside of cells, it particularly likes to infect macrophages. It spread to multiple organ systems including the lungs, liver, and lymphatics/spleen.
Treatment: Diagnosis can be difficult. Approved antibiotics to treat tularemia include: streptomycin, gentamicin, doxycycline, and ciprofloxacin.
Distribution: NH has reported 1 case of Tularemia infected humans, but mostly it is associated with central US.
TICK PARALYSIS
Tick paralysis is caused by a neurotoxin from an attached tick. This condition is characterized by a progressive paralysis that usually starts in the legs with muscle weakness, loss of coordination, numbness, and difficulty standing or walking. The symptoms progress upwards to the abdomen, back, and chest. If the tick is not removed, paralysis of the chest muscles can lead to respiratory failure and death within 24 to 48 hours after symptoms begin. Prompt removal of the tick usually leads to a complete recovery. Twelve cases of tick paralysis have been reported in Washington from 1990 through 2011. Ticks associated with tick paralysis include Ixodes and Dermacentor species that live in forested and brushy areas or along edges between open grassy areas and woods
Names: Ehrlichia chaffeensis, E. ewingii, E. muris eauclairensis
Transmission: Blacklegged tick (Ixodes scapularis), American Dog tick (Dermacentor variabilis), Lone star tick (Amblyomma americanum, most common), blood transfusion and organ transplant.
Signs and Symptoms: Fever, chills, headache, muscle aches, upset stomach.
Pathogenesis: Obligate intracellular bacteria that likes to infect monocytes and macrophages.
Treatment: Doxycycline.
Distribution: Most frequently reported from southeastern and south-central US.
HUMAN MONOCYTIC EHRLICHIOSIS
Names: Borrelia miyamotoi (Hard-tick relapsing fever)
Transmission: Blacklegged tick (Ixodes scapularis, Ixodes pacificus)
Signs and Symptoms: Need more information, appears to be Lyme-like symptoms: fever, chills, fatigue, severe headache, arthralgia/myalgia.
Pathogenesis: Unknown.
Treatment: Doxycycline (same as Lyme disease).
Distribution: Upper Midwest, Northeast, mid-Atlantic states, highest in July and August.
HARD-TICK RELAPSING FEVER
Transmission: Blacklegged tick (Ixodes scapularis), Woodchuck tick (Ixodes cookei), Squirrel Tick (Ixodes marxi), American Dog tick (Dermacentor variabilis), Rocky Mountain wood tick (Dermacentor andersoni).
Signs and Symptoms: Fatal neuroinvasive disease; Starts with: fever, headache, vomiting, weakness, and can lead to: confusion, loss of coordination, slurred speech, seizures.
Pathogenesis: It takes 15 min of tick feeding for Powassan virus for transmission. Infects the brain and spinal cord.
Treatment: No treatment.
Distribution: Primarily in the Northeast and Great Lakes Region.
POWASSAN VIRUS
Name: galactose-α-1,3-galactose
Description: An allergy to the Alpha-gal sugar molecule commonly found in products made from mammals, occurring 3-6 hours after consumption and exposure to these mammalian products.
Signs and Symptoms: Rash, hives, difficulty breathing, drop in blood pressure, dizziness, nausea, vomiting, severe stomach pain.
Distribution: Highest in Southeastern and Midwestern US.
Transmission: We need more definitive research to determine if tick bites can cause an alpha-gal allergy, but several data suggests it’s association especially with Lone Star Tick (Amblyomma americanum)
Treatment: Avoidance of mammalian food and products.
ALPHA-GAL ALLERGY
Name: galactose-α-1,3-galactose
Description: An allergy to the Alpha-gal sugar molecule commonly found in products made from mammals, occurring 3-6 hours after consumption and exposure to these mammalian products.
Signs and Symptoms: Rash, hives, difficulty breathing, drop in blood pressure, dizziness, nausea, vomiting, severe stomach pain.
Distribution: Highest in Southeastern and Midwestern US.
Transmission: We need more definitive research to determine if tick bites can cause an alpha-gal allergy, but several data suggests it’s association especially with Lone Star Tick (Amblyomma americanum)
Treatment: Avoidance of mammalian food and products.
Ehrlichiosis
An illness caused by bacteria, that can be spread by Lone Star ticks. The illness causes fever, muscle aches, and other symptoms.
Tularemia
A disease that can infect animals and people. Rabbits, hares, and rodents are especially susceptible and often die in large numbers during outbreaks. The signs and symptoms of tularemia in humans vary depending on how the bacteria enter the body. Illness ranges from mild to life-threatening. All forms are accompanied by fever, which can be as high as 104 °F.
Southern Tick Associated Rash Illness (STARI)
Name: “Lyme Like Disease”; Debatably caused by Borrelia lonestari
Transmission: Amblyomma americanum (Lone Star Tick)
Signs and Symptoms: Rash, Fever, Fatigue, Headache, Muscle Joint pain
Treatment: Oral Antibiotics usually Doxycycline
Distribution: Expanding distributions from Midwest and Southern US to Northern states.
Heartland Virus
Name: Bandavirus
Transmission: Amblyomma americanum (Lone Star Tick)
Signs and Symptoms: Fever, Fatigue, loss of appetite, Headache, Nausea, Diarrhea, muscle joint pain, low white blood cell counts
Treatment: No specific treatment against this virus.
Distribution: Midwest and Southern US, where deer is a predominant reservoir host. There are no commercially available kits for diagnosis and up to 50 confirmed cases.
References:
CDC
Maine COOP extension
Wikipedia