Nice weather can bring tick illnesses

BY STAFF REPORTS
05/25/2017 12:00 PM
Main Cherokee Phoenix
This Centers for Disease Control shows a map with 2010 incidence rates for ehrlichiosis in the United States. Oklahoma had a rate of 3.3 to 26 cases per million, one of the highest. CENTERS FOR DISEASE CONTROL
Main Cherokee Phoenix
This Centers for Disease Control shows a map with incidence rates for Rocky Mountain spotted fever shows Oklahoma with an incidence rate of 19 to 63 cases per million, one of the highest in the United States. The American dog tick, Rocky Mountain wood tick and brown dog tick can carry the disease. CENTERS FOR DISEASE CONTROL
Main Cherokee Phoenix
This Centers for Disease Control shows a map with incidence rates for tularemia. Most incidences occur in the Midwest and Plains states as well as the Rocky Mountain areas. CENTERS FOR DIESEASE
Main Cherokee Phoenix
With warmer weather here, ticks such as this lone star tick can carry different diseases such as ehrlichiosis and tularemia. COURTESY
TAHLEQUAH, Okla. – People tend to spend more time participating in outdoor activities in warmer weather. But it’s important to remember that warmer weather brings ticks and the illnesses they can carry.

Oklahoma ranks among the states with the highest rates of ehrlichiosis, Rocky Mountain spotted fever and tularemia, and May through August are the months when ticks are most active.

Ehrlichiosis

Human ehrlichiosis is caused by Ehrlichia chaffeensis, Ehrlichia ewingii and a third Ehrlichia species provisionally called Ehrlichia muris-like.

Ehrlichiae are transmitted to humans by the bite of an infected tick. The lone star tick is the primary vector of both Ehrlichia chaffeensis and Ehrlichia ewingii in the United States. Typical symptoms include fever, headache, fatigue, chills, nausea, vomiting, diarrhea, confusion, rash and muscle aches. Usually, these symptoms occur within one to two weeks following a tick bite.

Ehrlichiosis is an illness that can be fatal if not treated correctly. The estimated fatality rate is 1.8 percent. Patients who are treated early may recover quickly on outpatient medication, while those who experience a more severe course may require intravenous antibiotics, prolonged hospitalization or intensive care.

The severity may depend on the patient’s immune status. People with compromised immunity caused by immunosuppressive therapies, HIV infection or splenectomy appear to develop a more severe disease and may also have higher fatality rates.

Doxycycline is the first line treatment for adults and children of all ages and should be initiated immediately whenever ehrlichiosis is suspected.

Use of antibiotics other than doxycycline and other tetracyclines is associated with a higher risk of fatal outcome for some rickettsial infections. Doxycycline is most effective at preventing severe complications from developing if it is started early in the course of disease. Therefore, treatment must be based on clinical suspicion alone and should always begin before laboratory results return.

Rocky Mountain spotted fever

RMSF is caused by the bacterium Rickettsia rickettsia and is transmitted to humans by the bite of infected ticks. In the United States, these include the American dog tick, Rocky Mountain wood tick and brown dog tick.

Typical symptoms include fever, headache, abdominal pain, vomiting and muscle pain. A rash may also develop, but is often absent in the first few days, and in some patients, never develops. RMSF can be severe or even fatal if not treated in the first few days of symptoms. Doxycycline is the first line treatment for adults and children of all ages, and is most effective if started before the fifth day of symptoms.

The first symptoms of RMSF typically begin two to 14 days after the bite. The disease frequently begins as a sudden onset of fever and headache and most people visit a health care provider during the first few days of symptoms. Because early symptoms may be non-specific, several visits may occur before the diagnosis is made and correct treatment begins. It is a serious illness that can be fatal in the first eight days of symptoms if not treated correctly.

A classic case involves a rash that first appears two to five days after the onset of fever as small, flat, pink, non-itchy spots (macules) on the wrists, forearms, and ankles and spreads to include the trunk and sometimes the palms and soles. Often the rash varies from this description, and people who fail to develop a rash, or develop an atypical rash, are at increased risk of being misdiagnosed.

The red to purple, spotted (petechial) rash is usually not seen until the sixth day or later after onset of symptoms and occurs in 35 percent to 60 percent of patients with the infection. This is a sign of progression to severe disease, and every attempt should be made to begin treatment before petechiae develop.

Doxycycline is the first line treatment for adults and children of all ages and should be initiated immediately whenever RMSF is suspected.

Tularemia

The bacterium that causes tularemia is highly infectious and can enter the human body through the skin, eyes, mouth or lungs. In the United States, ticks that transmit tularemia to humans include the dog tick, the wood tick and the lone star tick. Deer flies have been shown to transmit tularemia in the western United States.

The signs and symptoms of tularemia 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 degrees Fahrenheit. Main forms of this disease are:

• Ulceroglandular. This is the most common form of tularemia and usually occurs following a tick or deer fly bite or after handing of an infected animal. A skin ulcer appears at the site where the bacteria entered. The ulcer is accompanied by swelling of regional lymph glands, usually in the armpit or groin.

• Glandular. Similar to ulceroglandular tularemia but without an ulcer. Also generally acquired through the bite of an infected tick or deer fly or from handling sick or dead animals.

• Oculoglandular. This form occurs when the bacteria enter through the eye. This can occur when a person is butchering an infected animal and touches his or her eyes. Symptoms include irritation and inflammation of the eye and swelling of lymph glands in front of the ear.

• Oropharyngeal. This form results from eating or drinking contaminated food or water. Patients with oropharyngeal tularemia may have sore throat, mouth ulcers, tonsillitis and swelling of lymph glands in the neck.

• Pneumonic. This is the most serious form of tularemia. Symptoms include cough, chest pain, and difficulty breathing. This form results from breathing dusts or aerosols containing the organism. It can also occur when other forms of tularemia (e.g. ulceroglandular) are left untreated and the bacteria spread through the bloodstream to the lungs.

• Typhoidal. This form is characterized by any combination of the general symptoms (without the localizing symptoms of other syndromes).

Tularemia is a rare disease, and the symptoms can be mistaken for other, more common, illnesses. It is important to share with your health care provider any likely exposures, such as tick and deer fly bites, or contact with sick or dead animals.

Antibiotics used to treat tularemia include streptomycin, gentamicin, doxycycline and ciprofloxacin. Treatment usually lasts 10 to 21 days depending on the stage of illness and the medication used. Although symptoms may last for weeks, most patients completely recover.

Preventive Measures

While it is a good idea to take preventive measures against ticks year-round, be extra vigilant in warmer months when ticks are most active.

• Avoid wooded and brushy areas with high grass and leaf litter.

• Walk in the center of trails.

• Use repellent that contains 20 percent or more DEET, picaridin, or IR3535 on exposed skin for protection that lasts several hours.

• Always follow product instructions. Parents should apply this product to their children, avoiding hands, eyes, and mouth.

• Use products that contain permethrin on clothing. Treat clothing and gear, such as boots, pants, socks and tents with products containing 0.5 percent permethrin. It remains protective through several washings. Pre-treated clothing is available and may be protective longer.

• Bathe or shower as soon as possible after coming indoors (preferably within two hours) to wash off and more easily find ticks that are crawling on you.

• Conduct a full-body tick check using a hand-held or full-length mirror to view all parts of your body upon return from tick-infested areas. Parents should check their children for ticks under the arms, in and around the ears, inside the belly button, behind the knees, between the legs, around the waist, and especially in their hair.

• Examine gear and pets. Ticks can ride into the home on clothing and pets, then attach to a person later, so carefully examine pets, coats and day packs.

• Tumble dry clothes in a dryer on high heat for 10 minutes to kill ticks on dry clothing after you come indoors.

• If the clothes are damp, additional time may be needed.

• If the clothes require washing first, hot water is recommended. Cold and medium temperature water will not kill ticks effectively. If the clothes cannot be washed in hot water, tumble dry on low heat for 90 minutes or high heat for 60 minutes. The clothes should be warm and completely dry.

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