Better weather can bring tick illnesses

BY STAFF REPORTS
06/11/2018 09:00 AM
Main Cherokee Phoenix
Lone lone star ticks can carry the tick-borne illnesses ehrlichiosis and tularemia, according to the Centers for Disease Control. Oklahoma ranks among the states with the highest ehrlichiosis, Rocky Mountain spotted fever and tularemia rates, according to the CDC. POPULAR SCIENCE
TAHLEQUAH – People tend to spend more time outdoors in warmer weather. But it’s important to remember that warmer weather brings ticks and the illnesses they can carry.

According to the Centers for Disease Control, Oklahoma ranks among the states with the highest ehrlichiosis, Rocky Mountain spotted fever and tularemia rates, and May through August is the stretch of months when ticks are most active.

Ehrlichiosis

The lone star tick is the primary carrier of ehrlichiosis in the United States. 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 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. Therefore, treatment must be based on clinical suspicion alone and should always begin before laboratory results return.

Rocky Mountain spotted fever

RMSF is transmitted to humans in the United States mostly by the American dog, Rocky Mountain wood and brown dog ticks.

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.

Symptoms 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.

Tularemia

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

Symptoms 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 and usually occurs following a tick or deer fly bite or after handing of an infected animal. A skin ulcer appears 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. 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 rare, and symptoms can be mistaken for common illnesses. It’s 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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