Beware the Pesky Tick

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Max Minnerop, M.D., Jerry Simons, RPA-C, Anna-Marie Wellins, DNP, Erin McGintee, M.D., Patricia Coyle, M.D., “Deerdra,” Southampton Hospital President and CEO Robert Chaloner, and Scott Campbell, Ph.D. Photo courtesy of Southampton Hospital

By Mahreen Khan

We may as well rename the spring and summer “tick season.”

Despite the bite and bull’s-eye rash that sometimes accompanies it, prevention methods are readily available, according to six medical professionals who made presentations at a symposium on tick-borne illnesses at the Southampton Arts Center on Saturday, July 15.

The three most common ticks on Long Island are the blacklegged, or deer tick, the American dog tick and the lone star tick. Each comes with its own set of pathogens and associated infections.

Lyme disease is a major tick-borne infection that East Enders need to be concerned about, according to the panelists. However, it is a bacterial infection that is treatable with appropriate antibiotics, said Dr. Patricia K. Coyle, M.D., a professor of neurology at Stony Brook University Medical Center and director of the Stony Brook Multiple Sclerosis Comprehensive Care Center.

Despite the fear surrounding deer ticks, “not everybody that gets inoculated with the bacterial spirochete, Borrelia burgdorferi, gets sick,” she said.

But that doesn’t mean people should ignore deer tick bites. A sure-fire way for a physician to diagnose Lyme disease is to see the bull’s-eye rash, the body’s reaction to the bite of a deer tick. Lyme disease targets the joints, heart and nervous system.

Most neurologic Lyme disease cases occur between the months of May and October, but can occur at other times of the year as well. Symptoms include a facial paralysis similar to Bell’s palsy. Also common are joint and muscle plains, headaches, a stiff neck, fatigue and tearing, hearing and taste abnormalities. Another symptom of early-onset Lyme disease is spinal pain.

Dr. Coyle said that up to 25 percent of facial nerve palsies reported on Long Island are caused by Lyme disease.

“And then the meningitis. Meningitis is inflammation of the lining membranes of the brain, so you get a bad headache, but it’s accompanied by a stiff neck. How would you check for that?” Dr. Coyle asked. “Put your chin to your chest. You’re stretching the meninges, which are inflamed.” Lyme meningitis, Dr. Coyle said, does not act like bacterial meningitis, which is life threatening. Instead, it is less severe, and patients typically recover after a few weeks.

What may appear three months after the initial infection with the Lyme bacteria is late neurologic Lyme disease, which can result in mild lapses in memory and cognitive abilities.

In children and adolescents, a common symptom is severe headaches. Another manifestation that may present with Lyme disease, is arthritis.

“If you have a clearly neurologic issue,” Dr. Coyle said, “it’s best to see a neurologist. Absolutely have an appropriate work-up, and that must include evaluation of spinal fluid. Intravenous antibiotics for documented or highly suspected neurologic diseases, I think, are really the best ways to go.”

It is typically between 24 and 72 hours after a bite that an infection will be contracted. When removing a tick that is not engorged and is free of blood, there is less of a likelihood that an infection was transmitted, said Dr. Max H. Minnerop, an emergency room physician at Southampton Hospital.

Another common tick, the lone star, causes the alpha-gal allergy, an oftentimes serious reaction to the meat of mammals. What predisposes some patients to developing the allergy is not yet known to scientists, but Dr. Erin E. McGintee, an immunologist with an office in Southampton, says patients who have been infected typically wake up in the middle of the night, three to six hours after eating mammal meat, with severe itching, redness and hives on their bodies. Those with more severe episodes can experience difficulty breathing or even die.

Dr. Minnerop said that from the view of preventing infection, the ticks to worry about are the deer and lone star.

“The deer tick carries anaplasma, powassan, Lyme and babesia,” he said. “The lone star tick carries ehrlichiosis. The reason we miss Lyme so often is, the nymph tick, which is the one that spreads most of the disease. It’s about the size of a poppy seed. Once it fills up and it’s engorged, it’s closer to the size of a sesame seed, but by that time often unfortunately it’s transmitted disease.”


Photo courtesy of Tick Ranger

Proper Tick Removal:

Place fine-tipped tweezers as close to skin as possible, trying to grab tick’s head or just above it. Pull straight up with a slow steady motion, and avoid breaking the tick. If tick’s head breaks off and stays in skin, do not fret. The entire tick body is necessary for disease transmission. Disinfect bite area with rubbing alcohol, soap and water or iodine. Apply a thick brown coat of iodine to the site and reapply every few hours to kill off germs.

Save the tick in a bag or pill vial to show to your doctor, and label the container with the date of removal and location of tick on body.

Monitor your health for a few weeks after being bitten, paying special attention to any development of rash, fever, aches, fatigue or swollen joints.

Courtesy Southampton Hospital Tick-Borne Disease Resource Center


Prevention: 

It is important to remember that ticks do not fly or jump. They come up from the ground via leaf litter or climb grass and plant stems, where they extend their front legs and wait for a potential host to pass by.

  • Check for ticks frequently and thoroughly.
  • Run a lint roller over your clothes when entering the house.
  • Apply repellents like DEET and permetherin, and reapply. Studies show essential oils and lavender are also effective.
  • Treat your shoes aggressively, because that’s where ticks first make contact. Also treat your clothing and wear long pants and sleeves, when possible.
  • Throw clothing in the dryer for 10 minutes upon entering the house.
  • Avoid tall grasses, leaf piles and brush. Walk along the center of a path.
  • Keep a “tick-safe” yard by mowing and raking.
  • Treat dogs and cats for ticks, as recommended by a vet. Get rid of bird baths, seed and food, because they attract birds which can drop ticks in your yard.
  • Consider placing a 3-foot wood chip border along the perimeter of your home. Ticks will rarely cross it.
  • Save toilet paper tubes and fill with cotton balls soaked in permetherin. Scatter them around your yard in April. Mice will use the cotton balls to help make their nests and kill ticks in the process.

Resources:

For information on ticks, prevention, safe removal and additional resources, contact:

Tick-Borne Disease Resource Center, Southampton Hospital
eastendtickresource.org
(631) 726-TICK
Request a free tick kit by contacting kwulffraat@southamptonhospital.org.

Centers for Disease Control and Prevention
cdc.gov/ticks/

University of Rhode Island TickEncounter Resource Center
tickencounter.org

Suffolk County Department of Health Services Arthropod-Borne Disease Laboratory
suffolkcountyny.gov/Departments/HealthServices/PublicHealth/PreventiveServices/ArthropodborneDiseaseProgram/Ticks.aspx 

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