Tick trauma

Tiny insect nearly did in veteran deputy
By JODIE TWEED
Staff Writer
Brainerd Daily Dispatch - Brainerd,MN,USA

CROSSLAKE -- In his 27-year career as a deputy with the Crow Wing County Sheriff's Department, Jan Mezzenga has had several harrowing experiences.

He wrestled with a large psychiatric patient at Building 22 at the Brainerd Regional Human Services Center three years ago, causing a knee injury that still bothers him today.

Mezzenga once responded to a man's request to speak to a law enforcement officer. When Mezzenga arrived at the home, the suicidal man pulled a double-barreled 10-gauge shotgun on him and told Mezzenga to kill him. The situation eventually ended peacefully.

And in an infamous scene that made statewide headlines last May, Mezzenga's squad car was rammed by a manure spreader and showered with a load of manure by the grandfather of murder suspect William Myears when law enforcement officers obtained a search warrant to search his property in the Erika Dalquist case.

"Stuff happens to me," Mezzenga said with a smile.

But Mezzenga's most life-threatening situation can be traced back to a tiny deer tick.

Mezzenga, 57, nearly died after his spleen inexplicably ruptured last June, causing him to bleed internally. Doctors at St. Joseph's Medical Center in Brainerd removed his spleen in an emergency surgery, along with the near gallon of blood that had pooled in his abdomen.

While doctors don't understand why Mezzenga's spleen suddenly ruptured, they do believe they know what caused the rupture: a rare tick-borne disease that is quickly becoming not so uncommon in the Brainerd lakes area.

Mezzenga was diagnosed with not one, but three tick-borne illnesses: Lyme disease, ehrlichiosis and babesiosis. Babesiosis, which is caused by a parasite that lives on some types of ticks and is similar to malaria, can be fatal for people who have had their spleens removed or have a suppressed immune system.

But Mezzenga's case is the only one, possibly in the world, in which a healthy person's spleen suddenly ruptured because of babesiosis. Mezzenga's spleen samples are now being studied and a St. Joseph's pathologist is co-authoring a case report for a national medical journal about Mezzenga's case.

What is babesiosis?

Babesiosis (pronounced bah-be ze-o-sis) is a tick-borne illness caused by a parasite that lives on some types of ticks.

Although the disease is considered rare, there have been several cases of babesiosis diagnosed in Crow Wing County.

Most cases are mild, but can develop into a severe infection and can be fatal, particularly for people who have had their spleen removed or have a suppressed immune system.

Symptoms are similar to erhlichiosis and include a sudden high fever, chills, sweating, fatigue, poor appetite and a severe headache. Some people with this illness may not have symptoms.

Antibiotics are administered to treat babesiosis, which is diagnosed via a blood test.

Mezzenga has become a medical anomaly.

"We're hoping it was just a fluke because there are a lot of ticks out there," said Dr. Nick Bernier, director of medical affairs at St. Joseph's. "Why Jan's spleen didn't take care of it (babesiosis), we don't know. We think he was just unlucky."

Mezzenga underwent a hernia operation June 13 and was recuperating at home when his health took a turn for the worse. By June 25, he had lost his appetite, was suffering from a constant fever and chills, was profusely sweating and had lost 10 pounds in five days. He had no energy. Walking to his garage was a chore.

"Basically, I felt like I got run over by a truck," said Mezzenga.

Since he was suffering from pain in his abdomen so soon after his hernia operation, Mezzenga made an appointment with Dr. Ross Bengston, who performed his operation. But Bengston told him the pain couldn't be caused by the surgery and suspected he may be suffering from Lyme disease. He immediately referred Mezzenga to another physician. Mezzenga tested positive for Lyme, was given antibiotics and sent home.

About 3 a.m. Mezzenga, suffering from incredible pain in his abdomen, passed out on his living room floor, eventually waking and managing to sit down in a chair. His wife, Doris, a Crow Wing County sheriff's dispatcher, awoke and found him in the living room. Despite his pain, he didn't want to drive from their Crosslake home to the Brainerd hospital to only be given pain medication, he said. His wife gave her stubborn husband three choices, he said. She told him he could go to the St. Joseph's emergency room by ambulance, go with her in their car or she'd call on-duty sheriff's deputy Tim Clarine to "throw you in a squad car and take you to the hospital."

"I know better than to argue with her," said Mezzenga, who rode with his wife to the hospital.

When Mezzenga arrived at the emergency room, his blood pressure was so low he couldn't be given pain medication. The hospital staff worked vigorously to save his life, running eight IVs in his body at one time in an attempt to get his blood pressure back up so he could undergo surgery. Bengston and Dr. James Dehen performed the life-saving operation in which they had to remove his spleen.

Doctors ran blood tests and discovered that Mezzenga had both Lyme disease and ehrlichiosis. The St. Joseph's pathology department went back over his blood smear to attempt to figure out why his spleen ruptured. It was then they found intracellular parasites in his blood, a sign of babesiosis.

Bernier has since joked with Mezzenga, telling him he won the tick lottery. He had suffered through all three tick-borne diseases found in Crow Wing County.

Bernier said now St. Joseph's Medical Center is performing automatic babesiosis tests on any patients who are sick enough to be hospitalized from Lyme disease or ehrlichiosis.

"It's a sneaky disease," said Bernier, of babesiosis. "If you're not familiar with it, it can sneak up on you."

Bernier said St. Joseph's sees a few cases of babesiosis a year, but usually in older patients without spleens or those with a compromised immune system. Many times healthy people with babesiosis don't realize they have it; their body fights off the disease.

Dr. Dianne Kendall, a pathologist at St. Joseph's, will co-author a case report with another academic physician that they hope to have published in a national medical journal about Mezzenga, though he won't be named.

"It's not unusual for someone to have multiple tick diseases at the same time but having his spleen rupture is unique," said Kendall.

Dr. Joe Howard at Brainerd Medical Center is continuing with follow-up patient care for Mezzenga. Mezzenga will have to take antibiotics for the next seven years to help ward off any illnesses because he no longer has a spleen.

"I've had patients who don't remember having a tick bite," Howard said of those diagnosed with a tick-borne disease. Mezzenga doesn't remember finding a deer tick on him either.

While people who contract a tick-borne illness won't likely become as ill as Mezzenga, they need to be aware that Crow Wing County has an unusually high rate of the diseases. Bernier said St. Joseph's has already had three patients hospitalized with severe cases of ehrlichiosis this spring and the tick season has just begun.

Symptoms of Lyme disease include a bull's-eye rash that may have a reddened area with a clear area in the middle at the original site of the tick bite. It also may appear in several other places in the body. Other symptoms include a fever, headache, chills, muscle and joint pain.

Ehrlichiosis symptoms usually start about 5-10 days after a person has been bitten by an infected deer tick or black-legged tick but can take up to a month to appear. Symptoms are similar to Lyme disease and include a sudden fever of 102 degrees or more, chills, shaking, fatigue, severe headache, muscle and joint pain, nausea and vomiting, cough, stomach pain and a sore throat. It is rare to have a stuffy nose or sinus problems with Ehrlichiosis, which can help distinguish the disease from the flu, a bad cold or sinus trouble. Like Lyme disease, ehrlichiosis can be treated with antibiotics.

Mezzenga has been on medical leave since March and is undergoing physical therapy for his knee injury. He said he's trying to get better so he can return to the sheriff's department, a job he's enjoyed for 27 years.