Tick bites cause more than Lyme

Poughkeepsie Journal - Poughkeepsie,NY,USA
By Dan Shapley
Poughkeepsie Journal

Local doctors are treating more patients than usual this summer for tick-borne diseases other than Lyme disease.

Some patients are infected with more than one tick-borne disease at the same time — and the fever, chills and aches initially caused by the infections seem to be more severe, two prominent doctors said.

"We've seen a lot more hospitalizations, and people have been a lot sicker," said Dr. Stuart Feinstein, a Poughkeepsie infectious disease specialist who specializes in the treatment of tick-borne diseases.

Feinstein said he's seen many more patients this year than in the past who appear to have ehrlichiosis (pronounced er-LICK-ee-osis). The disease's name recently has been officially changed to anaplasmosis, but most doctors and health experts still refer to it as ehrlichiosis.

Dr. Daniela Stokes, another Poughkeepsie infectious disease specialist who specializes in tick-borne disease treatment, said in addition to an increase in ehrlichiosis cases, she's seen more patients with babesiosis (pronounced ba-BEE-see-osis). The Lyme cases she's seen have progressed rapidly and resulted in more severe symptoms than in the past.

"We don't know if these bacteria and parasites are mutating into more virulent strains, or if there is some re-sistance developing because we treat so many of these infections in the area," Stokes said. "We're not sure what's going on."

Increase is seen

The Dutchess County Department of Health has tallied 69 cases of ehrlichiosis this year, compared to an average of 35 per year over the last five years. There are more under investigation, and many cases go untallied because early blood tests for ehrlichiosis are often inconclusive, said Andrew Evans, senior public health advisor for the Department of Health.

He said reported babesiosis cases are similar to past years. There have been an average of about four cases reported each year in the past five years. As with the other tick-borne diseases, many cases are not tallied.

"The bottom line is there seems to be an increase in cases of ehrlichiosis this year," Evans said.

The Ulster County Department of Health has also noticed a slight increase in ehrlichiosis cases, said Stacy Kraft, public health education coordinator.

Lyme disease is the most prevalent tick-borne disease. More than 1,000 Dutchess County residents are treated for the disease most years.

No rise seen in severity

The emergency room at St. Francis Hospital in Poughkeepsie has not witnessed the same trends the doctors described, said James Rawley, the chief physician assistant of emergency service.

Neurological symptoms of Lyme, like bells palsy, seem more common in the early stages of illness. Otherwise, emergency room doctors haven't noted any increases in tick-borne illness severity or incidence compared with past years.

"We've seen a tremendous increase, as we do every spring, summer and fall, but we anticipate that," he said. "Even people that come in with atypical symptoms, we presume a lot of times it's Lyme disease."

All three diseases are spread by the black-legged tick, a blood-sucking arachnid common in the Hudson Valley.

Black-legged ticks vary in size, depending on their life stage, from smaller than a poppy seed to about the size of a sesame seed. Also called deer ticks, they are found mostly in forests and brushy areas, and attach to people and animals that pass by.

Early treatment is must

Lyme and ehrlichiosis are caused by different bacteria; babesiosis, similar to malaria, is caused by a parasite. The patho-gens enter the body as the tick sucks blood.

If not treated early and effectively, Lyme can lead to chronic arthritis, fatigue and heart and neurological problems. There is some evidence ehrlichiosis and babesiosis can linger in the body if untreated, but long-term symptoms have not been observed, doctors said.

Lyme and ehrlichiosis can be treated effectively with antibiotics. Babesiosis has no specific treatment, but is sometimes treated with malaria drugs.

Jim Beretta, a Poughkeepsie resident, was diagnosed with ehrlichiosis last year after he felt fatigued, his muscles ached and a fever spiked as high as 104 degrees. It took two 21-day courses of antibiotics and several weeks of rest before he felt better.

"It took a long time for me to get my strength and energy back — weeks. I still sometimes wonder if I've really recovered 100 percent," he said. "I've gone back to my normal lifestyle, but I still think sometimes that I don't have the level of endurance and stamina I had prior to having the illness."

Symptoms listed

Doctors urged people to learn and quickly respond to early symptoms, which resemble the flu — fever, chills, body aches and fatigue. Lyme disease often causes a bull's-eye shaped rash, but the other illnesses do not.

Because the symptoms resemble viral infections, tick-borne illnesses can be misdiagnosed and left untreated.

"If you're having an illness over the summer — fever, chills, body aches — whereas in the past you might have thought it was a virus, you should consider ehrlichiosis," Feinstein said.

He said, in general, anyone with those symptoms persisting for more than two days should be treated with the antibiotic doxycycline as a precaution.

The doctors also recommended taking precautions to avoid being bitten by ticks.

Wearing long pants and using insect repellent can reduce the chance of being bitten.

People should also look over themselves and their children daily. If a tick is attached, grab it as close to the skin as possible with tweezers and pull it straight out so that the tick's mouth parts are removed but its body is not squeezed. The Health Department will identify ticks for free, but it costs to have them tested for disease.

"Definitely do nightly tick checks on the kids," Stokes said. "It's very easy to do tick checks once one learns how to do it."