By Prue Salasky, firstname.lastname@example.org | 757-247-4784
10:14 PM EDT, June 12, 2013
In Virginia the most common tick bite comes from the Lone Star tick. "You'll pick up 50 to 100 Lone Stars for every one black-legged tick," said David Gaines, state entomologist. Yet Lyme Disease, carried exclusively by the immature black-legged, or deer tick, is the most common tick-borne disease in the state, with more than 1,100 cases last year, according to Health Department statistics. Of those, the local region recorded only about two dozen.
Almost unknown in Virginia 10 years ago, Lyme Disease has spread steadily southward to include all of Virginia. "It's here and it's in any location," affirmed Gaines. "It's a troublesome disease. There's a lot of politics, anger and frustration around it — some of it justified. If you don't treat it in the early stages, then symptoms can last for years."
That's where the problem lies. By the time a blood test can verify Lyme Disease, then the symptoms shared by all tick-borne diseases in the early stages — fever, chills, muscle pain, headache, fatigue and possibly confusion, nausea and vomiting — have advanced to become difficult to treat. There's also the Southern Tick-Associated Rash Illness, STARI, caused by the bite of a Lone Star tick, which has a rash that mimics Lyme's.
Unlike other tick-borne diseases, such as Anaplasma, Ehrlichiosis and Babesiosis, untreated Lyme Disease can take hold and cause serious, years-long complications including neurological deficits and severe arthritis. Twenty years ago, Gloucester resident Trish Gurley, now 75, was misdiagnosed for several years and suffered joint swelling, short-term memory loss, hearing loss and intense pain, before she received intense antibiotic treatment that eased her symptoms, but left lasting deficits.
With the uncertainty surrounding its diagnosis, the Virginia General Assembly passed legislation this year requiring doctors to give literature to patients tested for Lyme Disease advising them about testing, notifying them that a negative test is not conclusive, and advising them to contact their physician with any questions about the disease. It is the only disease screening that carries this mandate in Virginia; it takes effect July 1.
Confusion is not confined to Lyme Disease. Rocky Mountain Spotted Fever, carried by infected American Dog ticks, routinely shows up as the second most common tick-borne disease in the state, according to Gaines. He believes it's a misrepresentation, citing 460 cases of Spotted Fever Rickettsiosis in the state last year, of which only one was identified as Rocky Mountain. (Tidewater Spotted Fever, discovered in Hampton Roads a decade ago, falls into the same rickettsiosis class.) If Rocky Mountain were really a big issue, there would be a lot of fatalities, he said, describing it as "a horrendous disease."
The immune response cannot be distinguished by a blood test, Gaines explained, and because of extensive exposure to the ubiquitous Lone Star tick, up to 20 percent of the healthy population test positive for the rickettsial organism, including himself. "I suspect that many had Ehrlichiosis, which only started being identified in the literature in the late 1990s, and doctors don't know about it," he said.
Beyond the difficulty in making a definitive diagnosis, the treatment is the same for all tick-borne diseases, with early intervention with antibiotics being the recommended course. "Anyone who's had a tick bite longer than 24 hours we treat with antibiotics. It's worth it," said Mark Hippenstiel, a family doctor with Patient First in Chesapeake, who saw a dozen confirmed cases last summer.
Avid outdoorswoman Mary Hyde Berg, a 74-year-old Gloucester resident, who owns a nature preserve, has been treated for Lyme Disease twice this year and five times since about 1990. "They're like little pieces of pepper, from fine-ground to coarse," she said, describing the deer tick. "They're not like the ticks we've always had here." The first time she observed the rash on her foot, she went to the dermatologist. Now she knows what to look for and to seek treatment quickly. "The antibiotics are very effective if taken properly," she said. "Not all deer ticks carry the bacteria. If you get them out within 24 hours there's supposedly no danger." She rejects the blood test as being inconclusive, so no longer bothers with it.
After a camping trip in the Blue Ridge Mountains last month, Smithfield resident Diana McFarland, 52, took herself to a doctor immediately. "I had at least six tick bites," she said, identifying them as Lone Star, "the large ones." She had no rash, but she threw up and felt as if she had the flu really badly. Blood tests came back negative for Lyme's, but her doctor prescribed antibiotics for 10 days and advised her to return for retesting later.
"I don't want to get sick again," McFarland said. "It was way worse than I'd ever had them. If you get off the beaten path, they latch on immediately wherever they can."
Ticks flourish in shady, wooded areas, leaf litter, walls and long grass and not in open fields, contrary to popular myth, said Gaines. "They're forest dwellers," he said. The Department of Health advises wearing long, light-colored (so you can see the ticks) clothing, tucked in, and spraying clothes with Permethrin to deter them. Exposed parts of the body can be sprayed with repellent containing DEET, but it should be used sparingly, particularly with children, and never applied under clothing.
If a tick attaches to your skin, the recommended method of removal is to grasp the tick's head — not body — with pointed tweezers held as close as possible to the skin and pulled straight out. A tick has to be attached for several hours before it can transmit infection. To ensure that ticks attached to clothing are killed, launder in hot water and dry on high heat, recommends the American Lyme Disease Foundation.
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