Be tick smart: How to protect your family from tick-borne diseases

The weather is warm, the grass is growing and it’s the time of year when the ticks appear.

Tick-borne disease has increased significantly over the last decade. Some ticks can carry pathogens that can cause human disease. We are all familiar with Lyme disease but there are many others. Rocky Mountain Spotted Fever, Anaplasmosis, Babesiosis, Erlichiosis, Rickettsiosis, STARI, Tularemia, and tick-borne relapsing fever. Some of these are relatively new tick-borne diseases and others will likely continue to be identified in the future.

When should I worry about tick-borne disease? It is important to remember that not all ticks will carry pathogens that can cause human disease – actually most tick bites do not result in transmission of disease. For example, only about 2-3 percent of all persons bitten by Ixodes scapularis ticks in endemic areas develop Lyme disease. There can be secondary infections and allergic reactions at the site of a tick bite. The allergic reaction is caused by a reaction to proteins in the tick’s saliva. Sometimes a local skin infection will need to be treated with an antibiotic, topical or oral. The allergic reactions can be treated with an antihistamine, again topical or oral.

Some signs and symptoms of tick-borne illness that should prompt you to see your doctor.

According to the Centers for Disease Control, the most common symptoms of tick-related illnesses are:

Fever/chills: With all tickborne diseases, patients can experience fever at varying degrees and time of onset.

Aches and pains: Tickborne disease symptoms include headache, fatigue, and muscle aches. With Lyme disease you may also experience joint pain. The severity and time of onset of these symptoms can depend on the disease and the patient’s personal tolerance level.

Rash: Lyme disease, southern tick-associated rash illness (STARI), Rocky Mountain spotted fever (RMSF), ehrlichiosis, and tularemia can result in distinctive rashes:
• In Lyme disease, the rash may appear within 3-30 days, typically before the onset of fever. The Lyme disease rash is the first sign of infection and is usually a circular rash called erythema migrans or EM. This rash occurs in approximately 70-80 percent of infected persons and begins at the site of a tick bite. It may be warm, but is not usually painful. Some patients develop additional EM lesions in other areas of the body several days later.
• The rash of STARI is nearly identical to that of Lyme disease, with a red, expanding “bulls eye” lesion that develops around the site of a lone star tick bite. Unlike Lyme disease, STARI has not been linked to any arthritic or neurologic symptoms.
• The rash seen with Rocky Mountain spotted fever varies greatly from person to person in appearance, location, and time of onset. About 10 percent of people with RMSF never develop a rash. Most often, the rash begins 2-5 days after the onset of fever as small, flat, pink, non-itchy spots (macules) on the wrists, forearms, and ankles and spreads to the trunk. It sometimes involves the palms and soles. The red to purple, spotted rash of RMSF is usually not seen until the sixth day or later after onset of symptoms and occurs in 35-60 percent of patients with the infection.
• In the most common form of tularemia, a skin ulcer appears at the site where the organism entered the body. The ulcer is accompanied by swelling of regional lymph glands, usually in the armpit or groin.
• In about 30 percent of patients (and up to 60 percent of children), ehrlichiosis can cause a rash. The appearance of the rash ranges from macular to maculopapular to petechial, and may appear after the onset of fever.
Tick-borne diseases can result in mild symptoms treatable at home to severe infections requiring hospitalization. Although easily treated with antibiotics, these diseases can be difficult for physicians to diagnose. However, early recognition and treatment of the infection decreases the risk of serious complications. So see your doctor immediately if you have been bitten by a tick and experience any of the symptoms described here.

Prevention is key. Try and avoid contact with ticks. Avoid wooded and bushy areas with high grass and leaf litter. Walk in the center of trails.

Insect repellants are effective and safe. Use repellents that contain 20 percent or more DEET (N, N-diethyl-m-toluamide) on the exposed skin for protection that lasts up to several hours. Always follow product instructions. Parents should apply this product to their children, avoiding hands, eyes, and mouth. You can also use products that contain permethrin on clothing. You can treat clothing and outdoor gear, such as boots, pants, socks and tents. It remains protective through several washings. Pre-treated clothing is available and remains protective for up to 70 washings.
Other repellents registered by the Environmental Protection Agency (EPA) may be found at http://cfpub.epa.gov/oppref/insect/.

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. If you find a tick, remove it immediately. See this page on the CDC website for help on tick removal.

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 clothes in a dryer on high heat for an hour to kill remaining ticks.

It’s important to be able to be active and enjoy the beautiful outdoors we have on Long Island. Just remember to be “tick smart.” Prevention is the best medicine.

Fatema Meah, MD, FAAP

Dr. Meah graduated from Albert Einstein Medical School. She continued her pediatrics residency at the same institution and went on to serve as chief resident at the Children’s Hospital at Montefiore. She is a board certified pediatrician and is an Assistant Professor of pediatrics at Albert Einstein. In addition to practicing general pediatrics, she is director of Undergraduate Medical Education at Flushing Hospital.

Peconic Pediatrics, a division of Allied Pediatrics of New York, is located at 34 Commerce Dr., Suite 2, Riverhead, NY 11901 Tel. 631-722-8880