Rare tick-borne disease on rise in Ontario
Artist Alice Hinther's high-energy life came to a screeching halt on July 6 when she suddenly began to feel sick with flu-like symptoms. When the fever, aches, sore throat, nausea and exhaustion continued, she dragged herself to Smiths Falls, near her cottage, for a COVID-19 test.
That test came back negative, but Hinther's condition worsened.
She eventually ended up in isolation at the Kingston Health Sciences Centre, hooked up to oxygen and barely aware of her surroundings, while doctors tried to figure out what was making her so sick.
After four more negative tests, doctors were convinced it wasn't COVID-19, but they weren't sure what it was.
One of her doctors told Hinther they were trying another test, adding: “I am not making any promises.” But he was soon rushing back into her hospital room, saying, “We found it!”
What they found was anaplasmosis, a disease caused by a bacterium that is spread by the same blacklegged ticks that are responsible for Lyme disease.
This tick-borne illness is fatal in about one per cent of cases, according to the U.S. Centres for Disease Control. People over 60 and those who don't get treatment quickly are most at risk for severe outcomes.
It is treatable with doxycycline, the same antibiotic used to treat Lyme. It is rarer than Lyme disease. But doctors in Kingston, like health officials south of the U.S. border, are seeing a sharp rise in cases this year.
It is one more serious reason to take precautions to avoid being bitten by ticks.
“It was one of the scariest things I have ever been through,” says Hinther, who is now recuperating at home.
Warming winters have contributed to a rise in ticks that carry the bacterium Borrelia burgdorferi, which causes Lyme disease. But they are also contributing to more cases of anaplasmosis, which can develop when people and livestock are bitten by ticks carrying the bacterium Anaplasma phagocytophilum.
Until recently, it was practically unheard of in Ontario.
Researchers, including Dr. Gerald Evans, an infectious-disease specialist at Queen's University and Kingston Health Sciences Centre, reported the first known human case, acquired from a blacklegged tick in Ontario, only in 2018. The first cases reported in the U.S. date back to 1994, in Minnesota and Wisconsin.
Before Ontario's first case, doctors had seen the disease only in people who had travelled to parts of the U.S. where cases were more common.
That has changed this year. Doctors are seeing more cases of anaplasmosis than ever even though people haven't been travelling — meaning all of the cases were acquired by tick bites near home.
“There has been a rise in cases. Anecdotally, my colleagues and I are seeing a larger number than in past years,” Evans said. Kingston is one of Canada's hot spots for ticks.
“This is the first year I can remember that we have seen multiple cases in a relatively short period of time.”
Hinther says one of her doctors told her he has seen one case a week — but hadn't seen any until this year.
Health officials in upper New York State, where the illness is reportable, have also seen a spike in cases this year. As of early July, cases in Warren County, N.Y., not far from the Canadian border, had quadrupled from a year earlier.
Officials there say it's one more reason to take precautions to avoid tick bites. While ticks generally have to be attached to humans for more than 24 hours to transmit Lyme disease, there is evidence that transmission of anaplasmosis can occur faster, and no telltale rash is left behind. Ticks can be as small as a poppyseed.
Hinther wasn't aware of having been bitten by a tick.
Ottawa Public Health says it doesn't know of any human cases in the city, although there is no requirement for cases to be reported to public health, as there is with Lyme disease. That could change if anaplasmosis becomes more common in Ontario and public health officials see a need to track cases, Evans said.
Ottawa is considered an area at risk for Lyme disease. Recent research from uOttawa found that one in three blacklegged ticks tested in the city were positive for Lyme disease.
Evans said Lyme and anaplasmosis present quite differently. Lyme disease can appear more subtly, usually beginning with a rash, most often in the shape of a bull's-eye. Symptoms include joint and muscle aches, fatigue, headache and low fever. In later stages, Lyme can lead to cardiac and neurological problems, among other things.
Anaplasmosis usually causes fever, chills, severe headache, nausea, vomiting and muscle aches. It can also result in an enlarged liver and spleen as well as low white-blood-cell and platelet counts.
“They both make people feel pretty dreadful,” Evans said.
Hinther, 67, a multimedia artist known for her cards, calendars and stained glass, is now at home after more than a week in hospital.
Those days remain a bit of a blur. But after she began improving with antibiotic treatment, a doctor told her she was lucky to be alive.
“I don't think you realize how sick you were,” he said to her. “We thought we were going to lose you.”
Hinther is determined to warn others to protect themselves and meticulously check for ticks to avoid a similar ordeal.
“I have been to hell and back,” she said. “I just want people to know it could happen to you if it happened to me.”