Tick-borne diseases: Every man for himself

With tick season in full swing, opinions differ in medical community over bites, treatment

Suffice to say, the medical community has a tremendous amount to learn when it comes to ticks, tick bites and tick-borne diseases. And they would be the first to admit it.

Consider two of the country’s top tick experts don’t completely see eye-to-eye when it comes to the tiny bloodsuckers and how they harm humans.

Take Dr. Nevena Zubcevik, co-director of Harvard Medical School’s Dean Center for Tick Borne Illness. For several years she’s been sounding the alarm that veteran doctors — and even worse yet graduating medical students —

“Two to 5 percent [of ticks] at most transmit disease.”

aren’t nearly up to speed on a tick-borne disease epidemic that is growing worse by the day.

For instance, many doctors today will inform patients that a tick has to sink its razor sharp jaws into human flesh for 24 to 48 hours before the little bugger spits its debilitating Lyme bacteria or else some other disease-causing crud into an unsuspecting person’s bloodstream.

Not true, at least in the opinion of Dr. Zubcevik.

She says only after 10 to 15 minutes of the tick grinding its sword-like hypostome, curvy spines, and hooked teeth into a victim and it can inject who knows how many of the 10 most common strains of tick-related viruses.

Then there’s the muchhyped bull’s-eye rash one strains their eyes to see in the days and weeks after prying a tick from their waistband, shoulder, armpit or anywhere else that blood flows — and when one isn’t found the person assumes they are out of the woods, right? Wrong.

Dr. Zubcevik, in fact, told one audience of medical professionals that tick-bite victims who discover a bull’s eye rash (in medical pamphlets it often resembles the logo of the Target retail chain, which isn’t always the case) should consider themselves lucky, because she insists they appear only about 20 percent of the time.

And how about the medically trendy “two-day” course of doxycycline to cure the less severe tick bite?

If it was the Harvard doctor’s patient she’d prescribe up to 200 milligrams of doxycycline twice a day for 20 full days, regardless of how short a duration the tick fed on its host.

Reached by this newspaper to expand further on what is arguably unorthodox guidance on ticks, Dr. Zubcevik gave us a referral to her fellow tick expert here in the mid-Atlantic: Dr. John Aucott, director of the Johns Hopkins Lyme Disease Clinical Research Center in Maryland.

With more than 15 years of research experience on the crippling effects of Lyme, Dr. Aucott has published numerous studies on the characteristics of early Lyme disease, even the differences seen in males and females, with an emphasis on prospects for prevention, diagnosis and treatment.

Without question, Drs. Zubcevik and Aucott are in agreement on most tick matters, but they also have their differences when it comes to what the ordinary person should know when it comes to tick bites and what often follows in their wake.

For starters, Dr. Aucott is of the opinion that if a tick is discovered “very early” in the gorging process, he would recommend “not taking a full course” of precautionary antibiotics, particularly in areas like Rappahannock where tick bites are a regular occurrence.

“If you did that you’d be on antibiotics all spring, summer and fall long,” the doctor points out.

Rather, says Dr. Aucott, if the tick is removed within “48 hours” then a “single dose of prophylactic antibiotics” can often arrest development of Lyme disease, which remains difficult to diagnose.

“The baseline to remember is not all tick bites result in tick-borne diseases,” Dr. Aucott says. “Two to 5 percent [of ticks] at most transmit disease.”

As for a telltale rash? “I believe 70 to 80 percent get the rash,” answers the doctor, although it doesn’t always appear in the shape of the Target logo, er, bulls-eye.

Dr. Aucott, like others in the medical field, stresses that tick bite prevention is key.

People must take protective measures when outdoors, especially given “ticks are biting their way all up and down the coast from Virginia to Maine” and increasingly moving westward, he says.

“Just like when we get into a car and automatically put on a seatbelt to prevent injury,” he says. “We have to do the same thing with ticks.”

He rattles off the usual safety precautions, like powerful bug sprays, tucking pants into socks and shirts into pants, basically “staying out of the bushes.” And then performing thorough tick checks, which for families in Rappahannock County is a nightly ritual like brushing teeth.

And if no rash appears to warn of Lyme, sooner or later one of the other numerous signs of tick-borne diseases will likely appear, including but not limited to headaches, body aches, fever, chills, irregular heartbeat, malaise, shortness of breath and brain fog.

Amazingly, Dr. Aucott tells us that certain people with “healthy immune systems” can actually get Lyme and never know they even have it until the disease eventually disappears from their bodies. In other words, that headache might not have been from pollen after all.

Meanwhile, diagnosing tick-borne diseases remains a serious issue. Many people suffering from Lyme (bacterium Borrelia burgdorferi) or other tick-borne diseases don’t initially test positive in blood samples. And if left untreated those diseases can all spell serious medical consequences, including musculoskeletal, nervous system and heart problems. If getting tested, wait until any early stage of infection has passed.

With Lyme there is also the ELISA assay test, which looks for the disease’s antibodies, and then there’s the Western Blot assay, which is considered the most reliable test available today.

There is hope on the horizon. Dr. Aucott says the medical field continues its work on an effective Lyme disease vaccine for humans, albeit the process is taking “years to accomplish.” How many of the other tick-borne diseases, besides Lyme, such a vaccine might prevent remains to be seen.

Take the dreaded TBRDs (Tick Borne Rickettsial Diseases), which are not only difficult to diagnose, they are increasing in number, put more people in the hospital, and are deadlier than Lyme. TBRD symptoms sometimes don’t develop until “years” after the tick bite.

And then there’s two types of POW, or Powassan virus, which are also difficult to diagnose, more debilitating and deadlier than Lyme. Virginia has now recorded its first case of POW. No antiviral drug exists for the virus, which can be transmitted from the bites of six known species of ticks.

And beyond the mice and ticks that carry Lyme, woodchucks and squirrels can be infected with POW. Time interval for POW transmission to humans: less than 12 hours.

Fortunately, the majority of POW cases are in northern states, from New England into the upper Midwest, while Lyme disease rules here in the midAtlantic and Rappahannock County, especially now that we are approaching summer.

One more thing: if you have an opossum in your yard, keep it alive and hope for offspring. The National Wildlife Federation states that with the huge rise in deer tick populations and spread of Lyme “opossums act like little vacuum cleaners . . . with a single opossum hoovering up and killing as many as 4,000 ticks per week.”

Bottom line: Dr. Aucott says if you notice any fatigue, soreness or fever during these warmer months, be suspicious first of Lyme.

“We like to say there’s no summer flu,” is how the doctor puts it.

If no rash appears to warn of Lyme, sooner or later one of the other numerous signs of tickborne diseases will likely appear, including but not limited to headaches, body aches, fever, chills, irregular heartbeat, malaise, shortness of breath and brain fog.