The Middletown Press (Middletown, CT)
Step by step: How to win the war against ticks
Dr. Peter Krause noticed a tiny new freckle in the center of his chest one day while shaving.
The day before, “I was on Block Island collecting ticks with my entomologic colleagues. I just wanted to see how it worked,” he said. The scientists collected ticks by running a felt cloth at the end of a pole through the grass and brush.
But that didn’t help him realize that the “freckle” was actually feeding on his blood. The next day, it was larger. He removed the tick and went on a course of the antibiotic doxycycline.
“It was a good example of how silent this was. I had no pain, no itch,” he said. That’s because a tick, when it latches on, injects proteins with its saliva that prevent itching and clotting. Those who have not been bitten a lot won’t feel the bite and can easily miss
the adult tick, which is the size of a poppy seed until it becomes engorged with blood, when it’s as big across as a pencil eraser, Krause said.
Oddly, people who have been bitten many times will feel it when a tick bites, because they’ve developed antibodies to the tick’s antiitch spit.
Intro: Which tick is it?
The blacklegged tick, Ixodes scapularis, also known as the deer tick, carries the bacteria that cause Lyme disease and anaplasmosis, as well as a protozoan parasite that infects red blood cells and causes babesiosis. Adults use white-tailed deer as hosts, while nymphs feed on white-footed mice, chipmunks, shrews and some birds.
Goudarz Molaei, director of the tick surveillance and testing program at the Connecticut Agricultural Experiment Station in New Haven, named two other, much rarer diseases that can come from the bite of the deer tick: relapsing fever and, the most serious, Powassan virus, which sometimes can be fatal.
Another common tick, the dog, or wood, tick, is common in Connecticut and can transmit Rocky Mountain spotted fever, but the disease is rare in the state, according to the experiment station.
The lone star tick, Amblyomma americanum, is far less common, but its numbers have been increasing in the state, particularly on deer living on islands off the Norwalk coast, where the experiment station is running a control program. The tick also has been found in New Haven County. It, too, travels on white-tailed deer. The only diseases it transmits are rare in Connecticut, however, Molaei said.
Krause said that when a tick feeds on its host, its sawlike proboscis sucks blood at the same time it injects saliva into the skin. “It has these large salivary glands and it spits proteins that will allow it to feed and one of these
proteins is an anticoagulant” that prevents clotting, he said. “Another prevents itch.”
It also produces “autoimmune factors,” preventing white blood cells from going to the site. “What that means is you’re not going to be able to detect the tick,” Krause said. It’s the saliva that carries the bacteria or parasite into the bloodstream.
“Spit-suck — that’s what it’s doing,” he said. “They’re doing this constantly while they’re feeding.”
But it takes some time for the Lyme bacteria to be transmitted. “It takes 36 to 48 hours for that Lyme agent to go into you,” Krause said. “If the tick’s been on you for 24 hours or less, you’re not going to get Lyme disease.”
So it’s important to “get the tick off as quickly as possible and … to take antibiotics, usually doxycycline, for 10 to 21 days. … If you’re bitten by a tick and … you take 200 milligrams one time, that will prevent in most cases your developing Lyme disease.
Step 1: Remove the tick
With a tweezers, “you grasp the head of the tick and pull it out,” Krause said. “If you do it [another] way, sometimes the mouth parts will stay.” He said a rash may develop and grow to be about 21⁄2 inches wide.
While only about 25 percent of deer ticks carry Lyme disease bacteria, and the chances of getting it are slim if the bite is found within 24 hours, “usually it’s about one or two weeks after the tick bite that you’re going to develop symptoms,” Krause said.
It’s also possible to get more than one disease from the same tick, he said, and while “the mortality rate for Lyme is less than 1 percent … for babesia it’s 2 to 20 percent.” Most fatalities from babesiosis are among people who are over 60 or have compromised immune systems.
In addition to fever and muscle aches, it’s possible for Lyme to infect the heart and the central nervous system. About 10 percent of patients get post-Lyme disease syndrome, he said, thought to be caused by the protein from the bacteria remaining in the
body after the organism is killed off.
Step 2: Submitting a tick for testing
While the experiment station does active tick surveillance, passive surveillance — ticks submitted by state residents — is the most helpful, Molaei said.
“We receive ticks from across the state, from every county and every town,” Molaei said. “We receive more ticks from more populated counties, including Fairfield and New Haven. It allows us to be well informed to what is happening throughout the state with regard to tick activity.”
The experiment station will identify any tick brought to a local health department or sent directly to its Huntington Street lab, but deer ticks are the only ones tested for disease.
“Unfortunately for blacklegged or deer ticks and dog ticks, in the great majority of cases they don’t even feel they are bitten,” at least not until the tick is engorged with blood, Molaei said. “In some cases, people may not notice and ticks could feed and drop off.” He said the telltale bull’seye rash is not always present.
“Once they realize or even suspect they’re been bitten by a tick, they have to immediately report to a physician,” Molaei said. Most doctors immediately will prescribe doxycycline.
“The No. 1 choice that they have is to bring the tick to a local health department,” Molaei said. The department then will forward the tick to the experiment station.
With the COVID-19 pandemic closing many offices, though, that may not be possible. “We were informed that a number of health departments are not accepting the public and not accepting ticks because they were involved in COVID work,” Molaei said.
“The second choice is to bring the tick to their physician’s office,” he said. “The third option is to send the tick or, if they live nearby, to bring the tick to us.”
Ticks can be put in hard containers (not glass) or a sealed plastic bag and mailed to the experiment station at 123 Huntington St., New Haven 06511.
It’s important to submit the tick, because tick-borne illnesses can have symptoms that mimic COVID, such as fever, headache and body pain. “Sometimes even there are certain particular illnesses that might present with gastrointestinal symptoms,” Molaei said.
“If the tick result turns out to be positive, then at that point the physician may continue or come up with an extended antibiotic treatment,” he said.
Step 3: Testing the tick
“We examine all ticks under a microscope in order to determine, first, their species, whether they are lone star ticks, deer ticks or other ticks,” Molaei said. “Then we also determine what life stage they are. Ticks are presented to us … as larvae, juvenile stage or teenager, or adult.”
There are two time periods when adult ticks are prevalent: April through May and then in October and November, Molaei said. In June and July, the nymphs are biting.
“Then we set aside only blacklegged or deer ticks,” if they are female adults or nymphs. “These are the only ones that pose great risk of infection to the public,” Molaei said. Male deer ticks do not feed on their hosts’ blood and do not spread Lyme disease.
Step 4: Looking for disease
The ticks then are ground up and their DNA isolated. “Then we proceed with a molecular biological method,” Molaei said. A polymerase chain reaction makes millions of copies of DNA and “would allow us to screen the DNA for evidence of infection,” he said.
The bacteria that cause Lyme disease and anaplasmosis live in the tick’s gut, while the babesia protozoa infects red blood cells.
“Once we find if the tick is positive or negative, we send the result to the health department, physician [and] residents,” Molaei said. But a tick testing positive for Lyme disease does not mean the person who was bitten will develop Lyme, if the tick was found soon enough. So the individual testing results are not reported to the state, Molaei said.
“At the end of every year we post all our findings,” he said. “We provide thorough detail of tick-testing results,” which are posted by town on the agency’s website. “Then we look at the data. We do data analysis: What are the areas in the state that ticks have a higher incidence of infection?” he said.
Trends also are analyzed.
“We try to understand what effect climate change is having on tick abundance, range expansion, dynamics of infection, prevalence of infection and co-infection of ticks.”
One trend is the increase in lone star ticks, from 0.2 percent to 3.2 percent last year and 4.4 percent so far this year, Molaei said. “The challenge is that a great majority of these towns now are coming from two counties and mostly from Fairfield County,” he said. The other, New Haven, lags because it is farther north and a bit colder, he said.
Step 5: The first step
The message for Molaei is that people should be watchful and do their best to prevent tick bites in the first place.
“They need to stay at the center of trails” and stay out of grassy, bushy or wooded areas, he said. “Be careful not to let their dog stray away and go to those wooded areas.”
Other precautions include tucking pant legs into one’s socks, wearing long sleeves, uand sing insect repellant that contains DEET both on the skin and sprayed on clothes.