by Camille Cunningham
For anyone living in the northeast, summer is the time to look out for ticks and the diseases they frequently carry. Ticks are most active late spring through early fall, but when the weather turns hot, jeans and long sleeves give way to t-shirts and shorts, leaving bare skin vulnerable to these bloodsucking pests.
Recent news reports say 2017 may be a banner year for ticks and Lyme disease due to two consecutive mild winters in the region. To make matters worse, Powassan, a less common, but potentially more serious tick-borne infection, may be on the rise. While very rare, the stakes are extraordinarily high. Inflammation of the brain can occur, leading to death in 10% of cases and long-lasting neurological deficits in another 60%. Unlike Lyme, which typically takes 24-to-36 hours to transfer from tick to host, Powassan can infect its victim in as little as fifteen minutes. There is no known treatment.
Nationally recognized Lyme disease expert and director of infectious disease at New York Medical College, Dr. Gary Wormser, doesn’t want people to overreact. “Powassan is very rare,” he said. There have only been two documented cases in the past three years in Westchester, with a third case yet to be officially reported. “There has not been a striking increase in the disease,” he said, rebuffing news reports.
Wormser is the director and founder of the Lyme Disease Diagnostic Center, a walk-in clinic for the care and study of patients with tick-borne infections, based at the New York Medical College in Hawthorne. He established the clinic 29 years ago. “I saw people needing help and I felt obligated to do something,” he said. Open June to August, it is a sort-of urgent care center for tick-borne infections. Anyone over 18 with suspicious symptoms, a rash, or recently bitten by a tick, can drop in from 5-7 p.m. Monday, Wednesday or Thursday. No appointment is necessary and virtually all insurance is accepted, including Medicare and Medicaid. Rash checks are free. He encourages those who have been bitten to retain the tick. An entomologist on staff can determine if it carries disease.
More concerning than Powassan, said Wormser, is babesiosis. “Until 2001 we didn’t see this disease in Westchester,” he said. “It was found mostly on Nantucket, Cape Cod, Block Island, and Shelter Island, but it has spread inland.” Last year the Westchester Center Medical lab diagnosed 21 cases. Because babesiosis is caused by a parasite, not by bacteria like Lyme, the approach to treatment is very different. “It is similar to malaria,” said Wormser. “The tipoff is a fever and laboratory abnormalities.”
One of his patients, Barbara, an active 50+ year-old professional who owns her own business, never noticed a tick on her body but came down with extreme flu-like symptoms: “A murderous headache, extreme fatigue, stiff neck, body aches, and chills and sweats,” she said. Her internist first diagnosed her with summer flu, but she wound up in the hospital, diagnosed with pneumonia. Three times, her symptoms gradually receded, only to return again after a week or so. When laboratory tests turned up positive for both Lupus and Hepatitis C, her doctor grew skeptical and referred her to Dr. Wormser. Treated with Mepron (a medication also used with Malaria) and azithromycin, she made a complete recovery.
Babesiosis often goes unnoticed because in 25% of adults and 50% of children, it is entirely asymptomatic and thus can be passed unwittingly through blood donations (blood banks do not yet screen for it), or to unborn children. There have been multiple cases of its spread in each of these ways. Immuno-suppressed patients, those without spleens and the elderly fare much worse with the disease and should be extra cautious.
Prevention is the key to all tick-borne diseases, as there is no vaccine currently for humans. The Center for Disease Control (CDC) recommends using an insect repellent that contains at least 20% DEET on exposed skin (excluding hands and face) and permethrin to treat clothing, especially shoes and socks, where ticks generally start their journey. Local mom Melissa Ray of Sleepy Hollow has battled ticks throughout her son’s years at summer camp with conscientious use of permethrin. Her son contracted Lyme at age five and was successfully treated with antibiotics, but when she used insect repellant on him, he broke out in hives. She first purchased clothes treated with permethrin from LL Bean, but then found it less expensive and more convenient to send his camp clothes to a company she found online that treat them with permethrin (www.insectshield.com). Now 16, her son has not had another tick encounter.
Besides diligent use of repellents, the CDC recommends avoiding areas with thick vegetation, high grass or leaf litter, walking in the center of trails when hiking, and showering as soon as possible after coming indoors. It also recommends tumble-drying clothes on high heat for ten minutes to kill ticks that may be on clothes. Do not wait to see a doctor to remove a tick; since the longer it is attached the more likely an infection can occur. A tick can be removed with simple tweezers, grasping the tick as closely to the point of attachment as possible and pulling slowly but firmly. Clean the site with an antiseptic such as rubbing alcohol.
For more information call the Lyme Disease Diagnostic Center, (914) 493- TICK (8425). Patients with long-term symptoms should call the Division of Infectious Disease at Westchester Medical Center/New York Medical College, (914) 493-8865, and for patients under 18, the Pediatric Lyme Disease Center (914) 493-8333.