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Tickborne diseases: It’s not just Lyme disease

Ticks are arachnids, like spiders, scorpions and mites,  from the Class Arachnida. While most tick bites do not transmit infectious disease, some very serious infections can be contracted from the bite of this vector.

The life cycle of ticks are complex that includes eggs, larvae, nymphs, and adult male and female ticks. Larvae, nymphs, and adult require blood meals where disease transmission occurs. Only Ixodidae (hard ticks) and Argasidae (soft ticks), are known to transmit diseases or illness to humans.

There are more than a dozen tickborne diseases in the United States and several others that are found only in other countries. Here is a brief introduction to seven tickborne diseases in the U.S.:

Lyme disease

This 2007 photograph depicts the pathognomonic erythematous rash in the pattern of a “bull’s-eye”, which manifested at the site of a tick bite on this Maryland woman’s posterior right upper arm, who’d subsequently contracted Lyme disease. Image/CDC/ James Gathany

This 2007 photograph depicts the pathognomonic erythematous rash in the pattern of a “bull’s-eye”, which manifested at the site of a tick bite on this Maryland woman’s posterior right upper arm, who’d subsequently contracted Lyme disease.
Image/CDC/ James Gathany

The Lyme disease bacterium, Borrelia burgdorferi, is spread through the bite of infected ticks. According to the Centers for Disease Control and Prevention (CDC), the blacklegged tick (or deer tick, Ixodes scapularis) spreads the disease in the northeastern, mid-Atlantic, and north-central United States, and the western blacklegged tick (Ixodes pacificus) spreads the disease on the Pacific Coast. Most humans are infected through the bites of immature ticks called nymphs.

Early stages of Lyme disease manifests itself with a red, expanding rash called erythema migrans (EM) seen about 70% of the time. In addition, non-specific symptoms like fatigue, chills, fever, headache, muscle and joint aches, and swollen lymph nodes.

Later symptoms may include Bell’s palsy, arthritis, severe headaches, heart palpitations and dizziness and shooting pains. Neurological symptoms may also be experienced. Many chronic Lyme sufferers experience these symptoms for years.

Lyme disease is wrought with controversy between the “medical establishment” and Lyme advocates. Controversy surrounds diagnosis and testing, treatment and geography, to name a few.

LISTEN: ‘Katrina’s Recovery’ author discusses battle and recovery from Lyme disease

Anaplasmosis

The organism that causes this disease is called Anaplasma phagocytophilum. It is an intracellular pathogen that is part of the Rickettsia (the same group of bacteria that cause Rocky Mountain spotted fever amongst other diseases) family.

Formerly known as human granulocytic ehrlichiosis, and as the former name of the disease implies, it’s an infection of the white blood cells.

People get this infection through the bite of an infected tick. Depending on the part of the United States you are, the tick species is different: the eastern part of the country is the black-legged tick, Ixodes scapularis, and in the western part of the country, Ixodes pacificus, is usually involved. These are deer ticks that are also involved in the transmission of Lyme disease.

According to the Centers for Disease Control and Prevention (CDC), there are about 600-800 cases of anaplasmosisare reported to CDC each year. States reporting the highest incidence of anaplasmosis in 2006 were Minnesota, Wisconsin, New York, New Jersey, and Connecticut.

The disease is also seen throughout other parts of North America, Europe and Asia.

After a period of a couple of days to a few weeks, most people infected with Anaplasma show influenza- like symptoms (fever, malaise, headache, nausea, vomiting, diarrhea and respiratory symptoms such as a cough). Symptoms tend to be more severe in those that are immunosuppressed and the elderly.

There are specific antibody tests against Anaplasma phagocytophilum that can be used in the diagnosis of anaplasmosis. The treatment is doxycycline, the same antibiotic used to treat other related organisms.

Babesiosis

Babesiosis is a parasitic disease of the red blood cells which can be found worldwide: however, most documented cases have been found in the United States. Most human infections are attributed to the species, Babesia microti, while other species are less often seen in zoonotic infections.

“tetrad” configuration of these Babesia sp. trophozoites/CDC

“tetrad” configuration of these Babesia sp. trophozoites/CDC

It is seen most frequently in the Northeast (Connecticut, Massachusetts, New Jersey, New York and Rhode Island) and to a lesser extent in the upper Midwest (Minnesota and Wisconsin).

The parasite is typically transmitted through a tick bite, Ixodes scapularis in the U.S., from late spring to early fall. It can also be transmitted through blood transfusions and this is not restricted by geographical regions.

Depending on host factors (people without a spleen, immunocompromised) the disease can range from asymptomatic to life threatening.

Symptoms if present typically appear as non-specific flu like symptoms, fever, chills, body aches, and hemolytic anemia.

The danger for donated blood is that even asymptomatic people may have low-level amount of Babesia in the bloodstream from months to longer than a year making blood transfusion infections an issue. Tests for screening blood donors for Babesia are not available.

After getting infected, the presence of symptoms is variable depending on the host and parasite factors. Typically after tick borne transmission symptoms appear in one to three weeks and it may be weeks to months post blood transfusion.

Laboratory diagnosis of acute cases is by identifying the parasite within red blood cells microscopically. It is sometime difficult to differentiate from the malaria parasite (Plasmodium falciparum).

A combination therapy of clindamycin and quinine is standard care for severe infection. In addition, coinfections with lyme disease or anaplasmosis should be considered.

 Rocky Mountain Spotted Fever 

RMSF is a tick borne disease caused by the organism, Rickettsia rickettsii. Typically, the progress of the disease is a sudden onset of high fever, deep muscle pain, severe headache and chills. A rash usually appears on the extremities within 5 days then soon spreads to palms and soles and then rapidly to the trunk.

Characteristic spotted rash of Rocky Mountain spotted fever/CDC

Characteristic spotted rash of Rocky Mountain spotted fever/CDC

Fatalities can be seen in greater than 20% of untreated cases. Death is uncommon with prompt recognition and treatment. Still approximately 3-5% of cases seen in the U.S. are fatal.

The absence or delayed appearance of the typical rash or the failure to recognize it, especially in dark-skinned people cause a delay in diagnosis and increased fatalities. Early stages of RMSF can be confused with erlichiosis, meningococcal meningitis and enteroviral infection.

This infection is seen in the U.S. primarily April through September, mostly in the southeast and south central. In recent years, the most cases have been seen in Oklahoma and North Carolina. Few cases are actually seen in the Rocky Mountain region. Outside the U.S., cases have been reported in Argentina, Brazil, Canada, Columbia, Costa Rica, Mexico and Panama.

Tularemia

Also known as rabbit fever and deer fly fever,tularemia is caused by the bacterium Francisella tularensis. This bacterium is found in nature in rabbits, rodents, beavers, squirrels and several domestic and farm animals.

People commonly get infected from the bites of infected ticks (wood, dog) and deer flies. Hunters are at risk of infection following skinning, dressing and eating infected animals.

Drinking contaminated water has been implicated in tularemia infection. People also contract it through inhaling dust and hay that have rodent feces and carcasses.

There have been cases where people got infected from a domestic cat. It is believed that cats get the organism from contaminated prey and their mouth and claws become infected. Certain animal associated occupations are also associated with the disease; farmers, veterinarians, sheepherders and shearers.

LISTEN: Tularemia in the United States 2001-2010: An interview with a CDC Epidemiologist

The disease in people depends on how it is acquired. After infection, incubation can be a couple of days to weeks, with non-specific symptoms like fever, chills, headache, sore throat and diarrhea.

The way the organism enters the body frequently dictates the disease and degree of systemic involvement. The six syndromes are ulceroglandular, glandular, oculoglandular, oropharyngeal, typhoidal and the one with the highest mortality rate, pneumonic tularemia.

Powassan virus

Powassan virus infection is caused by an arbovirus, which is similar to the mosquito-borne West Nile virus, but it is transmitted to people by infected ticks. Fewer than 60 cases of the disease have been detected in the United States and Canada since its discovery in 1958.

Some people who are infected may experience mild illness or no symptoms. Powassan virus can also infect the central nervous system and cause brain inflammation. Looking for a job in health care? Check here to see what’s available

LISTEN: Maine CDC Director, Dr Sheila Pinette discusses Powassan virus

Heartland Virus Disease

This newest tickborne disease, first discovered in 2009, has infected 10 people to date. It has reported from Missouri, Tennessee and Oklahoma.  The Center for Disease Control and Prevention (CDC) studies to date have shown Heartland virus is carried by Lone Star ticks (Amblyomma americanum), which are primarily found in the southeastern and eastern United States. Additional studies seek to confirm whether ticks can spread the virus to people and to learn what other insects or animals may be involved in the transmission cycle.

Symptoms of Heartland virus disease can include fever, fatigue, headaches, muscle aches, loss of appetite, nausea, bruising easily and diarrhea. There is no specific treatment, vaccine or drug for Heartland virus disease. CDC developed the blood tests used to confirm the new cases of Heartland virus disease. CDC teams are working to further validate these tests and develop additional tests. As more is learned, CDC hopefully can develop a diagnostic test that public health laboratories could use to test for the virus. For more infectious disease news and information, visit and “like” the Infectious Disease News Facebook page

LISTEN: What do we know about Heartland virus disease? An interview with a CDC expert

Other tickborne diseases seen in the US include Ehrlichiosis, STARI (Southern tick-associated rash illness) , Colorado tick fever and Tickborne relapsing fever (TBRF) (Not all-inclusive).

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About the Author

- Writer, Co-Founder and Executive Editor of The Global Dispatch. Robert has been covering news in the areas of health, world news and politics for a variety of online news sources. He is also the Editor-in-Chief of the website, Outbreak News Today and hosts the podcast, Outbreak News Interviews on iTunes, Stitcher and Spotify Robert is politically Independent and a born again Christian Follow @bactiman63

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  28. arch stanton says:

    Why would an informative article alleging to “keep the truth in the headlines” trump “Heartland virus” over “ehrlichiosis”?

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