Summertime in the First State means an increase in outdoor activities for many, and while the state’s beaches always draw large crowds, people also find their summer fun inland in the state’s woods and on its miles of trails.
But hiking and other outdoor activities in the summer also means a greater chance of an encounter with ticks, and the possibility of contracting one of many tick-borne diseases.
“Ticks are referred to colloquially as the sewers of the animal world,” says Garth Ehrlich, professor of microbiology and immunology at Drexel University School of Medicine. “They can carry multiple different types of pathogens that can carry viruses, they can carry bacteria, they can carry parasites.”
He says that, while there are a lot of possible conditions that can result from a tick bite, there are a few that are most common. Leading the list is Lyme disease.
“The two other pathogens that are most commonly associated with tick bites is another bacterium called Bartonella and then Babesia, which is a parasite in the same family as malaria,” Ehrlich says. “We call them the three Bs because the Lyme disease is caused by the Borrelia bacteria and then Bartonella and Babesia.”
Lyme disease, arguably the most well-known tick-borne disease, is characterized by flu-like symptoms and, in some cases, a very distinctive “bullseye” rash.
“The big sign is looking for that big target shape that occurs, and seeking treatment as well,” says Cara Kessler, a resident at Bayhealth Family Medicine.
Lyme disease has its own set of challenges, not just for those with the disease, but for health care providers as well. While many diseases begin to show signs in a matter of hours or days, it can be weeks or months before symptoms of Lyme disease make an appearance.
“It divides very slowly,” Ehrlich explains. “So people may be familiar with something like E. coli or something like that, or staph or strep. Those common bacteria will divide every 20 to 30 minutes under ideal conditions.The spirochete that causes Lyme disease, it divides about every 12 hours. And so by its nature, because it divides very slowly, it's almost always associated with chronic and long-term diseases, because it just takes a long time for it to get to the point where there's enough of it, to cause disease.”
It’s a diagnostic challenge, but it can also frustrate patients who are already feeling pretty bad.
“The average person who doesn't know that they've been bitten by a tick and just starts getting sick, they see between seven and 13 physicians before they actually get a diagnosis of Lyme disease,” Ehrlich says. “So it's emotionally very difficult on the patient because they keep seeing physicians and physicians are saying, ‘you don't have anything wrong.’”
But, if you can catch it early, Lyme disease can be treated with a round of antibiotics, says Preeti Gupta, a primary care doctor with Bayhealth.
“If we catch a patient within 72 hours of a tick bite or removal of the tick, we can give them the medication to prevent Lyme disease,” she says.
One advantage for those who catch a tick bite early enough is that it takes the tick awhile to actually transmit Lyme disease to a person.
“Just seeing a tick in the body doesn't cause Lyme disease,” Gupta says. “It has to be attached to the skin and present there for at least more than 24 hours.”
Also important, she says, is that not every tick carries Lyme disease.
“Maybe 10% of the ticks might be infected with the bacteria which can cause Lyme disease,” she adds.
But what about long-term consequences, especially if you don’t catch a tick in time? Left undiagnosed or untreated, tick-borne conditions can turn chronic.
“Once they become chronic, they're really only manageable. You're never going to eradicate them,” Ehrlich says. “And what you see is, these patients, who are chronically infected, they may have to go on antibiotics for a couple months, once or twice a year, to manage the infection. Once these pathogens get into the deep tissues, they're almost impossible to completely eliminate.”
Lyme disease is a concern, but what about another tick-borne disease which has been widely reported on in recent years? What about Alpha-gal syndrome?
“It is a delayed allergic reaction to the tick bite and then you cannot tolerate red meat, that's the common thing,” Bayhealth’s Gupta says. “It's from the allergy from the tick bite itself. I have read about it, but in my career I have seen only one or two cases of alpha-gal syndrome.”
Part of the reason for that, at least in Delaware, is that it’s usually carried by a different breed of tick, Ehrlich says. In the eastern US, deer ticks are more common.
The Alpha-gal is associated with the lone star tick. Now, that doesn't mean that the lone star tick couldn't transmit Lyme disease,” he says. “It doesn't mean that the deer tick couldn't cause Alpha-gal, but it's the general breakdown. On average they'll be associated with different conditions.”
The key to avoiding any of the myriad tick-borne diseases is twofold - prevention and vigilance.
“Prevention is key. Wearing your bug spray, hats, clothing, covering up. That's how we're going to prevent these diseases. And when you're concerned, it's always okay,” Cara Kessler says. “Reach out to your doctor, let us know. We'll look you over, think about your symptoms. And sometimes your symptoms take time to evolve. So maybe the first day when we see you, we might not have that as a top differential, but with time, we can always tell and we'll get there together. So when in doubt, ask your physician. It's okay.”
“It's a good idea to take a shower within two hours of coming from the wooded area,” Gupta adds. “So if you do catch any ticks, you can wash it away and that's a good time for doing the skin check. Make sure you're checking in your behind the knee area, groin area, armpits, behind the ears, in the hair where we can miss the ticks.”
If you find a tick on your body, removing it is usually simple, as long as you’re careful. You’ll need a pair of tweezers.
“You have to be very close to the skin - as close as possible,” Gupta says. “You hold the tick and move it slowly in all directions and a small pull to bring that guy out.”
But Gupta says, if you’re showing any symptoms, or just concerned about your exposure after a tick bite, see your doctor.
“Redness, swelling, itching, pain, or rash, they should contact their clinician,” she says. “Flu-like symptoms, fever, malaise, generalized body aches, pains, chills, they should contact their clinician.”
Ticks are a pretty common actor in our human experience, one we’ve been contending with for millennia. But, there is still a lot of research to be done, Drexel’s Ehrlich says.
“Where the work is going now is in the developing of new classes of diagnostics. So there's one group now that's developed what's called a biomarker panel,” he explains. “And so what they did is they looked at a large number of proteins in the blood of patients who were known to have Lyme disease. And then they compared it with people who were known not to have Lyme disease. And they actually used a machine learning program, kind of an AI program, to teach which of these many blood proteins are elevated.”
Meanwhile, one of Ehrlich’s colleagues is looking at how tick-borne diseases affect our antibodies.
“Most proteins are decorated with short changes of sugar molecules. And what she's found is that the Lyme disease agent is able to modify how the host, us, puts these sugar molecules on our antibodies so the antibodies are less effective,” he says.
And Ehrlich himself is in the early to middle stages of developing a new medication that could change treatment.
“We're trying to develop a new class of antibiotic, which essentially prevents the bacteria from going into what we call this quiescent state, so that it basically has to keep dividing. And so then you could kill it more easily with standard antibiotics,” he says.
Meanwhile, if you’re heading into the woods for a hike or some camping, wear appropriate clothes, check for ticks after you come in, and keep the bug spray handy.
