Delaware County Medicine & Health Spring 2017 - 26

FEATURE

Lyme Disease can be a
Diagnostic Challenge
By: Marina Makous, MD

pring is finally here, signaling the start of the
long-awaited outdoor play season, with opportunities
for hiking, gardening, lawn mowing, backyard relaxation, and picnicking. Spring is also the time of increased tick
activity, when the poppy seed-sized nymphal ticks are questing in search of a blood meal. These tiny creatures are often
infected with a number of bacteria, viruses, and sometimes,
parasites, which the ticks transmit to humans while they are
attached and feeding. There are several species of ticks, each
capable of infecting humans: deer ticks, or black-legged ticks,
prevalent in our area, can transmit multiple infections, including Lyme disease spirochetes, Babesia (microscopic parasites
that infect red blood cells), Anaplasma, Powassan virus, and
other organisms. American dog ticks can transmit various
Rickettsia (for example, Rocky Mountain Spotted Fever,
which is not limited to the Rockies, and may be found in our
area), and Tularemia; Lone Star tick bites can cause Ehrlichiosis, Tick-associated rash illness, and viral encephalitis. The
list of infections that may be acquired from a tick bite is long:
think of tick bites as being stuck by a dirty needle. In this
article, I will address Lyme disease; in the future, I will talk
about co-infections that may occur as a result of the tick bite:
Babesia, Anaplasma, and Bartonella.
Pennsylvania has the highest number of Lyme
disease cases in the US, and Chester county competes
with the surrounding counties for the dubious
distinction of having the most cases in our state.

The best thing is to avoid ticks altogether:
staying away from tall grass, using DEET
spray on exposed areas, wearing light colored
clothing covering exposed skin, and wearing
clothing treated with Permethrin. You can
order pre-treated clothing, or alternatively,
24 DELAWARE COUNTY MEDICINE & HEALTH

spring 2017

spray or soak your outdoor wearables,
including socks, sneakers, hats, shirts and
pants with Permethrin spray (available from
online or sporting goods stores). Permethrin
is not toxic to humans (keep it away from
cats). Permethrin-treated clothing can be
washes up to 6 times; you will need to reapply the solution after 6 washed, or 40 days.
Careful "tick check" of all family members
(including the 4-legged ones) after being outdoors
is important. Taking a shower within 2 hours of
hiking reduces the risk of tick attachment, too.
Despite the best precautions, there is always a risk of
tick exposure. Environmental scientists are predicting an
unusually high population of ticks this year. There are
complex factors playing a role in the increasing numbers and
spread of ticks. Following the previous year's prolific acorn
crops, there is substantial rise in small rodent population.
Rodents, such as mice and squirrels, are often infected with
Lyme bacteria. When larval ticks feed on the infected mice,
they acquire Lyme disease-causing spirochetes, as well as
other bacteria and viruses from the mice, and then pass these
on to the next host during the subsequent blood meal. Larger
population of mice and other rodents after a bumper crop
of acorns allows ticks to proliferate and continue to spread.

Table of Contents for the Digital Edition of Delaware County Medicine & Health Spring 2017