PJ’s Corner: Tick-borne Illnesses

Dr. Brandon Woods, a pediatric critical care doctor with Saint Francis Children’s Hospital, answers key questions about tick-borne illnesses.

Q: I hear more and more people talking about tick-borne illnesses. Feels like more now  than ever. Is that just me, or are they becoming more common?

Yes. We have seen an increase in the amount of emergency room visits or urgent care visits, as well as a handful of kids getting admitted to our hospital with tick-borne illnesses. And that’s primarily due to the life cycle and the changes we’ve seen in having a milder winter as well as rainier spring. I remember, last winter was pretty mild, followed by the April and May showers that kind of led to having an increase in tick prevalence in the summer timeframe. The early summer, May through July, is kind of the time of the year where we see a lot of tick bites. And so the more exposure we have during those time periods, the more bites we get, and then the sequela of illnesses that come from that. So yeah, the past few years, every time we have a milder winter, like we’re having now, we may see an increase in tick-borne illnesses.

That makes sense. Can you tell me about what some of those illnesses are, and how they present themselves?

There are 3 or 4 very common ticks that we see here in Oklahoma. The Lonestar tick, it has the characteristic white dot on the back. If you think of the Texas flag, how it has a single star on it, so maybe the Lonestar tick. The American dog tick, and then the deer tick are some of the most common. Those ticks live around 2-3 years, and they have a specific life cycle. They hang out in tall brush, grassy areas, and then they jump onto the host – us humans. And then their bite, if they stay attached to us, they do a blood exchange and actually give us some illnesses if they’re on for several hours, for a longer period of time.

Some of the common illnesses that we see from tick bites here in Oklahoma are Rocky Mountain Spotted Fever, ehrlichiosis or anaplasmosis. Very rarely we can see an illness called tularemia, and then Lyme disease as well as alpha-gal syndrome. I can talk a little bit more about that later, but it’s an allergic reaction that you develop specifically to the alpha-gal sugar molecule that gives you difficulty when you eat red meats or mammalian meats; you can develop an allergic-type reaction.

Rocky Mountain spotted fever and ehrlichiosis, those are more bacterial infections that you can get, and they are commonly treated with antibiotics. Lyme disease as well, we can test for Lyme disease, and it has a unique characteristic rash that’s sometimes prevalent in other things, too. Those are some of the common diseases that we see.

Thankfully, only less than 5% of ticks carry these types of bacteria within their bloodstream and can actually transmit it to humans. Thankfully these are very rare diseases that we don’t see too often, but we have to think about whenever we’re having a kid come in with specific symptoms.

I know parents wonder and worry about when they should bring their child in. What could you tell parents about that? Should they wait for a sign? Should they look at the tick?

I think a lot of it has to do with prevention and knowing whether you’ve been exposed to a tick. So, say you find a tick after doing some hiking. It’s best to just keep in mind when that tick bite was, and the symptoms can develop several days to several weeks afterwards. So it’s good to do some preventive measures up front, which I can talk about later, but also keeping a good diary of symptoms.

The typical symptoms that we see after a tick-borne illness are very nonspecific. Children may develop a fever. There are a lot of different causes for fever. They may develop some muscle pains, some joint pains, some aches. Those are all very nonspecific. But sometimes we do see a development of a rash, and it kind of looks like a bullseye or a target—that rash you see usually a week plus out from the actual tick-bite exposure. So doing the normal things you do at home for fever and general malaise and not feeling well, but knowing when you’ve had that tick-borne exposure might help us narrow the diagnosis down. And seeing your provider within the development of symptoms of rash, fever, malaise, etc.

Is it helpful to bring the tick in, if you’ve saved it in a bag or something?

Either that or, in the digital era, we can take a picture and a photo, we can match the specific type of tick that we think it is. That certainly helps us narrow what disease process we think is going on. We can match the tick with the type of illness that we think, and based on some other blood studies that we can draw from our patients, it helps us narrow down the diagnostics.

Can you tell us about how some of the diseases are treated? You mentioned alpha-gal earlier. That’s one that I feel like I do hear more and more about. Are some more complicated to treat than others?

Some require antibiotics, such as Rocky Mountain spotted fever. That’s more of a bacterial infection, as well as ehrlichiosis or anaplasmosis. Tularemia is also a specific bacteria that is transmitted. All of those usually require antibiotics to run their course and treat the illness.

Now, when you talk about Lyme disease and then possible the Southern tick-associated rash illness, so those are very two closely related illnesses. The STARI, or Southern tick-associated rash illness, mimics Lyme disease, except you only basically have primarily the rash, and that goes away, and you don’t actually have the blood test that we check you for for having Lyme disease. So those are more of a milder case, and it runs its course, and you don’t have the multi-organ effects that you do with Lyme disease.

Now, when you talked about alpha-gal syndrome, that’s more of an allergic reaction that your body can develop because of the antibodies, etc., that you developed from the tick bite. And so you have a difficulty eating red meat and mammalian meat. So, several hours after you consume meat products, you develop a typical allergic reaction similar to other food allergies. So we treat it the same way as if it’s a food allergy. That’s another diagnosis that we get our help from the allergist/immunologist to kind of help manage. But that can take several months to years to actually go away after this tick bite. Thankfully, that’s pretty rare, and it’s something that we kind of have to exclude other diagnoses before giving you that one, but it’s something we keep in mind if we have a kid coming in with an allergic reaction that we don’t know what the cause is.

Are children more at risk, or more susceptible to any of these particular illnesses?

Basically, probably because of their height, etc., being lower to the ground, and playing in brush and tall grass, yeah, they have a little bit more risk of exposure. So from that, they’re high-risk for getting the illnesses. Typically, any age kid gets several viruses per year, so we have to tease out the symptoms of fever, malaise, joint pain, other symptoms to actually be thinking about a tick-borne illness at the same time. So it’s a little bit harder to tease out what the true illness is. Therefore, seeing your pediatrician will always help.

Right. You had mentioned earlier about some practical steps that parents could understand to help prevent tick bites.

Preventing exposure is the best thing you can do for it.  Starting with keeping the child covered as best as you can, so long-sleeved shirts, long  pants, even tucking your. socks in. I know it’s a great, cool look, but tucking your pants into your socks will mitigate the exposure. Especially when you’re knowing that you’re going to be out doing hiking or in an area prevalent with ticks.

You can also use permethrin on your clothes, that also helps reduce exposure as well as using tick spray that can mitigate the exposure. Certainly, things you can do at home, knowing that you’re going to go hiking in the woods. First thing is to take off the clothes and then, if you want to throw them in the dryer on high for ten minutes, that also gets rid of the ticks. As well as doing a very thorough tick check. So, ticks like to hide in kind of darker areas, crevices in our skin, so the groin area, the buttocks region, between our toes, the hands, etc., those are places to look. I recommend all parents do a tick check as soon as they get home, and then the following morning. The ticks staying attached to the child for hours or even days is what really give them a high risk for developing tick-borne illness. So if you’re able to check immediately once getting home from a hike, and then again in the next morning.

Taking a bath right away also limits exposure and gets rid of any ticks that may have jumped on momentarily. Those are some very common practices that definitely help mitigate your risk and exposure to getting a tick bite.

I know some parents worry about, when they see the tick, do they just pull it? Is there a way to use alcohol? Is there a good way to take it out?

So the best method that we recommend is using tweezers, and not to do any twisting motion. But to grab tweezers, grab the, not really the head, but the mouth portion of the tick, and pull straight up. The twisting motion can cause dislodgement of some of the teeth and the mouth apparatus that the tick uses to exchange blood with the patient. So doing a clean swoop, pulling straight up, that helps remove the tick completely.

You want to wash your hands with soap and water on the exposed site, as well as your hands if you’re the one that took the tick out of your child. And then you kind of want to note the date and time of when you removed it, so that way you can just be sort of monitoring for those symptoms to develop, sometimes days to weeks later. So storing it in your phone, say, “Hey, Johnny was exposed with a tick on this date, and I pulled it. He developed symptoms a few days later.” That helps us really narrow down what type of illness they may have.

Are there any common myths or misunderstandings about tick-borne illnesses?

I would say what we see most commonly is a person gets bit by a tick, and they immediately want to jump to Lyme disease or come in and immediately think that their child has a long, debilitating condition. But a lot of it is just watchful waiting, and we have several blood tests that we can do, but sometimes those take days to weeks to return – as well as they won’t turn positive for days or weeks. So kind of careful vigilance and watchful waiting, treating the child normally until they develop those symptoms of fever, rash, joint pain, malaise, and watching for that characteristic bullseye pattern on the rash. So you don’t have to come in immediately unless you’re concerned about developing a skin infection. But if you just pull the tick, just monitor the time and note the date that you were able to remove the tick and kind of be watchful waiting for those symptoms to develop.

I know we’re in the winter now, but it will be spring before we know it, and I know people will really be appreciative of these tips. So thank you very much, Dr. Woods.

May, early May through July is the time frame that we typically see a lot of these. These are quite rare occurrences, so just doing your best to keep kids covered and doing those tick checks as soon as you get home from the hike.

Very good to know. Thank you so much.