It’s Tick Time: Step Up the Body Checks

Spring has sprung, baseball season’s first pitch has been thrown, April’s rains have been falling, and the ticks are back. Even if you can’t see them. Just ask Michael Noonan of Florence.

On a Thursday, a couple of weeks ago, Noonan, 62, noticed a red spot the size of a half dollar on the inside of his elbow, with a small dot in the center. The dot was a deer tick. His wife removed it with a pair of tweezers.

“It looked like a little piece of wood,” Noonan said, “except it was moving.”

His arm had been hurting all week — since cleaning up leaves in his driveway on Sunday — but Noonan figured he had a spider bite and didn’t think much of it until his wife did some online research.

After a trip to the OnCall Urgent Care Center in Northampton, he was told he would be treated for Lyme disease. Noonan was put on the antibiotic doxycycline for 11 days. Later, when he told the OnCall staff that he had probably been bitten while out raking five days before finding the tick, they upped his prescription to 24 days.

Nasty carriers

Just a few minutes in the yard these spring days is all it takes to attract a deer tick which can carry pathogens that cause Lyme or other diseases. While antibiotics cure some who contract Lyme, others suffer from chronic illness for years. Their symptoms can include headaches, heightened allergies, nausea, night sweats, joint pain, distractability and more.

These disease-carrying critters have been on the rise in the Northeast for the past decade.

According to the federal Centers for Disease Control and Prevention (CDC) in Atlanta, confirmed cases of Lyme disease in the United States have risen by over 10,000 in the past 12 years, from 17,029 to 27,203. The majority of these cases were reported in the Northeast and the Great Lakes regions of the country.

The latest CDC figures indicate that more than 300,000 people were infected with Lyme disease in 2014 alone, said Maria Malaguti, founder and executive director of the Northampton-based Lyme Disease Resource Center. “That figure is 10 times more than previously reported in 2013,” she said.

That leap is due to the rise of the region’s tick population as well as advances in diagnosing Lyme disease, which, because its symptoms as similar to those of so many other tick-borne illnesses, has been difficult to pinpoint, said Malaguti. Thus it has earned the nickname The Great Imitator.

Borrelian burdorferi, the pathogen associated with Lyme disease, is one of many pathogens carried by ticks. And one tick could be a carrier of several. Others include Babaseosis, which can mimic malaria in severe cases, and Rickettsia, which causes Rocky Mountain Spotted Fever. However, Malaguti said, because so many of these diseases have the same symptoms, such as a headache, fever and muscle fatigue, it is often difficult to determine which pathogen to treat.

“Not all bites are infectious,” said Stephen Rich, director of the University of Massachusetts Laboratory of Medical Zoology where the insects are tested, “but every tick can carry a pathogen.”

The longer a tick is biting a person, he said, the more likely it is to pass along a pathogen. “If you get it off in under 24 hours, it is much less likely to pass along a disease.”

The exception is the very rare but extremely dangerous Powassan Virus — named after a town in Ontario, Canada. It can be transmitted instantly by a tick bite, with an incubation period of up to a month. According to the CDC, Powassan can cause meningitis and encephalitis — inflammation of the spinal cord and brain, respectively.

Gauging the danger

Ticks become carriers of Lyme disease by feeding on the blood of mice that carry the pathogen, said Rich. But the spread of the disease is caused by deer, which are necessary to help ticks breed. As the deer population in the Northeast has risen, so has the population of deer ticks and reported incidents of Lyme disease.

Deer, however, cannot be infected by Lyme disease. “They seem to have something in their blood that kills off the disease,” Rich said.

Humans, unfortunately, aren’t so lucky.

Though dogs are susceptible to Lyme disease, Rich said, there has been no proven connection between having a dog and contracting Lyme. While no hard evidence exists, some have speculated that there is such an association with having an outdoor cat. Because ticks do not feed on cats it may be more likely that they will ride into the house on a feline’s body, then jump off to wait on a couch or a chair for a human host, he said.

Since its inception in 2006, Rich’s lab at UMass has tested over 2,000 ticks that have been sent in from 40 states. Testing costs $50 per insect and anyone can send one in. Last year, as part of a state-funded program called the Tick-Borne Disease Network, the lab waived the fee for people in 32 communities in Massachusetts, including 10 in Franklin County. Rich is hoping funding will be increased to allow the lab to offer similar services to all towns in the Commonwealth.

Though ticks are found everywhere in the state, such testing, he said, helps researchers gauge precisely where and when ticks are biting people, who is getting bitten and what pathogens they are transmitting.

While 50 percent of adult ticks carry Lyme disease, only 25 to 30 percent of nymph ticks carry it, Rich said. Still, those nymph ticks present the highest risk to humans, he said, because they are smaller and tend to go unnoticed.

Adult ticks are active now, but nymphs, which are harder to see, are prevalent from mid-May to July, Rich said, making early summer the most dangerous time for contracting a tick-borne disease. It becomes safer to be outdoors at the end of July, he said. By early fall, larvae ticks are active, but they are less dangerous than nymphs and adults.

Though only one kind of tick in this region — the deer tick — is a carrier of Lyme disease, local tick populations are changing. New to this area is the Lone Star tick, Rich said, which previously had been found on Long Island, in Virginia, and farther south. The Lone Star tick has been connected to a serious red meat allergy.

With information provided by people requesting tick tests,the lab has been able to chart tick incidents specific to certain populations, Rich said. For example, 35 percent of children age 5 or under have been bitten on the upper thigh. And while ticks usually travel to y-shaped joints, such as the armpits or groin, the lab’s latest data shows that ticks just as often migrate upward on the body.

Still, Rich said, “Lyme disease isn’t very well understood. Less serious cases are under-reported, while most people with chronic Lyme disease say they don’t remember getting bit at all.”

Diagnosis controversy

That was the case with Maria Malaguti, who contracted the disease in 1997. She thinks she was bitten while hiking in New Hampshire in August of that year, she said, but it took a year for her flu-like symptoms to be correctly diagnosed. An emergency room doctor told her she was imagining her ailments, she said, which developed gradually. Eventually her regular physician determined she had Lyme disease.

Malaguti said she suffers from over 40 symptoms, including a raspy voice, difficulty breathing, unexplained chills, forgetfulness, disorientation, muscle pain and light-headedness.

“Some of these symptoms come and go,” she said. “Most are with me all the time, but are tolerable most of the time.

The diagnosis of Lyme disease has become a controversial topic, she said.

The Infectious Disease Society of America (IDSA), led by a group of academic researchers, has “rigid guidelines” she said, and claims chronic Lyme is rare, if not nonexistent.

On the other hand, the International Lyme and Associated Diseases Society (ILADS), led by a group of practicing physicians, disputes that and “is doing cutting edge research,” she said, while training doctors to more effectively diagnose tick-borne diseases.

The Lyme Disease Resource Center’s position is that increased discussion and information sharing regarding Lyme disease is critical, Malaguti said. It hosts monthly support groups for those with Lyme and other tick-borne diseases every second Saturday at Forbes Library. This Saturday at 1 p.m. the group is showing the documentary “Emergence: Under Our Skin 2,” which focuses on several patients with chronic Lyme disease. It will be followed by a question and answer session with Northampton-based physician Charles Brummer — who is chairman of the resource center’s medical advisory committee, and Hadley-based naturalpathic physician Meg Hartmann.

First and foremost, Malaguti said, “Prevention is so crucial. Take precautions.”

Avoiding bites

Rich agrees. “The best way to avoid getting Lyme disease,” he said, “is to avoid getting bitten by a tick.”

He recommends using a repellent that is toxic to ticks, but not to humans, like Permethrin. “It can be applied to clothing — not directly to skin — and it kills the ticks,” he said, adding that it can be purchased in outdoor and sporting goods stores.

Outdoor gear and clothing retailers like REI and LL Bean also sell clothing with repellents already in the fabric. Another method is to “send your own clothes to (the company) InsectShield to have them sprayed professionally,” he said. “It’s good for something like 70 washes.”

Regularly checking your body after being outdoors is especially recommended, particularly around the neck and waist, armpits and groin, and in the hair.

“If allowed to, ticks will feed for several days,” said Rich. They balloon up larger and larger, changing color as they do, and will eventually drop off their host when fully fed. “They can gain up to 200 times their own body weight,” he said.

The University of Rhode Island website is a good resource, Rich said, offering help identifying ticks and providing updates of regional tick activity.

As for Michael Noonan, his experience has taught him not to ignore a bothersome spot on his skin. He dislikes yard work, he says, and usually hires someone to do it for him. So, it was ironic that he got bitten in a rare foray outside to rake leaves.

“If I get through this, I probably won’t have to do yard work again,” said Noonan. “That will be my excuse.”

(Originally appeared in the Hampshire Gazette.)

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