Summertime in the south inevitably means the occasional tick bite, and with it an increased risk of tick-borne diseases. In fact, Tennessee is among five states that collectively account for nearly 60 percent of Rocky Mountain Spotted Fever cases diagnosed in the U.S. each year. As an infectious disease specialist, I often talk to patients about prevention and early detection of tick-borne diseases, seen most often in June and July.
Health Risks in Middle Tennessee
While recent cases of Lyme disease have made the diagnosis a household name, the majority of cases I’ve seen at Vanderbilt Infectious Disease at Williamson Medical Tower have originated outside the state. The dangerous nature of Lyme disease keeps it on the forefront of my radar, but many patients are unaware that Rocky Mountain Spotted Fever and Ehrlichiosis are actually more common health threats here in Middle Tennessee. According to the Centers for Disease Control and Prevention, there has been a dramatic increase in incidence of Rocky Mountain Spotted Fever, increasing from 1.7 cases per million persons in 2000 to an all-time high of 14.2 cases per million persons in 2012. Cases are more frequently reported in men than in women, and the majority of reported cases are among people at least 40 years old. Children under 10 years old, American Indians, people with a compromised immune system, and people who do not receive treatment within the first five days of illness are at an increased risk of death from SFR.
Ehrlichiosis is the general name used to describe several bacterial diseases that affect animals and humans. Ehrlichiae are transmitted to humans by the bite of an infected tick, typically the lone star tick.
Ehrlichiosis and RMSF have virtually identical symptoms including headache, body ache, fatigue and the occasional rash, and typically develop two to five days after exposure. Without medical attention, which involves a 7-10 day course of doxycycline, both illnesses can become critical as they begin to affect organ function.
Since there’s no true test for acute RMSF, doctors must use clinical suspicion to treat patients and will check antibody levels before and after treatment to confirm their suspicion. Ehrlichiosis testing is available at select laboratories, but is not widely used. The diagnosis is often confirmed by an abnormal white blood cell count, low platelets, elevated liver enzymes and occasionally anemia.
Because most people who acquire tick-borne diseases never even see the tick, prevention is crucial. That means checking daily for ticks, even if your outdoor time is limited to the front yard. By removing ticks the same day, you virtually eliminate the possibility of bacterial transmission, which typically takes 24-48 hours of tick exposure. Teach kids to shower nightly, and to be on the lookout for ticks hiding around the groin, back of the knee, armpit, hairline and waistband. Reduce risk of infection by keeping covered when outdoors, and use insect repellent with diethyltoluamide, or DEET, which is effective against ticks and mosquitoes. To remove a tick, simply pull it straight out with tweezers rather than twisting. And steer clear of old tick removal wives’ tales, which involve any use of nail polish remover or matches.
If you feel flu-like with upper respiratory symptoms in the spring or summer, there’s a good chance tick-borne diseases are to blame. By the time patients see an infectious disease specialist they’re often gravely ill, and many experience long-term fatigue weeks or even months after treatment. By proactively educating yourself about prevention and symptoms of tick-borne diseases, you can help make this summer a healthy one.
About Dr. Spires
S. Shaefer Spires, M.D., is a physician at Vanderbilt Infectious Diseases at Williamson Medical Tower, located at 4323 Carothers Parkway, Suite 400, in Franklin. To schedule an appointment, call (615) 936-1174.