Bitten by a Tick?

by Cory Tichauer, ND

So you’ve just been bitten by a tick and are wondering what to do now. This is a scenario that is becoming both more prevalent in the Rogue Valley as well as more concerning with an increased public awareness about tick borne illness. Unfortunately, these concerns are warranted as milder winters and a healthy deer and rodent population have contributed to the dissemination of tick-borne bacterial diseases including Lyme, Ehrlichia, Anaplasma, Rocky Mountain Spotted Fever, Babesia, Bartonella and others.

A 2010 Jackson County tick study headed by Southern Oregon Lyme Disease (SOLD) showed approximately 5% of the adult ticks (sample size approx. 185 ticks) harbored Borrelia burgdorferi, the bacteria responsible for Lyme. As well, a 1997 field study at two sites in Jackson County and one site in Josephine County demonstrated Borrelia infection rates of 4-6% in the adult Ixodes pacificus ticks and 18-19% in the rodent population (Thomas R. Burkot, 1999). To complicate things further, a preferred host for the adult Ixodes pacificus tick is the western fence lizard, which contains a thermostable borreliacidal factor that destroys the Lyme spirochetes in the tick; thereby reducing transmission potential. In contrast, the Ixodes nymphs, which are as small as a poppy seed, prefer grey squirrels and other rodents as hosts and, therefore, may have infestation rates as high as 20-30% (Thomas R. Burkot, 1999). What this means is that you could be bitten by a tick so small you didn’t even notice it or scratched it off thinking it was nothing more than an itch or a small scab.

Given this wide-spread epidemiology and the frequent interface between people and ticks, the CDC has categorized Lyme as the fasted spreading vector-borne illness in the country and reports over 30,000 new cases each year (CDC, 2002–2011) with an acknowledgement that this number may in fact be 10-fold higher implicating a whopping 300,000 new infections each year making Lyme an epidemic larger than AIDS, West Nile Virus and Avian Flu combined (Young, 1998).

The first thing to do if you have been bitten is take note of how long the tick has been attached or whether the tick is already engorged with blood. While Lyme can be transmitted within hours of a bite, the incidence is significantly reduced if the tick has been attached for less than 12 hours and the tick is properly removed. Nonetheless, a Lyme infection can never be excluded after a tick bite irrespective of the estimated duration of attachment time (Cook, 2015). The appropriate technique for tick removal is to grasp the tick with a fine tweezers, as close to the skin as possible, and gently pull it straight out. Squeezing the tick when removing it or aggravating it with the use of Vaseline, matches or chemicals can cause the tick to regurgitate its stomach contents into your body, significantly increasing the risk of Lyme transmission.

Since only 15-30% of Lyme disease cases start with the appearance of the characteristic bulls-eye rash (Kind, Schned, Anderson, & et al., 1999) and fewer than 50% of patients recall the presence of any rash (Krupp, Hyman, Grimson, & et al., 2003), this should not be a guideline for whether you get tested. In the initial infection stage, which typically occurs 7-21 days from the bite, a variety of flu-like symptoms may occur such as fever, fatigue, muscle and/or joint pain, swollen lymph nodes, headaches and altered mental status. The unexplained appearance of any of these symptoms following a trip outdoors should prompt a visit to a physician familiar with the diagnosis and treatment of Lyme.

Traditional testing for Lyme remains unfortunately unreliable with the standard two tier testing approach missing 35-50% of culture proven cases (Nowakowksi, Nadelman, Sell, & et al., 2003). Fortunately, there are several effective testing options that are more reliable. A basic Lyme test, which includes both a Western Blot and an Immunoflourescent Antibody study, with a tick-lab such as IGeneX will detect Lyme in approximately 80% of infection cases after 30 days. This lab improves the testing sensitivity by using both the CDC B31 strain as well as the 297 strain of Borrelia (Shah, Du, Narciso, Lo, & Harris, 2014). Another option which can detect Lyme in as little as two weeks is the Lymphocyte Transformation Test which detects antigen-specific T-cell production of interferon-alpha as a biomarker of Borrelia exposure. This test boasts a sensitivity of 84% and a specificity of 94% (Chenggang, Roen, Lehmann, & Kellermann, 2013).

Should you end up with a confirmed or suspected Lyme infection, immediate treatment intervention within the first 14-45 days is key to ensuring that the bacteria is eradicated and unlikely to progress to a more chronic and embedded state. As per the International Lyme and Associated Diseases Society (ILADS) guidelines and in contrast to the Infectious Disease Society of America, a patient who presents with symptoms consistent with Tick-Borne Illness should be treated for a minimum of 4-6 weeks with appropriate antibiotics (Cameron, Johnson, & Maloney, 2014). Furthermore, since the potential for co-infection with other Tick-Borne Diseases exists, persistence of symptoms or the appearance of new symptoms following antibiotics should be reported to a Lyme-literate physician, as testing and/or treatment for these other infections should be performed as soon as possible.

Ultimately, prevention of a bite is the best approach to avoiding Lyme. Thorough tick checks after spending time outdoors is imperative as well as dressing protectively by tucking in pant legs and applying bug repellant such as DEET to clothing prior to venturing into infected areas. If you are bitten, it is prudent to keep the tick for testing following removal. Local public health facilities as well as IGeneX or readily available Tic-Kits (www.tic-kit.com) can assess whether the tick was infected with Borrelia, Babesia, Anaplasma, Ehrlichia and/or Bartonella with a higher sensitivity that standard blood testing in people.

Cory Tichauer, ND is an ILADS fellowship trained physician in Medford Oregon who has been in practice since 2003. He works at Bear Creek Naturopathic Clinic and has focused his practice on the treatment of tick-borne illness, mold and environmental toxicity, neurodegenerative conditions and chronic illness. He is available for free-15 minute consultations.

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Works Cited

Cameron, D. J., Johnson, L. B., & Maloney, E. L. (2014). Evidence assessments and guideline recommendations in Lyme disease: the clinical management of known tick bites, erythema migrans rashes and persistent disease. Expert Rev. Anti Infect. Ther., 1-33.

CDC. (2002–2011). Reported Cases of Lyme Disease by Year, United States. Available online: http://www.cdc.gov/lyme/stats/chartstables/casesbyyear.html.

Chenggang, J., Roen, D. R., Lehmann, P. V., & Kellermann, G. H. (2013). An Enhanced ELISPOT Assay for Sensitive Detection of Antigen-Specific T Cell Responses to Borrelia burgdorferi. Cells, 2, 607-620.

Cook, M. J. (2015). Lyme borreliosis: a review of data on transmission time after tick attachment. Int J Gen Med, 8, 1-8.

Kind, A., Schned, E., Anderson, F., & et al. (1999). Lyme Disease Guidelines for Minnesota Clinicians: Epidemiology, Microbiology, Diagnosis, Treatment and Prevention. Minnesota Department of Public Health.

Krupp, L. B., Hyman, L. G., Grimson, R., & et al. (2003). Study and treatment of post Lyme disease (STOP-LD): a randomized double masked clinical trial. Neurology, 60(12), 1923-1930.

Nowakowksi, J., Nadelman, R. B., Sell, R., & et al. (2003). Long-term follow-up of patients with culture-confirmed Lyme disease. Am J Med, 115(2), 91-96.

Shah, J. S., Du, C. I., Narciso, W., Lo, W., & Harris, N. S. (2014). Improved Sensitivity of Lyme disease Western Blots Prepared with a Mixture of Borrelia burgdorferi Strains 297 and B31. Chronic Dis Int, 1(2), 1-7.

Thomas R. Burkot, J. R. (1999). Isolation of Borrelia burgdorferi from Neotoma fuscipes, Peromyscus maniculatus, Peromyscus boylii, and Ixodes Pacificus in Oregon. Am. J. Trop. Med. Hyg, 60(3), 453-457.

Young, J. D. (1998). Underreporting of Lyme disease. N. Engl. J. Med., 338, 1629.