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By Doug MacQueen, MD
The warm weeks ahead will bring more opportunities to enjoy outdoor recreational sports, gardening and family gatherings. They also bring a higher risk for contacting tick-borne infections such as Lyme disease, the most common disease spread by ticks in New York and anaplasmosis, a relatively new disease spread by ticks in our region. A few precautions can minimize risk of contracting a tick-borne disease without reducing the enjoyment of outdoor activities.
The bacterium that causes Lyme disease and anaplasmosis is spread by black-legged deer ticks. These ticks have expanded their range in upstate New York. Tests show about half of the adult ticks in the Finger Lakes region carry Lyme disease and a much smaller, but rising percentage of ticks, carry anaplasmosis. Two other tick-borne diseases, babesiosis caused by a bacterium and Powassan virus, have been rare in this region, but more common in downstate communities.
Deer ticks live in shady moist areas and can be found throughout New York State. Adult deer ticks are the size of sesame seeds and are most active from March to mid-May and from mid-August to November. Nymphal ticks are active from mid-May to mid-August and are about the size of poppy seeds. Both adults and nymphs can transmit Lyme disease, but it usually takes 36 to 48 hours after an infected tick has attached itself to a person to transmit the bacterium.
Most deer tick bites will not transmit Lyme or anaplasmosis and finding a tick on your body does not require an emergency room or doctor’s office visit. If the tick is fully engorged you have two options after removing the tick: Monitor the bite area to see if a circular rash develops, or take a one-time dose of antibiotic, which may decrease the chance of getting Lyme disease. My recommendation is to limit antibiotic exposure and monitor for symptoms.
What are the symptoms of Lyme disease?
Some people experience fever, aches, sweats, and low energy. A circular bull’s eye rash often appears around or near the site of the tick bite. If the illness remains untreated for a few weeks, it may cause multiple red rashes and fever. In rare instances, untreated Lyme can infect heart tissue, spinal fluid, and joints. However, even at these later stages, Lyme and anaplasmosis are curable with antibiotics. Commonly used oral antibiotics include doxycycline or cefuroxime for adults, and amoxicillin, which is most often used to treat young children and pregnant women.
What are the symptoms of anaplasmosis?
Anaplasmosis symptoms are like a Lyme disease infection, but rarely include a rash. Some patients have chills, nausea, muscle aches, cough, fatigue and mental confusion, but not everyone has symptoms.
What steps can I take to avoid tick bites?
Ticks are active any time the temperature is above 30 degrees and there is no snow cover. After you have been hiking in brushy areas, check yourself and family for ticks. Look in all the nooks and crannies, including your armpits and in your hair. Be sure to check young children because they may not notice a tick. Adult deer ticks are hard to find; nymphal deer ticks are even smaller and look like freckles with legs.
How can I prevent getting ticks on me?
During tick season wear long pants and long sleeves when you are outside. Trim brush in your yard and keep the grass cut to reduce tick habitat. The New York State Health Department lists many tick and insect repellent products. Some common active ingredients in repellents include:
- DEET (N,N-diethyl-m-toluamide) products have been used for many years and come in many concentrations, some as high as 100 percent. The health department recommends avoiding products with DEET concentrations of more than 35 percent.
- Picaridin, or KBR 3023 on some labels. Products containing picaridin repel ticks as effectively as products containing similar concentrations of DEET.
- Oil of lemon eucalyptus (OLE) is found naturally in eucalyptus trees. Products containing OLE are about as effective in repelling ticks as lower concentration DEET products.
- P-menthane 3,8-diol is a manufactured version of OLE and has similar repellent properties.
- IR3535 is used in insect repellents; but in some cases, these products also contain sunscreen and moisturizers. Avoid combination products. Sunscreen and moisturizers should be applied generously; repellents should be applied sparingly.
- Permethrin kills ticks on contact. Permethrin-containing repellent products are only registered for use on clothing, not on skin. Permethrin-treated clothing remains effective against ticks through several washings.
What do I do if I find a tick on my body?
Use tweezers to grasp the tick at its head where it is embedded in the skin, pull with gentle, steady pressure, then flush it down the toilet. Clean that spot with soap and water. If the tick is not full of blood when removed, it has not had enough time to transmit the diseases. Testing for Lyme and anaplasmosis is not helpful just after a tick bite because it takes four to six weeks to develop antibodies that indicate an infection is present.
Dr. MacQueen is board certified in internal medicine and infectious diseases. He is on the medical staff of Cayuga Medical Center and can be reached at the Cayuga Center for Infectious Diseases at (607) 241-1118.