It is TICK time!
We have had a huge uptick in cases of tick exposure and potential infections over the past few weeks. Every spring and summer, many children present to our clinic with tick bites and other insect issues. While most bites are benign, some are not.

We all should be aware of the realities and risks of tick exposure in order to make good decisions regarding medical care.

Ticks are little 8-legged creatures that live on animals in the woods and then grab onto us when we come into contact with a plant or animal that they were waiting, or “questing” on, for a “sucker” to pass by. Ticks can migrate via birds that can carry them miles away from their previous location. They travel with all kinds of animals, but seem to be on mice, deer, livestock and birds predominantly. Ticks feed only on blood and utilize special mouth adaptations to cut the skin and suck out the blood. They keep our blood from clotting by releasing anti-coagulants into the blood as soon as they suck it out.

While the amount of blood that a given tick removes from us is minimal to almost undetectable, they have a nasty habit of leaving behind dangerous pathogenic microbes in our blood stream. Of note, the most troublesome tick-borne illnesses are caused by a bacteria called Rickettsia which causes Rocky Mountain Spotted Fever as well as the Borrelia bacterium which causes Lyme disease.
Tularemia, babesiosis, tick paralysis and ehrlichiosis are a few other diseases that are tick born in the United States. Read about each at www.cdc.gov and know the corresponding tick to each illness.

We do know that Lyme disease is coming south. I grew up in the hotbed of Lyme disease in the Hudson Valley of New York. It appears that mouse overpopulation is making things worse. This overpopulation is a result of shrinking predator populations as forest space is reduced in urban and suburban areas. Mice are highly efficient transmitters of Lyme and are responsible for infecting the majority of ticks carrying Lyme in the Northeast. A mouse can have up to 100 ticks covering its ears and face.

Rocky Mountain spotted fever,RMSF, is notorious for being a bad player if left untreated without antibiotics. It can be deadly in short order. RMSF presents with fever, headache, body aches and maybe nausea/vomiting and a rash that is a later finding on days 4 through 7 but occasionally as early as 2 days. The rash is a purplish spotted rash on the palms, wrists, ankles and soles. The illness mimics many viral illnesses in the first few days, making diagnosis tricky. In general, it is recommended to start antibiotics in the first few days when the suspicion changes from virus to possible RMSF. Take this illness seriously.

Lyme disease, on the other hand, is not deadly in the early stages. It is a tick-borne illness that presents with a bullseye rash called erythema migrans within the first few weeks of a bite. The symptoms can progress over subsequent months with inflammation that involves the joints, heart and neurological system. It is a serious disease with significant morbidity if not treated with antibiotics. Read up on this illness further to know when to seek medical attention.

Go to google images – key word ticks – for some nice pictures.

The next insect trouble maker is the mosquito, meaning “little fly” in Spanish. This little annoyance follows the same survival principals as the tick, by feeding on blood to survive. Unfortunately, it has adapted a flying lifestyle to go along with its 6 legs, making it vastly more irritating than the tick. The adaptation has enabled it to essentially touch most humans in the world. This matters because mosquitoes can carry pathogens long distances. Unfortunately, as the Earth warms we may see more of these infectious organisms moving north in the Americas.

The most dangerous pathogens cause diseases like malaria, chikungunya, yellow fever, Eastern equine encephalitis, dengue fever, West Nile virus, tularemia and now zika. These pathogens are bacterial, parasitic and viral in nature. Familiarize yourself with these illnesses at the CDC site and be ready for any possible exposure.

The third blood sucking player in the insect world is the flea. Fleas are small flightless insects that are up to 3 mm long and can jump 50X their body length in distance. Fleas carry many of the same pathogens as ticks but differentially cause plague and typhus by carrying the respective bacterial pathogens. Flea-borne disease is rare but increasing in the United States. Read the CDC site again for information on these flea and mosquito based diseases.

Prevention is the key to avoiding exposure to these creatures. Here are some tried and tested methods to keep your family free of insect borne disease.

Ideas:

) Perform tick checks on your children daily after outdoor play. Check behind the ears, nape of the neck, groin, armpit and between the toes. Ticks in general need to be attached for roughly 24-36 hours to transmit the spirochete or pathogen that causes Lyme disease and Rocky Mountain Spotted fever. Remove them gently with tweezers by gently pulling and not squeezing. S
2) Mosquito and chigger bites can leave a nasty itchy bump or bumps. Kids will often scratch them open and leave a place for infection to occur. We are seeing a lot of MRSA (a resistant bacterial skin bacteria) abscesses from these bites. Prevent them by using insect repellents and long clothing. Also, reduce outdoor time at dawn and dusk when these bugs are most active.
3) Treat all domesticated animals for fleas if they have them. Prevent flea infestations by having your animals wear flea collars or take flea and tick medicine.
4) Use topical products with DEET or oil of lemon eucalyptus 30% to prevent tick bites. (not for kids under 3 years old). See the EWG’s website, www.ewg.org for details on insect repellants.
5) Apply all repellents by hand to avoid inhalation by yourself or your child. (same with sunscreens. Aerosolized chemicals are no good, period.)
6) Shower after outdoor activity. Especially if repellents are used.
7) I like creams like Calendula, aloe vera and cortisone for itching. Also, rubbing a moist tea bag on bites can help with itching and swelling. The tannins act like an astringent.
8) Avoid having standing water in your yard. Mosquito haven.
9) Keeping mice and deer away from your living area is a great prevention strategy. Having an outdoor cat, using fences to keep deer out and treating your domesticated animals for tick prevention are solid choices for your families health.
10) Treating your hiking clothing with 0.5% permethrin is an effective prevention strategy if you are going to be out for days.

Pray that you have a lot of bats nearby so that they can ping the mosquitoes with their radar and swoop in for meals.

Stay insect free,

Dr. M

Dr. Chris Magryta is a physician at Salisbury Pediatric Associates. Contact him at newsletter@salisburypediatrics.com