Barnstable Patriot

Tick-borne illness remains a serious threat

By Bethany Gibbons

Spiraling footballs sail past young receivers, landing in the deep grass at the edge of the yard where children chase after them. Dogs race through the dune grass to launch themselves into the surf for a refreshing bath. Both are idyllic scenes for the Cape Cod summer season. Unfortunately, disease-carrying ticks, the ultimate party crashers, cloud the scenarios.

With the dreaded Lyme disease on board, as well as the far less common but equally horrid babesiosis and ehrlichiosis, ticks are plentiful, infectious, and looking for hosts. Dave Simser, entomologist for Barnstable County said, "The rate of infection (for Lyme disease) is up about 40 percent."

"I saw a four-year old this morning with a significant rash, presumed to be a Lyme case," said Dr. Gay Freeman of Harwich. "In the past two business days I have removed about five ticks from patients. It's really looking like a bad year for ticks," she said. Freeman noted that about half of the patients coming in for treatment of tick bites or Lyme symptoms have the distinctive bullís eye rash.

While some physicians will not treat for Lyme without a positive antibody test, Freeman is a proponent of early and aggressive treatment for potential Lyme victims. "I'd rather treat 100 people that don't have it than miss the one person who does," she said. "If you wait for the antibodies to appear, you have to delay treatment, thereby allowing the spirochete to become established." Her treatment protocol can include an eight-week regimen of antibiotics if the patient's symptoms are consistent with infection.

Both nymph and adult deer ticks can transmit Lyme disease, and they are active whenever the temperature is above 40 degrees, which on Cape Cod means nearly year-round. The poppy seed-sized nymph is hard to spot, and the sesame seed-sized adult is not much easier. Constant vigilance is necessary to avoid infection.

"I'll try anything now," said Audrey Osborn, a nurse. "I use insect repellant all the time, and when I come in from the garden my clothes go right in the washer. I used to put them in the hamper, but sometimes you will find ticks crawling along the floor away from the clothes, so now they go right in the wash. I also do a thorough body check."

Osborn has reason to be cautious. During a hot night last August she began to experience severe chills. By the next day her temperature was 102.6 degrees and she could not lower it with acetaminophen. Extremely uncomfortable and increasingly distressed, she was examined by her doctor. The blood test revealed babesiosis, a parasitic infection transmitted by the deer tick. Osbornís tick delivered a double blow, with a Lyme diagnosis following shortly thereafter. Unable to find an opening with a specialist on the Cape she quickly decided to travel to New Jersey where she was prescribed a nine week course of antibiotics for treatment.

Nearly a year later she has residual joint pain in her wrists, requiring her to wear carpal tunnel syndrome braces when she sleeps. Her feet experience something akin to neuropathy with tingling and pins-and-needles sensations troubling her when she sleeps and soon after she wakes up. "People really need to be more aware of the dangers of ticks," she said.

Doctor Lorraine Hurley, a member of the Cape Cod Lyme Disease Association, recommends an integrative approach to managing chronic Lyme disease infection. "I encourage patients to address pre-existing immune vulnerability and reduce toxicity in the body," she said. As chronic Lyme disease can result in neurotoxic syndrome, Hurley uses diagnostic tools to determine the degree of infection then focuses on overall health in an effort to help the body fight the spirochete. "Treating chronic Lyme requires committed, persistent and intelligent effort," she said.

Humans are not alone in their battles with tick-borne illness. Household pets can be infected with a number of diseases, and they also provide an easy way for ticks to enter the home. "It seems to be a particularly bad year," said Tom Burns of Veterinary Associates of Cape Cod in South Yarmouth. "We're not just seeing Lyme, we're seeing two kinds of ehrlichiosis, the canis and equine, and a fair amount of rocky mountain fever."

While a deer tick needs an estimated 24 to 72 hours to transmit Lyme disease, it is suspected that the other diseases require as little as seven hours to be transmitted. "People have a false sense of security and view other ticks as no big deal," said Burns. "No tick is a good tick," he warned.

Burns recommended prevention from tick bites in the form of topically applied medication, such as Frontline and Advantix for pets. "Neither are working 100 percent," he noted. "It seems the ticks are more infectious, that there's more tick borne illness," he said. "The ticks seem to be hardy and not as concerned about the medications." Burns cautioned pet owners to avoid wooded areas and check pets well for ticks.

Simser confirmed that the population of deer ticks is "high but stable." He reported that "20 to 25 percent of nymphs are testing positive for Lyme disease, while 50 percent of adults are positive." Nymph season will last until mid-August. "We are right in the middle of nymph season, with few adults out," he said. Although he does not test nymphs for ehrlichiosis, he said that five percent of adults are positive for that disease, with less than five percent testing positive for co-infections with other illnesses.

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