Tick Season is Here

Black flies can put a damper on summer fun, but a tick bite can change your life forever. Deer ticks (ID links provided below) are known to transmit Lyme disease, which is caused by any of three species of spirochete bacteria in the genus Borrelia. When a deer tick latches onto us for longer than 24 hours, it barfs a load of these fast-moving, corkscrew-shaped microbes into our bloodstream. The spirochetes, which have a particular craving for hearts, brains, and joints, begin to drill through our tissues in search of a nice place to settle down and reproduce.

As you might imagine, the results are unpleasant. What you might not expect is that early Lyme symptoms are often transient and sporadic. Even more surprising is the fact they can range tremendously from person to person. Lyme is regularly misdiagnosed, harder to treat than we tend to assume, and can debilitate a person for years. In a few instances, effects can last a lifetime.

Fortunately, we know a lot more about Lyme now than we did just a few years ago. Since about 2016, an avalanche of new findings on tick-borne illness has crushed long-held beliefs and assumptions. If you have literature older than 2016, toss it. Tick literature, that is – save your other books.

Lyme and Rash Decisions

Early indicators of Lyme vary so much that it’s imprudent to speak of “classic” signs. Yes, it often presents with a fever and joint aches, but the first clue something’s wrong can be heart palpitations or profound confusion, things once believed to occur only in late-stage Lyme.

Years ago, some doctors refused to consider Lyme disease as a possibility unless an expanding “bull’s-eye” rash was present, as the “bull’s eye” was once believed to be the hallmark of Lyme. As it turns out, that’s bull. It is true that Lyme frequently involves an area of inflamed skin, but fewer than 20 percent of Lyme cases present with a concentric bull’s-eye rash.

A large number of Lyme cases are misidentified as lupus, multiple sclerosis, fibromyalgia, or chronic fatigue. Not uncommonly, it’s diagnosed as depression or other psychiatric condition. In the elderly, it can easily be mistaken for sudden-onset dementia. Children under five and elders over seventy-five are the two age-classes that go the longest before being diagnosed with Lyme.

Testing: “Possibly Pregnant?”

The Western blot blood test gets a failing grade. It is tailored to a single 40-year-old strain of Borrelia burgdorferi, whereas there are over ten distinct genotypic and phenotypic variants of B. burgdorferi which are not detected easily, if at all. In addition, two closely related tick-borne microbes have recently been found. B. miyamotoi (2013) and B. mayonii (2016) also cause Lyme or so-called “Lyme variants.” Yet neither of these microbes show up in standard blood tests.

A little-known fact is that the Western blot does not give a “yes-no” result like a pregnancy test. First of all, labs get to choose how sensitive to make their tests. Some labs assay for as few as seven immunoglobulin bands, while others look at ten or twelve bands. And bizarrely, the results are purely subjective. One lab technician might count two bands as a “yes” while another may require three. Follow this logic: Two bands: “Stop whining – the test is negative.” Three bands: “Your test is positive – you poor thing!”

The Western blot has very low sensitivity and a high false-negative rate (Clinical Infectious Diseases, Vol. 57, Issue 3, August 2013). According to lymedisease.org, “56% of patients with known Lyme disease tested negative using the two-tiered testing system recommended by the CDC. (Stricker, 2007)”

Most doctors in Lyme-prevalent areas use clinical presentation to diagnose, which is as it should be.

Solutions: Panic is Optional

I’m not saying to panic, but feel free. Those who work in the real world can’t avoid ticks, but exposed skin should be protected using products such as DEET (25-30%), Picaridin (20%), Oil of Lemon Eucalyptus (30%), or IR3535 (20%). Nootkatone, a component of Alaska yellow cedar, has been found effective, too.

On clothing and footwear, 0.5% permethrin is unsurpassed. Permethrin not only repels ticks; it kills them in seconds. As well, it stays effective through 20+ wash cycles, and you can even buy factory-treated work clothes.

Never follow a deer trail in the woods, and treat your pets regularly with a systemic anti-tick product so they don’t bring live ticks into the home. After showering in the evening, check for ticks. It was once thought ticks did not transmit Lyme until they had been attached for 36-48 hours, but experts now say we have just 24 hours, after which we’re at risk. Ticks prefer hidden places like armpits, groin, scalp/ hairline, backs of the knees, beltline and sock hems.

If you find an embedded tick, grasp it with tweezers as close to the skin as possible and pull up with steady pressure until it releases. Don’t use heat, petroleum jelly, or other home remedies. These get the tick to release, but they also force it to spew the diseased contents of its gut into your blood. Tick fragments normally remain in the skin afterward, which is not a problem. Apply a topical antibiotic – your body will expel the fragments.

If Lyme is detected early, most people recover with a three-week antibiotic course. Stevia alcohol extract (not powder) has been shown to greatly boost the effectiveness of antibiotics.

But Lyme may refuse to vacate the premises in some cases. In a 2018 paper, the US National Institutes for Health stated “Several recent studies suggest that B. burgdorferi may persist after antibiotic therapy.” Much controversy surrounds the question of why symptoms last for months or years after an infection. I won’t wade into that morass, except to say that everything we know about the issue would fit in a thimble.

Tick-ID links: https://web.uri.edu/tickencounter/species/blacklegged-tick/

https://nysipm.cornell.edu/whats-bugging-you/ticks/what-do-ticks-look/

Paul Hetzler is a former Cornell Extension Educator.