Maryland’s Tick Problem: Prevent Lyme

 

Maryland’s Tick Problem
Prevent Lyme Disease

School is out and everyone is excited about summer–especially Maryland ticks. In and around Annapolis, the increase in outdoor activities in parks, woods and particularly our own gardens and yard, means ticks and Lyme disease. Get the inside scoop on Maryland’s tick problem and what you can do to keep you and your family tick and Lyme-free this summer.

What kind of ticks are “bad”

Examples of the kind of ticks that carry Lyme and other diseases are pictured to the left and right. Notice that they are tiny. Dr. Freedman of Evolve Medical states, “I’ve had people come in for a mole removal only to find the mole had legs and tried to run away.” More importantly, he emphasizes to his patients that finding a “nymph” or “larva” size tick requires a “serious, involved and focused check for both adults and kids whenever they come in doors from high risk areas.”

How to remove a tick

• Use fine-tipped tweezers to grasp the tick as close to the skin’s surface as possible.
  

  Grasp as close to the surface of the skin as possible. 

• Pull upward with steady, even pressure.
• Don’t twist or jerk the tick; this can cause the mouth-parts to break off and remain in the skin.
  • If this happens, remove the mouth-parts with tweezers. If you are unable to remove the mouth easily with clean tweezers, leave it alone and let the skin heal.
• After removing the tick, thoroughly clean the bite area and your hands with rubbing alcohol or soap and water.
• Dispose of a live tick by submersing it in alcohol, placing it in a sealed bag/container, wrapping it tightly in
  

  Pull upward without twisting. 

• tape, or flushing it down the toilet.
• Never crush a tick with your fingers.

Other ways to remove ticks, such as using a hot match head or painting the tick with nail polish, gasoline, or other materials, are not advised. Such treatments can cause the tick to release more fluids back into the bite.

What are the symptoms of tick disease such as Lyme?

Lyme disease symptoms can be grouped by early (within 3-30 days after a tick bite) and late (days to months after the tick bite). The rash of Lyme is called “EM” or “Erythema Migrans” and occurs in 80% of infected people, usually at the site of the tick bite. The rash may appear within 3-30 days, typically before the onset of fever and is often the first sign of infection. It is circular, warm but not usually painful. It can be a “bullseye” or red throughout.

Early symptoms: 

1. Red expanding rash (bullseye or solid)
2. Flu like symptoms:
   1. Headache
   2. Fatigue
   3. Fevers
   4. Chills
   5. Muscle aches

Late symptoms: 

1. Bells (Facial) Palsy
2. Swelling of a large joint (such as knee)
3. Severe neck stiffness or headache
4. Additional expanding red rashes (bullseye or solid)
5. Heart palpitations or irregular heart beats
6. Dizziness or shortness of breath which comes and goes
7. Shooting pains, numbness or tingling in hands and feet
8. Problems with short-term memory
9. Pain in tendons, muscles, joints, and bones which comes and goes

Lyme in Maryland

As is evident in the image to the left, the diagnosis of Lyme disease has dramatically increased over the last 3 decades from near 0 to at least 38,468 cases. The CDC estimates that actual cases of Lyme may be closer to 230,000 to 461,000 (6-12 times greater than reported). 

At the same time, the risk for Lyme is not spread evenly in the US. In fact, the image on the right shows that most of the risk is from Maryland through New England. Areas in red are Lyme disease hot spots.

How to prevent tick bites

Ticks can be present all year but be extra vigilant in warmer months (April-September)

• Avoid wooded and bushy areas with high grass and leaf litter.
• Walk in the center of trails.
• Repel Ticks with DEET or Permethrin
  • Use repellents that contain 20-30% DEET (N, N-diethyl-m-toluamide) on exposed skin and clothing.
  • Use products that contain permethrin on clothing.
    • Treat clothing and gear, such as boots, pants, socks and tents with products containing 0.5% permethrin.
    • Remains protective through several washings.
    • Pre-treated clothing is available and may be protective longer.
• Find and remove ticks from your body.
  • Bathe or shower as soon as possible after coming indoors (preferably within 2 hours).
  • Conduct a full-body tick check using a hand-held or full-length mirror.Check under the arms, in ears, belly button, behind knees, between the legs, around the waist, and especially in their hair.
  • Parents should check their children for ticks under the arms, in ears, belly button, behind knees, between the legs, around the waist, and especially in their hair.
  • Examine gear and pets.
    • Ticks can ride into the home on clothing and pets, then attach to a person later, so carefully examine pets, coats, and day packs.
    • Tumble clothes in a dryer on high heat for an hour to kill remaining ticks.

What to do after a tick bite

Lyme disease is not usually transmitted within the first 48 to 72 hours of tick attachment. The likelihood of transmission is increased if the tick is engorged and/or has been attached for at least 72 hours. If you have had a tick bite, Dr. Freedman says, “Get seen right away. It’s easier to take 2 tabs of Doxycycline than to deal with Lyme disease later.”

Other tick-related illness seen in Maryland

It is also important to remember that other disease can come from ticks. Not all are caused by the same tick that caries Lyme disease but it would be very difficult for the average person to know the difference. Below are a few of the other tick-related illnesses that have been found in Maryland. 

Rocky Mountain spotted fever (RMSF)

• Rash varies greatly from person to person in appearance, location, and time of onset.
• About 10% of people with RMSF never develop a rash.
• Rash begins 2-5 days after fever starts
• Rash spreads from hands/feet toward the trunk. 

The red to purple, spotted rash of RMSF is usually not seen until the sixth day or later after the fever.  Making this diagnosis is very important as RMSF is a serious illness that can be fatal in the first eight days of symptoms if not treated correctly, even in previously healthy people, according to the CDC. 

Tularemia

Ulcer forms at the site of bite and is accompanied by swelling of lymph glands, usually in the armpit or groin. There are several different types of symptoms depending on the infected area and these range from Typhoidal (generalized) to primarily involving eyes, lungs, throat or skin.

Ehrlichiosis

According to the CDC, the kind of tick that carries Ehrlichiosis has not been clearly established. In fact, 50% of people who are diagnosed do not even recall a history of a tick bite. Further, “Ehrlichiosis” is term broadly applied to several different kinds of bacteria (Ehrlichia chaffeensis, Ehrlichia ewingii and Ehrlichia muris-like.) 

The illness of Ehrlichiosis usually begins within 1-2 weeks of the tick bite. Rash occurs in only 30% of adults (up to 60% of children) Rash is similar to RMSF and may appear after the onset of fever. 

Symptoms associated with Ehrlichiosis include the following: 

• Fever
• Headache
• Chills
• Malaise
• Muscle pain
• Nausea / Vomiting / Diarrhea
• Confusion
• Conjunctival injection (red eyes) 

If you have any questions or have been experiencing any of the above symptoms, see your primary care physician immediately or visit Evolve Medical. Same day scheduling on-line here or call 844-322-4222. Or email them at info@emc4me.com.

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