August Provider Newsletter: Tickborne Illness

          Summer in Tennessee means lots of outdoor activities such as swimming, sports, camping, hiking, food trucks, and festivals! With all of this outdoor time, we are unfortunately at risk for tick bites and possible tick-borne illnesses. This is a very common reason people visit our walk in clinic during the summer months. We have three types of ticks in Tennessee including deer ticks (or black-legged ticks), Lonestar ticks, and dog ticks. Each of these ticks carry unique pathogens and can possibly infect us with their bite. Being able to properly identify a tick upon removal is very helpful to aid in evaluation of possible exposure risks.

There are many different kinds of illnesses we can get from tick bites. I will go over just a few of the most common ones that cause people the most concern.

              Rocky Mountain Spotted Fever (RMSF)- This infection is most prevalent in our area, the southeastern/south central United States. This can be contracted after a tick has been attached to a host for 6-10 hours. The dog tick is the usual vector for this illness. Symptoms may take up to 14 days to develop, but most cases develop within 2-5 days after exposure. Symptoms include fever, headache, body aches, fatigue, joint pain, or rash. With RMSF, rash is not typically present until the illness has progressed. The rash typically starts at the ankles and wrists, and progresses to the trunk.

              Lyme- A lot of patients are worried about Lyme disease. This disease is spread through exposure to the deer tick. Though deer ticks are found across our state, Lyme is not common in Tennessee. Most exposures to Lyme occur in the Northeast or the Northwest. Approximately 80% of people who have contracted Lyme from a tick will develop the bullseye rash known as erythema migrans (EM). This is often one of the first signs of Lyme, and typically develops about 7 days after exposure. There is often redness at any site of a tick bite, and the difference is that EM will slowly expand over time. After the rash, people often have joint pain, fatigue, headache, and body aches. We do not routinely do Lyme titers at our clinic due to laboratory testing often coming back as false positives.

              Ehrlichiosis- This disease is spread by the Lonestar tick, and is most prevalent in the southeastern/south central US. Incubation period for this illness is 5-14 days. This means that it may take up to 2 weeks after tick bite to develop symptoms. Common symptoms include fever, chills, headache, body aches, muscle pain, gastrointestinal symptoms, and rash (common in children).

Tick titers and bite prophylaxis

              If you have been bitten by a tick, remove it as soon as possible. It is normal for there to be redness at the site along with some possible itching or irritation. Keep area clean with soap and water and monitor for development of rash or other symptoms. If you experience any of the symptoms discussed above such as fever, body aches, joint pain, rash, etc. after a tick bite, come to the clinic to be evaluated. Tick-borne illness can be easily and successfully treated with antibiotics if started early. We will treat with a course of Doxycycline long enough to cover for any of the above tick-borne illnesses if there is concern. If being treated prophylactically for illness, we will also draw tick titers to confirm diagnosis. Often times these may not be conclusive if done too soon after tick bite, so we will ask that you return for a second draw 4-6 weeks after exposure.

Tick Prevention

              Ticks are found in wooded, grassy, and brushy areas which includes your backyard. If you plan to spend time outdoors, you should plan accordingly. Using an insect repellant containing DEET, oil of lemon, or eucalyptus should be used anytime you are outdoors. If you are camping, you can pre-treat clothes and gear with 0.5% permethrin. If you are hiking, plan to walk in the center of trails. Always check your body and clothing for ticks after spending time outdoors. Pets are included too! Showering as soon as possible is beneficial as well. I have included a graphic showing commmon places ticks like to hide. Be very thorough when checking for ticks, and concentrate in these areas.

Sources

https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-rocky-mountain-spotted-fever?search=rocky%20mountain%20spotted%20fever HYPERLINK "https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-rocky-mountain-spotted-fever?search=rocky%20mountain%20spotted%20fever&source=search_result&selectedTitle=1~65&usage_type=default&display_rank=1"& HYPERLINK "https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-rocky-mountain-spotted-fever?search=rocky%20mountain%20spotted%20fever&source=search_result&selectedTitle=1~65&usage_type=default&display_rank=1"source=search_result HYPERLINK "https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-rocky-mountain-spotted-fever?search=rocky%20mountain%20spotted%20fever&source=search_result&selectedTitle=1~65&usage_type=default&display_rank=1"& HYPERLINK "https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-rocky-mountain-spotted-fever?search=rocky%20mountain%20spotted%20fever&source=search_result&selectedTitle=1~65&usage_type=default&display_rank=1"selectedTitle=1~65 HYPERLINK "https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-rocky-mountain-spotted-fever?search=rocky%20mountain%20spotted%20fever&source=search_result&selectedTitle=1~65&usage_type=default&display_rank=1"& HYPERLINK "https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-rocky-mountain-spotted-fever?search=rocky%20mountain%20spotted%20fever&source=search_result&selectedTitle=1~65&usage_type=default&display_rank=1"usage_type=default HYPERLINK "https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-rocky-mountain-spotted-fever?search=rocky%20mountain%20spotted%20fever&source=search_result&selectedTitle=1~65&usage_type=default&display_rank=1"& HYPERLINK "https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-rocky-mountain-spotted-fever?search=rocky%20mountain%20spotted%20fever&source=search_result&selectedTitle=1~65&usage_type=default&display_rank=1"display_rank=1

https://www.cdc.gov/ticks/tickbornediseases/ehrlichiosis.html

https://www.tn.gov/health/cedep/vector-borne-diseases/tick-borne-diseases.html

https://www.cdc.gov/ticks/avoid/on_people.html

Author

Alexis Purdom, FNP-C Alexis grew up in Columbia, TN. After obtaining her Bachelor's of Science in Nursing from Middle Tennessee State University, she moved to Nashville to work at Vanderbilt University Medical Center. She worked as a registered nurse in the Surgical ICU and Labor and Delivery before ultimately settling in as a NICU nurse. She earned her Master's degree at Austin Peay State University and is a board certified Family Nurse Practitioner. Alexis was nominated for the March of Dimes Nurse of the Year in 2018, and is a member of the Tennessee Nurses Association. She loves spending time with her husband and daughter, exploring Nashville one restaurant at a time, traveling, and hiking.