The dangers of ticks: Not just Lyme disease

I have a story in the forthcoming March issue of SELF Magazine that has just been put up online: The Rising Dangers of Ticks. It’s a long look at the under-appreciated other diseases that can be transmitted by tick bites — that is, not the Lyme disease that most people associate with ticks, but babesiosis, erlichiosis, anaplasmosis, and others. From the story:

“We’ve seen pretty dramatic increases,” says Jennifer McQuiston, an epidemiology team leader in the vector-borne disease division of the Centers for Disease Control and Prevention in Atlanta. “We’re told to get out and exercise and enjoy nature, so we need to be aware.” Most people have heard of Lyme disease, which appeared among residents of that town in Connecticut in the mid-1970s and now affects more than 35,000 Americans per year. Most Lyme cases occur in the Northeast and upper Midwest; if you don’t live there, you might be safe from Lyme but still at risk for other diseases. Cases of a tickborne illness known as ehrlichiosis grew from 200 to 957 nationwide—a 378 percent jump—between 2000 and 2008, according to the CDC. The infection anaplasmosis nearly tripled in the same period, and Rocky Mountain spotted fever quintupled. The new disease STARI (southern tick-associated rash illness) has spread across the South, and strains of an infection called rickettsiosis have hit the Gulf and Pacific coasts.

All of these non-Lyme tick diseases attack victims in a similar way, bringing on fever, headache, and muscle and joint pain—making it easy to misdiagnose them as anything from flu to meningitis, says [Gary P. Wormser, M.D., the chief of infectious diseases at Westchester Medical Center and New York Medical College and head of a team researching tick diseases]. If the patient remembers finding a tick, or develops a rash, that’s a big clue. If not, “it is somewhat common for these to be missed. The symptoms resemble so many other common viral infections,” says Gregory A. Storch, M.D., a pediatric infectious-disease specialist at Washington University in St. Louis, which created a multidisciplinary tickborne-disease research team because cases have surged there.

…[B]ecause medical awareness has not kept up, patients have been overlooked, undertreated and taken by surprise when their enjoyment of the outdoors—a hike, a run, a round of golf, their own backyard—turns into a life-altering threat.

Sometimes these infections can be transmitted by a tick bite at the same time as Lyme, making them what physicians and Lyme patients call “co-infections.” Sometimes they are mistaken for Lyme. Some of them require different drugs to treat, so if they are not diagnosed correctly, people will not be treated properly and the diseases can linger.

That’s especially important for one of them, babesiosis, because it is caused not by a bacterium but by a parasite that lives in red blood cells much as malaria does — in fact, one researcher described it to me as “American malaria.” Because many people don’t show obvious symptoms, babesiosis isn’t always detected and treated. As a result, it is spreading, both from women to their children prenatally, and also, troublingly, through the blood supply. Babesiosis is currently the No. 1 cause of infections transmitted through blood transfusion in the United States. Unlike other infections that are potentially passed by blood, such as HIV and West Nile virus, there is no test for babesiosis that blood banks can use.

In 2007, in a case that rang alarm bells, a cancer patient in California arrived at the hospital weak and throwing up blood. Tests revealed babesiosis: He had been infected by blood from a man who had donated in Maine, say Van P. Ngo and Rachel Civen, M.D., epidemiologists at the Los Angeles County Department of Health who investigated the case. The FDA has since reported that over the past 10 years, babesiosis has infected more than 100 Americans via transfusions—and 11 of them have died.

These are tiny numbers compared with the more than 5 million people who receive transfusions in the United States each year. But there are almost certainly more cases than there would be if blood banks could effectively check for the parasite. Right now, donors merely complete a questionnaire that asks whether they have had babesiosis or unexplained fever. In one study in Connecticut, 1 out of every 100 donors who passed that screening was shown to be potentially infectious.

These infections aren’t often deadly, but sometimes “deadly” isn’t the point: For many of the women (and men) who have had them, they are life-interrupting and sometimes life-changing, requiring tough drug treatment and long recovery times. A number of women who suffered from babesiosis and erlichiosis generously shared their stories with me, and two are featured in SELF. I hope you’ll take a look.



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