Tick Talk with Infectious Disease Specialist Robert Smith, MD, and Vector Ecologist Chuck Lubelczyk

May 30, 2019

Warmer weather means many of us will be heading outdoors for recreation. In recent years, Maine has seen an increase in the number of ticks and reports of tick-borne illness. Scientists at the Maine Medical Center Research Institute (MMCRI) study tick ecology as well as the diseases ticks carry. Robert Smith, MD, the director of MMCRI’s vector-borne disease lab, and MMCRI vector ecologist Chuck Lubelczyk answer some of our frequently asked questions about ticks and Lyme disease.

What is Lyme disease?
Smith: Lyme disease is an illness caused by bacteria transmitted by deer tick bites. The initial symptoms of Lyme disease may include malaise, muscle aches and pains, headache, chills and fever, in addition to a rash. Most people with Lyme disease develop a distinctive rash at the site of the bite. This rash may be circular or oval and expands with time. Untreated, additional symptoms may occur including hot swollen joints, paralysis of one side of the face (Bell’s palsy), and dizziness caused by disturbances in cardiac rhythm. Most symptoms of Lyme disease respond to antibiotic treatment.

True or false: You get a bullseye rash when you have Lyme disease?
Smith
: Circular red rashes do appear in 70 to 80 percent of people who acquire Lyme disease, often in the area where the tick bite occurred, but usually several days or more after the bite. If present long enough, the rash may develop a target or bullseye look, but early on may be less distinct. Sometimes the rash may develop as multiple circles over the body.

I hear other diseases can be transmitted by these ticks. Are they different than Lyme?
Smith:
Yes, there are several other diseases that can be carried by deer ticks in Maine. Other than Lyme disease, anaplasmosis is the next most common. It causes fever, headache and other symptoms but does not cause a rash. It can be particularly severe in elderly persons. Babesiosis is less common, but can cause severe illness with fever, anemia and other symptoms, usually in the elderly and those who have no spleen or are immune suppressed, such as people receiving chemotherapy. Rarer still is another cause of fevers, Borrelia miyamotoi. Finally, we are seeing less than one case a year in Maine of encephalitis caused by a virus sometimes carried by deer ticks called Powassan virus. It is rare to get sick with more than one of these microbes, and all but Powassan virus can be effectively treated with antibiotics.

I never worried about getting Lyme disease as a kid in Maine. Why do I hear so much about it now?
Lubelczyk:
Our research shows that deer ticks that spread Lyme disease are surviving Maine winters in higher numbers than they did in the past. Ticks are able to survive under snowpack, and when that snow melts, the moisture left in the soil helps keep ticks healthy. Maine’s Center for Disease Control (CDC) reports that the deer tick is now present in most of Maine.

How do I prevent tick bites?
Lubelczyk:
There are several things you can do:

  • Tuck your pant legs into your socks and your shirt into your pants when walking in woods, brush or tall grass.
  • Wear light-colored clothing so ticks may be seen more easily.
  • Use a tick repellent that contains 20-40 percent DEET or Picaradin on skin and clothing. The American Academy of Pediatrics states that DEET is safe for children, but recommends that lower concentrations (10 percent) be used and applied by an adult.
  • Pre-treat your clothing with a product that contains permethrin, a chemical that both repels and kills ticks. Permethrin should be sprayed on clothing only (not skin). Outdoor clothing stores sell pre-treated tick-repellent clothing that remains effective through the life of the garment.
  • Protect your pets by using tick repellents, acaricides and Lyme vaccines for dogs as recommended by your vet.
  • Do a tick check whenever you've been outdoors. Ticks often attach in body folds, behind knees, ears, in the pelvic region and on scalps. Showering removes unattached ticks, but not attached ticks.
  • Tumble clothes in a dryer on high heat for 10 minutes to kill ticks.
  • Use caution in wooded and bushy areas with leaf litter. Walk in the center of trails.

How do I properly remove a tick?
Lubelczyk:
It is important to remove attached ticks promptly. If you believe you may have been bitten by a deer tick, consult your physician.

  • Grasp the tick as close to the skin as possible, preferably with fine tweezers, and pull gently but firmly until the tick releases.
  • Do not handle ticks with bare hands.
  • Clean the bite with soap and water and apply an antiseptic or antibiotic cream.
  • Save the tick in a small bottle of 70 percent alcohol for identification if needed.

You can learn more about ticks and tick-borne diseases at www.ticksinmaine.com.