What’s eating you?

The other day, a young mother from the Midwest called the Tick-Borne Infections Council of North Carolina. She had just visited North Carolina, had gone hiking, and upon her return home had found a tick embedded in her skin. She couldn’t identify what kind it was, but when a circular, growing rash developed around the bite—a symptom often associated with Lyme disease—she went to see her doctor.

This really sucks: The lone star tick, while only a recent migrant to North Carolina, is nevertheless a major health concern for people who spend time outdoors. The tick pictured is an adult female. courtesy Centers for Disease Control and Prevention

Her situation was particularly urgent because she happened to be nursing a 4-month-old baby at the time. “I was crying when he told me I would have to stop nursing,” she said. Now, the doctor is looking for a treatment that will enable this woman to resume nursing her child. In the meantime, she wonders what our state is doing about its tick problem.

In North Carolina, ticks carry and transmit a host of diseases, including Rocky Mountain spotted fever and Lyme disease. Two years ago, several concerned state residents formed the Tick-Borne Infections Council (www.tic-nc.org), alarmed by the increasing incidence of such diseases and the lack of public awareness about the problem. The group’s mission is to improve the recognition, treatment, control and understanding of tick-borne diseases in North Carolina and enhance the public-health response to them.

Although our state lacks reliable, up-to-date maps showing the distribution and frequency of human-biting ticks, anecdotally there seem to be fewer of them in the mountains. The Piedmont is home to all four species of human-biting ticks, with the lone star being the most common. The black-legged or “deer” tick is believed to be more prevalent on the coast than in the rest of the state, perhaps due to its preference for moist conditions.

The most common tick affecting humans in North Carolina is the lone star, named for the white dot that marks an adult female’s abdomen. It’s a relative newcomer: Back in the 1970s and ‘80s, people started seeing tiny ticks and assumed they were the black-legged ticks notorious for carrying Lyme disease. In fact, most of these were actually the larval or nymph stage of the lone star, commonly known as “seed ticks.”

Ticks have three life stages and may spend a year passing through each one. Regardless of species, all newly hatched ticks are about the size of a pinhead. After molting, ticks become nymphs but remain very small—roughly the size of a poppy seed—as they go through additional molts before becoming adults.

The lone star, a voracious feeder, preys on a number of animals and overwinters on deer. It is implicated in several diseases.

Most tick-borne infections produce similar symptoms, often starting with flulike aches and pains. Rocky Mountain spotted fever is especially dangerous, killing 20 to 30 percent of untreated victims. It usually causes fever and severe headache.

Lyme disease is present in North Carolina as well, though it’s more prevalent in New England and the Midwest. The lone star tick also appears to carry another type of infection whose symptoms mimic those of Lyme disease. If not treated promptly, both these ailments can be very serious and debilitating.

Rashes accompany some infections but are not a reliable symptom. Only about half of people infected with the Lyme or Lymelike bacteria develop a rash, and the so-called “bull’s-eye” rash associated with Lyme disease is a misnomer: The rash may also be solid red. Over time, the rash grows larger, as opposed to the small, local swelling and redness most people get at the site of the bite.

Lyme disease is highly controversial. There’s a great deal of disagreement within the medical community about what diagnostic tests are effective for it, whether or not fetal and sexual transmission of the disease is possible, how long the infections should be treated, and whether chronic Lyme disease even exists. For complex reasons, these medical controversies have also found their way into the political sphere in the form of insurance companies’ fear of long-term liability, tourism-industry concerns and many other issues.

Because of overlapping symptoms, any flulike illness or fever during tick season (March to November) should be considered suspect. And the quicker they are treated, the better the likely outcome.

Regardless of where you live, prevention is the best way to avoid getting sick. Wearing long pants and light-colored, long-sleeve shirts sprayed with permethrin helps, especially when pant-cuffs are tucked into socks and then duct-taped in place. Spray exposed skin with deet; non-DEET products are generally less effective. Conduct frequent body checks, including all crevices and private areas. Showering with a washcloth helps remove loose ticks.

If you discover an embedded tick, grasp it as close to the skin as possible and pull it out slowly. Don’t use matches, Vaseline or similar methods to loosen the tick. They serve only as an irritant and can actually increase the risk of infection. To help narrow the diagnostic possibilities, record the date and place the tick was found on an index card and tape the tick to it.

As North Carolina’s deer population grows, tick populations also appear to be on the rise. And because no completely effective prevention methods have yet been developed, the problem is becoming ever more serious. Educate yourself, take steps to avoid being bitten, and see a health-care professional if in doubt.

[Marcia Herman-Giddens, an adjunct professor of child and family health at the UNC School of Public Health, is president of the Tick-Borne Infections Council of North Carolina. She can be reached at meherman@mindspring.com. The information in this column is not intended as a substitute for consultation with a licensed health professional.]


To learn more about North Carolina’s tick problem, visit the Tick-Borne Infections Council Web site (www.tic-nc.org).

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