The areas in red denote areas of high tick activity and associated tick borne diseases. As you can see, the Northeast is a hotbed of tick activity and the Centers for Disease Control predicts another very active tick season for the spring and summer of 2018.
Just a few days ago, a news story was reported stating that the Centers for Disease Control (CDC) is expecting an extremely active tick season this year and with it, an increase in tick related infections. This brought to mind a gentleman, who we will call Ray, who had come into the office to discuss Estate Planning and Medicaid Planning a few years back.
As we reviewed the options available to him, the discussion turned to his mother whom he said was being treated for a serious tick related illness. I expected the conversation to turn to Lyme Disease but instead he told me of another tick-borne parasite I had never heard of until that time – Babesiosis.
Ray told me that his family and his mother had taken an extended vacation on Martha’s Vineyard and Nantucket. All was fine upon their return, according to Ray, but two weeks later, his mother started to become ill.
“It started almost like she had the flu -- a fever, tired and some nausea. Because we had hiked along the shore and into some wooded areas, I immediately suspected Lyme Disease. My wife looked over my mom expecting to find that telltale “bullseye” pattern that doctors talk about with a Lyme Infection but instead, she saw nothing. So, we thought perhaps it was just a stomach bug,” Ray said.
Several days went by and her fatigue grew worse and she developed a massive headache. Getting out of bed had become a chore and she was unable to keep down any food.
Watch this video from Fox 61 in Hartford, Connecticut about a man in New Milford, CT who died from a Babesiosis infection. As spring arrives, so does the tick problem and the CDC is reporting that this year could be a serious tick season.
“We took her to our primary care doctor who suspected a stomach virus as well but still took a blood test. He did state that he wasn’t ruling anything out and had concerns about a tick bite even though we didn’t see anything, what came next was a shock.”
Ray said the doctor called a couple of days later and told him that the lab had found Babesiosis parasites inside her red blood cells. His mother did recover after being treated with two different medications, but it appears that some seniors may not be so lucky.
According to the CDC, Babesiosis symptoms typically appear between 1 to 6 weeks after the bite of an infected tick. Many people infected with Babesiosis develop no symptoms and those that do, like Ray’s mother, report symptoms that are non-specific and flu like.
Symptoms start with a gradual onset of fatigue and discomfort, followed by one or more of the following:
Severe illness typically requires hospitalization and commonly occurs in individuals with underlying risk factors such as being elderly, compromised immune system and asplenia (lacking a spleen).
Babesiosis can lead to a specific type of anemia (hemolytic anemia) that can last for months. In the most serious cases, the person begins to form blood clots, organs fail, blood pressure becomes unstable and in rare cases, death can occur.
Treatment includes antibiotics such as doxycycline and, while majority of the younger patients respond fairly quickly to it, in the elderly, the regular therapy often takes longer to show results. This is further exacerbated by the existence of other health conditions.
The tick that carries this parasite is the Black Legged tick or the Deer tick. Those who have been infected by these creature’s recall being bitten by a “bug the size of a poppy seed” and according to the Journal of Medical Entomology, this disease is on the rise as the tick that spreads the illness has increased its geographic presence across the U.S. by 47 percent since 1998.
Unfortunately, living in the Northeast puts us at particular risk to babesiosis as most cases occur in New England and tend to be concentrated in areas such as Rhode Island, Connecticut, Nantucket and Martha’s Vineyard.
Other areas of the United States affected by this disease includes the Upper Midwest, New York State and New Jersey.
Babesiosis, however, is not the only other tick carried disease on the rise. The CDC also reports that a deadly disease called the Powassan virus has jumped from the ground hog tick, which is a non-human biting tick, over to the deer tick and even more alarming, reports indicate that the virus is showing up more and more in the Upper Midwest and New England.
According to the Massachusetts Department of Health, there have been 16 cases of Powassan virus infection in Massachusetts in the last 10 years. No information could be found regarding Powassan infections in Rhode Island but just last year, Connecticut reported its first case of the virus in an infant who fortunately did recover.
According to tick experts, for this virus to be transmitted to humans, the tick needs to be attached to a person for a certain length of time before it can cause disease. This time interval of attachment is not known for Powassan virus disease, but it is likely shorter than 12-24 hours.
Many people who become infected with Powassan (POW) virus do not develop any symptoms but in those that do, the illness can be deadly. Some facts on the Powassan virus:
The incubation period (time from tick bite to onset of illness) ranges from about 1 week to 1 month.
POW virus can infect the central nervous system and cause encephalitis (inflammation of the brain) and meningitis (inflammation of the membranes that surround the brain and spinal cord).
Symptoms can include fever, headache, vomiting, weakness, confusion, loss of coordination, speech difficulties, and seizures.
Approximately half of survivors have permanent neurological symptoms, such as recurrent headaches, muscle wasting and memory problems.
Approximately 10% of POW virus encephalitis cases are fatal.
As with other tick-borne infections, seniors and those with diminished immune systems are most at risk.
Another disease spread by deer ticks and one that is especially dangerous to the elderly is Anaplasmosis. According to the Saint Luke’s Health System in Kansas City, the bacteria is called anaplasma phagocytophilum. The illness causes fever, muscle aches, and other symptoms that range from mild to life-threatening, and may include:
Fever and chills
Nausea and vomiting
Extreme tiredness (fatigue)
Rash (less common)
A person may only have some of these symptoms that begin within a week or two of the tick bite. Some people can be infected and have no symptoms while older adults and people with weak immune systems are more likely to have severe symptoms.
Finally, ticks also carry another disease called Ehrlichiosis. According to the American Lyme Disease Foundation, Ehrlichiosis, unlike Lyme disease, is considered an acute infection without chronic long-term consequences. Its severity varies from person to person. Many people exposed to the disease agent exhibit no symptoms, while others suffer mild symptoms that resolve without treatment.
In a minority of cases, however, Ehrlichiosis produces severe symptoms requiring immediate antibiotic treatment. These cases can be life-threatening and even fatal for elderly patients and others with compromised immune systems.
The ticks that carry this disease, called the Lone Star tick, has recently expanded into New York state (particularly Long Island) and coastal New England which has resulted in cases of Ehrlichiosis being reported from these areas with increased frequency.
To help protect yourself and your family, the CDC suggests that you:
Use a chemical repellent with DEET, permethrin or picaridin.
Wear light-colored protective clothing.
Tuck pant legs into socks.
Avoid tick-infested areas.
Check your family for ticks and carefully remove any ticks.
And remember this -- the sooner you remove a tick, the better. It takes time for infections to reach a person's blood stream, especially Lyme disease. A tick needs to remain attached for 36 hours before Lyme disease can be transmitted, so remove any ticks as quickly as you can. If you find a tick on a senior, contact your doctor as a precaution.
And there is a way of removing ticks. Below is the best method according to medical professionals.
One last thing, a person does not need to hike into the woods or roam the marshlands of Southern New England or the islands to be bitten by a tick. Urban parks and dog walking routes in cities like Boston, Providence, Hartford and even New York City, are also habitats for these parasites.
So, enjoy the outdoors this spring and summer but remember to be tick aware.
Next Week's Senior Issues Blog - The Coming Pandemic of Lyme Dementia
Attorney Connelly practices in the area of elder law. This area of law involves Medicaid planning and asset protection advice for those individuals entering nursing homes, planning for the possibility of disability through the use of powers of attorney for the both health care and finances, guardianship, estate planning, probate and estate administration, preparation of wills, living trusts and special or supplemental needs trusts. He represents clients primarily in the states of Rhode Island, Connecticut and the Commonwealth of Massachusetts. He was certified as an Elder Law Attorney (CELA) by the National Elder Law Foundation (NELF) in 2008. Attorney Connelly is licensed to practice before the Rhode Island, Massachusetts, Connecticut, and Federal Bars.