As warmer weather arrives, those heading outdoors for recreation, gardening, yard work and other activities should be aware of tiny enemies lurking in the underbrush.
The blacklegged ticks, also called deer ticks, are also coming out for the season. The tiny arachnids are carriers of Lyme disease, which infects more than 10,000 Pennsylvanians every year, the Lyme Disease Association reports.
“Pennsylvania is the No. 1 state for Lyme disease and southwest Pennsylvania is a hot spot,” said Dr. Richard Wozniak of Conemaugh Memorial Medical Center’s family medicine residency faculty.
May is the beginning of Lyme disease season. Although it’s possible to contract the infection any time of year, most cases are reported in late spring and early summer.
The Pennsylvania Department of Health notes that not only is this when people go outdoors, it’s also when ticks emerge.
“(Tick) nymphs are most active in the late spring and early summer,” the department said in a paper last year. “Most cases of Lyme disease are attributed to nymphal ticks. Their small size makes them very hard to detect and remove in order to prevent Lyme bacteria transmission.”
Typical symptoms include fever, headache, fatigue and a characteristic skin rash that spreads from the bite location. If left untreated, infection can affect joints, the heart and the nervous system.
“It’s at least something we have to think about when patients present with these symptoms,” Wozniak said.
About 80% of Lyme disease patients will develop the rash, frequently called a “bulls-eye rash” because the center is a lighter color than the surrounding inflammation. Wozniak said the rash can develop with in a few days to as long as a month after the tick bite.
It is one symptom of early localized Lyme disease, which can be easily treated with antibiotic pills, said Dr. Fiona McLellan of UPMC Altoona family medicine residency faculty.
Prevention is key
Left untreated, the bacteria spreads through the body, and becomes early disseminated Lyme disease. Symptoms can include numbness in the arms or legs, vision changes, heart palpitations, chest pain and facial paralysis.
The third stage is late disseminated Lyme, which can cause arthritis, severe headaches or migraines, vertigo, dizziness, pains that come and go in joints or tendons, a stiff or aching neck, sleep changes, meningitis, mental fogginess, concentration issues and severe fatigue.
More advanced stages require more aggressive antibiotics, including intravenous antibiotics, McLellan said.
“The stage of the disease defines what you treat it with,” she said.
Both local doctors agreed the best way to avoid becoming ill with Lyme disease is to avoid getting bitten by ticks or at least remove the tick before enough bacteria enter blood to cause an infection.
“The message should be: The best thing to do for Lyme disease is to prevent Lyme disease,” Wozniak said.
It is best to wear long-sleeved shirts tucked into long pants when outdoors in the woods or brushy areas. If possible tucking pant legs into socks eliminates another access point, McLellan said.
“If possible, wear light-colored clothing because the ticks are easier to see,” she said.
Insecticide containing Deet may keep the ticks off and spraying clothing with insecticide containing permethrin may also help kill the ticks before they bite.
'Do a tick-check'
Ticks must attach themselves to the skin in order to feed. The longer they are attached, the more chance of infection, the doctors said.
“Take a shower within two hours of coming in from tick-prone areas,” Wozniak said. “Wash off and do a tick-check and get them off early before they have a chance to spread Lyme disease.”
If a tick is attached, the best way to remove it is to use a sharp set of tweezers and pull it straight out, he said.
Home remedies of rubbing the tick with petroleum jelly or touching it with a hot match head may actually make the situation worse, he said.
“That just makes it spit up and spread the disease more,” Wozniak said.
Just because a tick has attached to the skin doesn’t mean the individual has contracted Lyme disease, McLellan said.
“If it was attached less than 36 hours, the recommendation is for no treatment,” she said. “They should watch the area for a couple weeks and make sure they don’t get a rash.”