Author: Nijmih Siryani

A common myth of ticks being able to fly and jump to attach to their hosts may have proved some validity as of recent findings. Ticks will engage frequently in what’s known as questing behavior. Questing behavior is different across several tick species, but in general, most species will wait on the top of blades of grass with their legs outstretched until a host brushes by. They will then attach to their host, and remain there as long as possible, or until they are found by humans. 

The University of Bristol has recently discovered that ticks use static electricity to clear gaps of space between them and their potential hosts. This makes their questing more efficient in the long run since they have energy reserves designated for questions behavior, around ~30%. All humans, and animals carry electrostatic charge, this is naturally occurring for animals especially, as they brush against grass and the ground. However, we know now there is an electrical charge that passes between them and the ground. This has been replicated within a laboratory setting by placing ticks on what’s known as a grounding plate. Grounding plates discharge energy into the ground. 

Researchers dragged several objects with charge on top of the ticks. To mimic the static charge of mammals, rabbit fur and electrodes were used that had a voltage of 750V. As the researchers dragged the objects above the ticks they were propelled through the air onto the charged object. The researchers increased the charge and saw even higher lengths the tick was propelled on the object which acts as the hots (us). 

Although ticks do not jump, or fly, the distance they can be thrown into the air is a huge benefit to them. It is equivalent in human terms to 3 flights of stairs! You should always remain vigilant against ticks, especially knowing you are a magnet to the dangerous parasites. Using repellents like permethrin are highly recommended, especially knowing that there is a higher chance of having a tick attach to you. While we don’t know the frequency in which the static charge can cause ticks to be propelled onto their hosts, you should still be aware and perform tick checks on yourself or loved ones in the meantime. 

In 2009, two Missouri farmers were exhibiting symptoms of low white blood cell (leukopenia) and low blood platelet counts (thrombocytopenia) after several recent tick exposures. They were given a course of Doxycycline, however, they were not responsive to treatment. They were identified by the CDC with what we now know as Heartland Virus. Since then, there have been approximately ~40 confirmed human cases. The cases are usually allocated to southern states including Arkansas, Georgia, Illinois, Indiana, Iowa, Kansa, Kentucky, Missouri, North Carolina, Oklahoma, and Tennessee. The distribution of these cases towards southern states may be due to the main vector that carries the virus, Amblyomma americanum or the lone star tick.

Lone Star Tick

The Lone Star tick is found predominantly in the Southeast and Northeast parts of the United States, however, their distribution has been rapidly expanding due to climate change and land usage patterns. Lone Star ticks are considered an extremely aggressive tick species. They actively seek out hosts via carbon dioxide emission and vibrations. To complete their life-cycle, all ticks must take three full blood meals. The three stages of a tick include larvae, nymph, and adult, a blood meal is required to molt into each new stage. Generally, the later the stage, the greater the possibility of pathogen exposure. However, when it comes to Lone Star ticks, there is some evidence of transovarial transmission of pathogens from the mother to the offspring. So even some larvae may already be exposed to transmissible pathogens even before their first blood meals. It is important to recognize that all stages of the Lone Star ticks can be a possible threat.

Lone Star ticks are also linked to Rocky Mountain Spotted Fever, southern tick-associated rash illness (STARI), and alpha-gal syndrome (red meat allergy).

Heartland Virus

Heartland virus (HRTV) is a novel RNA Bunyaviridae Phlebovirus. The virus has been found to be genetically similar and closely related to thrombocytopenia syndrome virus (SFTSV) which is also a tick-borne phlebovirus endemic to Korea, Japan, and China. Since HRTV is a new/emerging virus, replicating it within a laboratory setting has been problematic because no mammalian host that was used was able to undergo the full stages of the virus, such as viremia. Understanding the full mechanism behind the virus is still underway.

Symptoms/On-Set

The incubation period of Heartland virus ranges from two days to two weeks from the initial tick bite.

Commonly experienced symptoms include:

Diagnosis And Treatment

Diagnosing Heartland virus can be difficult. Most physicians should use the following guidelines when diagnosing the illness.

An acute febrile illness (acute fever) within the last three months. Along with one of the following criteria from each group:

Epidemiologic Criteria:

• A known tick bite, finding a tick on your body, or potential exposure to ticks through outdoor activities in the 3 weeks prior to symptom onset during spring through fall OR
• Resides in or recently traveled to an area with previous evidence of Heartland virus.

Clinical Criteria:

• Leukopenia (white blood cells <4,500 cells/µL) or thrombocytopenia (platelets <150,000
  cells/mL) not explained by another condition; OR
• Suspected tick-borne disease with no response to the appropriate treatment given, such as a course of doxycycline.

Currently, no set treatment is available for Heartland virus. Most people would be treated with supportive therapy such as IV fluids, fever reducers, and pain medications. Antibiotics are NOT effective against viruses.

References:

https://ldh.la.gov/assets/oph/Center-PHCH/Center-CH/infectious-epi/EpiManual/HeartlandBourbonBackgroundTesting.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6164824/

https://academic.oup.com/ofid/article/7/5/ofaa125/5819209

Tick saliva and salivary glands have long been studied regarding the effects they can induce when obtaining blood meals. 

Ticks have salivary proteins that contain immunomodulatory molecules that can affect the hosts environment, and therefore influencing blood feeding or the potential to transmit pathogens. 

Ticks have two main methods of feeding on hosts: 

1.) Pool feeding 

2.) Piercing and sucking 

• During pool feeding, the ticks’ unique mouthparts will cut open the hosts skin and superficial vessels/capillaries which results in blood leaking. This blood is later consumed by the tick.  

• Feeding by piercing and sucking occurs when the ticks insert their mouthparts into the skin of their host and eventually the blood vessels to take a blood meal. 

Both of these methods allow ticks to successfully acquire a blood meal and to potentially transmit any pathogens carried to their designated host. 

The saliva of ticks is made up of a few basic components;: water, ions, tick proteins/peptides, non-peptide molecules, exosomes, and host proteins. 

Some important components that ticks will inject into their host include: 

• Anti-immunomodulatory (Immune system evasion)
• Anti-vasodilatory (Blood vessel shrinkage)
• Anti-coagulants (Blood clotting)
• Anti-complement factors  (Preventing immune responses towards infections)
• Anti-platelet aggregation factors. (Preventing blood from clotting)

Most vertebrates will react to skin injuries caused by a tick bite by forming a haemostatic plug. This “plug” closes the damaged site of the blood vessels and helps to control bleeding. Some other reactions that are seen with the initial tick bite are vasoconstriction, inflammation, and wound healing. Disabling these processes allow ticks to ensure blood flow and evasion from the hosts immune system.

Ticks are separated into two broad groups: 

• Hard (Ixodidae) – ie;  deer, lone star, dog ticks. 
• Soft (Argasidae) – ie; Antricola, Ornithodoros, Argas. 

The salivary glands of both groups consist of several types of acini (small sac-like cavity located within glands). 

Female ticks in the Ixodidae (hard tick) group consist of type I, II, and III acini. 

Male ticks in the Ixodidae group consist of type IV acini. 

Female and male ticks in the Argasidae (soft tick) group consist of type I, and II acini. 

• Type I acini –  involved in osmoregulation which is maintenance by an organism of internal balance between water and dissolved materials regardless of the environmental factors. The acini aid in the absorption of humidity from a ticks environment. This is essential for maintaining the ticks reservoir or energy to engage in questing behavior when seeking out hosts. 

• Type II and III acini – involved in synthesis protein/lipid factors, pathogen osmoregulation, development, and replication. 

• Type IV acini – involved in salivation that contributes to the transfer of spermatophores to the females genital opening during mating. 

Recent studies show that ticks are capable of actively controlling specific types of acini through the neuropeptidergic network that stems from their synganglion (central nervous system of ticks). 

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8809362/

Ixodes scapularis is the main vector for Borrelia burgdorferi which is the causative agent of Lyme disease. Ixodes scapularis is primarily known as a woodland-associated tick, due to its natural habitat. Ixodes scapularis ticks have a 2-3 year life cycle that consist of four life stages. 

Stage 0: Mating – Mating occurs while the adult female ticks are taking a blood meal from a host. Male ticks insert their hypostome and chelicerae into the female’s genital opening and transfer spermatophores. Males can stay attached to the female throughout the 6-11 day feeding time frame. Male ticks do not take blood meals after their second stage (nymphs). Their life-cycle generally revolves around mating with females, as after mating they will die. 

Stage 1: Egg – After 14 days, multicellular eggs are expelled from the genital opening of the female. The eggs pass over the capitulum where they are coated with wax. This wax protects the eggs from drying and also binds them together into a mass. After 35 days the eggs embryonate, the body and legs of the nymph are formed. Over the next 14 days the larval will mature. Larvae seek out small hosts to whom they attach, and feed for the next 6 days. Afterwards, they drop off to molt into leaf litter to molt into their next life-stage. 

Stage 2: Larva – Larval and nymphal ticks must take a blood meal before they are able to molt into the next life stage. During this process, they may acquire dangerous pathogens, through host choice, or through co-feeding transmission. Co-feeding transmission occurs when an uninfected and infected tick feeds on the same host in close proximity. Larvae and nymphs normally feed on smaller mammals, which may include chipmunks, white-footed mice, birds, lizards, and sometimes even deer. 

Stage 3: Nymph – Nymphs emerge from larvae in roughly 28 days, however, many nymphs fail to complete the molting process and die. Peak nymph activity is highly correlated with months May, June, and July. Nymphs are considered highly dangerous due to their incredibly small size which allows them to remain incognito on various parts of a host’s body. The longer a tick remains attached to a host, the higher the chance of transmission occurring.

Stage 4: Adult  – Within 4-5 weeks nymphal ticks molt into the adult, and final stages of their life-cycle. Molting is a slow process and during this time the emerging adult ticks breathe through tubes that connect the spiracles with the exoskeleton. Adult female ticks feed on larger mammals, such as deer, humans, pets, etc. They lay a large batch of eggs, and die. Adult ticks are active specifically in the fall and spring months, however, they can show just as much activity in some of the winter months. Climbing temperatures throughout winters can create very habitable environments for ticks. As long as daytime temperatures stay above freezing and there is little snow covering the ground, tick activity can proceed as normal. Although adult female ticks may lay eggs towards the end of spring, their offspring will not begin to seek out hosts until months later.

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4650338/#MOESM1

Lyme disease is a debilitating tick-borne illness spread by ticks. The CDC estimates that half a million of Americans have been treated for Lyme disease. That does include the numerous other co-infections that exist, and often go unnoticed next to Lyme disease. Although some states do have state-wide programs in place to combat tick issues, a lot of states fail to acknowledge just how serious it is. It is important to understand the several factors as to why so many states experience a surplus of tick issues, and why some states are only in the early stages of a tick dilemma. 

Host choice – Rodent density is a key factor in tick population growth. Rodents are the most hospitable  hosts for larval ticks . White-footed mice are  the main harborer for Lyme disease bacteria, B. burgdorferi. One main difference between the Eastern and Southern regions is that rodents seem to be less prevalent in the South. Instead, the Southern regions  have a dense population of reptiles. A large portion of ticks in southern states have been found on lizards, as opposed to the abundant rodent life Eastern states exhibit.Reptiles are shown to be ill-fitting hosts for spirochetes from B. burgdorferi to survive. Because of this, tick population size in the South is %x smaller than the North. 

Questing behavior – This behavior is seen in hard ticks (deer, dog, and lone star ticks). It is the ticks way of increasing its chances of coming into contact with a host. This mainly includes ticks sitting at the peak of grass blades with their legs outreached waiting to feel something brush up against them. This behavior differs based on climate factors. Southern states are notoriously hotter,  lacking humidity compared to northeastern states which experience vast seasonal changes. 

• More desiccation in Southern states. 
• Questing behavior requires a lot of energy, about 30% more. If there is less moisture in the air, then ticks will allocate less time to questing so they can conserve their water intake/reserve. 

Elevation differences – Higher elevations see a smaller number of tick populations via research conducted. Evidence is not solid as elevations between places like Europe and the United States yield different conclusions regarding tick populations. It would make sense to see less ticks at higher elevations as only certain rodents/animals will be at much higher elevations than on ground level. 

Urbanization – With developing rural areas into cities comes major drawbacks. The endemic wildlife tends to adapt and thrive in the urban environment. This includes deer, and mice, which we know are some of the ticks most sought after hosts. You’re thrown into a tick’s natural habitat with deforestation. 

Climate change – Ticks are exotherms, meaning they can’t regulate their internal temperatures as mammals do. Increasing temperatures on the outside allow them to remain active in winters when they would normally be in diapause. As we continue to see warmer temperatures in the winter, we will also see an increasing population of ticks the following Spring as they are now able to survive through the cold season. 

Public awareness – Although still heavily underreported, tick-borne illnesses and tick species have gained more awareness over the years. New information emerging might only be due to a spotlight being shined on the topic. Tick-borne illnesses have been an issue for quite a while, perhaps now the number of tick-borne illness cases can be controlled with proper safety information being distributed to the general public. 

If you are able to communicate with people who are unaware of the dangers of tick-borne illnesses, we implore you to do so. The more of the general public that becomes aware of the issue surrounding ticks, the easier it is to gain funding for tick testing, research, and solutions. If your state does not offer free tick testing, our laboratory offers some of the most comprehensive and affordable tick testing available! https://www.tickcheck.com/. 

Insect repellents should have an adequate percentage of the active ingredient in order to be effective/long lasting. 20-30% of an active ingredient is the recommended amount to have in insect repellent products. The products should always be Environmental Protection Agency (EPA) registered.

Properly applying repellent is an important process and can heavily alter the efficacy of a repellent product. Always apply an even thin coat to the skin, or clothes. Never spray products directly into the face. Spray first into your hands then apply to the face.

DEET

• N, N-diethyl-meta-toluamide
• Can be applied directly to the skin
• Safe for children and pregnant women
• Strong smell

Recommended DEET products:

• Cutter Backwoods Insect Repellent

• OFF! Deep Woods Insect Repellent

Picardian

• KBR 3023
• Synthetic ingredient closely related to piperine which is a natural compound from black pepper
• Can be applied directly to skin
• Safe for children and pregnant women
• Concentrations of 10-20% provide protection for up to 12 hours
• Mild smell

Recommended Picardian products

• Sawyer 20 % repellent Picardian

• Ranger Ready Picardian

IR3535

• 3-[N-Butyl-N-acetyl]-aminopropionic acid, ethyl ester
• Structurally related to β-alanine which is an amino acid that occurs naturally
• Can be applied directly to the skin
• Safe for children and pregnant women
• Works best on deer tick nymphs
• Odorless

Recommended IR3535 products

• Avon Skin Soft Plus

Oil of Lemon Eucalyptus

• p-Menthane-3,8-diol
• Naturally occurring active ingredient from the lemon eucalyptus plant
• Not an essential oil; mixed with PMD
• Can be applied directly to the skin
• Safe for pregnant women
• Safe for children over 3 years old
• You have to reapply the product more often than others ~2 hours of protection

Recommended Oil of Lemon Eucalyptus products:

• Repel Plant-Based Lemon Eucalyptus Insect Repellent

Permethrin

• 3-(2,2-dichloroethenyl)-2,2-dimethylcyclopropanecarboxylic acid
• The only repellent that repels and kills ticks
• Safe for children and pregnant women
• Works best when sprayed on clothes as opposed to directly on skin
• Permethrin treated clothing is found to be more effective than the sprays
• Highly toxic to aquatic life and cats

Recommended Permethrin products

• Sawyer Trigger Spray Permethrin

• Repel Permethrin Clothing and Gear Repellent

Essential Oils As Repellents:

Essential oils have shown promise in recent years as being an alternative to chemical/synthetic insect repellents. However, currently there has not been adequate research to give a definite answer. Be careful when replacing your repellents with natural oils as you may have a false sense of security regarding being protected from ticks.

Citronella
– Registered with the EPA as a natural repellent against insects
– It is derived from several species of lemongrass
– Often a key ingredient in most botanical insect repellents

Nootkatone
Registered with the EPA as a natural repellent against insects
It is found in Alaskan yellow cedar tees and in grapefruit skin
It is able to repel ticks and mosquitoes
Used abundantly in the food industry to flavor foods

Pine oil
– The oil repels ticks due to its potent smell
– If ticks come into contact with the oil they die very quickly

Botanical brands currently on the market that are backed by science:

• Organtick

• Wondercide

• Evolva

• YAYA Organic

Factory-Treated Clothing

Permethrin is currently the main and only insect repellent used in the process of pre-treated insect repellent clothing. Permethrin has been used as an insect repellent for over 40 years. Pre-treated clothing has been highly effective at repelling troublesome insects such as ticks and mosquitoes. Permethrin interrupts the ticks’ ability to bite humans by causing irritation to the ticks/insect. They tend to fall off or detach because of this. It has been shown to be highly effective against the Ixodes scapularis (deer tick/blacklegged tick), which is the main vector for Lyme disease. Pre-treated clothing is an important tool for people who spend the majority of their time outside. Whether that be for leisurely activities or because of their work.

Some important tips to keep in mind are that pre-treated clothing should be washed separately from your normal laundry. There has been research that suggests small traces of permethrin can come off during the washing process due to the detergent used. Factory-treated clothing is meant to be effective for at least 6 wash cycles. If you are interested in getting some of your clothing pre-treated, Insect Shield is one of the top companies that specializes in this. The process is extremely simple and can save you a lot of issues in the long run. You send your clothes into them, they pre-treat it, and send it back to you. What could be simpler than that?

Tick-borne illnesses do not only plague people. Our pets can also fall victim to very debilitating and sometimes deadly tick-borne pathogens. Being aware of the dangers and illnesses that ticks can cause should be noted for animals as well. We will be covering the most common pathogens found in ticks as well as commonly transmitted pathogens in the United States. 

Lyme Disease: Borrelia burgdorferi the main causative agent for Lyme disease that can affect humans dogs, horses, and possibly cats. Although there are multiple strains that can cause Lyme disease, the majority of cases have been found to be caused by B. burgdorferi. Its main vector is the deer tick/black-legged tick (Ixodes scapularis, Ixodes pacificus). The Northeast, Upper Midwest, and Pacific coast have the highest cases of Lyme disease. 

The clinical symptoms for Lyme disease include fever, loss of appetite, swollen joints, lethargy, and swollen lymph nodes. Sometimes symptoms may never occur, which is why Lyme disease can be a silent debilitating disease. 

Diagnostics rely on clinical symptoms as well as laboratory testing.If your pet has had a recent tick bite with the symptoms previously listed your veterinarian might immediately put your pet on antibiotics, especially if you live in an area with a high index of Lyme disease. Normally testing will include PCR, ELISA, and serological testing that should be done 4-6 weeks after the initial tick bite to eliminate a chance of false negatives occurring. 

Treatment for Lyme disease is at least four weeks of doxycycline due to B. burgdorferi’s latent and resistant nature. If you are concerned about your dog or horse contracting Lyme disease, vaccination is an option that many veterinarians offer. 

Ehrlichiosis: Ehrlichia canis is a bacteria that is primarily carried by the brown dog tick (Rhipicephalus sanguineus). E. canis is endemic to southeastern and southwestern parts of the United States. 

The clinical signs of ehrlichiosis are separated into three stages: 

1. Acute (early disease) – In this stage, infected dogs might experience fever, swollen lymph nodes, respiratory issues, weight loss, bleeding disorders. This stage can last ~2-4 weeks. Dogs can recover naturally from this stage, otherwise, they will head into the next phase of the infection. 

2. Sub-clinical – Although the dog is experiencing an active infection, they may not show any symptoms during this stage. Unless laboratory diagnostics are performed there is little to go off during this time. Again, the dog may be able to overcome the infection. If not, they enter the last stage. 

3. Clinical Ehrlichiosis – If the dogs immune system fails during the previous two stages to eliminate the infection they are left with a wide range of symptoms. The most commonly seen symptoms are unexpected bleeding, anemia, lethargy, swollen limbs, blindness, and neurological issues

For laboratory diagnostics standard PCR or ELISA testing is recommended at least 4-6 weeks later than the initial tick bite occurred. Blood tests including a complete blood cell count are recommended since anemia and spontaneous bleeding are symptoms. German Shepherds, Doberman Pinschers, Belgian Malinois, and Siberian Huskies seem to have more severe manifestations of an ehrlichiosis infection. 

Doxycycline is normally given as an effective treatment for most tick-borne illnesses, including Ehrlichiosis. It is recommended that a four week course be given, but this will be up to your veterinarian to decide. 

Rocky Mountain Spotted Fever: Rickettsia rickettsii may cause several diseases, but the most common being RMSF. The bacteria can affect humans as well as dogs. The primary vector of R.rickettsii is the American dog tick (Dermacentor variabilis). American dog ticks as a vector are quite dangerous as they often feed on humans and dogs. They are also quick to change their geographic locations, this might be due to climate change. 

The clinical signs of RMSF are especially debilitating to dogs. They include fever within a few days from exposure of the tick bite, skin rash, edema of limbs, myalgia, and neurological issues. 

Diagnostic testing for RMSF relies heavily on serological results as it is the most common method used by veterinarians. Indirect fluorescent antibody assay (IFA) and ELISA are most commonly used. Thrombocytopenia is a hallmark of rickettsial infections, therefore it would be wise to have a blood count performed if RMSF is suspected. 

Doxycycline is the main treatment for canine and human rickettsial infections. The recommended course would be 4 weeks. Sometimes corticosteroids can be given to dogs to help with the intense inflammation they experience during the infection. 

Anaplasmosis: Anaplasma phagocytophilum or Anaplasma platys. A. phagocytophilum affects humans, dogs, cats, and horses. Its main vector is the black-legged and western black-legged ticks (Ixodes scapularis/Ixodes pacificus). A. platys affects dogs and is carried by the brown dog tick (Rhipicephalus sanguineus). Anaplasma has a very high index in the Northeast and the Upper Midwest.

The clinical signs of anaplasmosis in dogs are joint pain, limping, lethargy, fever, vomiting, loss of appetite and anemia. Thrombocytopenia can occur due to the infection targeting blood platelets. 

Diagnostics include PCR, ELISA, and IFA. Blood smears and a complete count should also be performed to rule out anemia and thrombocytopenia. 

Treatment for canine anaplasmosis relies on doxycycline. The normal length of antibiotics would be 2-4 weeks depending on clinical signs/laboratory results. Sometimes doxycycline is also combined with the main treatment to eliminate any co-infections. 

Babesiosis: Babesia canis is very different from the other illnesses mentioned above. It is a protozoan infection instead of a bacterial infection. Protozoa have complex life-cycles and mimic human cells which makes them quite difficult to treat and cure. Babesiosis can be transmitted multiple ways; blood transfusions, transplacental transmission, and of course through tick bites which is the most common transmission route.

Clinical symptoms include lethargy, reduced appetite, pale gums (due to anemia) and weakness. Diagnostics rely on PCR, ELISA, and serological testing – complete blood count to rule out thrombocytopenia. Certain dog breeds including Terriers, and Greyhounds are at an increased risk of infection. 

Treatment is a combination of specific antiprotozoal/antiparasitic antibiotics of azithromycin and atovaquone. Blood transfusions may be needed in some dogs with severe anemia. The length of treatment should be determined by your veterinarian based on the severity of symptoms. Traditionally, ten days is the recommended time frame. 

Hepatozoonosis: Hepatozoon canis is a protozoan parasite carried by the brown dog tick R. sanguineus. The parasite affects carnivores such as dogs, foxes, jackals, hyenas, and many more. The mode of transmission differs vastly from the usual tick bite. Instead, dogs ingest the infected tick and obtain the parasite through digestion. Hepatozoonosis has been reported in several states including Texas, Alabama, Mississippi, Georgia, Oklahoma, Tennessee, and Florida. 

Clinical symptoms are fever, lethargy, anorexia, and muscle wasting. Since H. canis reproduce in the organs associated with blood storage like the spleen and bone marrow your dog may become sick quite quickly. 

Diagnostics should heavily rely on blood smears and complete blood counts as they are found in the neutrophils and monocytes. Leukocytosis (increased white blood cells) is seen in numerous cases as well as elevated ALP activity (marker of bone disorder). 

Treatment for hepatozoonosis in dogs requires a dose of imidocarb dipropionate every 14 days or until parasites are no longer shown on blood smears. Sometimes completely eliminating the parasite is difficult and a low amount of them are sufficient for normal function. Without proper treatment a dog may die within 12 months of infection. 

Causative Agents of Lyme Disease: B. burgdorferi, & B. mayonii. 

There are 4 stages of Lyme disease. It is important to note that antibiotic treatment and stage class should go hand-in-hand regarding dosage/length.

1. Early localized Lyme disease – This stage mainly includes the notorious erythema migrans rash (bullseye). Note. This symptom is not indicative of every case of Lyme disease and only occurs in ~40% of confirmed cases. Flu-like symptoms are commonly reported, including fever, headache, and fatigue. 

1. Early disseminated Lyme disease – Once the short window of early antibiotic treatment has passed, the next stage indicates that the bacteria has spread from the initial tick bite zone. Facial palsy, nerve pain, and nerve weakness are common symptoms of this stage. 

2. Late Lyme disease – Commonly reported symptoms include severe headaches, neck stiffness, arthritis, neurological complications, vertigo/dizziness, and numb limbs.

3. Post-Lyme disease syndrome(s) – In some individuals, antibiotic treatment doesn’t seem to rid the infection completely. Instead, lingering symptoms and flare-ups occur throughout the individual’s life. The symptoms are generally chronic and vary. The common issues revolve around severe joint pain, extreme fatigue, brain fog, and severe headaches. The topic is controversial as some physicians do not recommend treating with antibiotics any further based on medical guidelines. On the other hand, many physicians see improvement in their patients with PICC line antibiotics and long-term antibiotic use in general. 

First-line oral antibiotics for Lyme disease and other tick-borne illnesses include doxycycline, amoxicillin, and cefuroxime. Intravenous administration of ceftriaxone is preferred for late stages of tick-borne diseases that cause neurological sequelae.

Doxycycline is the most well-known and used antibiotic in regard to Lyme disease and other tick-borne illnesses. This medication belongs to the tetracycline antibiotic class and is referred to as a bacteriostatic antibiotic because it halts growth of bacteria. Doxycycline has properties that can aid in controlling inflammation associated with things like rheumatoid arthritis, so it is a plus when given to patients with Lyme disease. In addition, it can cross multiple membranes within the body due to high lipophilicity, allows it to target bacteria well, as it can dissolve in fats, oils, and lipids more easily than other antibiotics. 

While you should always check with your healthcare provider for best efficacy, patients should generally take doxycycline on an empty stomach and ~3 hours before taking any other supplements. In regards to the time frame that it should be administered, based on the current research, anything below two weeks leaves the potential for bacteria to be left over. Unfortunately, this happens quite often as B. burgdorferi has latent properties which allow it to remain undetected within the body, blood or tissue. 

Negative side effects associated with doxycycline 

As with any antibiotic, side effects can and do occur. How bad those side effects are vary from person to person. Some of the most common side effects include diarrhea, nausea, vomiting, headaches, migraines, and leukopenia. Your physician will always take your age, previous health history, current health issues, and symptoms into account when prescribing antibiotics. Contact your healthcare provider immediately if you notice severe symptoms like shortness of breath, chest pain, irregular or fast heart rates, or bloody stools. Other antibiotics are available to take in place of doxycycline. 

Babesiosis causative agents: B. microti, B. odocoilei & B. duncani

Babesiosis is a protozoal infection. It differs from Lyme disease, a bacterial infection, so completely different antibiotic treatments are required. Protozoal conditions are harder to treat as they don’t respond to antibiotics alone. As a result, healthcare providers must use a combination of antibiotics and antiparasitic drugs (like the ones used for malaria). Physicians will often omit treatment for babesiosis if their patients are asymptomatic. The severity of babesiosis depends on the amount of infection present within someone and the state of their immune system. If the parasite is present in the blood after 3 months, your provider with usually treat it. This can be determined with blood smears and PCR testing. 

According to medical guidelines, the current recommended treatment is atovaquone and azithromycin or clindamycin and quinine. The combination of anti-parasitic/anti-fungal and antibiotic has been effective thus far. However, protozoal infections have become increasingly harder to treat in recent years due to resistance to the required medications. 

If you have ever had a babesia infection, you are not allowed to donate blood indefinitely. Babesia microti has been determined to be the most common transfusion-transmitted pathogen in the United States. This could be due to several factors, including persistent parasites within the blood and a high chance of people being asymptomatic despite infection. 

Rocky Mountain Spotted Fever causative agents: R. rickettsii

RMSF is one of the most common pathogens spread by Lonestar, wood, brown, and American dog ticks. It belongs to the Spotted Fever group, which has a ~1% fatality rate in the United States. Although it can become deadly, most cases are subclinical and respond well to antibiotics. The most common symptoms associated with RMSF are fever, headache, myalgia, and the notable rash that is seen in roughly ~90% of cases. 

Due to the name having the Rocky Mountain region attached to it, many people, including physicians, might not realize that you can contract the illness outside of that area. The disease has been reported in almost every state in the US. 

Doxycycline is the preferred treatment because it covers a broad spectrum of potential co-infections and other rickettsial pathogens. RMSF is a bit more acute in terms of symptom onset compared to illnesses like Lyme disease. They usually occur 2+ days from the initial tick bite. Although most cases will have a rash, it may not show up until about the 4th day, so diagnosis can be tricky. On the other hand, some may not develop the rash at all. If RMSF is suspected, most physicians will begin treatment immediately, even when laboratory results are still pending. As with any antibiotic treatment, the earlier it is started, the better.