I live in the upper Hudson Valley (Albany-Saratoga area) and we have had to deal with high-levels of ticks and tick-borne Lyme disease for about 15 years. When we moved here more than three decades ago it was a rare event to find a tick on a dog that had been in the field for days. Heck, I used to nap in the tall grass in my fields in the summer.
That changed in the early-90s: first ticks became common and shortly afterward people started getting sick with something called Lyme disease. I suspect that a fair number of people got sick with Lyme when it was largely unknown and never got treated at all. When you have Lyme initially you may feel sort of OK; may (or occasionally may not) develop the characteristic bull's eye rash but often you just feel sick in an undifferentiated way. Left untreated Lyme can cause joint, neurological, cognitive and for some people, chronic illness. Other people seem to recover, just fine. Most people who are treated recover completely
Luckily for my family we didn't get sick with Lyme until there was enough info out there for us to recognize it and get it treated, promptly. I am out in my fields and woods all the time so my exposure to ticks is relatively high. I've been bitten so many times that I have developed a kind of allergic reaction to any tick bite that is a kind of good thing since I know pretty quickly because of the intense itching. As a kid, I lived in the tropics in some extraordinarily tick-ish places - places that make the NE US seem practically tick-free in comparison - so I attribute my hyper-sensitivity to the 100's of tick bites I've had over the years. Peculiar as it sounds, I count that as a blessing these days.
Anyway, this isn't a thread about Lyme, but about the one of the other diseases you can get from ticks: anaplasmosis. It's primarily found in the NE, and the Upper Midwest. But anywhere there are ticks of one species or another you can get tick-borne diseases that are not Lyme. In the Far West and Rocky Mountain area there are different things to catch. (When I started researching the topic after getting sick, I went to my local medical school library and there are several thick tomes devoted just to the diseases transmitted by ticks; not all insects and spiders, just ticks!)
This is what happened to me: I got a deer tick bite on March 14. No biggie, just wrangled it off with my O�Tom tick twirlers (see Bee's recent thread for info I posted about them) and kept an eye out for Lyme symptoms, which did not develop. This is totally unremarkable for me.
A bit less than two weeks later (on a Tuesday) I felt sort of off-color: tired, listless, headache-y. Just down enough that I awarded myself a rest day. On Wednesday I woke up feeling quite sick to my stomach - very nauseated, but not vomiting or w/diarrhea. But sick enough that I reviewed in my mind what I had eaten and wondered if I had come down with serious food-borne illness. By evening the nausea had abated, but I had a mild temp which increased overnight. I woke up Thursday feeling headache-y, feverish (103F), but hey it's March and I didn't have a flu shot last fall so I figured that was it. (And my DH had had a flu shot which I thought explained why he wasn't feeling sick.) So I prescribed myself more rest and fluids and just waited to get over it. By evening I was much, much sicker with a high spikey fever (104F) accompanied by severe chills and almost convulsive shakes, in alternation. I took some aspirin for the fever, with only modest effect.
Now there's something else unusual about my medical history: as a child I had a severe case of malaria. Malaria makes some permanent changes in your body's response to fever. I can easily get a slight fever from something like a sunburn. And for me, fever is usually accompanied by chills and shakes, but these are just the left-over physiological artifacts of having had malaria so I generally ignore them. I just asssumed the high fever I had was idiosyncratically "normal" to me and the flu.
I woke up in the night even sicker with a fever I couldn't keep down, even with aspirin, and by Friday AM I knew I really had to see a doc. My own primary guy wasn't available and his nurse suggested I go to the ER. It seemed silly to go to the ER for the "flu", but my high, cycling fever worried me. I am terrified of needles so this was a huge decision for me as I knew that would be the first thing they'd do. (I am such a wuss!). My DH took me to the ER and I donned a mask (against spreading the flu) and so it began. I was right, they immediately tested my blood in all the usual ways (CMP, CBC, LFT, blood cultures, plus urinalysis, chest X-ray, the whole works). They gave me IV fluids. We stayed the whole day. In the end, they told me that I didn't have a bacterial infection, (dead wrong on that as you will see), UTI, or pneumonia. So by process of elimination they decided I probably had a viral infection, most likely the flu. And what I needed was rest, fluids and Tylenol to bring down my fever, and yada, yada, yada. I felt like a complete dope having just spent a couple of thousand dollars only to be told that I had the flu and having used the resources of an ER for something that pretty much should be cared for at home. They did note a couple of things: slightly decreased white cell count (the reason they believed no bacterial infections were involved) and my liver function tests were abnormal which they attributed just to be being feverish. They didn't mention that my platelet level was cratering (was 70 on that first day, and headed steeply downward from there), but I wouldn't have recognized the significance of that clue anyway.
So we went home. I thought I was hungry but didn't feel like eating. And as soon as the Tylenol wore off the fever came back, but worse. It was now spiking to 105F and accompanied by fierce chills, sweats, and delirium. Off and on during the night the fever would break in a cataclysmic chill. About 6:30 am I woke drenched in sweat, freezing, but momentarily clear headed. The first thing I thought was: am I dead? After a moment, I figured I'd test that by sitting up and putting on my glasses and checking my temp. (You can't be the home-schooled daughter of a biologist and engineer without wondering if there's some hypothesis to test in any situation.) Obviously, I was still with this world.
In the short period of clarity I had before another cycle of fever started I thought back over all the questions they had asked me in the ER for some other explanation of what was going on. They had asked me when was the last time I had taken antibiotics (cat bite around last Labor Day), but I realized that in my fevered state I had missed a crucial variant to that question: when was the last time you might have considered taking antibiotics, but didn't. Duh! The tick bite when I had NOT taken even an anti-Lyme prophylactic dose because the little beast hadn't been on long enough.
I reached for my laptop and Googled "tick-borne diseases, not Lyme". The first thing that appeared was babeseosis, dubbed "the malaria-like new plague in the NE". Bingo! (Or at least I thought so at the time.) Having had malaria, what I now had seemed so much like it I knew I had to go back to the ER to get tested for babeseosis even if it meant more needles!
In the last few minutes before the fever came roaring back I had one last unmuddled realization that I was facing an important choice: if I didn't go back and get treated whatever I had might very well kill me. It wasn't a scary feeling, simply a clear sense that I was at a turning point and I needed to ACT.
As it happened we were just at that very moment having one of our farm outbuildings burglarized. Luckily one of our neighbors saw the burglars in the act and called us. My DH rushed out of bed, went to deal with it and the ensuing cops, etc. I used the time to get up, wash and dress, so when he walked back in I asked to be taken back to the ER immediately. Afterward, he told me that really scared him as he knows I would do almost anything to avoid an ER.
When we got back to the hosiptal, they protested, but you have the flu, etc. But my by-now 106F fever got their attention, as did my determined insistence on being tested for non-Lyme tick diseases, especially babeseosis. Still, it took five more hours for them to locate an infectious disease specialist and come around to seeing the need for more testing and admission to the hospital.
An important take-away from this whole long story is this: if you have been bitten by a tick and come up really sick, especially with bad headache, unproductive nausea, very high fever, chills, etc. that may feel like the flu on steroids, you need to think not about Lyme but about the possibility of the other tick-borne diseases. Bring the tick bite, or exposure to ticks, up. Be proactive since even in the ER my anaplasmosis was not recognized. Which was too bad because there is a constellation of abnormal results to common blood tests that along with fever and possible exposure to ticks gives a good indication to diagnose anaplasmosis.
The three common changes in lab results are: decreased white blood cells, sharply lowered platelets and abnormal liver function (3 to 4 times normal ranges). All of these were clearly visible on the first day's testing, but were misinterpreted or explained away as the result of a feverish-flu.
The infectious disease doc ordered the full range of tick-borne disease blood tests, but explained to the ER docs about the triad of lab results and recommended I start immediately on some doxy, without waiting for the results of the new tests. They were drawing the blood for the tick tests and holding a cup with 100 mg of doxy over my head. I took the doxy. The fever came down to normal within an hour and I've been recovering steadily ever since. (Took doxy for a further 8 days, as ordered.) My lab results normalized (mostly) over the next few weeks. My recovery has been slow because I went through several days of being a very, very sick puppy. But I have no doubt I will be fine in the end.
Now here's another important point: I went back to the ER because I thought from reading on the net that I had babeseosis because of its similarity to malaria, which quite unusually I was also familiar with. But I was completely wrong, I didn't have babeseosis, I had another tick-borne disease, anaplasmosis. Only afterward when I was reading about it in medical journals did I get the full picture of its symptoms. I had pounced on babeseosis' "malaria-like" symptoms and misdiagnosed myself - though at least it got me back to the ER where an infectious disease doc could sort it out. What you read on the net can often lead you in the wrong direction.
Here's the scoop on anaplasmosis: it's a bacterial disease, not a spirochete-caused disease like Lyme. You can get more than one tick-borne disease in the same bite. There are two other tick-borne bacterial diseases, erlichiosis and babeseosis in the NE and upper midwest. Until recently anaplasmosis and erlichiosis were sometimes combined or thought of as co-variants of the same disease which can be confusing. Lyme, anaplasmosis and erlichiosis are all treated with doxy. (And in the case of anaplasmosis, the therapeutic response to doxy is extraordinarily fast, often it takes just hours before symptoms start to abate.) Babeseosis is treated with a combination of two different (oral) antibiotics.
With anaplasmosis some people never develop clinical illness. Others, like me, are overwhelmed. It is more likely to affect people who are older (I'm 62), or who have weakened immune systems (chemo, transplant, immunosuppressant drugs for other diseases, etc.). It has this extremely characteristic trio of lab results: lower white blood cells, much lower platelets and abnormally high liver function values. Most people recover completely, some without ever knowing they've been infected and with no treatment. If you do get ill, you will need treatment to avoid further illness from the disease's effects, like thrombocytopenia (very low platelets) and possible liver or kidney damage. Some people wind up in the ICU, and a (very) few die.
It is not known how long a bite-exposure is needed to transmit the virus; it may be quite short (mine was probably only a two or three hours). It is believed that post-bite prophylaxis of 200 mg. of doxy, in a single dose will prevent anaplasmosis. There are no known reports of chronic anaplasmosis. And if you have a significant bout of it, your antibody titer may be high enough for some time to prevent re-catching it.
Dogs are susceptible to the same disease and are treated the same way. If your dog has had it, consider yourself at risk of getting it from the same disease reservoir in your area and the same vectors (ticks). The disease reservoir is primarily deer or white-footed mice; ticks are just the unintentional passers-on of all the tick-borne diseases. Their only interest in you is having a hot meal. Both nymph and adult deer ticks can transmit the disease. Larval ticks are not confirmed, only theoretical vectors. Deer can be infected with anaplasmosis and there are reports of deer butchers catching it without exposure to ticks. (Presumably they were exposed to infectious deer blood through small skin cuts, blood contact on their conjunctiva or through inhaled aerosolized blood from meat-cutting saws. Total ick.) The reports of the most serious illness from anaplasmosis actually come from the upper mid-west; until this past year it was mostly considered a milder, uncommon disease in the NE. I haven't left the NE in years, however.
I'm on a small personal mission to alert people to the existence of the other tick-borne diseases and to their symptoms that are so unlike the now-familiar ones of Lyme. If you live in a tick area with known Lyme, consider the other ones as well, if you should become sick. But don't get too caught up in the chronic-disease issue. The main risk now is that these diseases aren't recognized when they occur and can be easily treated. You can help by spreading the word about the symptoms and indications for anaplasmosis.:
Of the two other tick-borne diseases (babeseosis and erlichiosis) in both cases you may be quite sick (list of symptoms is very similar, but NOT with the same pattern of lab results), so don't forget to volunteer any possible exposure to ticks when seeking care. It could be the critical clue that's needed to get you the right treatment.
I apologize for the length of this essay, but I wanted to make it into a little story so readers would remember my saga, if they also get sick. If I had known what I now know about these other diseases, I would have been spared the worst of it as I would have recognized it right away.
Liriodendron
