Tick-Borne Diseases Overview by Humbert Zappia

1. Tick Borne Diseases Humbert Zappia Public Health Entomologist WV Department of Health & Human Resources Humbert Zappia

2. Tick Borne Diseases • Rocky Mountain Spotted Fever (Rickettsia rickettsii) • Human Ehrlichiosis (Ehrlichia spp.) • Lyme Disease (Borrelia burgdorferii) • Southern Tick-Associated Rash Illness (spirochetes) • Babesiosis (Babesia spp.) • Tularemia (Francisella tularensis) Humbert Zappia

3. Rocky Mountain Spotted Fever • American Dog Tick (Demacentor variabilis) is vector and reservoir in WV Humbert Zappia

4. Rocky Mountain Spotted Fever cont. • Incubation 5-10 days • Initial symptoms non-specific • High fever • Severe headache • Muscle pain Humbert Zappia

5. Rocky Mountain Spotted Fever cont. • Later signs symptoms • Maculopapular rash on extremities (often palms and feet) • Abdominal pain • Joint pain • Diarrhea Humbert Zappia

6. Rocky Mountain Spotted Fever cont. • Diagnosis • Combination • Clinical signs and symptoms • Specialized confirmatory lab testing • i.e. PCR Humbert Zappia

7. Rocky Mountain Spotted Fever cont. Number of Cases per Year Average Humbert Zappia

8. Rocky Mountain Spotted Fever cont. • Case fatality rate 13 – 15% without treatment • Best treated using a tetracycline antibiotic • Acquired immunity • Exposure thought to give long-term immunity, however, personal protection is recommended Humbert Zappia

9. Ehrlichiosis • Vectors • Lone Star Tick (Amblyomma americanum) • Human monocytic (HME) • Deer tick (Ixodes scapularis) • Human granulocytic (HGE) • Reservoir • White-tailed Deer (commonly) Humbert Zappia

10. Lone Star Tick : Range Humbert Zappia

11. Lone Star Tick : Proposed life cycle Humbert Zappia

12. Deer Tick : 2 year life cycle • Fall and winter: adult tick feeds and mates on white-tailed deer • Spring: fall off, eggs laid and hatch into larvae • Summer: larvae feed on small rodents and become infected • After feeding larvae molt into nymphs which are dormant during the winter • Second spring/summer: nymphs actively feed on small and large animals • Second fall: nymphs become adults Humbert Zappia

13. Ehrlichiosis cont. • Incubation period 5-10 days • Often mild or no symptoms • When symptoms present • Nonspecific • Fever • Headache • Muscle aches • Sometimes rash Humbert Zappia

14. Ehrlichiosis cont. • Other symptoms include • Nausea • Vomiting • Diarrhea • Cough • Joint pain • Confusion Humbert Zappia

15. Ehrlichiosis cont. • Diagnosis • Combination • Clinical signs and symptoms • Specialized confirmatory lab testing • i.e. PCR • Can be fatal without treatment • Best treated using a tetracycline antibiotic • Acquired immunity • Uncertain, personal protection is recommended Humbert Zappia

16. Lyme disease • Vector • Ixodes scapularis (Eastern US) • Reservoir • wild rodents: Peromyscus spp. • Lyme disease can account for as much as 95% of all reported vector-borne illness in the U.S Humbert Zappia

17. Infectious agent Reservoir Borrelia burgdorferi Deer Mouse Humbert Zappia

18. Ixodes sp. life stages Adult female Adult male Nymph Larvae Humbert Zappia

19. Lyme disease cont. • Incubation period days to weeks • Symptoms • Rash (erythema migrans) can be presented in 7 to 14 days (80% of patients) • Later symptoms • General tiredness • Fever • Headache • Stiff neck • Muscle aches • Joint pain Humbert Zappia

20. Lyme disease cont. • Diagnosis • Clinical (rash) OR • At least one late manifestation and laboratory confirmed • i.e. A two-test approach using a sensitive enzyme immunoassay or immunofluorescence antibody followed by Western blot is recommended Humbert Zappia

21. Lyme disease cont. • Untreated (weeks or months later) • Arthritis can develop • Intermittent episodes of swelling and pain in large joints • Neurological abnormalities • Aseptic meningitis • Facial palsy • Motor and sensory nerve inflammation • Encephalitis • Cardiac problems (rarely) Humbert Zappia

22. Lyme disease cont. • Best treated using • Doxycycline or amoxicillin (early disease) • IV in later manifestations • Acquired immunity • None Humbert Zappia

24. Average

25. STARI: Southern Tick-Associated Rash Illness • Vector: Lone Star Tick (Amblyomma americanum) • Similar to Lyme Disease • Unable to culture the spirochete Humbert Zappia

26. Babesiosis • Deer Tick (Ixodes scapularis) vector • Hemoprotozoan • Similar to malaria • Complex life cycle Humbert Zappia

27. Babesiosis cont.Life Cycle • During a blood meal, infected tick introduces sporozoites into mouse host • Sporozoites enter erythrocytes and undergo asexual reproduction, some differentiate gametes • The definitive host (I. scapularis) ingests gametes, they unite and sporozoites result • During a subsequent blood meal, sporozoites are introduced to human hosts Humbert Zappia

28. Babesiosis cont.Life Cycle • Sporozoites enter erythrocytes asexually reproduce  • Multiplication of the blood stage parasites is responsible for the clinical manifestations of the disease.  • Humans are dead-end hosts, however, human to human transmission is well recognized to occur through blood transfusions . Humbert Zappia

29. Babesiosis cont. Humbert Zappia

30. Tularemia • Dermacentor (Dog) and Amblyomma (Lone Star) species vectors • Multiple forms of infection • Local • Systemic (most lethal) • Treatment with antibiotics Humbert Zappia

31. Prevention of tick borne disease • Personal protective measures • Prompt careful inspection of your body and removal of ticks after visiting tick infested areas • It may take 24-48 hrs of attachment before transmission of disease • Wear light colored clothing • Tuck pants legs into your socks • Apply repellants • DEET • Permethrin Humbert Zappia

32. Tick Removal • Use fined tipped tweezers • Grasp tick as close to skin • surface as possible • Pull steadily upward • Do not twist • Do not jerk • If mouthparts remain, remove with tweezers • If infection occurs see healthcare provider Humbert Zappia

33. Tick Removal • Do not squeeze, crush, or puncture tick • Do not handle tick with bare hands (especially when removing them from domestic animals) • Disinfect site after removal of tick and wash hands • You may save the tick for identification, in case you become ill within several weeks Humbert Zappia

34. Contact Information Greg Chrislip Public Health Entomologist Phone: 800-423-1271 Email: gregchrislip@wvdhhr.org Humbert Zappia Public Health Entomologist Phone: 304-728-2147 District phone: 304-725-9543 Email: humbertzappia@wvdhhr.org