We survived Boston’s snowiest winter and now with the warmer weather we get many visits and questions about tick bites. It is important for you and your family to take preventative measures against ticks especially from April-September when they are most active.

Here are our recommendations for decreasing your risk of tick bites:

• Avoid areas where ticks are most abundant (wooded and bushy areas with high grass).
• Walk in the center of trails.
• Wear protective clothing such as long legged and long sleeved clothing treated with permethrin.
• Use a tick repellent containing DEET.
• Conduct a full-body tick check of all parts of your body and shower after outdoor activities.
• Examine your gear and pets for ticks.

If you notice a tick bite we recommend using tweezers to grasp the tick as close to the skin surface as possible. Pull the tick straight up applying gentle steady pressure then disinfect the skin and wash your hands thoroughly. If sections of mouthparts of the tick remain they should be left alone and will be expelled spontaneously. The duration of tick attachment is important to assess the risk of transmission of a tick-borne illness. For example, Lyme disease is rarely transmitted within the first 48 hours of tick attachment. The tick usually needs to be attached for two to three days before transmission of Lyme so prompt identification and removal of the tick often prevents infection.

The most common symptoms of tick-related illnesses are rash, fever, chills, headache, fever, muscle aches, and joint pain. Lyme disease is the most common tick-borne illness in the United States. Lyme is transmitted by the black-legged tick (deer tick).

The top row of the photo below are deer ticks. From left to right are the immature, adult male and female, and engorged adult female. The bottom row are the American dog ticks which are not thought to transmit Lyme disease.

If you or a family member has a deer tick bite which was attached for more than 36 hours we can prescribe a prophylactic dose of an antibiotic called Doxycycline within 72 hours of the tick removal to decrease your risk of developing Lyme disease. Following a tick bite, you will want to observe the local area for development of a bulls eye rash called erythema migrans for up to 30 days following the exposure. Below is a photo of a classic erythema migrans rash, which occurs in some (but not all) cases of Lyme disease.

You should be aware that there are other tick-borne illnesses in the U.S. Anaplasmosis, babesiosis, and borreliamiyamotoi are transmitted by tick bites mostly from the black-legged tick (deer tick) common in the northeast.

Your recent travel history will be important in identifying your risk of other tick-borne illnesses. Ehrlichiosis is transmitted by the lone star tick found primarily in the south central and eastern U.S. Powassan disease is transmitted by the black-legged tick and the groundhog tick with cases primarily in the northeastern states and Great Lakes region. Rocky Mountain spotted fever (RMSF) is transmitted by the American dog tick, Rocky Mountain wood tick, and the brown dog tick. Colorado tick fever is also caused by the Rocky Mountain wood tick in the Rocky Mountain states at elevations 4,000 to 10,500 feet. STARI (Southern tick-associated rash illness) is transmitted by the lone star tick found in the southeastern and eastern U.S. The heartland virus is also thought to be transmitted by the lone star tick which has been identified in eight patients in Missouri and Tennessee as of March 2014.

Rickettsia is transmitted by the Gulf Coast tick. Rickettsiosis is transmitted by the Pacific Coast tick which is a new disease found in California. Tickborne relapsing fever (TBRF) is transmitted from infected soft ticks reported in 15 states including Arizona, California, Colorado, Idaho, Kansas, Montana, Nevada, New Mexico, Ohio, Oklahoma, Oregon, Texas, Utah, Washington, and Wyoming and is associated with sleeping in rustic cabins and vacation homes. Tularemia occurs throughout the U.S. and is transmitted by the dog tick, the wood tick, and the lone star tick.

Many tick-borne diseases can have similar signs and symptoms. In most cases, these diseases can be easily treated with antibiotics. However, early recognition and treatment of tick-borne diseases is important to decrease the risk of serious complications. If you have been bitten by a tick and develop symptoms such as unexplained fever, excessive fatigue, joint aches, or rash within a few weeks we recommend prompt evaluation by a health care provider. All of our providers at AFC Doctors Express have practiced for many years in the Northeast and are exceptionally knowledgeable in the management of tick-borne illness.