Chester County Medicine Spring 2021 - 16

www.CHESTERCMS.org

How to Recognize and
Avoid Tick-Borne Infections
BY MARINA MAKOUS, MD

Image by Erik-Karits

pring has finally arrived! With that, we will all be spending
more time outside: playing in the yard, hiking, gardening,
playing sports, frolicking with our pets. With more time in
nature, our risk of exposures to ticks and a number of infections
they carry greatly increases.
In Pennsylvania, the most common ticks we encounter are the
black-legged tick (the deer tick), dog tick, and the Lone Star tick.
Lyme and Lyme-like infections are carried by the deer ticks.
In addition to Lyme, Babesia, Borrelia miyamotoi, other bacteria,
parasites and tick-borne viruses may be transmitted by the same
tick bite. It is important to know and test for the known coinfections, in addition to Lyme disease (Borreliosis) when patients
are not recovering from their illness during Lyme treatment, also,
because several infections occurring at the same time may cause
may severe symptoms and may need to be treated by different
medications. Dog ticks and Lone Star ticks may be infected with
other bacteria that cause illness, so it is important to be medically
checked out in case any symptoms develop following a tick bite.
Most people know about the " bull's eye rash " that may develop
in 6-7 out of 10 people with Lyme disease. Many people may not
know that Lyme rash may not look like a typical bull's eye that we
see in pictures: in fact, it's more likely to look like a red patch of

16 CHESTER COUNT Y Medicine | SPRING 2021

circular, oval, or somewhat irregular shape that slowly enlarges over
the course of several days to weeks. It may feel warm to touch, but
rarely is painful or itchy. Swollen lymph and tender glands may be
found in the closest armpit or groin.
At times, patients may have a known or suspected history of
a tick bite, and/or symptoms strongly suggestive of Lyme disease,
and yet their Lyme tests (ELISA and Western Blot) are negative.
This situation may occur for several reasons, most commonly
because Lyme tests are imperfect and may fail to detect each
and every case of the infection; the testing may be done too
early, before the antibody levels are high enough to be detected
(antibody levels usually rise to a detectable level within 3-6 weeks,
but not always). In addition, co-infections may interfere with
the immune system's ability to produce the antibodies, or the
immunoglobulins that we measure in the typical tests for Lyme
disease.

http://www.chestercms.org

Chester County Medicine Spring 2021

Table of Contents for the Digital Edition of Chester County Medicine Spring 2021