What doctors need to know about ticks

Lyme disease is spreading faster and farther than ever before. And while it’s vital that healthcare professionals can recognize and treat the infection, it’s not the only tick-borne disease they need to know about. A series of diseases, ranging from Rocky Mountain spotted fever to the relatively new meat allergy caused by a compound in the saliva of a Lone Star tick, are more prevalent than ever before.

To help healthcare professionals learn about these conditions, Brown University’s Emergency Medicine program and Rhode Island Hospital are presenting a special CME-eligible Grand Rounds on Figure 1. Physicians who complete the mobile-friendly material and take the post-test tick-borne illness will be able to claim a maximum of 0.5 AMA PRA Category 1 Credits™ provided by Rhode Island Hospital.

The Grand Rounds was developed by

- Kristina McAteer, MD, MPH, Professor of Emergency Medicine at Warren Alpert Medical School of Brown University, Providence, RI;

- Joshua Kaine, MD, Emergency Medicine Resident Physician, Warren Alpert Medical School of Brown University, Providence, RI; and

- Jamie McKee, DO, Emergency Medicine Resident Physician, Kent Hospital, Warwick, RI

Healthcare professionals can take the Grand Rounds CME pre-test here to begin the process.

Here are some highlights from the Grand Rounds:

1. There are many kinds of ticks, and they are difficult to tell apart

“Successfully identifying a tick can be quite difficult. Not only do they have slightly different appearances across the larval, nymph, and adult life cycle stages but their distinguishing features can be lost as they become engorged with blood. The easiest way to identify a tick is by knowing which types are endemic to your area. The hard shield-like scutum on the back doesn’t distort as their abdomens engorge. ‘Blacklegged’ Ixodes ticks have a black scutum that matches their legs while Lone Star and Dog ticks have unique patterns.”

2. The number of tick-borne illnesses doubled between 2004 and 2016

According to the Centers for Disease Control (CDC), the U.S. is on the verge of a vector-borne disease epidemic. The number of tick-borne illnesses has doubled in the twelve years between 2004 to 2016. One hypothesis for this increase is due to a simultaneous growth in the deer and rodent populations, leading to an abundance of hosts. Improved testing, detection, and reporting may also be playing a role in the number of cases documented. Regardless of the cause, endemic cases are increasing.”

3. Tick history — where it was found, what it looked like, and what state it was in upon removal — is vital knowledge.

“Before removing a tick, ensure you have taken a tick history. Appropriate tick history includes the local geography, the identity or description of the tick, and what stage of feeding the tick was at the time of removal. While the migration of Borrelia spirochetes from the tick’s gut to its saliva takes approximately 48 hours, other agents like HGA are present in the salivary glands. For this reason, engorged long-feeding ticks are associated with higher disease transmission rates. (Images from the Tick Encounter Resource Center of the University of Rhode Island).”

4. Co-infection is possible and must be considered

“Making a firm diagnosis is both important for treatment decisions and the patient’s peace of mind. Up to two-thirds of patients with confirmed babesiosis also have Lyme disease, and one-third also have human granulocytic anaplasmosis. Recommendations for testing are listed in the graphic above. Testing for multiple diseases simultaneously should be considered in endemic areas.”

5. Early treatment and prompt diagnosis are key to improving outcomes.

“Diagnosis is challenging because testing takes days to weeks, and in some cases a clinical diagnosis is required. Concomitant infection is likely and clinicians must maintain a high index of suspicion for coinfection. Treatment should be initiated early in the appropriate clinical setting. Early treatment, prompt diagnosis, and close follow-up are key to improving outcomes.”

Take the Grand Rounds CME pre-test now.