Alabama Articles: BACK
Tick threat goes beyond Lyme
Penelope McClenny, Staff Reporter
The Press-Register
Mobile, AL
October 1, 2006
While the risk of Lyme disease in lower Alabama remains a debated topic among health professionals, another dangerous type of tick-borne illness poses a real threat to local residents, according to physicians and scientists.
Tick-borne rickettsial diseases, including Rocky Mountain spotted fever and ehrlichioses, are increasing in states such as Alabama, where development is pushing more people into previously wooded areas, said Dr. David Wood, a microbiologist at the University of South Alabama and an expert in rickettsial diseases.
"Tick-borne diseases have increased over the last few years," Wood said. "We're cutting down a lot of places, moving houses into wooded areas that used to be forest, but the deer are still around; the vectors are still around."
Rickettsial diseases are unique because their bacteria grow inside a cell, unlike most diseases, in which growths occur on the cell, said Wood. They're difficult to diagnose because early symptoms are similar to many other illnesses, but left untreated the diseases can cause serious illness and death.
"They're probably more prominent than we really know, because a lot of times, these diseases, people have them but are not really diagnosed properly," Wood said. "The problem is diagnosing it correctly and giving the right antibiotic."
In response to an increase in cases, the Centers for Disease Control and Prevention featured rickettsial diseases in a March edition of its Morbidity and Mortality Weekly Report. The article included guidelines for physicians on properly diagnosing a patient, stating that 60 to 75 percent of those with a tick-borne disease often receive an alternate diagnosis.
Getting a correct diagnosis as soon as possible is critical to treatment, since antibiotic therapy is most effective in the early stages. Symptoms usually begin about 10 days after the tick bite, Wood said. Common symptoms at that stage include fever, chills and headache. A headache is almost always reported by adults, and can be severe, the CDC reports.
Those infected with Rocky Mountain spotted fever often develop a rash, but that usually occurs after seeking medical attention for another illness.
Rocky Mountain spotted fever frequently becomes a serious illness, according to the CDC, and patients usually require hospitalization. Long-term health effects can include partial paralysis of the lower extremities and gangrene infections that require amputation. The disease can also lead to blindness, speech disorders and loss of movement and bowel or bladder control.
Ehrlichioses can lead to serious illness and death as well, but at lower rates than Rocky Mountain spotted fever.
"They're very severe diseases," Wood said. "Rickettsial diseases have probably caused some of the worst bacteria in humans. The organism can infect so many different cells of the body." As much as 20 percent of untreated Rocky Mountain fever cases and 5 percent of treated cases become fatal, making it the most commonly fatal rickettsial disease in the United States, the CDC stated.
Dr. Steven Alsip, an infectious disease specialist in Mobile, said Rocky Mountain fever cases are not uncommon in his practice, especially in people who have recently returned from a trip to the North Carolina mountains. North Carolina had 625 cases of the disease in 2005, more than three times the number of the next-highest state, Oklahoma, and nearly half of all cases nationwide, according to the CDC.
"We've got a lot of folks who come back from their vacation and have it or are scared they have it," Alsip said.
Alabamians don't have to travel to be at risk, however. Seventy-two cases of the disease were reported in Alabama in 2005, the CDC reported, and Wood says there were likely even more. "I think it's estimated that we're probably underestimating these diseases by at least fourfold," Wood said. "If that is the case, then tick-borne rickettsial diseases would be high on the list of life-threatening disease in our country."Courtesy: www.lymeinfo.net
lymeinfo-subscribe@yahoogroups.com
Madison County man gets delayed diagnosis from tick bite
Waff-TV 48 News (NBC)
Alabama
Sep 4, 2006 10:53 PM CDT
A close call for a Valley man who became seriously ill after he was bitten by a tick.
The disease that came from that tick was diagnosed in the nick of time. Mike Gilbert was eventually able to find doctors who tracked down his problem. "It never was much more than that little spot right there," said Gilbert, pointing to a tiny spot on his leg.
But that's all it took, one little tick bite that swelled just a little bit, and turned a bit red in color, to make the 67-year old seriously ill.
He was working in his backyard, just along the edge of the woods back in June. Gilbert pulled the tick out and didn't think anything more about it, until a few days later. "I had a 103-plus fever, chills, shaking," he said, describing some of his symptoms.
Gilbert went to one Valley emergency room two different times and shared his symptoms and told them he was bitten by a tick days earlier.
"He horse laughed the idea that a tick had anything to do with it," said Gilbert. "He said you've got a virus, go home and see your family doctor."
So, Gilbert did. He says his family doctor dismissed his concerns as well.
Gilbert got weaker and weaker, he lost 26 pounds in two weeks and could no longer work on his farm or in his yard. On a third visit to a different hospital, Gilbert was admitted to the cardiology floor. His illness had taken a toll on his heart.
His diagnosis: Tularemia--an infectious disease most often spread through tick bites. "It's a close cousin to Rocky Mountain Spotted Fever, Lyme Disease and several of them are real close," he said.
Nearly seven weeks after the bite and weeks of treatment, Gilbert is slowly recovering and happy to have survived. He hopes his story will help others.
"If you go to the Dr. With some kind of fever and things like that and a few days later you're not making progress just raise the roof and demand to have an infectious disease doctor on the case," he said.
Gilbert's still on several medications to help regulate his heart but feels he will make a full, albeit slow, recovery.
Courtesy: www.lymeinfo.net
lymeinfo-subscribe@yahoogroups.com
Tick-borne Lyme disease stirs debate in South
Penelope McClenny, Staff Reporter
The Press-Register
Mobile AL
October 1, 2006
Just three cases of Lyme disease were officially reported in the entire state of Alabama last year, but Dr. George McCullars says his patient load paints a much different picture.
McCullars, a general medicine physician in Mobile who specializes in Lyme disease, says he treats hundreds of cases of the tick-borne illness each year. "It occupies about 20 percent of my practice, 80 percent of my time," McCullars said during a recent interview. "It's labor-intensive."
His patients come from 23 states and 126 different cities, he said, but include dozens of local patients.
So far in 2006, only one case of Lyme disease has been reported to the Mobile County Health Department, according to its records. The discrepancy between McCullars' patient load and local and state reports of Lyme disease is part of a debate that has played out for several years in some Southeastern states.
The Lyme controversy is fueled by several factors, including the difficulty of getting a diagnosis through laboratory tests, the challenges to getting that diagnosis confirmed and the recommended treatment of antibiotics.
"Using reportable disease statistics is always tenuous or very tenuous for Lyme," McCullars said.
On one side of the debate, skeptics contend that the disease is overdiagnosed and overtreated, leading to an increased use of antibiotics that weakens the medicine's ability to fight infection. On the other side, people who have been sick for months and had their own suspicions of Lyme doubted by numerous doctors say the illness deserves more attention.
Outbreak in 1975
Lyme disease was first recognized in the United States in 1975, after a mysterious outbreak of arthritis near Lyme, Conn., according to the Atlanta-based Centers for Disease Control and Prevention.
Since then, annual reported cases of the illness in Northeastern states often reach well beyond 1,000, but some question whether the disease has migrated this far south.
There has been no information to indicate that the bacterium linked to Lyme disease is present in Mobile and Baldwin counties or any of the bordering counties, according to a study from 1985 to 1990 of ticks removed from deer killed by Alabama hunters.
"It doesn't seem to be in our area right now," said David Wood, a microbiologist at the University of South Alabama and an expert in another type of tick-borne illnesses, rickettsial diseases. That doesn't mean that area residents who travel to other parts of the state are safe from exposure.
One patient's story
"I went to one physician one time, and he said there's no way you could have it because you haven't been to Connecticut," said Kara Tyson, a Mobilian who was diagnosed and treated by McCullars several years ago and now leads a patient support group for his patients.
Several local Lyme patients recounted some instances in which doctors did say that Lyme was a possible diagnosis, just not a likely one in this area.
Dr. Steven Alsip, an infectious disease specialist in Mobile, said he definitely sees patients with Lyme, but not often. "There are some patients that are pretty insistent. They've done their research," Alsip said. "It can happen in our area, but it's not very frequent. We see a case or two from the upper counties periodically."
While Lyme might not be a frequent diagnosis in his clinic, Alsip said he has seen patients with the disease become quite ill.
Before her diagnosis nearly a year after being exposed, Tyson said, she had reached that point. Her story started with a mountain hike near Huntsville in 1999 and didn't end until nearly two years later, when she finally felt like herself again.
The day after she returned from the hike, she noticed a rash around one of her ankles. Suspecting a spider bite, she made an appointment with a doctor a few days later who confirmed her suspicions.
About six weeks later, Tyson became even more ill. Tests continued to show no problems, but she knew her body and knew something was wrong.
Symptoms of Lyme
In its primary stages, Lyme causes flu-like symptoms, according to John Foster, a University of South Alabama microbiologist. Victims may experience fever, muscle aches and fatigue, and about half of them will get a rash that looks like a bull's-eye target, called erythema migrans.
Like West Nile virus and other similar diseases, some people can become very sick, while others might be infected and never show symptoms, Foster said.
"I'm convinced that many people who get Lyme never get really sick," McCullars said. Those who do progress to the next stages can become seriously ill.
"About 80 percent of those people that have the primary symptoms, in about a month to two years after that, they move into the second stage, which can be more serious," Foster said. "As you get into the secondary and tertiary stages, it starts to become something of an autoimmune response."
About 60 percent of those who don't receive treatment will begin to have intermittent bouts of arthritis, with severe joint pain and swelling, according to the CDC. Large joints are most often affected, particularly the knees.
In addition, up to 5 percent of untreated patients may develop chronic neurological complaints months to years after infection, including shooting pains, numbness or tingling in the hands or feet and problems with concentration and short-term memory.
McCullars said he has seen Lyme patients that received a previous diagnosis of amyotrophic lateral sclerosis or Lou Gehrig's Disease, a terminal neurodegenerative disease that causes loss of muscle movement even while the mind function stays intact.
After experiencing viral-type illnesses for a few months, Saraland resident Randy Patterson began to worry about ALS. He had pulled a tiny tick off his side after a day of turkey hunting a few weeks before, and his health had declined since then.
Medical tests revealed emerging problems in his liver and kidneys, he said, and one doctor suggested mononucleosis. When Patterson mentioned the tick and Lyme disease, doctors brushed off his suggestions. "He said, 'Oh, there's no Lyme disease in Alabama,'" Patterson recalled. "I just took it for face value that this man knows what he's talking about."
Another doctor finally said Lyme could be a remote possibility, but he could give Patterson no definitive diagnosis. The symptoms continued to get worse, and Patterson, who was 38 at the time, got scared. "I was starting to get some neurological things, tingling in my hands, tingling in my feet. My muscles were starting to hurt worse, and I started losing weight this time," he said.
One night, Patterson broke down and told his wife, "I think I got something really bad. Something's breaking me down slowly."
'You've got Lyme'
Patterson's sister recommended McCullars. After a battery of tests and a clinical evaluation, McCullars called Patterson at the lumberyard where he worked and told him, "Randy, you've got Lyme."
A large part of the debate over the presence of Lyme disease in lower Alabama has actually centered on the tick itself.
Lyme disease is caused by the tick-borne bacterium, Borrelia burgdorferi. In the past, much of the attention surrounding Lyme carriers has been focused on the deer tick, also known as the black-legged tick, a species found less often on humans in Alabama than in other parts of the country.
In fact, of the more than 900 ticks removed from Alabama residents between 1989 and 1999 as part of an Auburn University study, just 3 percent were reported to be deer ticks.
Another study revealed, however, that the Lyme disease threat to Alabamians may come from another species of tick.
Over the course of three non-consecutive hunting seasons from 1985 to 1990, researchers collected 665 ticks from white-tailed deer that were killed in 18 Alabama counties and tested for the Borrelia burgdorferi bacterium.
Ticks from six counties along a central strip of Alabama tested positive, according to the study, printed in the Journal of Wildlife Diseases in 1992.
Those counties included Hale, Coosa, Lee and Barbour as well as Butler and Wilcox, popular destinations for Mobile-area hunters. Patterson was hunting in Clarke County near the Wilcox County line when he got bit in 2001.
While several of those positive specimens included deer ticks, the bacterium was also found in the Lone Star Tick -- the same species found to be responsible for 68 percent of the human bites in the Auburn study.
Lyme is a difficult disease to diagnose for a number of reasons, Wood said.
"A lot of the symptoms are similar to a lot of diseases," Wood said, adding that physicians will probably not consider a tick-borne disease "unless the physician is told, 'I had a tick on me about 10 days ago.' Sometimes patients don't even know they have a tick."
In 1997 the Food and Drug Administration issued a Public Health Advisory saying that tests for Borrelia burgdorferi, the bacterium that causes Lyme disease, should only be used to support a clinical diagnosis of the disease, since the results could be inaccurate, depending on the length of time since the patient's exposure.
"It is important that clinicians understand the limitations of these tests," the advisory stated. "A positive result does not necessarily indicate current infection with B. burgdorferi, and patients with Lyme disease may have a negative result."
In 1999 the FDA approved a new test -- the PreVue B. burgdorferi Antibody Detection Assay -- to be used as a first step in diagnosing Lyme disease, according to a release from the agency. Positive results then had to be confirmed by a Western blot test conducted in a laboratory, with the CDC recommending two-stage testing.
In his office, McCullars said, 75 percent of his Lyme disease patients get a laboratory diagnosis.
To transmit Lyme disease, a tick generally has to be attached to a human for a day or two, Foster said. This makes it much more likely that a person is infected by a tick that's in its nymph stage, when it's about the size of a pinhead and easily overlooked.
Tyson said physicians should be more open to a possible diagnosis of Lyme instead of brushing off patients' questions by saying it doesn't exist in the area. "To me, that approach is very hard to understand because you don't have to go to Egypt to get West Nile," she said. "We are a mobile society."
Another issue Tyson said needs to be tackled is the criticism aimed at the use of antibiotics for Lyme treatment. She and Patterson both received antibiotic treatments to overcome their disease, including several rounds of intravenous antibiotic treatment for Patterson.
"We've almost reached the point, we've gone too far the other way. Physicians don't want to give it even for bacterial infections," she said. "We need to find a middle ground here."Courtesy: www.lymeinfo.net
lymeinfo-subscribe@yahoogroups.com
© 2006 The National Lyme Disease Memorial Park Project
