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Health officials search for illness as warm weather brings out ticks
Ginny Merriam
The Missoulian
May 9, 2007Through the years, Lyme disease in Montana has been an open-and-shut case. To Montanans who thought they had it, the response from health officials has been the same: You couldn't.
Montana has the wrong kind of ticks. It's deer ticks that carry Lyme disease, and Montana's ticks are Rocky Mountain wood ticks."We've told people, 'We don't know what you have, but we know what you don't have, and that's Lyme disease,' " said state epidemiologist Todd Damrow.
But Damrow and others were troubled by a nagging repetition of a similar set of symptoms reported by patients and by physicians: fever, severe fatigue and a bull's-eye rash at the site of a tick bite on the patient. A couple of years ago, Damrow got a photograph of a perfect bull's-eye rash from a public health worker in Montana. The rash was on a patient who had not left the state. At the same time, the Centers for Disease Control and Prevention were investigating a connection between Lone Star ticks in the Southeast and similar symptoms. They found a Lyme disease-like agent in the tick.
"So I thought, 'Well, gosh, maybe I should not be so cavalier when we get these reports,' " Damrow said.
The result was a study that began last tick season. The hypothesis is this: Could Montana have a similar phenomenon in its ticks, a Lyme disease-like agent that has adapted to the wood tick and is causing this similar illness?
"We know we don't have Lyme disease, because we don't have the right kind of tick," said Pam Goldberg, an infectious disease specialist at the Missoula City-County Health Department. "But we might have a cousin to it."
The study is a collaboration among local health departments around Montana, the state Department of Public Health and Human Services and the federal Rocky Mountain Laboratories in Hamilton.
"We're real excited about it," Damrow said. "Doctors are concurring with this, and they think we're right on line."
With western Montana's warmer weather in the past couple of weeks, ticks have appeared. Around Missoula, they've been picked up on Waterworks Hill, Mount Sentinel, Mount Jumbo and Blue Mountain. Hikers and bikers who extract blood-sucking ticks should think twice before crushing or flushing them.
"When you get bitten by a tick," Damrow said, "don't throw it away because it may be of scientific value."
Here's how it works: People who find ticks actively biting themselves or other people - not pets - should carefully remove it using tweezers or protected fingers. Pull steadily up and out; jerking may break off pieces of the tick's mouth under the skin, which can cause infection. Disinfect the bite and wash your hands. Put the tick in a plastic bag or jar, label it with your name and phone number, where it was found on the body and where it was picked up and take it to your local health department. Local health officials will send the ticks to the state.
If you develop a bull's-eye rash around the tick bite, see your doctor. The doctor will draw a blood sample for state scientists to look at. Two months later, another blood sample will allow scientists at the state and at Rocky Mountain Labs to check for an antibody the patient may have developed to fight the illness. The health department will also want to take a photograph of the rash.
Ticks that bit a person who developed a rash will be tested for evidence of infection at Rocky Mountain Labs, said Tom Schwan, a senior investigator and acting chief of its laboratory of human bacterial pathogenesis.
"We'll try to detect the DNA from the bacteria that we suspect will be in them," Schwan said. "That could lead to an association between an infected tick and the symptoms in the human."
The labs, which Schwan said are still waiting for official approval of the study from their parent agency, the National Institute of Allergy and Infectious Diseases, will use a test to amplify the DNA in the organism taken from the tick and map its sequence. Scientists will then compare that sequence to other organisms in a database, looking to prove the suspicion that illness is being caused by bacteria related to the Lyme disease spirochete.
"We will either make that link or not make that link," Schwan said.
If that link is solidified, then it can be said there's a public health risk, he said.
With help from the University of Montana and UM professor Mike Minnick in the Department of Biological Sciences, the study's protocol has been approved by the Investigation Review Board, Damrow said.
Another benefit of the study will be the ongoing look at the Lyme disease-like illnesses people develop. Because these cases haven't been followed, it's not known if they go on to the neurological and arthritic involvement characteristic of Lyme disease, Damrow said.
"It's significant," he said, "because we really haven't characterized these cases."
Last year, 345 ticks were collected around the state. Six of them were definitively linked to a photographed or physician-documented rash. For those six cases, paired blood samples were also collected.
All this is not to say that people should try to attract tick bites for the advancement of science. Montana's own wood ticks can be infected with the bacteria that cause Rocky Mountain spotted fever. One or two cases occur in Montana every one or two years, Damrow said.
"Untreated, it can be fatal," he said. "It is a potentially serious illness that is transmitted by our ticks here."
The risk of infection is reduced if an embedded tick is found and removed before three hours have passed, Goldberg said.
It's a good idea to check your dog, too, after you've been outdoors, she said. While ticks on dogs are not being studied, dogs can bring ticks into the house that can migrate to humans.
The best defense outside is to keep covered with clothes that fit snugly around the wrists and ankles. Ticks wait on bushes and plants with their front legs ready to grasp anything that brushes against them. Right now, they are out in force.
"The temperature's just right," Goldberg said. "It's warm. We have the sun. Right now it's the peak."http://www.missoulian.com/articles/2004/03/30/news/top/news01.txt
Ticks Making Early Appearance This Year, Montana Health Officials Warn
All American Patriots
March 8, 2005State health officials warned Tuesday that ticks are on the prowl earlier than usual this year because of unseasonably warm weather and lack of snow cover. They urged Montanans to begin taking precautions now to avoid tickborne diseases.
"Ticks are usually active from late March until July, when dryness and heat finally force them to take cover on the ground," said Todd Damrow, epidemiologist with the Montana Department of Public Health and Human Services. "But this year, they're out earlier than usual. The diseases they carry are sure to follow."
Ticks are parasites that feed by latching on to an animal or human host, imbedding their mouthparts into the host's skin, and sucking its blood. This method of feeding makes ticks perfect disease transmitters. They are responsible for at least nine known diseases in humans in the United States and at least four in Montana, including Rocky Mountain spotted fever, Colorado tick fever, tularemia, and Q fever, Damrow said. So far there is no record of a Montana tick spreading Lyme disease.
Damrow said people should be on the lookout for ticks in town as well as when they're hiking, fishing, or camping in the mountains, forests, or sagebrush plains.
"We're continuing to see more tick bites within city limits, presumably because more deer are moving into urban areas and bringing their parasites with them," he said.
Ticks range in size from the size of the period at the end of this sentence to the size of a pea. They are shaped like pumpkin seeds and are brown to reddish-brown in color. They do not fly or jump but crawl slowly up vegetation and wait for their human and animal victims to brush against them.
Damrow recommended taking the following precautions against ticks: wear clothing that covers the body, such as long-sleeved shirts tucked into pants; spray insect repellent on clothing; examine yourself and your children regularly for ticks, particularly around the ears, hairline, underarms, and folds in the skin; and protect pets with flea and tick repellents.
If you find a tick embedded in your skin, Damrow said, it's best to use tweezers to remove it.
"Grasp the tick near the point of attachment and pull upward firmly, but don't jerk or twist," he advised. If tweezers aren't available, use your fingers, but protect them with plastic gloves or at least tissue paper since tick fluids may be infective. Apply antiseptic and a bandage to the site and finish by washing your hands with soap and water.
Rates of infection in ticks vary by area but are generally low, Damrow said.
Ticks cannot tolerate extreme heat or cold, so they have two primary feeding periods: spring and fall. As winter closes in, ticks take cover under leaf litter or other surface vegetation, becoming inactive in temperatures below 40 degrees Fahrenheit.
For more information about tickborne diseases, contact your local health department or visit the Web site of the U.S. Centers for Disease Control and Prevention at www.cdc.gov/ncidod/diseases/list_tickborne.htm .
Mysterious tick disease afflicts Montana
March 8, 2003
Scientists believe an undiscovered Lyme disease-like illness is being transmitted by wood ticks in Montana, particularly in the Yellowstone River area from Livingston downstream to Forsyth. The bulls-eye rash, fever, body aches, and lingering exhaustion caused by the illness have stumped doctors for at least a decade, said State Epidemiologist Todd Damrow. Local, state, and federal scientists are now launching an effort to crack the mystery.
"We could have a new disease here, we just don't know right now," Damrow said. "We don't know how prevalent it is, how pervasive, or even the nature of the illness. Those are questions we need to address."
The state receives a "handful" of reports each year of unexplainable illnesses believed to be caused by a tick bite, Damrow said. The cases have been clustered in the Yellowstone River drainage, but reports have also come in from both Helena and Missoula. In each instance, Lyme disease has been ruled out, as has Rocky Mountain Spotted Fever.
"As far as we can tell, these cases are fairly uncommon," Damrow said. "We don't think it's a large epidemic, but you never know. We've never followed it."
Antibiotics have been used successfully to treat recent cases reported to the state. Damrow doesn't know whether the illness has ever caused any deaths. "We've never looked. We have no way of knowing. Even if someone died from it, the cause wouldn't show up on the death certificate. There's no test for it," he said. "We also have no idea whether, like Lyme disease, there are serious long-term consequences."
A Former Yellowstone County Commissioner developed symptoms of the illness 2 years ago, shortly after his wife spotted a tiny 8-legged tick on his lower back. She plucked the tick off with a tweezers, sealed it in a pill bottle and stashed the bottle in the freezer. A few days later, he began feeling like he had the flu. The next morning, a red rash the size of a silver dollar surrounded the bite. He immediately went to see his physician. Lyme disease was suspected and the tick sent off to Helena for testing.
[Though an] active person, after being bitten, the patient struggled to find the energy to do basic tasks. "It felt like someone pulled the plug and I was 2 quarts low," he said. It was even worse not knowing what was wrong.
Although the microorganism that causes Lyme disease -- _Borrelia burgdorferi_ -- was named after a Montana scientist, Willy Burgdorfer, Montana is the only state in the nation where a case of the disease has not been confirmed. The species of tick [_Ixodes scapularis_ - Mod.LL] that carries Lyme disease also has never been found in Montana.
State officials, including Damrow, were convinced the patient was suffering from Lyme disease and had contracted it during a recent visit to California. He insisted, however, he never did anything during his brief stay to put him in contact with ticks. He maintained the tick came from his heavily wooded 54-acre property south of Billings. Ticks are common in the area, he said. Tests came back negative for Lyme disease. The tick was then shipped to the Vector-Borne Disease Unit of the Centers for Disease Control in Fort Collins, Colorado, USA
Meanwhile, the patient was put on antibiotics. His physician continued searching for answers. This wasn't the first time she had a patient with unexplainable Lyme disease-like symptoms, She said. "I think most of the physicians who practice in Montana have seen cases like this."
5 months later, results came back from the CDC. Experimental DNA analysis was used to search the gut contents of the tick, but nothing conclusive could be found, according to the report. The tick was identified as a Rocky Mountain wood tick [_Dermacentor andersoni_ - Mod.LL], a species common to Montana and one that does not carry Lyme disease. The affliction could not be identified, the report concluded.
Whatever it was, the disease no longer bothers the patient. "I've had no ill-effects since they put me on medication," he said. His physician hopes the new investigation will identify the source of the disease and, eventually, lead to a test and a treatment. There have been too many unexplained cases to shrug off, she said.
"I do think there's something to this," she said. "I'm glad they're getting fired up over this."
Rocky Mountain Laboratory in Hamilton will help state and local officials study suspected disease-bearing ticks. The federal lab was founded in 1928 to study Rocky Mountain spotted fever, a tick-borne illness that killed hundreds of settlers in Western Montana. In the early 1980s, the lab also identified the spiral-shaped bacteria that causes Lyme disease. The lab's specialized equipment will play a vital role in finding the culprit behind Montana's mysterious tick-borne illness. Damrow said he "strongly suspects" a cousin of the Lyme disease-causing bacteria has adapted to Montana's tick population.
"Unless we look, we'll never know," he said. "Who knows how much health we could be protecting?"
http://www.wildlifedamagecontrol.net/diseases/tickdisease.php
© 2006 The National Lyme Disease Memorial Park Project
