Even ID Specialists Can Get Tick-borne Diseases

Judy Stone, MD

Disclosures

July 13, 2021

I'm on vacation in "paradise," in mid-coast Maine, and became ill last week. Many things ran through my head, not the least of which was, Where am I going to get care? How do you find a competent physician when you don't know people?

My symptoms were initially pretty nondescript: headache, nausea, and loss of appetite.

At first, I thought my feeling poorly was caused by outgassing from a newly installed room air conditioner. I'm like the canary in the coal mine when it comes to detecting and becoming ill from fumes. Still, it was unusual for me to start retching out of the blue.

That night, I woke up with teeth-rattling chills, on a day that had been close to 90° F. This was my first clue that my illness was due to something more than a whiff of solvents or plastics.

The headache persisted, as did my loss of appetite — very unusual for me. I also developed myalgias, with aching back and neck muscles, and was generally dragged out. This constellation of symptoms, I've since been reminded, is typical for anaplasmosis.

I don't know what care is like in many small towns. We had a good hospital, but mergers led to the closure of our critical-access hospital, as happened in many small towns. Since then, patients have a choice of an urgent care (during the day) or going off the peninsula. That's a dangerous and challenging drive if dark or snowy — or if you are significantly ill.

Not wanting to take my chances with an unknown walk-in clinic, I called my physician at home. She kindly called in a prescription for doxycycline.

Why doxy? While we didn't know what I had, any bad headache at this time of year or symptoms suggestive of "summer flu" should prompt consideration of a tick-borne disease (in addition to more serious things, like meningitis or a subarachnoid hemorrhage). Anything from Rocky Mountain spotted fever to anaplasmosis, Ehrlichia, or related zoonoses. These symptoms were unlikely to be Lyme, which is less likely to cause a headache.

I also contacted a local physician I was fortunate to know casually and, after hearing my history, he ordered lab work. My white blood count was abnormally low, CRP was 6, and liver enzymes were minimally up.

There's a mantra in infectious disease: Thou shalt not die without doxycycline. I'm happily on doxy again. My "tick panel" came back negative, but that does not change the presumptive diagnosis from the physicians I consulted: anaplasmosis. It's apparently increasingly common in Maine. The PCR test can be falsely negative from antibiotics (which I had started) and also simply miss cases. The CDC stresses that antibiotics should not be withheld due to a negative test.

I treat my outdoor clothes, shoes, and socks with permethrin and am pretty careful about doing tick checks. Yet, I still became ill.

Similarly, my husband became ill with Lyme a few weeks ago in Maryland. We were fortunate that he developed a characteristic rash. Otherwise, we could have easily attributed his being more tired than usual to "age" catching up with him. I've had Lyme before as well, and my rash was somewhat atypical.

Courtesy of Judy Stone

Have a low threshold for thinking about tick-borne disease. Ixodes (deer tick) are tiny little suckers and easily overlooked. The CDC has this humorous educational pic about deer ticks:

View Tweet

If only they were as sharp in developing better diagnostic tests. The lack of reliable diagnostic tests for Lyme, in particular, is shameful.

Remember, too, that tick co-infections are common. While most respond to doxycycline, babesiosis is a protozoal infection and requires different diagnostic tests and treatment. So, if you are not getting completely better after a tick bite has been treated, push to make sure babesiosis has been ruled out.

When planning a vacation, I also suggest that you try to plan where you might get care should plans go awry.

It seems like if COVID-19 doesn't get us, the ticks will.

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About Dr Judy Stone
Judy Stone, MD, is an infectious disease specialist and author of Resilience: One Family's Story of Hope and Triumph over Evil and Conducting Clinical Research: A Practical Guide.

She survived 25 years in solo practice in rural Cumberland, Maryland, and now works part-time. She especially loves writing about ethical issues and advocating for social justice. Follow her at drjudystone.com or on Twitter @drjudystone.

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