What are the symptoms of the other tick-borne diseases?
All of the tick-borne infections have a nonspecific initial presentation, that is, there is no way to distinguish them just based on signs and symptoms. Yes, acute (new) Lyme disease cases usually have the expanding rash (more than 60 percent of the time, perhaps more…the rash can be under the hair on the scalp and easily missed) but someone with fever (more than two days), headache, chills, muscle aches, migratory joint pains, and fatigue could still have Lyme disease. But on Martha’s Vineyard it could also be anaplasmosis (also called human granulocytic ehrlichiosis or HGE), babesiosis, deer tick encephalitis, Borrelia miyamotoi disease (BMD), Rocky Mountain spotted fever (although a widespread “spotty” rash usually develops), or tularemia. You could even have West Nile fever or another of the three or four mosquito transmitted viruses, although most of these are marked by a stiff neck. You could also just have the flu or enterovirus, and many of the listed signs and symptoms could be seen the day after too much merry making. Usually, though, unless you were truly naughty, debauchery-based symptoms would not persist more than a day.
Lyme disease is the most common of all of the tick-borne infections, perhaps 4-10 times more common, and should be at the top of the list for the Island doc’s differential diagnosis for anyone with fever, headache, etc. during the summer (Memorial Day to Labor Day). Some docs will just assume that it is Lyme disease and issue a prescription for 3-4 weeks of doxycycline or amoxicillin (for those who are in the sun a lot). Doxycycline will treat Lyme, anaplasmosis, BMD, spotted fever and tularemia and so even if the exact diagnosis is not made, the patient gets better and there is no harm done. If amoxicillin is given and it is not Lyme disease or BMD, patients will come back sick and that will prompt a further workup. Babesiosis is not treated by these antibiotics and requires specific oral drugs. Deer tick encephalitis and the mosquito-transmitted infections have no treatment, other than supportive care.
The M.V. Tick Borne Disease Initiative has a Medical Education Committee that has made great progress in continuing education for Island health care providers, and has advocated for a standardized approach to the “summer fever” patient. Such a standardized approach would include appropriate use of testing, presumptive treatment using doxycycline, aggressive follow-up, and reporting of all cases.
Visit the MV Tick Borne Disease Initiative website, sponsored by the Island-wide boards of health (www.mvboh.org) for tips on prevention.
Sam Telford is Professor of Infectious Disease and Global Health at Tufts University Cummings School of Veterinary Medicine.
