After the drawn-out drizzle and chill of late winter, it’s finally full-blown spring in Maine. For many residents of the Pine Tree State, it’s time to get out into the natural world to garden, hike, play and work.
Unfortunately, the advent of warmer weather brings its own problems. Among these is the growing geographic range of ticks, those tiny arachnids, and the dangerous human diseases they transmit. In addition to rising rates of Lyme disease, the best-known of these tick-borne diseases, Maine is seeing a smaller but growing caseload of anaplasmosis, babesiosis, ehrlichia and Powassan virus, all potentially serious and even deadly infections that should be of concern to anyone who works or plays outside.
In 2017, nearly 1,800 Mainers contracted Lyme disease, setting a new record for a disease that has been increasing dramatically here in recent years. In 2016, 1,496 cases of Lyme were reported in Maine, up from 1,210 cases in 2015, according to data from the Maine Center for Disease Control.
One of them was Karen Greenlaw, a 61-year-old registered nurse who lives in Orrington. She also contracted babesiosis, possibly from the same bite. Her symptoms started on Thanksgiving, a few weeks after she found an engorged tick on her bathroom floor.
“I thought I had the flu,” she said. “I couldn’t eat, I had a fever, I couldn’t even move I was so fatigued.” A provider at the nearest urgent care center swabbed her throat and took a blood sample, then sent her home with a prescription for an antiviral flu medicine.
The throat swab was negative for flu, but suggestive of Lyme disease and clearly positive for babesiosis. She was switched to an antibiotic. A later test confirmed Lyme as well.
Greenlaw suffered “unbearable fatigue” and missed two weeks of work before regaining her health.
“But I haven’t had any symptoms since,” she said. “I think it’s because I started medications early.”
Dr. Robert Pinsky, an infectious diseases specialist in Ellsworth and Bangor, said even more alarming than the growing problem of Lyme is the spike in anaplasma, babesiosis and other tick-borne infections.
“These are potentially very serious if they’re not treated promptly,” he said.
Most infections will respond to antibiotics and other pharmaceuticals, he said, but when treatment is delayed, underlying damage may be impossible to reverse.
Because the flu-like symptoms of Lyme and other tick-borne illness are similar, Pinsky said, it’s best to act quickly if they arise.
“If you get a fever and chills, I wouldn’t ignore it,” he said, “especially this time of year … when the risk of infection is high.”
Tick-borne diseases in Maine
Tick bites rarely cause discomfort at the time they occur and may go completely unnoticed. Early symptoms of the diseases found in Maine typically develop with one or two weeks, according to the U.S. Centers for Disease Control and Prevention, and often include flu-like complaints such as fever, fatigue, chills and nausea.
Most of these diseases are transmitted by the deer tick, but Rocky Mountain Spotted Fever and ehrlichiosis are carried by the less common Lone Star Tick. In most cases, these diseases are effectively treated with oral antibiotics. Delayed care is likely to lead to serious complications.
— Lyme disease is by far the most common of the tick-borne diseases. Early symptoms include flu-like symptoms as well as a signature “bulls-eye rash” that may develop around the site of the tick bite. Untreated, Lyme can cause long-term problems, including painful inflammation of the joints and neurological problems such as meningitis, facial paralysis, weakness and impaired muscle control.
— Anaplasmosis causes symptoms similar to Lyme. Left untreated, anaplasmosis can lead to internal hemorrhage, kidney failure and death. About 662 cases were reported in Maine in 2017, up from 372 cases in 2016 and 186 cases in 2015.
— Babesiosis is caused by microscopic parasites that infect red blood cells. Some people never develop symptoms, but for others, babesiosis can cause flu-like symptoms and severe anemia. In Maine, 117 cases of babesiosis were reported in 2017, compared with 82 cases in 2016 and 55 cases in 2015.
— Ehrlichiosis is a bacterial infection that can cause life-threatening breathing difficulty and bleeding disorders. In 2017, 20 cases were reported in Maine, up from four cases in 2016 and just one case in 2015.
— Rocky Mountain Spotted Fever can lead to limb amputation, hearing loss, paralysis and mental disability. It sickened three people in Maine in 2017, four in 2016 and just one in 2015.
— Powassan virus causes neurological problems including brain inflammation and seizures. It has no specific treatment but hospitalization may be required for breathing difficulty and dehydration. Three cases were reported in Maine in 2017, one in 2016 and none in 2015.
All these diseases are preventable.
“To prevent Lyme disease and other tick-borne illnesses, the best protection is to avoid contact with ticks,” Dr. Bruce Bates, director of the Maine CDC, saud in a recent news release. Bates and other public health experts recommend the following preventive measures for those who work or recreate in the outdoors:
— Avoid wooded and brushy areas, as well as tall grasses.
— Walk in the center of trails to avoid contact with plant materials.
— Wear light-colored clothing so ticks are more visible.
— Wear long sleeves and long pants, and tuck pant cuffs into socks.
— Use a repellent approved by the federal Environmental Protection Agency containing proven ingredients such as DEET, picaridin, or IR3535. Apply to clothing as well as to exposed skin.
— Perform daily tick checks, including pets and gear, preferably right after coming inside.
Ticks that have attached and are feeding should be removed as promptly as possible, preferably using tweezers or a special, slotted “tick spoon.” Grasp the tick near its head and pull steadily until it releases.
Homeowners and managers of public areas such as parks or playgrounds may consider using professionally applied chemical pesticides to keep tick populations in check.
A changing landscape
“Maine is very much a changing landscape. We have new areas where ticks are moving in and disease is following,” Chuck Lubelczyk, a scientist at the vector-borne diseases laboratory at the Maine Medical Center Research Institute in Scarborough, said. Lubelczyk has been studying ticks in Maine since the mid-1990s.
“Ticks are moving inland and they’re moving up the coast,” he said.
Those areas are seeing warmer temperatures as well as more residential development, he explained, meaning longer seasons for ticks to be active as well as a growing human presence. A substantial population of whitetail deer, the primary feeding target for the deer tick, is another essential factor.
Lubelczyk says the percentage of ticks carrying disease-causing organisms in Maine has stabilized at about 50 to 60 percent.
For the past few years, Maine’s midcoast area, including Lincoln, Knox and Waldo counties, has seen the fastest growth in reported cases of Lyme disease. But Hancock County is also seeing a rise, from 121 cases in 2015 to 152 cases in 2016 and 202 cases in 2017, according to data from the Maine Center for Disease Control and Prevention.
Lubelczyk said northern and western areas of Maine are still seeing lower rates of illness. But he expects that to change as deer ticks spread northward toward Canada, where, nationwide, fewer than 1,000 cases of Lyme disease were reported in 2016.
“Maine is not going to be the dead end,” he said.
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