Tick-Borne Triple Whammy

By Blake Kerr

As a general practitioner on eastern Long Island for 25 years, I have become habituated to tick-borne illnesses. I have had Lyme disease four times. Last summer from Memorial Day to Labor Day, while my office in Wainscott saw 100 cases a week, a tick the size of a poppy seed almost killed me.

I attributed headaches on the Fourth of July to too little sleep. A different joint pain every day was from not getting enough exercise. Fits of fatigue were normal trying to accommodate the Hamptons’ quadrupling population. After a week, the migratory and intermittent symptoms made it difficult to ignore the obvious Lyme.

I figured that I had been bitten by an infected deer tick nymph and did not get the characteristic circular or oval rash, erythema migrans. It is underappreciated that the primary culprit transmitting Lyme to humans, the blacklegged deer tick, has a two-year life cycle. Every spring each adult female can lay 3,000 eggs that hatch into larvae in the summer. The minuscule larvae are not infected and latch onto rodents, birds, pets, or humans for their first blood meal. The larvae become infected if their hosts are infected.

In the Northeast, white-footed mice and other rodents are the primary reservoir for the bacterium that causes Lyme. After a blood meal, larvae molt into nymphs that need another blood meal before they can mature into adults. In endemic areas, 25 percent of the nymphs may be infected, and 50 percent of the adults. Female ticks, not males, transmit infections.

Knowing that many blood tests for Lyme are negative, I was glad that my antibodies were elevated. When I started taking amoxicillin and felt worse, I took consolation that this paradoxical accentuation of symptoms, a Herxheimer reaction, was common.

The second week of July was hot enough to soak my shirts with perspiration, but the clinic had air-conditioning. When patients commented on my profuse sweating and pallor, and suggested that I see a doctor, I reassured them that I had Lyme disease. Then I became too weak to work, losing a pound a day, putting spoons in the refrigerator.

In addition to Lyme, my office also saw three to five cases of ehrlichiosis and anaplasmosis every week, from bacteria that infect white blood cells, and babesiosis, a parasite that infects red blood cells, both from deer ticks. Lone Star ticks can also carry ehrlichiosis. Unlike Lyme, where it can take weeks or months to run out of excuses, people with anaplasmosis, ehrlichiosis, and babesiosis are acutely ill and need to be treated promptly. Rocky Mountain spotted fever also presents itself with high fevers and rash, but it is much less common and comes from a dog tick.

When a second blood test showed a drop in my white blood cells that made me susceptible to infections, low platelets that increased my risk of bleeding, and elevated liver enzymes, I recognized the stamp of ehrlichiosis. I started taking doxycycline, which covered Lyme and ehrlichiosis. But I was confined to my living room, sweating in front of a fan, writing a short list of things I wanted to do before dying.

As a physician with an inflamed imagination, I rivaled my most hypochondriacal patients, blithering with alarm. After 16 days the headache behind my left eye became so severe I thought I had a brain tumor. Bleeding gums when I brushed my teeth fueled worries of leukemia. Afraid of picking up another infection in the emergency room, I went to Southampton Hospital’s lab, which was experienced in all tick-borne diseases.

I cried when the lab called and said that there were intracellular ring forms in my red blood cells. I had three tick-borne diseases at the same time: Lyme, ehrlichiosis, and babesiosis. Babesiosis is similar to malaria and required two additional medicines, atovaquone and azithro­mycin.

My headache’s vanishing 12 hours after taking the first dose of the new medicines reminded me of an old adage, “There is no greater pleasure than the cessation of pain.” Although I had to take the medicines for babesiosis for 10 days, in addition to doxycycline for four weeks, I recovered enough to get back to work by the end of the month. I was lucky. (There is not enough space here to address chronic Lyme, or the origin of eastern Long Island’s tick-borne endemic.)

After treating tick-borne diseases for a quarter-century, I am impressed that most patients with Lyme have been easy to diagnose and treat, if you listen to family members or co-workers who say, “I know what you have. You’re crazy! Every day you complain about a different ache and pain.”

Because of the epidemic of tick-borne diseases, the Centers for Disease Control and Prevention recommends a prophylaxis of one or two days of doxycycline for patients bitten by an engorged tick. With the exception of babesiosis, doxycycline helps prevent all known tick-borne diseases on Long Island, including miyamotoi, a new spirochete in deer ticks. There is no prophylaxis for children under the age of 8 or 9 years old — doxycycline permanently stains their teeth.

Anyone who is acutely ill with high fevers and sweats should go to the emergency room, where preliminary blood tests are available within an hour. Anaplasmosis, babesiosis, ehrlichiosis, and Rocky Mountain spotted fever can be life-threatening.

Fully recovered, I am encouraged by the recent push for a Lyme vaccine, and better diagnostic tests. In the meantime, I am lengthening my short list, and checking for ticks.

Beware of nymphs!

Blake Kerr, M.D., runs Wainscott Walk-In Medical Care. He lives in Water Mill.