MAR-B-10
MY RESPONSE TO A WILDERNESS ACQUISITION OF A DEER TICK
AND ITS MANAGEMENT
I picked this up at Camp
Lejeune in NC last weekend. It is probably a deer
tick - I managed to save it,
it's crawling around in a plastic baggy on top
of the fridge. Pinhead size.
An unbelievable infestation of these things
down there, way beyond all
my past experience in tick environments.
No necrosis, just a raised
central red welt about 3/4" across. No bulls eye
pattern. It was not big and
engorged.
But, I have been lucky in
the past so this one was disturbing. Thanks for
getting back to me.
At 09:12 AM 3/14/2002 -0500,
you wrote:
>Dear Chris:
>
>I just got your call
now--I hope I am not too late! (If it
were a matter
>of life and death, you
can be assured I would have found you!)
>
>First, yes, I plan to be
here on April 2, so let me know details of when
>and where the Board
Meeting will be held.
>
>Second--NO, do not worry
now, except if there is a local inflammatory
>reaction that looks
necrotic, and then we would treat only the local
>manifestations of the
tick bite.
>
>if you have a
significant local reaction, I would calling a script for
>Doxycycline, (which I
myself have been on for the past month as an
>antimalarial
prophylaxis). This would cover any systemic signs of the
>disease. A single hazard for an outdoorsman on this
drug is taht one
>should be very careful
about sun exposure while taking it.
>
>There are many
tick-borne illnesses, but they are rare--even in
>ticks. The most common one here is Rocky mountain
Spotted Fever, which is
>treatable and curable
with the antibiotic I just mentioned, and a number
>of other illnesses for
which children are principally at risk.
These
>sound bad, such as an
ascending paralysis, mimicking polio, but are rarer
>than hen's teeth and are
treated by support. The others come
from
>epidemics--of the kind
not currently going through here. But,
all of the
>above are borne by the
common tick--the dog tick, the kind you can see
>without magnifiers,
Dermacentor andersoni. So, if you saw
the tick, and
>it was big and
engorged--as you have no doubt seen them on dogs or,
>perhaps, self, the
worries are principally just the local skin
>inflammation and the
other rarer instances I just mentioned, and for which
>Doxy would be the
treatment IF, and not WHEN systemic symptoms
>occur--fever,
generalized spotty rash.
>
>Now, for the other kind
of tick also endemic here, the deer tick, these
>are so minute as to be
invisible except in a concerted search for them, so
>most people never find
them upon their person. So, when
someone reports a
>"tick bite" I
assume it is a dog tick if they have seen it.
>
>As everyone knows, there
is a joint and muscle systemic illness that comes
>from the deer tick--Lyme
Disease. it is over-diagnosed, has very
poor
>serologic testing
capability with a lot of false negatives, and is a
>lasting debilitating
disease. If someone has such an
illness, I treat
>empirically with or
without evidence form the poor diagnostic tests, with
>the same tetracycline
family of antibiotics, with only slow and variable
>improvement, hardly
distinguishable form the natural history course of the
>disease itself.
>
>For future reference, if
someone is a deer hunter, outdoorsman, camper,
>spending more than the
average "Summer Vacation" period of time in
>exposure to the deer
tick environment (e.g a logger) I would recommend
>the new Lyme vaccine, even though it has some
questionable effectiveness
>and is expensive.
>
>As for someone who is a
WFA instructor or is out in the Outward Bound
>wilderness
regularly--take me for example, in the wildernesses of the
>world exposed to nearly
everything and far from any medical aid I do not
>carry with me--I have
NOT had the Lyme vaccine, and, even as ardent a deer
>hunter as I might happen
to be, I have no plans to get it. The risks and
>expense are not
warranted in view of the very low probability of the
>event, which is
"diagnosed" as a "wastebasket" specific etiologic
>condition about ten
times more frequently than it occurs.
>
>I hope this is helpful
and that you can now "Tick Off" this worry from
>your list!
>
>Cheers!