By Aparna Taylor, ND
Each spring in most parts of Canada, we watch green grass start to peak out of the sea of yellow, and buds start to fill out tree silhouettes waking from winter. Seeing the landscape change brings the promise of warmer weather activities in the outdoors though more and more we are hearing about the risks and fear associated with being in nature—as if it is separate from us as humans. The threat of a tiny tick sneaking its unwanted cargo into unknowing bodies is real and often under reported; being mindful and prepared can help us remain balanced and increase peace of mind to enjoy being outside while still being responsible. Being outside brings tranquility, positive effects on our health, and cleans the slate of our over processed world. I support being present, aware, and doing what brings calm to each individual; we are a part of nature.
There are multiple resources available through local Lyme support groups (for example, CanLyme in Canada) that provide practical and useful information. The ILADEF (International Lyme and Associated Diseases Society Educational Foundation) is another resource for prevention: https://iladef.org/education/chronic-lyme-dos-and-donts/. I encourage the reader to explore these and other resources to find what resonates.
What if an individual is bit by a tick? Is there always an unwanted infection?
The cases discussed in this writing reflect examples of how acute tick bites were managed, using the following five questions:
- Is there a potential risk of infection(s), and was the tick identified?
- Was it attached and engorged?
- Was it removed with all parts?
- Are there any symptoms?
- What is important to the individual/family?
Anya*
Anya’s family lives near a valley and river. Her grandmother’s garden was frequented both by the grandchildren and unfortunately, also deer, known hosts for ticks. One evening after spending a weekend playing in the garden, Anya’s mom noticed an attached bug on Anya that looked like a tick.
Is there a risk of potential infection(s)? Yes, the area is a known endemic region for Lyme disease. Not every tick carries an infection, though can carry more than one—thus it is not only Lyme disease that can be transmitted. Was the tick identified? While there is some question of other vectors or carriers of the infections, the Ixodes species of ticks are known vectors. There is no harm in keeping whatever vector/bug is found to send away for further assessment and peace of mind. Anya’s mom identified the bug as the black legged Ixodes scapularis tick from an online resource and saved it in a hard-sided container. Keeping the tick/bug will allow it to be identified in the future, if not immediately identifiable.
Was the tick attached and was it engorged? The tick was embedded in Anya’s skin and was engorged. Remember, not all ticks carry all infections. While the probability of transmission of an infection is less with a shorter feeding time, it is not zero. Since it was engorged, this represents a longer feeding time and increased probability of transmission of infection(s) if the tick is infected.
Was it removed with all parts? Ticks have retractable mouth parts like barbs; pulling it out will snap off the body and leave the head and mouth parts attached thus increasing the chance of transmitting the infection(s). Anya’s mom, while understandably panicked, took her time to review how to properly remove the tick from an online source and was able to do this without any parts being left behind.
Are there any symptoms? Anya was fatigued, though her parents did not observe much other than that. There was no rash or other signs, and her fatigue could be attributed to late nights and a busy weekend. Each person must be evaluated individually. While Anya did not show all of the “typical” symptoms associated with transmission of an infection (fever/chills, joint pain, fatigue), each individual is unique as is their own immune system and each tick bite/potential infection(s) may be different also. While tempting to treat all the same way, taking time to review symptoms and history together is valuable.
What is important to the individual/family? This will outline the next steps and will guide informed decision making. Anya’s family and I reviewed her history and did a risk benefit analysis. Testing Anya was discussed, with T cell tests, which can indicate an acute response; in contrast, antibodies take weeks to mount an immune response, which may be too late to test and then treat if there is an infection. T cell tests are indirect looking for immune responses rather than the pathogen itself and can be costly depending on how many infections are tested for. Since Anya’s mom had the tick, this was the most practical direction to take. We sent the tick to a private lab in Canada (Geneticks in Ontario; author has no conflicts of interest or affiliation) and tested the broadest possible list of infections.
While waiting for the results, the family opted for herbal treatments that would have minimal risk and other individualized supports specific to Anya’s health and history. While there are various public health facilities that test ticks, I consider a found tick to be extremely valuable!! I have had reports of individuals who have sent the tick for testing to a local lab and either had only one infection tested for (and only 1-3 Borrelia species), or worse, nothing tested due to the opinion that the risk is low and the tick thrown out or reported lost. I encourage individuals to make informed decisions about which place they feel comfortable working with, and since there are private labs that test ticks for the relevant infections that may be present, this is an option. There are also research facilities, some associated with universities, that test possibly with no cost, though they may not have the quick turn around the private labs have.
The results were back within a few days, and we all did a dance of joy when they came back negative for all tested tick-borne diseases. Anya continued with the herbal treatments for a few more weeks, exhibited no adverse or new symptoms and regular tick checks and other preventive strategies are now a part of their routine when outdoors. We discussed what is important to the family, and Anya’s love of the outdoors was top of the list. Following the practical strategies, and the steps to follow should there be another bite, provided peace of mind to the family and to Anya. This may not be the case for others, highlighting the importance of informed decision making and a case by case evaluation of what is important to the individual or family. Monitoring after the testing comes back, even if negative, is recommended as there may be infections that testing was not available for.
Pauline*
Pauline contacted me with questions after a tick bite. While she had been given a prophylactic dose of antibiotics, over the next week she began experiencing some troubling symptoms. She requested more antibiotics, though it did not help.
Is there potential risk of infection(s), or was a tick identified? Pauline was visiting the east coast of Canada, and found a tick attached to her just before leaving. This area of Canada is a known endemic area, and she identified the tick as an Ixodes species tick comparing it to an online picture.
Was it attached and engorged? It was attached, though did not appear engorged. This would imply less time for feeding, though only decreases the probability of transmission, does not exclude it. The longer a tick is attached feeding, the greater the probability more of the gut contents will be regurgitated (including pathogens) and transmitted to the new host.
Was it removed with all parts? She was able to remove the tick with all mouth parts intact and saved it.
Are there any symptoms? Pauline had pre-existing arthritis, though was exhibiting other symptoms now that were generalized and new to her. They did not all fit the “typical” list of symptoms and she was unsure how to proceed, as her primary care physician believed the doses of antibiotic she was given were sufficient.
What is important to the individual? Pauline was concerned her treatment was not long enough as it did not seem these symptoms were a flare of her pre-existing condition; and while she did not have a bull’s eye rash, she was concerned she may have Lyme disease. Another question was whether she was treated for the actual infection(s) that may have been transmitted by the tick, as it is possible it was different than Lyme disease. The cost of testing Pauline’s blood (T cell tests) for the potential infections was prohibitive, and since she had the tick it would be a direct window into a testing method. She sent the tick off to a private lab and based on her history and presentation of symptoms, we reviewed her overall treatment plan and her health goals.
