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Welcome to TickWise MV

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Providing expert, science-based diagnosis, treatment & education on all aspects of tickborne illness—including Alpha-Gal Syndrome—on Martha's Vineyard and Nantucket

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Art by Alan Claude
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Local Tickborne Illnesses & Symptoms 

Lyme Disease:

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  • Transmission by Deer Ticks bites only
     

  • Caused by a bacteria in the tick’s gut (Borrelia burgdorferi )
     

  • Transmission typically requires attachment for >24-36 hours (must be engorged)
     

  • Most humans infected by nymphs in spring and summer months
     

  • Infection also by adult Deer Ticks in cooler months
     

  • Larger and more likely to noticed and removed 
     

  • Incubation period (time until you feel sick) is 3-30 days

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Early Lyme Symptoms

  • FLU-LIKE fever, chills, swollen nodes, body aches, joint pain, malaise,  headache
     

  • Erythema migrans (”BULL’S EYE RASH)
     

  • Red, annular or homogenous rash at bite site
     

  • Expands over days to >5 cm
     

  • Possible central clearing (Bull’s Eye)
     

  • Extremely variable in presentation, looks different on different skin shades
     

  • Warm, rarely painful or itchy
     

  • Occurs in 70-80% of Lyme cases
     

  • Often overlooked
     

  • TESTING CAN BE NEGATIVE IN EARLY PHASE; TREATMENT  IS OFTEN PROVIDED ON THE BASIS OF THE RASH ALONE

Later Stage Lyme Symptoms and Manifestations

  • 60% pts w untreated early Lyme progress to Disseminated Lyme Disease
     

  • Diverse clinical manifestations

    • ​Neurological

      • Bell's palsy, meningitis, fatigue
         

    • Cardiac

      • heart blocks, carditis
         

    • Musculoskeletal/Rheumatologic

      • joint pain an swelling, fatigue 
         

    • Dermatological

      • rashes including multiple EM lesions
         

  •  Appears w/in weeks to months w/o treatment

Ehrlichiosis

  • Transmission is by the bite of both Lone Star and Deer Ticks 
     

  • Caused by a bacteria:

    • E. muris eauclairensis from Deer Ticks

    • E. chaffeensis and E. ewingii from Lone Star Ticks
       

  • Incubation period 5-14 days

Symptoms

  •  Non-specific flu-like: fever, chills, headache, malaise, msucle aches, nausea, vomiting, diarrhea, poor appetite
     

  •  Non-specific rash 

    • More common in children
       

  • Neurologic manifestations
     

  • Cardiac inflammation

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Babesiosis

  • Transmission by Deer Tick bite (primarily)
     

  • Caused by a protozoa that infects red blood cells (like malaria)
     

  • Incubation period 1–4 weeks but can range from 5–33 days
     

  • 25% adults and 50% children have no symptoms

Symptoms

Flu-like and non-specific and can include:
 

  • Fever, chills, sweats, headache, nausea, fatigue, muscle aches, poor appetite, yellowing of the skin, enlarged liver, dark urine
     

  • ​Can range from no symptoms to severe
     

  • ​Risks for severe babesiosis include not having a spleen, advanced age, impaired immune system
     

    • These cases can be life-threatening

 

​Only local tickborne infection NOT treatable with doxy other than Powassan (a virus) and Alpha-gal Syndrome (an allergic syndrome, not an infection)

 

​Treatment is with Atovaquone and Azithromycin

 

​4-5 % may have coinfection w Lyme and  may also need doxycycline 

Anaplasmosis

  • Transmission by Deer Tick bites
     

  • Caused by a bacteria, Anaplasma phagocytophilum
     

  • Incubation period 5-14 days

Symptoms

  • Vague, non-specific flu-like symptoms and vary between patients
     

  • Fever, headaches, muscle pain, chills, fatigue
     

  • 20% have gastrointestinal symptoms (nausea, abd pain, diarrhea, poor appetite)
     

  • 10% have non-specific rash
     

  • Frequent coinfection with Lyme Disease (most common coinfection)

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Tularemia

  • NOT JUST A TICKBORNE ILLNESS
     

  • Transmission locally by the bite of Dog & Lone Star Ticks OR

    • Via inhalation

    • Via contact with infected carcasses / animals (rabbits, hares, and rodents) or contaminated food or water
       

  • Caused by a bacteria, Francisella tularensis 
     

  • Incubation period 3-5 days (range, 1-21 days)

Symptoms

  • Non-specific, flu-like:

    • Fever, chills, HA, body aches, poor appetite, fatigue, cough, sore throat, vomiting, diarrhea, abdominal pain
       

  • Skin ulcers at bite site (not always present), swollen nodes
     

  • Pain breathing, abnormal chest xray findings
     

  • Light sensitivity, vision impairment/loss, conjunctivitis, swollen lymph nodes 
     

  • Severe throat pain, pus in throat or on tonsils, locally swollen lymph nodes

Rocky Mountain Spotted Fever

  • Transmission locally by the bite of an American Dog Tick
     

  • Only 4-6 hrs attachment required
     

  • Caused by a bacteria, Rickettsia rickettsii
     

  • Incubation period 3-12 days

Symptoms

  • Early symptoms (1-4 days):

    • High fever, severe headache, malaise, body aches, swelling around eyes and back of hands
       

  • Late symptoms (>5 days):Altered mental status/confusion, coma, brain swelling

    • Respiratory compromise

    • Tissue death (may req. amputation)

    • Multi-organ system damage
       

  • Rocky Mountain SPOTTED Fever

    • Rash

    • 2-5 days after onset of symptoms

    • Seen in ~90% of patients
       

  • Early rash:

    • flat to raised red or purplish lesions, initially on wrists and ankles, spreads to trunk, occasionally to palms and soles
       

  • Late rash:

    • Petechial (small, pinpoint bruising): red to purplish, > day 6 after symptoms start

    • Considered a hallmark of severe disease

STARI (Southern Tick-Associated Rash Illness)

  • Associated w Lone Star tick bites
     

  • Causes a Lyme-like bullseye rash
     

  • Single or multiple, generally at bite site
     

  • Typically smaller diameter than Lyme rash
     

  • May have central “papule” or bump
     

  • Often misdiagnosed as Lyme where Lone Star and Deer ticks coexist
     

  • A syndrome of unknown cause, thus, no diagnostic test
     

  • Avg time from tick detection to rash 12 days (range 2-21 days)
     

  • Other symptoms are mild if present at all

    • Can include mild fever, headache, generalized aching, fatigue, nausea
       

  • No treatment needed if there was a confirmed Lone Star tick bite as Lone Star ticks don’t carry Lyme
     

  • If unsure if Lyme rash or STARI, we treat for Lyme!

Powassan Virus

  • Transmission locally is by the bite of a Deer Tick
     

  • Time from bite to transmission can be as little as 15 min
     

  • Caused by a VIRUS
     

  • Incubation period 1-5 weeks

Symptoms

  • Flu-like: fever, aches, malaise, weakness, headache, sore throat, nausea, vomiting, rash
     

  • Typically self-limited or even may go unnoticed
     

  • Weeks to months later, some develop SEVERE neurologic issues

    • Most commonly inflammation of the brain and/or around the brain

    • Prolonged fever, confusion, decreased consciousness, seizures

    • Eye symptoms; paralysis or impaired movement

    • Spastic or flaccid paralysis
       

  • Treatment: NONE. Supportive care for symptom control

Alpha-Gal Syndrome

  •  Alpha-Gal Syndrome (AGS) is a serious, potentially life-threatening allergy to a sugar called “alpha-gal”a
     
  • The alpha-gal sugar is naturally found in all non-primate mammals but also in the saliva of some tick species.
    ​
  • Locally, the LONE STAR tick is the species of concern with regard to AGS
     
  • When a person is bitten by a Lone Star tick, the alpha-gal sugar in the tick’s saliva enters their blood stream. In some people, the immune system identifies this sugar as a threat. Later, when those individuals consume the alpha-gal sugar in mammalian meat, dairy or other products, this immune response can trigger an allergic reaction​​a
     
  • Unlike other tickborne illnesses, AGS is NOT an infectious disease and is not treatable with antibiotics
     
  • Not everyone who is bitten by a Lone Star tick develops AGS. It is currently unclear why
     
  • Currently, there is no cure for AGS although symptoms can be managed with dietary changes and vigilance, some medications, and prevention of additional Lone Star tick bites
     
  • Research is ongoing regarding other potential treatments
REMEMBER:
TESTING POSITIVE ALONE DOES NOT MEAN YOU HAVE OR WILL DEVELOP ALPHA-GAL SYNDROME

Symptoms and When to Test:

  • This a confusing topic for those worried about having Alpha-Gal Syndrome
     
  • Current recommendations are that that
    testing ONLY be performed to confirm a very high likelihood of someone having AGS based on symptoms and the timing of onset of symptoms after ingesting products derived from mammals
     
  • This is because many more people test positive for the Alpha-Gal antibody than who actually have the Alpha-Gal SYNDROME
     
  • The definition of Alpha-Gal SYNDROME is testing positive WITH symptoms consistent with the condition
     
  • Testing positive without any symptoms can cause significant anxiety about what, if any, dietary changes need to be made
     
  • Additionally, the symptoms of AGS can be vague. Establishing a patten of symptoms is key to determining if testing is warranted
     
  • Whether or not to test should be discussed with a clinician skilled in this field
     
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