What Healthcare Professionals Need to Know About Ticks and Tick-Borne Diseases

Diagram of tick located on body

Lyme disease is spreading faster and farther than ever before. And while it’s vital that healthcare professionals can recognize and treat the infection, it’s not the only tick-borne diseases they need to know about. A series of diseases, ranging from Rocky Mountain spotted fever to the alpha-gal syndrome caused by a compound in the saliva of a Lone Star tick, are more prevalent than ever before.

To help healthcare professionals learn about these conditions, here are five things you should be aware of.

1. There Are Many Kinds of Ticks, and They Are Difficult to Tell Apart

Identification images of four different types of ticks
Image source: Tick Encounter Resource Center of the University of Rhode Island

According to experts at the Brown University Emergency Medicine program and Rhode Island Hospital familiar with ticks and tick-borne diseases, identifying ticks can be quite difficult. Not only do they have slightly different appearances across the larval, nymph, and adult life cycle stages but their distinguishing features can be lost as they become engorged with blood. The easiest way to identify a tick is by knowing which types are endemic to your area. The hard shield-like scutum on the back doesn’t distort as their abdomens engorge. “Blacklegged” Ixodes ticks have a black scutum that matches their legs while lone star and dog ticks have unique patterns.

2. The Number of Tick-Borne Illnesses Doubled Between 2004 and 2016

Maps with locations of different ticks in the United States

According to the Centers for Disease Control (CDC), the U.S. is on the verge of a vector-borne disease epidemic. The number of tick-borne diseases has doubled in the 12 years between 2004 to 2016. One hypothesis for this increase is due to simultaneous growth in the deer and rodent populations, leading to an abundance of hosts. Improved testing, detection, and reporting may also be playing a role in the number of cases documented. Regardless of the cause, endemic cases are increasing.

3. Tick History — Where It Was Found, What It Looked Like, and What State It Was in Upon Removal — Is Vital Knowledge

How to remove a tick from the skin
Image source: Tick Encounter Resource Center of the University of Rhode Island

Brown University Emergency Medicine program and Rhode Island Hospital experts advise that before removing a tick, ensure you have taken a tick history. Appropriate tick history includes the local geography, the identity or description of the tick, and what stage of feeding the tick was at the time of removal. While the migration of Borrelia spirochetes from the tick’s gut to its saliva takes approximately 48 hours, other agents like HGA are present in the salivary glands. For this reason, engorged long-feeding ticks are associated with higher disease transmission rates.

4. Co-Infection Is Possible and Must Be Considered

Diagnostic testing of tick bites

Making a firm diagnosis is both important for treatment decisions and the patient’s peace of mind, share the Brown University Emergency Medicine and Rhode Island Hospital teams. Up to two-thirds of patients with confirmed babesiosis also have Lyme disease, and one-third also have human granulocytic anaplasmosis. Recommendations for testing are listed in the graphic above. Testing for multiple diseases simultaneously should be considered in endemic areas.

5. Early Treatment and Prompt Diagnosis Are Key to Improving Outcomes

Brown University Emergency Medicine and Rhode Island Hospital experts say diagnosis is challenging because testing takes days to weeks, and in some cases a clinical diagnosis is required. Concomitant infection is likely and clinicians must maintain a high index of suspicion for co-infection. Treatment should be initiated early in the appropriate clinical setting. Early treatment, prompt diagnosis, and close follow-up are key to improving outcomes.

Published 2019; updated June 22, 2022

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