Tick-borne disease kills 3-year-old
Dirty Secrets of Bloodthirsty Ticks
Ticks can carry the West Nile virus
By Kim T. Dudek, THE PRESS, Sept. 8, 1999
"Tick found in Avon tests positive for disease
A Lorain County health official confirmed last week that a tick removed from a child in Avon tested positive for Rocky Mountain Spotted Fever.
Ken Pearce, health commissioner for the Lorain County General Health District, said that although the tick did test positive, the child who was bitten by the tick did not contract the illness. However, Pearce said, it's important for adults and children to be aware that if there was one tick carrying the disease, there are probably more.
"It was either an American dog tick or a wood tick, both of which can carry the disease. We would have to assume that if there is one out there, there could be more," Pearce said. "The child was from Avon, and the exposure occurred in Lorain County, so it wasn't as if the tick was picked up in another state and brought here."
The tick had been taken to the county health agency for testing, a practice that Pearce encourages when a tick is found on a child or an adult. From the county office, the ticks are sent to Columbus for testing by the Ohio Department of Health. Reports are sent directly to a person's physician and the county department.
"We will take ticks for testing, and while it's not common that we find something, it's always good to do a little prevention. This is not an area known for finding ticks infected with the disease, which is what makes it significant. Usually, it's found in southern Ohio, along the Ohio River," Pearce said.
Rocky Mountain Spotted Fever is a potentially fatal infectious disease caused by a rickettsial organism and transmitted most commonly by the wood tick. It got its name because it was first recognized in the Rocky Mountains in 1873. Cases of the disease have been reported in almost every state. Most cases occur in the spring and summer months.
Early symptoms include headache and fever, followed by a patchy, rose-colored rash that appears on wrists and ankles. The rash turns to a dark red and brown as it covers the rest of the body. Treatment with tetracycline or chloramphenicol is usually successful.
"Early detection and removal of the tick will help prevent infection," Pearce said, adding that he encourages anyone who finds a tick on themselves or a child bring it to the health department for testing.
Ticks are commonly found in overgrown vacant lots, along weedy roadsides and at the edges of hiking paths and trails. When a person or pet passes by, the tick will cling to fur or clothing and then crawl to a place to attach and feed, Pearce said.
The health district suggests several precautions when walking in tall grass or weedy trails, including pulling socks over long pants, wearing long sleeves and using a tick repellent on clothing. After the walk, inspect your body, your children and your pets, looking through hair, underarms and around the ears. After showering, inspect the body again. Wash all clothing immediately and keep lawns and brush cut low.
If a tick is found, use fine-pointed tweezers to grasp the tick's head as close to the skin as possible and pull straight out. Do not twist, crush, prick, smother or burn the tick. Clean the bite area with antiseptic and wash your hands with soap and water.
For more information, the Lorain County General Health District can be reached at 322-6367 or 244-3418.
© 1999 by THE PRESS Lear Road, P.O. Box 300 Avon Lake, Ohio 44012 USA
NEWS ARTICLE from THE KALAMAZOO GAZETTE, 7-13-00, By BILL KRASEAN,
"Tick-borne disease kills 3-year-old in Cass County
Rare spotted fever death prompts warning to parents
LAWRENCE - Public health officials have issued a reminder to area residents to be leery of biting ticks after a 3-year-old Cass County boy died in June of a rare case of Rocky Mountain Spotted Fever.
Dr. Frederick A. Johansen, deputy medical director of Van Buren/Cass County Health Department here and medical director of the Berrien County Health Department, said Wednesday that "we don't want the public to panic, but just take precautions" in areas where ticks live ...
Johansen said the boy, Joel Garnett, died June 5 less than five days after first having a high fever. His symptoms were not uncommon for what was suspected to be a garden-variety viral disease, he said.
Blood tests subsequently analyzed by the Centers for Disease Control and Prevention in Atlanta showed that the cause of death was infection by a bacterium that causes Rocky Mountain Spotted Fever, Johansen said. Results of the tests were made available last week.
Robert Hause, director of environmental health for the Van Buren/Cass County District Health Department, said the Garnett's home and property were scoured Tuesday by public health and agricultural officials for dog ticks - the insects that carry the Rocky Mountain Spotted Fever bacterium - and only two were found. The ticks were sent to Ohio State University for tests, he said ...
There was no reason for Joel's physicians to suspect Rocky Mountain Spotted Fever since his symptoms were similar to viral and other common and temporary infections, he said.
Johansen said Joel Garnett did not have a rash until less than a day before he died."
NEWS ARTICLE from THE NEW YROK TIMES, 7-11-00, By ANDREW C. REVKIN
"Dirty Secrets of Bloodthirsty Ticks
Dr. Stephen K. Wikel pulled a little gauze-topped glass jar from a warm, damp incubator in his laboratory, and, with the heat from his palm and a puff of exhaled breath, roused the tiny blood-sucking creatures inside.
"These are the beasts," he said.
Bristly brown dots, each the size of a poppy seed, began to mill across the gauze, excited by the heat and gust of carbon dioxide that signaled the presence of a possible meal ticket on the other side.
One dot was immobilized on some cellophane tape and placed under a microscope, revealing just a few of the myriad tools that enable Ixodes scapularis, the deer tick and the main carrier of Lyme disease, to detect, climb aboard and surreptitiously dine on a host.
Lyme disease deer ticks
Photo courtesy of Centers for Disease Control
It is this diminutive eight-legged arachnid, a cousin of spiders, that has taken the carefree pleasure out of a summertime walk in the woods for millions of people in the Northeast. Other Ixodes species are spreading Lyme disease on the West Coast and in parts of Europe.
The visible features of the tick are impressive enough, including forearm hooks that snag fur or fabric on a passing target, a pair of cutting mouth parts -- like scissor blades with the sharp edge outward -- and a serrated tube that serves both as an anchor and a drinking straw. Ticks are the "Inspector Gadget" of parasites.
But it is the tick's invisible armamentarium, dozens of elaborate chemical weapons in its saliva, that have become the prime focus of Dr. Wikel, an entomologist at the University of Connecticut Health Center, which sits on a hilltop near Hartford overlooking wooded suburban yards that are prime tick habitat.
He and other experts in tick biology have found that the seemingly primitive parasites use an array of sophisticated chemical strategies to subvert a host's immune defenses, to prevent blood from clotting, and to muffle any itch or pain that might elicit scratching that could dislodge a tick and ruin a vital blood meal.
Ticks, which spend their lives stealthily avoiding detection, are beginning to give up some of their secrets.
A central goal of the scientists is to develop a vaccine from some of the molecules pumped into a host when a tick bites, thereby turning its own weapons against it.
A vaccine that deters the Ixodes tick, Dr. Wikel and other tick experts say, could prove more useful than the existing vaccine for Lyme disease, which only attacks the bacteria transmitted by the tick, not the tick itself.
Recent research has shown that deer ticks carry at least two other diseases besides Lyme -- human granulocytic ehrlichiosis and babesiosis. So an "anti-tick" vaccine, Dr. Wikel said, could essentially be "a three-in-one" vaccine.
Some preliminary work has shown that the strategy can be effective, and one anti-tick vaccine is being used against a different species that infests cattle in Australia -- sometimes with up to 20,000 ticks on a single host.
But it will be years before scientists clearly identify the structure and purpose of the soup of molecules in tick spit, Dr. Wikel said, and years more before there is a marketable human vaccine.
In the meantime, other scientists are finding that tick saliva is fertile territory for seeking potential new drugs, especially for controlling clotting and inflammation.
"Ticks know everything we know and don't know about pharmacology," said Dr. Jose M. C. Ribeiro, a tick expert at the parasitology laboratory of the National Institutes of Health in Bethesda, Md ...
There are about 840 tick species, divided into two families, those with leathery bodies like the dog and deer tick -- which have three life stages and take only one big, momentous meal during each stage -- and others with soft bodies, which behave more like fleas, feeding repeatedly and often.
Ticks feed on just about every kind of back-boned animal except fish, said Dr. Keirans, the curator of the National Tick Collection, which is owned by the Smithsonian Institution but is located at Georgia Southern University in Statesboro, Ga.
He rattled off a few examples, including ticks that hopscotch continents on migrating seabirds, specialized ticks that may soon become extinct as the rhinoceroses on which they feed dwindle, even ticks that only feed on the Galapagos tortoise. The largest is a tick that feeds only on sloths in the American tropics. When fully engorged, he said, it is the size of a Ping-Pong ball.
There is some debate, but many biologists say that ticks probably evolved more than 300 million years ago, possibly feeding on dinosaurs and amphibians.
"For them, the mass extinction of dinosaurs just meant a menu change," said Dr. Ribeiro. A new target, the mammal, had a new feature in its blood, platelets, which aid clotting and would have thrown a roadblock at ticks. But, Dr. Ribeiro said, evolution carried on and ticks -- in the endless spy-versus-spy game of life -- developed ways to keep the blood flowing.
"They have a very ancient wisdom about how to take blood," he said.
The hard-bodied ticks have been the focus of most research in North America because they are the predominant carrier here of diseases that affect people and their livestock and pets. (Wildlife, of course, is not immune. Biologists have documented the presence in northern forests of "ghost moose" -- moose that have as many as 400,000 ticks feeding on them and that lose all their hair as they rub hopelessly against trees.)
In its life cycle and habits, the deer tick is typical of many species, said Dr. Daniel E. Sonenshine, a biology professor at Old Dominion University in Norfolk, Va., and author of the two-volume "Biology of Ticks" (Oxford University Press, 1991 and 1993). A tick's prime goal is to find an appropriate host, climb aboard, find the ideal spot to latch on, and to dine on red blood cells, the source of the globin molecules needed to molt and mature and, in the end, for females to make and lay eggs.
In each stage of life -- larva, nymph and adult -- the process of finding and feeding on a host is almost exactly the same. Only the targets change. The larvae almost always feed on mice, while the adult deer tick, which is big enough that it tends to be detected by a person and brushed or plucked off, targets mainly deer.
For deer ticks, the nymph stage -- the stage milling around in Dr. Wikel's jar -- is the main transmitter of disease to people, with its peak of activity coming from late spring to late summer.
A nymph's day generally starts in a moist, protected place, typically buried in leaf litter and only rarely out in the middle of a mowed lawn. Without adequate moisture it can quickly dry out and die.
As the hours pass, it begins to "quest," in the parlance of tick biology, climbing instinctively in the opposite direction of gravity, usually up a blade of grass or a twig, and generally no more than a foot or two off the ground.
It sits poised, waiting. In this posture, resumed daily, the tick is like a land mine, primed and ready and patient as can be, with weeks or even months passing before a potential target comes along. Most, Dr. Keirans said, never find a meal.
But enough do. They detect a rustling vibration and a whiff of carbon dioxide and maybe a slight sensation of warmth. A shadow passes, triggering nerves attuned to changes in light. Holding onto the perch with that third pair of legs, they wave the rest of their appendages. Especially active are the forearms, which contain a sensory organ that is exquisitely tuned to sense chemical changes.
The legs are tipped with sharp hooks. The lucky ones snag a ride.
But, Dr. Sonenshine said, for the tick, the job has only just begun.
It begins to explore the host, he said, generally moving up against gravity until it either reaches an obstruction -- the elastic of underpants or a tight shirt collar -- or until it finds an ideal feeding spot, a place exuding sweat and warmth, indicating an ample blood supply.
The sensory tools that led it to this place are now disregarded and it relies on its palps, paired arms next to its cutting mouth parts, to select an ideal dining spot.
Once there, ticks do not bite like a horsefly or use a syringe like a mosquito. Unlike these insects, which eat and run, ticks have taken an evolutionary path requiring them to settle in for the long haul.
Ticks dig a well.
Using their serrated mouth parts, they excavate a pool beneath the host's skin from which they draw sustenance using the hypostome, a straw-like tube that resembles a drywall anchor and holds the animal almost as effectively.
A tough, rubbery cement is released, helping hold the tick in place ...
The tick only sips tentatively at first, while steadily pumping into the wound saliva that carries a variety of ingredients that help it stay attached, avoid detection, suppress the immune system and keep blood flowing.
The result is a pool brimming with just what the tick wants, red blood cells. The white blood cells that would normally flood a wound have been tricked to stay away ...
Finally, there comes what tick biologists call "the big sip," a binge of feeding reserved until the end so there is the least risk that the now rapidly growing parasite will be detected.
As it ingests blood, it has to expel water, and it does so through its saliva, accelerating the passage of any hitchhiking Lyme bacteria into the host.
Researchers stress that old methods for removing ticks -- like touching it with a burned match or daubing with alcohol -- probably cause it to expel even more spit into the wound. The best approach, they say, is to use steady pressure with small tweezers to draw the tick away from the skin until it pulls free.
As the meal comes to a close, the tick grows sometimes a hundredfold in weight before finally dropping from the host and crawling into leaf litter and -- in the case of adult females -- laying thousands of eggs and starting the cycle all over again.
Dr. Ribeiro has spent more than a decade hunting in tick saliva for all the hidden molecules used during feeding. A few have been identified by him or other researchers:
Apyrase, an enzyme that destroys substances released by injured cells that would normally cause platelets and white blood cells to accumulate ...
Increasingly, it appears that the infections transmitted by ticks take advantage of the conditions created by this chemical cocktail, Dr. Wikel said.
All the more reason to find a way to vaccinate potential hosts so that the body -- instead of being tricked by the influx of weapons -- recognizes one of them and mounts a counterattack, he said ...
PEOPLE MAGAZINE, p. 113, August 21, 2000, By Matt Birkbeck
"... Increased world travel will make exotic disease a fact of life
When Dr. Mahfouz Zaki first came to the U.S. in 1959 to pursue a doctorate at New York City's Columbia University, Americans had never seen the West Nile virus--so named for having been discovered in his native Egypt. Yet four decades later, Zaki, then director of public health for Suffolk County, N.Y., found himself confronting a disturbing outbreak of the virus, which is carried by birds and passed on to humans through mosquitoes
Last summer West Nile infected 62 people in the New York area, causing 7 deaths from encephalitis, a swelling of the brain, and inciting enormous public anxiety as authorities unleashed military-scale pesticide attacks.
Dormant for months, the virus resurfaced this July  among birds and mosquitoes as far north as Boston ...
Unnerving as West Nile is, Zaki, a married father of two, says it is only one of many exotic insect- and tick-borne diseases Americans can expect to see in years to come--and by no means the most serious.
[Dr. Zaki] discussed West Nile and other afflictions with contributor Matt Birkbeck.
[Matt Birkbeck:] WHY IS THERE SO MUCH CONCERN ABOUT THE WEST NILE VIRUS?
[Dr. Zaki:] Because it was newly introduced into this country--no one likes to see a new virus that can cause deaths and severe illness ...
WHAT ARE THE SYMPTOMS?
In 95 percent of cases they are like those of any other viral or bacterial infection. You may have some fever, headaches, muscle pain and vomiting. There is sometimes a rash on the trunk, or enlarged lymph glands. In children there can be a little fever with muscle aches. Many people don't even have symptoms.
WHY ARE OLDER PEOPLE SO SUSCEPTIBLE?
Their immune systems are sometimes compromised ...
CAN WEST NILE BE CARRIED BY OTHER MEANS?
In some countries in Africa, ticks transmit the virus. That can be a problem--mosquitos can be controlled. They also have a short life span--a male lives one to two weeks, a female five or six weeks.
But a tick can live for a year or two and proliferate. An infected tick will give you 500 to 1,000 infected daughter ticks. And ticks are very difficult to control because they spend a good deal of their live cycle attached to animals and are not out in the open.
DO OTHER INSECT- OR TICK-BORNE DISEASES POSE AS MUCH OF A THREAT AS THE WEST NILE VIRUS?
There are many such viruses and bacteria in the U.S. similar to West Nile--or worse. At first, you'll recall, West Nile was mistaken for the St. Louis virus, which is also mosquito-borne and causes encephalitis ...
Erlichiosis, a tick-borne affliction, which produces fever, chills and headaches and has been fatal in some instances, is prevalent in the Southeast, Northeast and Midwest.
And of course there is Lyme disease--in New York's Suffolk County alone, we have between 700 and 1,000 [new] cases a year.
HOW ABOUT MORE EXOTIC DISEASES? ARE THEY THE WAVE OF THE FUTURE?
I'm afraid so ... [with the] dramatic rise in international travel, we can expect to see in the U.S. any disease that is endemic in any other part of the world."