As you spend more time outdoors with summer in full swing, remember the ticks; they’re a bigger problem than they once were

Experts caution that it’s important to take precautions through September, when ticks are still active, and to learn how to remove them properly to decrease the risk of tick-borne disease.

Jonathan Larson, a UK extension entomologist, said the best way to remove a tick is to grasp it as close to the skin as possible with tweezers and to pull it straight out with gentle, even pressure.

He stressed that it is important to not use alcohol, essential oils, matches, liquid soap or petroleum jelly, because they agitate the tick and cause it to vomit from deep in its gut, where the disease-causing agents reside.

Larson explained that in the process of feeding, a tick passes stuff from its body into its host’s blood and then sucks blood back into its body. Typically, the disease-causing agents take several hours or days to make their way into its host, but when a person agitates the tick, that happens more quickly.

“If you speed that process up by say pouring alcohol on it while it is plugged into you or essential oils or trying to burn it with a match or a lighter, it will possibly puke into you and increase your chances of picking up that pathogen,” Larson said.

Tick researcher Anna Pasternak

When you remove a tick, it’s important to take a picture of it, and save it in alcohol or nail-polish remover to keep it hydrated, said Anna Pasternak, a graduate tick researcher at the University of Kentucky.

“If you do find a tick on yourself, monitor your health for the next month or so,” Pasternak said. “Certain ticks only carry certain diseases and if you can have that tick or a picture of the tick, that will help the doctors diagnose you and makes knowing what to look for a whole lot easier.”

Pasternak is part of the Kentucky Tick Surveillance Program, which has been collecting information on ticks in Kentucky since January 2019. She said Kentucky has a high tick population, largely because the state offers an ideal environment with its forests, humidity and large populations of livestock, deer and other wildlife.The best ways to protect yourself from ticks are:

• Avoid grassy, wooded and leaf-covered areas
• Keep grass and shrubs trimmed and cleared away
• Walk in the center of walking trails
• Wear light-colored clothes, which make it easier to spot ticks
• Wear long pants tucked into boots and tuck in your shirts
• Use tick repellent that has DEET or picaridin
• Treat your clothes with permethrin, which repels and kills ticks
• Do a body check at the end of each day
• Check your pets and equipment for ticks
• Shower within two hours of potential exposure if possible

To kill ticks on clothing, tumble dry for 10 minutes; wash dirty clothes in hot water. If clothes can’t be washed in hot water, tumble dry for 90 minutes on regular heat or 60 minutes on high.

Ryan Mynatt, a clinical infectious disease pharmacist at UK HealthCare, offered some guidelines for seeking medical care related to a tick bite.

“Persons known or suspected to be bitten by a tick who also have symptoms of potential tick-related diseases (rash, fever, chills, flu-like symptoms, aches, pains, etc.) should seek prompt evaluation by their health-care provider prior to deciding on a course of therapy,” Mynatt said in an e-mail. “It is also recommended to seek evaluation from your medical provider if you cannot remove all of the tick.”

Tick species and the diseases they carry

Fortunately, only a small percentage of ticks in Kentucky transmit disease, and most who get bitten by one won’t develop a disease, Pasternak said.

She said Kentucky’s most common tick-borne diseases are Rocky Mountain Spotted Fever, erlichiosis and Lyme disease.

RMSF cases have been increasing in Kentucky, she said. A state Department of Public Health report  found that between 2012 to 2017, annual cases in the state increased 290 percent. In 2012, Kentucky had 64 probable and confirmed cases; in 2017, it had 250. In 2018, Kentucky had 48.9 cases of RMSF per million persons, according to the Centers for Disease Control and Prevention. 

RMSF is caused by the bacteria Rickettsia rickettsii. In Kentucky, the American dog tick (Dermacentor variabilis) and the brown dog tick (Rhipicephalus sanguineus) can carry and transmit this bacterium.

Signs and symptoms of RMSF include: fever, headache, nausea, vomiting, stomach pain, muscle pain, lack of appetite and a spotted rash. The rash usually develops several days after the start of fever and can vary between splotches and smaller pinpoint dots.

Ehrlichiosis is caused by several bacteria of the Ehrlichia genus. These bacteria are transmitted by the the lone star tick (Amblyomma americanum).

Signs and symptoms of ehrlichiosis include fever, headache, chills, cough, malaise, muscle pain, nausea, vomiting, diarrhea, confusion and red eyes. A rash is also common in children but less common in adults.

The CDC reports that Kentucky had 16.8 cases of erlichiosis per million people in 2018.

The lone star tick is also a vector for alpha-gal syndrome, known as the red meat allergy, which is becoming increasingly more common, Dr. Kourtney Gentry Gardner, a Bowling Green allergist-immunologist, told Adair County Community Voice last fall that she diagnoses about five people a month with the allergy.

Pasternak said, “The lone star actually has the potential to carry the longest list of diseases; however, not all of those diseases have been found in Kentucky.”

Lyme disease is caused by the bacterium Borrelia burgdorferi, which is carried by the blacklegged tick (Ixodes scapularis), commonly called the deer tick.

Signs and symptoms of Lyme disease include fever, chills, headache, fatigue, muscle and joint aches and swollen lymph nodes. The distinctive “bull’s-eye” rash, or erythema migrans in medical terminology, occurs in 70 to 80 percent of infected persons, and appears at the site of the bite three to 30 days after infection.

Lyme disease was once rare in Kentucky, but expansion of the blacklegged tick’s range and distribution may have caused more cases in the state, but the CDC reports that Kentucky still has a low incidence of Lyme disease, with four confirmed and 18 probable cases in 2018, the latest count available.

However, the CDC says the actual number is likely much higher, noting that its research shows Lyme disease affects about 10 times as many Americans as previously indicated by confirmed case reports.

The black-legged tick is active year-round in Kentucky, Pasternak said, so if you or your pets spend time in wooded and bushy areas that have tall grass or leaf litter or anywhere there might be wild animals in the winter, you should check yourself and your pets for this small tick year round.

Ticks and covid-19Because both covid-19 and tick-borne disease have similar symptoms, including fever, muscle aches, headache and sever fatigue, Dr. Sorana Segal-Mauer of the New York Presbyterian Queens health care system told CNN that it is important for providers to not assume a patient has the coronavirus, and to ask about a patient’s travel and other activites. “You have to cover all your bases,” she said. “We don’t want to be covid-blinded.” CNN reports that patients should also be asking about both possibilities.

In addition, health-care experts are regularly warning Kentuckians to not delay care because they are worried about contracting the virus, stressing that it is safe to seek care and that facilities are taking every precaution to decrease the spread of the virus.

Having Lyme disease can put a person at greater risk for serious illness due to covid-19, Shannon L. Delaney, director of child and adolescent evaluation at Columbia University’s Lyme and Tick-Borne Diseases Research Center, told The New York Times.

“We already know people with underlying conditions are more vulnerable for complications with coronavirus,” she said. “Certainly, people with tick-borne illness fall into that category.”