Tick season is in full swing, and the nasty little culprits may be carrying more than Lyme disease. Experts are also concerned about Borrelia miyamotoi, a cousin of Lyme disease that even your doctor may not know much about.
“Right now, this is new, and physicians need to be trained about this disease. We all need to learn about this,” Peter Krause, M.D., tick-borne disease researcher at Yale School of Public Health, said in an interview with WTNH Channel 8. He is the lead investigator in a study that tracked Borrelia miyamotoi disease in humans. While preliminary information from that study suggests the disease is not as common as Lyme disease, early data from a Borrelia miyamotoi antibody test in 639 residents of southern New England showed evidence of previous infection in 4 percent of these residents. “Four percent is a high percentage,” he said.
The antibody test was developed by Erol Fikrig, M.D., and Sukanya Narasimhan, M.D., at the Yale School of Medicine in collaboration with Dr. Krause and Alan Barbour, M.D., at the University of California, Irvine. Yale Medical Group (YMG) rheumatologist Linda Bockenstedt, M.D., and these researchers have submitted a grant to NIH to study the epidemiology, clinical manifestations, pathogenesis, genetics, and diagnosis of Borrelia miyamotoi.
Meanwhile, L2 Diagnostics LLC in New Haven has plans to provide diagnostic testing in Connecticut for the disease by mid-to-late summer.
Catching tick-borne disease early
Tick-borne diseases in general have become more prevalent as black-legged ticks, which are linked to six different diseases, expand their range. “Some of them might be due to the climate change and other environmental factors, but I think in the future we’ll see a lot more tick-borne diseases,” said Yale researcher Durland Fish, Ph.D., who is also part of the Yale group studying Borrelia miyamotoi.
There were 1,646 confirmed cases of Lyme disease in Connecticut in 2012, according to the latest available statistics. Recommendations on avoiding tick-borne disease haven’t changed. YMG pediatrician Eugene Shapiro, M.D., an expert in infectious diseases, advised talking to a doctor right away if a small red bump develops into the “bulls-eye” pattern rash with a red outer ring surrounding a clear area. Most patients with Lyme disease develop this erythema migrans rash, which will persist and enlarge for weeks if untreated. Other signs of Lyme disease include multiple erythema migrans rash, facial droop, swollen joints, and, rarely, meningitis.
So far the main symptoms of Borrelia miyamotoi seems to be fever and other viral-like symptoms such as headache, fatigue, and muscle aches. The fever may relapse. Two cases of Borrelia miyamotoi meningitis in people whose immune system was impaired have been reported.
No need to stay inside all summer
While it’s important to be cautious, Dr. Shapiro said fear of ticks shouldn’t keep anyone from going outside this summer. “The anxiety is as large a problem, or larger, than Lyme disease itself,” he said. “There is a lot of misinformation in the lay press and on the Internet, and misdiagnosis is rampant. The thing to keep in mind is that, in most cases, Lyme disease is fairly easy to diagnose and cure, and if it’s treated effectively there is little risk of long-term complications.”
If the disease is diagnosed, the doctor will typically prescribe doxycycline or amoxicillin, or, rarely, intravenous antibiotics. Borrelia miyamotoi is treated with the same antibiotics that are used for Lyme disease.
Matthew Grant, M.D., a Yale Medical Group infectious diseases specialist, said precautions go a long way toward avoiding the disease. That includes wearing long pants and long sleeves, especially in wooded or grassy areas, and using insect repellent with a 20 percent or higher concentration of DEET. In addition, it is important to check for and to remove ticks on your body after spending time in potentially tick-infested areas.
To make an appointment at Yale Infectious Diseases call 203-785-3561.