With climate warming and increased human exposure to tick-prone areas, tick-borne diseases have become a significant health concern worldwide. There are 850 species of ticks around the world, including 90 in the United States. Florida, with its warm, humid climate, provides the ideal environment for a number of these species, all capable of transmitting tick-borne diseases.
“Tick-borne diseases are very hard to identify because there are so many and their symptoms are very similar,” said Dr. Mariejane Braza, infectious disease physician at Cleveland Clinic Indian River Hospital. “Most tick-borne diseases are caused by bacteria, but not all ticks carry the bacteria and not everyone who gets bitten will get sick.
“If you see a tick on your skin, you should remove it immediately. If the tick is engorged it may have been there a while and is already feeding on your blood. It takes at least four hours or more after a tick bite to start developing redness, called erythema, which looks like a bump with clearing in the center. You should monitor it and wait to see if any symptoms like fever or muscle aches develop. If they do you should seek medical attention promptly.”
Data from the University of Florida confirms that ticks can be found throughout the year in Florida, but seasonal differences dictate the abundance of nymphs and adults. While ticks in either stage can transmit diseases, there is an increased risk of disease from nymphs because they are often small enough to avoid being noticed. Most species of ticks are nymphs in the spring, becoming adults in the summer, with the peak season for tick infestation in July.
Tick species common to Florida include:
Lone Star ticks are the most common human-biting ticks in Florida and easily recognized by the distinctive white spot on the females back. This tick can transmit ehrlichiosis, tularemia, and STARI (Southern Tick Associated Rash Illness).
American Dog ticks are primarily found on dogs but are known to attach to other animals and humans. These outdoor ticks are commonly found in grassy areas and are known for transmitting Rocky Mountain Spotted Fever (RMSF) and tularemia. American Dog ticks can cause paralysis by a toxic secretion in dogs and children when the ticks attach to the base of the skull or the spinal column. Fortunately, recovery usually occurs within 24 hours of tick removal.
Gulf Coast ticks are prevalent in the southeastern U.S. They look similar to the American Dog tick but with a larger mouth. They are most commonly found on the ears of large mammals like cattle and can transmit a less severe form of RMSF called rickettsia parkeri.
Black legged ticks, commonly known as deer ticks, carry Lyme disease.
Most tick-borne diseases have similar symptoms, including fever, muscle aches and fatigue, but others have distinctive symptoms that make them more identifiable.
Lyme disease, carried by black legged ticks, is less common in Florida than in the northeastern U.S. According to the CDC, only about 30 percent of Lyme disease cases are acquired in Florida. A distinctive bull’s-eye rash appears 60 percent to 80 percent of the time, but it may not appear at the bite site. If left untreated this illness can lead to joint pain, heart palpitations and neurological issues.
Southern Tick Associated Rash Illness (STARI) is a Lyme-like disease transmitted by the Lone Star tick. While it shows itself with a bull’s eye rash, it does not affect the nervous system.
Rocky Mountain Spotted Fever (RMSF) is considered the most severe tick-borne disease in the U.S. with a high mortality rate among untreated cases. The American Dog tick is the primary transmitter in Florida. It’s often identified by a red, spotted rash in addition to fever, headache, lack of appetite and muscle pain.
Ehrlichiosis is transmitted by the Lone Star tick. It manifests in fever, headache, muscle aches and fatigue. In severe cases, it can lead to damage to the central nervous system.
Tularemia, or rabbit fever, is transmitted by both American Dog and Lone Star ticks. Skin ulcers, swollen glands and pneumonia are common symptoms.
Babesiosis, transmitted by the black-legged tick, can result in malaria-like symptoms such as chills, sweats and anemia.
Ticks must feed on their hosts for several hours to transmit disease organisms, so quick identification and removal will help reduce the chance of contracting a tick-borne disease.
To remove a tick, grasp it on its mouth with tweezers and pull it straight out. Clean the bite area with rubbing alcohol or soap and water. Take a photo of the tick to show to your doctor in case symptoms develop. Dispose of the tick by placing it in alcohol, sealing it in a bag or flushing it down the toilet. Watch for signs of tick-borne illness and see a doctor if you experience symptoms.
“It’s not like a person is bitten and they get sick immediately,” Dr. Braza explained. “They probably don’t even remember getting bitten, and unless they physically extracted the tick it’s nearly impossible to identify which tick caused the infection.
“The best thing to do is monitor it. If they are experiencing symptoms, we treat all tick bites the same, with a dose of antibiotics like doxycycline or amoxicillin. Hopefully, that will clear up the symptoms in about four days. If symptoms persist there are blood tests we can do to try to identify which strain of tick related infection was contracted. Treatment is based on clinical judgment and exposure.
“The best way to protect yourself from tick bites is to wear long sleeves, long pants and closed-toe shoes when walking in the grass or the woods,” Dr. Braza advised. “Use an insect repellent containing DEET to exposed skin and clothing and perform tick checks on you and your pets when spending time outdoors. Strip out of your clothes immediately after you’ve spent time in a wooded area and wash your hair because ticks can fall out of trees and latch onto your scalp. Just use common sense and be aware that ticks are all around us.”
Dr. Mariejane Braza received her medical education at Cebu Institute of Medicine in Cebu City, Philippines. She completed her internship and residency at the University of Texas Health Science Center at San Antonio, Regional Academic Health Center in Harlingen, Texas, and her fellowship in infectious diseases at the University of Texas Health Science Center at San Antonio. Her office is in the Rosner Family Health and Wellness Center, 3450 11th Court, Vero Beach. The phone number is 772-794-5631.