Friday Family Photo

Summer is tick season, so I want to tell you about "my tick." When I was in elementary school, my family lived in Forreston, IL, but we went back to Mt. Morris for our dental appointments. It was either the summer of 1947 or 1948, and I probably had a tooth ache, because in those days, I don't think we went to the dentist unless something was wrong. While I was in the chair, Dr. Boyle (I think that was his name) noticed something in my hair when he was leaning over me to examine my mouth (dentists loved my mouth because it is big). My mother was horrified (in those days moms were allowed to stay in the room with the child--I don't think they do that now). I was old enough to be combing my own hair, but she still washed it on Saturday nights in the sink for me. So the tick probably hadn't been there too long. The ticks are tiny, unless getting a meal of your blood, then they are big. Dr. Boyle removed it with a heated tweezers being careful to get all the mouthparts out. Mother took it home and looked up the critter in our encyclopedia (I get that from her--she always wanted to be a librarian) and pronounced it a "Rocky Mountain Spotted Fever Tick."

Both the American Dog Tick (Dermacentor variabilis) and the Rocky Mountain Wood Tick (Dermacentor andersoni) are vectors for Rickettsia rickettsii, the causative agent of Rocky Mountain Spotted Fever, D. andersoni is much more common from the east coast through the plain states and western California, and D. variabilis for the most part is in the mountain states.

I probably did get my tick from a dog, because not only did we have dogs which stayed outside all the time, but I was a fearless dog hugger, and would wrap my arms around one and lay my head on them. I also played outside constantly, and we lived in a rural area where hiking or biking outside the town limits to visit friends or just to play was pretty common.

I didn't get sick, but ticks are really dangerous. I have great respect for them, and you should steer clear! They can cause Lyme Disease, which got its name when an unusual number of children near Lyme, Connecticut came down with juvenile rheumatoid arthritis in the 70s, caused by the bite of a tick (Ixodes scapularis, also called Blacklegged Tick) carrying Borrelia burgdorferi. (I think when I was a vet librarian I actually met Dr. Burgdorfer, for whom it is named.) Now there's a entity caused by ticks (Amblyomma americanum, also called Lone Star) which hang out in North and South Carolina, Georgia, Tennessee and Missouri, termed STARI, or Master's Disease. Symptoms are similar, but it's not Lyme Disease.

The reason I'm telling you all this isn't because I know a lot about ticks, but because there is a clinical article in JAMA 297:23 (June 20, 2007) about Erythema Migrans. That's a rash that is associated with tick bites. There seems to be quite a bit of overlapping of this rash, depending on which tick has bitten you, and the right antibiotic is important. And you don't always have erythema migrans with Lyme Disease, or with the other tick bite diseases, but you might.

As a librarian I always read the authors' method, because this is the type of thing I helped researchers with. For this study they examined 1266 articles in the medical literature with a very specific set of criteria, narrowing the search down to 53 articles. I won't repeat everything the authors report, only that they weren't thrilled with the inconclusive evidence currently reported and seem to suggest that the doctor will need to eyeball it (my non-medical term) which means you need to have some experience with these rashes.

"Physician education should emphasize the wide variability in the clinical presentation of erythema migrans and the need to factor in multiple components of the clinical examination and epidemiological context into clinical decision making."

If you live in a tick area (which seems to be every state except the extreme southwest), you might pick up this issue at your library and photocopy p. 2664, which is the JAMA patient page for Lyme Disease. Moms need to know a lot. And it doesn't hurt to have a sharp eyed dentist.