Ehrlichiosis in Northern California

EHRLICHIOSIS

Two previously unknown tick-borne diseases have been discovered in the past decade: Human monocytic erhlichiosis (HME) and human granulocytic ehrlichiosis (HGE). The agents are bacteria that live inside monocytes and granulocytes, two types of circulating white blood cells. Since 1964, more than 400 confirmed cases of HME, and 170 cases of HGE have been reported, including some from northern California. Many were first thought to be Rocky Mountain Spotted Fever.

HME is caused by a bacteria named Ehrlichia chaffeensis, and HGE by another bacteria closely related to Ehrlichia equi. Similar agents cause severe disease in animal populations. The still undiscovered source of the human infections may involve domestic (HGE) and wild mammals (HME). Many cases of E. equi infection have been recorded from horses in Marin and Sonoma counties, but there is no formal reporting system so the actual numbers are not known. In one study site in the Sonoma Valley, workers found E. equi in 16 horses. A possible role of other vertebrates, like reptiles, in maintaining ehrlichia in the wild has not yet been studied.

In 1994, health workers studied a rural community in the Sonoma Valley, after several reports of locally acquired Lyme disease. Laboratory tests reported by the County and State Departments of Health Services, the Univeristy of California and the Centers for Disease Control, found that ten of the 219 residents tested had antibodies against E. chaffeensis, showing that at some time in the past they had been infected with the HME bacteria. Three of the ten reported having symptoms that could have been caused by the infection.

The ticks most often found carrying E. chaffeensis has been Amblyomma americanum and Dermacentor variabilis (see photo), while Ixodes and Dermacentor ticks have been discovered carrying the E. equi-like agent. The western black-legged tick, Ixodes pacificus is believed to transmit E. equi among horses in northern California.

Human ehrlichiosis is virtually impossible to diagnose from the symptoms alone. The first signs usually appear one to three weeks after a tick bite. Initial symptoms suggest a developing flu, with a high, non-specific fever, pains in the muscles and joints and severe headache. A skin rash may develop. These, plus a marked decrease in the numbers of thrombocytes and other white blood cells, and a history of contact with ticks, suggest a patient should be tested for ehrlichiosis. Kidney, heart or respiratory failure and nerve deterioration may occur later on, and fatalities have been reported.

Recent reference: Human ehrlichiosis: new emerging tick-borne diseases in California. by K. Glynn, V. Krammer and D. Vugia. in California Morbidity, January 1996.

A recently discovered and sometimes fatal illness carried by ticks can be difficult to distinguish from Lyme disease. This illness, called human granulocytic ehrlichiosis, is spread by the deer tick, the same tick that carries Lyme disease. The following information has been compiled from various sources by Thomas H. Nicholls, research wildlife biologist, working on bird vectors for these diseases. The following key facts are designed to provide field workers with important information needed to protect themselves. The upper Midwest (MN & WI) is a "hot zone" for these human pathogens.

1. The chief vector of both diseases is the deer tick, Ioxdes scapularis (I. dammini).
2. Both diseases are caused by bacteria. The white-footed mouse is the principal reservoir host for these bacteria in nature.
3. Early detection, disease identification, and treatment are critical to prevent long term complications caused by these diseases.
4. Laboratory diagnostic tests are not always reliable.
5. Antibiotic treatment of choice is doxycycline or tetracycline for 14 days for persons older than 8 years.
6. Humans apparently are not immune following natural infection and can become infected again, after being cured and bitten by another infected tick.
7. The deer tick can transmit both diseases simultaneously. This coinfection can complicate disease diagnosis. To complicate matters further, a third, rarer tick-vectored parasitic disease, babesiosis, causes similar symptoms.
8. Infected nymphal deer ticks cause 80% of the infections from May to August.
9. There is no human vaccine available to prevent these diseases, although they are being worked on. A Lyme vaccine is available for dogs.
10. Prevention: Wear proper clothing such as light colors to see ticks, long pants tucked into socks or boots (tape around socks), long-sleeved shirts with collar and cuffs buttoned, and a cap. Also use tick repellents (DEET on skin and/or clothes or Permanone only on clothes). After field work, brush off clothing, launder clothes, and check entire body for ticks. Remove attached ticks properly and promptly and save these ticks for identification and disease evaluation by medical personnel. Symptoms usually appear 6 or more days after being bitten by an infected tick and a Doctor should be seen as soon as possible.

NOTE: If you experience any of these symptoms after being bitten by a tick or after having visited a deer tick-infested area, you should see your doctor as soon as possible.

Prepared by Thomas H. Nicholls,
Research Wildlife Biologist
3/6/97

Before Trail Riding

An application of "Deet" works very well for humans. Wear a helmut when riding. This safety measure also provides additional protection from ticks! Apply "Permethrin" (be sure read and follow directions regarding solution mixture) to your horse, especially the legs. Use a hand-held spray bottle or spray on to a towel and then wipe the horse's entire body down.

Return from Trail Riding

Check your horse's legs and body for ticks. Remove any roaming ticks. Remember to put a "flea" comb in your grooming kit. This aids in removal. Wash your horse's legs down with a solution of betadine and water. Check your clothing and saddle pads/blankets. Remove infested clothing and bag it up.

When you return home, don't put clothing on bedding or carpeting but in a clothes dryer. A few minutes of heat will kill the ticks. Then check your entire body or have someone else do it and do it carefully. The larva of a deer tick is smaller than a pinhead. Shower and thoroughly wash your hair.

If you find a "biting" tick, do not apply heat, chemicals or substances such as Vaseline to the tick. This makes the tick vomit into the skin. The Lyme bacteria are in the gut of the tick. Vomiting increases the bacteria that move from the tick gut to the skin and increases the chances of disease."

Squeeze the tweezers around the tick's head and pull slowly but firmly, never jerking. Use a magnifying glass to determine if the entire head of the tick has been removed. Wash the bite area with antiseptic soap. Most tick bites less than four hours old generally are not infectious.

As a safety precaution, tape the tick to a piece of cardboard, noting the date, location of the bite and the likely place from where the tick came. Pharmaceutical company literature advises to call the state board of health to have the tick identified or call your veterinarian.