Tick Borne Infections are widespread, increasingly common, and a major public health threat. Even the CDC recognizes that reported cases are the tip of a very large iceberg. For instance, one common tick borne infection, Bartonella, once the most common tick borne infection in Virginia is not even reportable in that state, though its consequences can be devastating. Every week during high tick season in rural Virginia I see at least 6 patients with a new Bulls-Eye/Erythema Migrans rash and about 6 others who have chronic symptoms that started after a tick bite.

Ticks Carry Many Illnesses Besides Lyme: Most people have heard of Lyme disease. However, ticks carry many other bacteria besides lyme, and many of these can cause serious illness. Each of these bacteria can cause its own set of symptoms, different from the symptoms of classic Lyme disease. In my area (Southwestern Virginia), Babesia, Rock Mountain Spotted Fever, Bartonella and Lyme are commonly found in ticks. Sadly there is little funding for the study of tick pathogens, so we do not have a complete understanding of what bacteria inhabit the ticks in each region. This is a page where you can see the significant exposure risk of tick bites. This is a commercial tick-testing company, relying on customers who send in ticks for testing – it represents a mere glimpse into what many call an epidemic of tick borne illness.

Tick Borne Infections are Poorly Studied: Lyme and other tick borne infections are relatively new and are seldom fatal. New diseases that are both contagious and fatal, like COVID, garner enormous attention and funding. Because the study of tick borne infections gets little support our understanding has not changed much since the discovery of Lyme around 50 years ago. While Lyme is the most famous tick borne illness, several other infections transmitted by ticks emerged at the same time and remain woefully understudied. Because knowledge about tick borne infections has not expanded at the rate of the illnesses, the majority of practitioners remain unaware of the widespread impact that these infections can have on their patients.

 Testing is Problematic: Methods to test for tick borne infections are fraught with problems and controversy. No single test asks the question: Is a tick-carried disease responsible for this person’s symptoms? Among the multitude of problems are these: nobody knows how long a test remains positive after an infection has resolved, and very few practitioners test for tick borne infections besides Lyme. Because of these issues and others, practitioners who rely on tests rather than clinical experience to dictate care often refuse to treat people or undertreat. 

Clinical Guidelines Often Lead to Treatment Failures: Treating infections is often a complicated and multi-step process, even with illnesses much simpler than Lyme. Non-tick borne infections that do not improve with initial antibiotics are treated until symptoms resolve. In the case of Lyme and other tick borne infections, CDC treatment guidelines recommend only a short course of antibiotics, even for cases that have persisted for several years before diagnosis. Even when patients improve with antibiotic treatment and feel worse when antibiotics are discontinued, practitioners are reluctant to provide further antibiotics. Rather, they treat patient’s symptoms as though each arose independently, sending them to specialist after specialist.  

Poor Understanding of Persistence: Many studies show tick borne infections persisting long after the use of antibiotics. It is thought that this could occur for many reasons: the bacteria become antibiotic resistant rapidly within our bodies, can become dormant or change shape so that they are not harmed by antibiotics, or clump together to form thin protective layers called biofilms. Unfortunately, too little is known about these phenomena. Further studies are critical if we intend to eradicate tick borne infections in all patients with ease.   

Overactivation of the Immune System: Sometimes the immune system’s reaction to tick borne infections can be as problematic as Lyme itself. While every illness has its own set of symptoms, many infections, including COVID-19 also activate the immune system. In early illness, the activated immune system often looks like the flu: fever, chills, sweats, and profound tiredness. If the body does not clear the infection, or in some cases even when it has cleared a long-standing infection, the immune system cannot right itself and the symptoms of an overactive immune system persist. The most common symptoms of an over-activated immune system are autoimmunity, fatigue, mental status and mood changes, and achiness. 

Tick Borne Infections Often Do Not Have a Standard Set of Symptoms: Illnesses are defined by clusters of symptoms. These clusters are defined by infectious disease doctors in hospitals who work with the extreme manifestations of illness. Even in extreme cases not everyone has every symptom that defines the disease. A person’s reaction depends on a unique interaction of genetics and environmental factors, so two people with the same disease can have no common symptoms. Recently, we have seen this in action with COVID-19.

It seems that people who become very ill early in tick borne infections do not always go on to develop as many chronic symptoms. Perhaps this is because the immune system’s strong initial reaction helped eradicate the problem, perhaps because the person was treated earlier and more aggressively. In the case of tick borne infection, variability in symptoms and outcome is compounded because the symptoms of extreme cases do not overlap perfectly with those of low grade or long term infections. People with a non-extreme disease course often do not go to a doctor for their symptoms, as they are initially mild and easily explained away. Even when people with low grade or long-lasting infection do see a physician, their symptoms do not match the case definition, so the infection can go undiagnosed. Left untreated, tick borne infections can slowly grow and lead to chronic symptoms. Finally, many people have been bitten by more than one tick and have been exposed to multiple tick borne infections. This complicates diagnoses and the treatment of these complex infections.

The symptoms unique to Virginia’s five most common tick borne illnesses are discussed below.

Lyme Disease: Headache at the base of the skull, joint pain that does not come from injury, roving pain, Erythema-Migrans rash. 

Bartonella: Frontal headache, often involving eyes, digestive complaints, odd neurologic symptoms that do not correspond to known neurologic problems.  Out of character emotional reactiveness, hand and foot pain.  Younger people, sometimes get dark red stretch marks.

Babesia: Night sweats, air hunger, chest wall pain, pain in large joints and muscles, lethargy.

Ehrlichia: Fever, chills, severe headache, muscle aches, nausea, vomiting, diarrhea, loss of appetite, confusion rash, changes in liver enzymes.

Rocky Mountain Spotted Fever: Headache, fever, rash, nausea, vomiting, stomach pain, muscle pain, lack of appetite.

Approaches to Treating Lyme

Any practitioner or patient involved with tick borne infections knows that there is no protocol that works for everyone. Most people who show up at my office have been to multiple specialists and have suffered through many tests, failed treatments, and procedures.

Though the following will not get rid of infections, it is important to start by ensuring your body has what it will need to heal. Set the foundations for a rapid return to health by eating clean, staying hydrated, making sure you have fresh air, and attempting to move and stretch everyday. Find ways to lower your stress reactions. 

No single approach works fully for everyone although many interventions have merit.  Treating long-standing tick borne infections requires patience and attention. People who have developed chronic illness from tick bites can recover, but often several attempts and adjustments are necessary. In my experience, treatments that feel harsh or make you feel worse might be causing harm and need to be reconsidered.