Karen Young, a woman whose short reddish-brown hair reminded me of Julie Andrews from the movie “Sound of Music,” tells me her fever and body aches started a few days before the 4th of July weekend.
“I was hurting all over, like arthritis bothering me on a rainy day.” She is stiff, uncomfortable lying in the hospital bed holding her head. “My body hurt, my head hurt. I was exhausted just coming home from work and feeding my dogs.”
Like a detective, I get more details. Karen called her primary care doctor a day before the holiday, but the office was closed. On the 4th of July she had more fever, up to 102. Then the following day she went to a minor medical clinic, which sent her to the emergency room.
The initial tests were all negative for the flu, pneumonia, or urine infection. “So what was causing my fevers?” she wonders.
One bit of critical information, which is often missed in a hurried doctor-patient encounter, reveals the answer. “Have you been traveling?”
“Two weeks earlier with my dogs, I had gone camping.” She says.
In her RV, Karen went to Roosevelt State Park in Jackson, Miss., where she walked trails and hiked in the woods.
“Just as the emergency room doctor had suspected,” I tell her. “I think this is fever from a tick-related illness.”
“You think so?” she says, surprised. “But I didn’t have any ticks on me. I spray myself before going out and shower after I come back in.”
“Nearly half the people with the bite don’t give a history of a bite,” I say, confident about my diagnosis.
One piece of history, “gone camping,” is a big giveaway to her diagnosis. Her lab tests — a low white blood cell count and a low platelet count — support the diagnosis, as does the early response to treatment. She is started on doxycylcine, an antibiotic, which treats nearly all tick-related illnesses, and her fever comes down in just 24 hours.
According to the Centers for Disease Control and Prevention website www.cdc.gov, there are 10 tick-borne illnesses in the United States and each transmits a different bacteria by a different tick, and is prevalent in different part of the country.
For example: Lyme disease is caused by the bacteria Borrelia burgorferi, which is transmitted by the blacklegged tick and occurs mostly in the Northeast (it’s named after a town in Connecticut.).
Rocky Mountain spotted fever (RMSF) is caused by the bacterium Rickettsia rickettsii, which is transmitted by the American dog tick and occurs in North Carolina, Tennessee and Oklahoma (not the Rocky Mountains as the name deceptively implies.).
Over a decade ago, I saw a middle-aged man, a teacher, with RMSF, a case I will never forget. He had a fever and headache and a profound pink-purple rash.
He had delayed visiting the doctor, and did not avail the history of being in the woods.
Unfortunately, he was overwhelmed by infection and died. While deaths are rare due to tick-borne illnesses, timely diagnosis (facilitated by giving a history of being in an area with possible ticks) and timely treatment (docycycline) cuts down on the morbidity and mortality rate.
Two weeks later, Karen comes to my office for a follow-up appointment. In a red blouse, pearl earrings, designer glasses, and a broad smile, it was hard to recognize her. She is back to her work as a paralegal.
I leaf through her chart: Her RMSF test is negative, her Lyme test is negative, and then one result clinched it.
The PCR (polymerase chain reaction; an extremely sensitive test) was positive for Ehrlichia chaffeensis, a bacterium transmitted by the lone star tick.
“Lone star tick? But I never saw it,” she says
I tell her the CDC website has plenty of information on tick-borne diseases, and “if you find a tick on you, use fine-tipped tweezers to grasp the tick as close to the skin’s surface as possible and pull upward with steady pressure without twisting or jerking.”
I ask if I can write her story. “Please do — if it will help others,” she says.
Source : Commerical Appeal