State: Tick bite can be deadly
Public health officials report that at least 10 people in Massachusetts died
last year after contracting diseases carried by the freckle-sized tick.
Steve Heaslip/Cape Cod Times
It wasn't long ago that the tiny deer tick that transmits Lyme disease was seen as dangerous — but not a killer.
That view is changing. Public health officials report that at least 10 people in Massachusetts died last year after contracting diseases carried by the freckle-sized tick.
Battling tick-borne disease
Doctors treat babesiosis with atovaquone, which goes under the brand name Mepron in the U.S. It is combined with an antibiotic such as azithromycin.
- Anaplasmosis, a bacterial infection, is treated with the same antibiotic used to knock down Lyme disease, doxycycline.
- It's important for Cape residents to reduce exposure to ticks by using repellents on clothing and skin and doing tick checks, according to Dr. David Pombo, an infectious disease specialist with Cape Cod Healthcare.
One was a young adult who, as reported last week by the Centers for Disease Control and Prevention, collapsed in November 2012 after suffering a rare cardiac event known as Lyme carditis.
In addition, at least nine other people were felled by two emerging tick-borne illnesses heavily concentrated on the Cape and Islands, according to the Massachusetts Department of Public Health.
Babesiosis, also known as Nantucket fever, was responsible for taking the lives of five people in 2012, according to the DPH. Health officials did not release where the people lived or where they may have contracted the disease.
And at least four other people in the state died that year after contracting anaplasmosis, caused by a bacteria carried by the same black-legged deer tick that passes on Lyme spirochetes and the babesia parasite, the DPH says.
"The issue is that both of these diseases can occasionally cause severe illness that can lead to death," said Dr. Catherine Brown, DPH state veterinarian.
This is the first year the state has included death statistics for the two tick-borne diseases with its latest surveillance data, which is for 2012.
While less common than Lyme disease, babesiosis and anaplasmosis cases have more than quadrupled since 2008.
Last year, nearly half of the state's 233 babesiosis cases — 103 — were on the Cape and Islands.
In the young and healthy, babesiosis might seem like nothing more than a mild flu or be barely noticeable.
But for those with compromised immune systems, including cancer patients, individuals who have lost their spleens and senior citizens, the malarial-like disease can prove dangerous — and sometimes fatal.
Nearly 60 percent of confirmed babesiosis cases last year occurred in people over age 60, the DPH said. Thirty-nine percent were hospitalized.
Patients frequently report fatigue, malaise, fevers, shaking, chills, drenching sweats and sometimes discolored urine.
"Babesiosis destroys your red blood cells," Brown said. "You may have trouble catching your breath."
Difficult to detect
The majority of cases occur in the summer months, but only 25 percent of people stricken with babesiosis recall getting a tick bite, the DPH says.
That's a frightening statistic to Joyce McConnell of Brewster, whose 77-year-old husband, Lewis "Sandy" McConnell died in 2008 after contracting the disease.
"He was in good health," McConnell said of her husband. The last time he recalled getting bitten by a tick was two years before his death, she said.
The couple enjoyed working in the yard of their house abutting Nickerson State Park and taking off in the car with pencil sketch kits to look for inspiration in other natural settings.
"We had fun years," McConnell said.
After experiencing extreme fatigue in August 2008, her husband consulted with a cardiologist, who said his heart looked fine, McConnell said.
But "he was just getting weaker," she said. He had the sweats but no fever, she said. "I'm talking profuse sweating, clothes being wet, sopped."
The morning of Aug. 14, McConnell said, her husband fell and hit his head as the couple prepared to take a visiting grandson to summer camp.
Doctors in the emergency room at Cape Cod Hospital diagnosed her husband with babesiosis and said his red blood cell counts were dangerously low, McConnell said.
Her husband died a few hours after arriving at the hospital, McConnell said. She said babesiosis was not listed as the cause of death.
"You do get weak from the illness due to anemia," said Dr. David Pombo, medical director of infection prevention for Cape Cod Healthcare.
In addition, platelet counts can drop so low that blood has trouble clotting after a traumatic injury such as a fall, he said.
Despite the recent wintry weather, Pombo said in the past two weeks he has seen three cases of babesiosis and another of anaplasmosis in November.
Like malaria, which is also caused by a parasite, babesiosis can be relapsing and require additional treatment, Pombo said.
"I'm still struggling to get rid of it," said Lisa Freeman of Brewster.
Freeman, who also suffers from Lyme disease and anaplasmosis, said she was first diagnosed with babesiosis in 2006.
Four years later a test showed its staying power, said Freeman, a nurse and patient advocate with Lyme Awareness of Cape Cod. "I'm still suffering with drenching night sweats, chills, neck pain," she said. Freeman said her doctor is talking about treating her with a medicine called Coartem that is supposed to be good for resistant babesiosis.
Island origins
The type of babesiosis transmitted by ticks to humans was first diagnosed in a previously healthy person in 1969 on Nantucket, according to Peter Krause of Yale University and Edouard Vannier of Tufts Medical Center.
With more cases popping up in the 1970s, the illness became known as "Nantucket fever," the two reported in the New England Journal of Medicine in June 2012.
In addition to tick bites, babesiosis can be transmitted through blood transfusions.
Brown said that workers at transfusion centers now ask patients if they've ever had babesiosis and are working on developing a screening method.
Last year six Massachusetts residents came down with babesiosis after receiving a blood transfusion or tissue or organ donation, according to the DPH.
Concerns about transfusion are growing as babesiosis cases increase.
Between 2008 and 2012 the number of babesiosis cases statewide shot up more than four times while cases on the Cape and Islands have more than tripled, the DPH says.
Anaplasmosis also is on the increase. In 2008 there were nine cases on the Cape and Islands, compared with 43 cases in 2012, according to state health officials. Statewide numbers rose about the same amount, going from 41 confirmed cases of anaplasmosis in 2008 to 237 in 2012, the DPH reports.
Anaplasmosis has the distinction among tick-borne illnesses of being most prevalent in the Berkshires rather than the humid coastal areas.
The incidence rate in the western part of the state is almost 23 percent per 100,000 people, compared to about 18 percent on the Cape and Islands, which comes in second for prevalence.
Anaplasmosis is a bacterial infection that attacks white blood cells. Symptoms include headache, muscle ache, fatigue, fevers, chills and weakness, Pombo said.
"I've seen people come in with gastrointestinal symptoms like diarrhea and vomiting," he said.
Babesiosis and anaplasmosis are diagnosed through tests including blood smears, serology studies and polymerase chain reaction analyses of DNA, Brown said.
Labs report positive tests to the DPH, which then direct local boards of health to follow up on patient conditions, she said.
It's possible there are more deaths from anaplasmosis and babesiosis than the state has reported, Brown said. "We don't always have complete information on that."
Over the past five years, McConnell said she has met many people diagnosed with babesiosis, including a woman she employed to help with her garden.
McConnell herself was treated for the illness for six days at Cape Cod Hospital in August 2012 — four years to the day after her husband's death.
She said she called an ambulance after a doctor dismissed her health complaints as "the summer flu."
"Everybody should be more aware. Nobody has to be afraid," McConnell said. "The later you are diagnosed the more at risk you are. I was diagnosed in time, and I didn't die."
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