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Tick-Borne Illnesses

Nurse role in treating and educating patients about the many different diseases and infections transmitted by ticks.

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Ticks are relatives of spiders that dwell in wooded areas and tall grass, surviving by feasting on the blood of their hosts, some of which are humans.

In addition to Lyme disease, ticks can transmit a plethora of infections, including Anaplasmosis, Babesiosis, Ehrlichiosis, Rocky Mountain Spotted Fever and more.

Until recently, there has been limited information about these diseases, causes, routes of transmission, symptoms and proper use of treatment medications, said Jean Sniffin, BA, RN, who believes tick-borne illnesses are underdiagnosed and therefore undertreated.

As a community health nurse for Century Health Systems, it is Sniffin's responsibility to educate communities and let them know the ramifications of not taking precautionary measures.

"Nurses are in a position and have the knowledge to emphasize that the symptoms of these diseases are extremely varied and involve many of the body's systems," she said.

Disease Symptoms

Virginia Caples, MHA, RN, CNOR, CIC, infection preventionist at Cambridge Health Alliance in Massachusetts, mentioned that tick-borne diseases have many similar symptoms, including headache, fever, fatigue, body aches, chills, rash (in some but not all patients) and nausea.

"These are all very similar to flu-like symptoms and are often ignored because people think they may have the flu, not a tick-borne illness," said Caples, noting that some cases, if left untreated, can lead to debilitating illnesses and even death.

Sniffin elaborated on the most common illnesses in New England caused by "deer" or dog ticks:

Lyme disease - Early symptoms of Lyme disease include a circular rash where the tick was attached (although there is not always a rash) three to 30 days after the tick bite. Flu-like symptoms may go away on their own, but the individual is still considered to be infected. Late-stage symptoms, if left untreated, can include joint disease, arthritic pain, nervous system problems and a slow heart beat that leads to fainting.

Tularemia - Caused by bacteria that can affect both animals and humans, Tularmemia can also be caused by the bite of an infected dog or tick and results in an ulcer at the site of the bite. Symptoms can include skin sores/ulcers at the site of a tick bite; diarrhea, pain and vomiting, and fever and chest symptoms (cough and pain) if germs were breathed in.

Rocky Mountain Spotted Fever - RMSF is caused by a bacteria that is spread by the bite of an infected dog tick. Unlike other tick-borne diseases, RMSF can be spread within 24 hours of a tick bite. Symptoms include a fever and severe headache, deep muscle pain, nausea, vomiting and cough. Many people will develop a rash on their arms, legs, palms and soles. Serious complications can also occur, including death, if not treated early with antibiotics.

Babesiosis - A Malaria-like disease caused by a microscopic parasite, Babesiosos is spread via an infected deer tick and passed from mother to child during pregnancy and delivery; via contaminated blood transfusions; and via organ donation. Symptoms include either mild/no signs or fever, chills, headache, achy joints, fatigue, nausea, vomiting or dark urine. Symptoms can last for months, and those at greater risk include people with weakened immune systems, the elderly and people who are asplenic.

Human Granulocytic anaplasmosis/ehrlichiosos - This is caused by bacteria that attacks white blood cells. It's spread via infected deer ticks, and may also infect someone with Lyme and Babesiosis in a single bite. Symptoms, which appear seven to 14 days after a bite, can include fever and headache that are not relieved by OTC medications. Additionally, the following symptoms may present themselves: chills, aches, fatigue, achy joints, cough and GI symptoms (nausea, vomiting, diarrhea).

Treatment & Education

Tick-borne diseases are bacterial illnesses that are usually treated with antibiotics. Depending on when the disease is detected, the illness can be treated with just a short course of antibiotics, said Caples. If the illnesses have advanced into a more severe state, other treatments may be required, including hospitalization.

Nurses should be aware of the symptoms and vigilant about assessing patients for rashes or other signs of tick-borne illnesses, especially if the patient may have been exposed to a tick bite.

"Outdoor activities, particularly during the summer months when ticks are more active, increase chances of exposure, and it is extremely important for the nurse to get a thorough history from the patient and communicate the findings to the physician," she explained.

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In addition, public health nurses especially should be presenting understandable-and valuable-information about tick-borne diseases, commented Sniffin, adding that such information should include the following:

  • Lyme disease can be contracted multiple times; one episode does not mean future protection.
  • Patients should be reassured that their symptoms are not psychosomatic.
  • The sooner symptoms are treated, the better.

Caples believes a nurse's greatest tools are education and communication with their patients.

"Nurses often spend a significant amount of time with their patients," she said. "This time allows them to realize the full picture of the patient's illness and provides an opportunity to educate the patient, family and others invested in the care of the patient."

On top of offering information sheets on how to avoid exposure and when to see a healthcare provider if a tick-borne illness is suspected, nurses can present information at community events, such as town fairs, health fairs, farmer's markets, the library and at councils on aging.

"These events/locales present opportunities to reach a variety of people," explained Sniffin.

She added that nurses can also seek to partner with other public health and school nurses as well as recreation department staff.

School Nurses

In the past year, the National Association of School Nurses (NASN) has confirmed a need for individual school nurses to obtain more information on statewide and national tick-borne diseases, their symptoms, treatment and prevention.

As a result, a continuing education program sponsored by the Product Ingredient Review program's DEET Educational Program, NASN, CDC and the State of Missouri Department of Health and Senior Services was released on August 1, 2013.

The CE program consists of an overview of tick-borne illnesses and where they occur most often, Lyme disease in children, other common tick-borne diseases in the U.S. and the role of the school nurse.

Carolyn Duff, MS, RN, NCSN, president of NASN and school nurse at A. C. Moore Elementary School, in Columbia, S.C., advises students to avoid tick habitats and walk in the center of trails, use DEET (with a minimum 20% concentration) and wear permethrin-treated clothing, shower after being outdoors, perform a daily tick check, treat pets year-round for ticks and contact a healthcare provider if a rash or signs of illness develop.

Beth Puliti is a frequent contributor to ADVANCE.

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