Dr. Kevin Most: Summer is here…
Well Summer is here and with summer we have issues of sunburn, heat stress and insect bites. We have touched briefly on sunburn and heat exhaustion so I thought a little info on insect bites would be helpful.
First just some basics, most insect bites will cause the body to have a reaction. The insect will cause the body to feel trauma by a foreign object and will go to the area to protect it. It will cause swelling and release histamine which is a chemical in our body that sees foreign substances and tries to eliminate them. (this is the same histamine that causes allergy symptoms) The skin is our most important defense mechanism that we have so any break in it is a concern. Insects when they bite can inject bacteria, viruses and toxins. For the vast majority of insect bites there is nothing you need to do but a few things you can do to minimize the symptoms. First a little ice on the area will minimize the swelling, second an antihistamine will help minimize the itching. Try to not to itch the area, first itching it will only cause more histamine to be released and thus causing more itching, second itching can cause bigger breaks in the skin and increases the chance of infection, so try not to itch.
The chance of these getting infected is fairly low, however washing the skin with warm soapy water will help and antibacterial ointment won’t hurt. Some like topical Benadryl and others like topical hydrocortisone cream, these won’t have much of an impact but some individuals swear by them. They won’t cause harm for the most part.
The area will usually get a little red and swollen but it should really be limited to the area of the bite. If the area continues to increase in size , gets more red and feels warm, the concern for a cellulitis (skin infection ) is present. If you notice any red streaking that is concerning as well and should be seen by a doctor. The concern for that is MRSA bacteria and often may need an oral antibiotic to eliminate the infection.
We can touch briefly on a few specific insect borne illnesses that always get our attention this time of the year.
There has been a lot of news recently about the concern of tick borne illnesses in Illinois rising dramatically this summer. The concern this year is that we are looking at a very active tick season as well as some new disease carrying ticks are now being found in the Chicago area. The mild winter allowed for ticks to survive as well as their hosts.
The reason for this awareness is the spread of ticks across the country, for example the number of Lyme disease cases has tripled in the past 20 years and there is no sight of slowing.
We all have heard of Lyme disease which is a bacterial infection that is transmitted from the bite of a deer tick. It was first noted in Old Lyme Connecticut in 1975 and has spread across the country. It is the most common disease spread by ticks, infecting 300,000 a year. The problem with Lyme disease is not only can it give you acute illness but it also has some chronic illness that individuals may suffer from.
So first let’s talk about the illness. The tick will bite the skin and approximately a week later you may see the start of a rash. The key finding in Lyme disease is the finding of a rash that looks like a bulls eye. The rash will be red but often it is not painful or itchy, so depending on where the rash is it may be noted by others. The rash is only found in about 50% of individuals with Lyme disease so, no rash, does not rule out Lyme disease. The symptoms for Lyme disease are not specific, they include fever, headache, feeling tired or worn out. If not identified and treated other symptoms may arise like heart palpitations, neck stiffness, severe headaches and joint pain. The difficult thing is how do you decide to treat these patients without the rash as many people have headaches , fever and feel tired.
These symptoms mimic many other illnesses and the doctor and patients index of suspicion must be elevated.
The good thing about this is that it is a bacterial disease and can be treated if identified with simple antibiotics. The bad thing is there is no reliable test early on and the symptoms must be taken into consideration with the possible history of a tick bite.
For this illness prevention is key. If you are going to walk in tall grass or in a wooded area, dress appropriately. Wearing long pants and applying a DEET product with 20% DEET, will be helpful. Also a total skin exam upon completion of your walk is important as well. One thing we should always think about is the clothing that you were wearing as well. These clothes should be washed in hot water immediately and dried in a dryer on high heat until dry. If you don’t want to wash the clothes at least place them in the dryer for 10-15 minutes on high heat.
Also don’t forget your dog ! They should be treated with flea and tick medicine and also inspected after being in a wooded area or in high grass.
In order for the tick to transmit the bacteria the tick will usually need to be on the skin for 24-48 hours, so a good skin exam is important. Removing the tick with tweezers and washing the area with antibacterial soap is the best prevention. Many physicians will consider a short course of antibiotics with a known documented tick bite.
There was at one time a vaccine but for many reasons it was removed from the market in 2002 and new vaccines are being worked on.
Another downside is the size of the tick we are talking about, in most cases the ticks are young and attach to the skin looking for nutrition (your blood). This small size often makes them missed with a good skin exam.
The bad thing about Lyme disease is it can cause chronic symptoms. Some of the areas this bacteria can affect are joints in the body, the heart and the brain. It can cause swelling in the brain, pain in the joints and issues with the electrical activity of the heart.
You may have heard or seen in the news the emergence and expansion of the Powassan virus. This is a virus that can be transmitted by tick bites as well. This one is very rare with less than 100 cases over the past 10 years, however this illness can be much more severe and cause long term neurologic issues. It can cause fever, headache, vomiting, seizures, memory loss as well as long term damage.
The downside for this illness is there is no treatment to cure. Supportive measures can be started but still over 10% of people will die. This is truly a case where prevention is the best medicine.
West Nile Virus
The West Nile Virus is an illness that is spread by infected mosquitos. This is another illness that has spread dramatically across the country. The first cases were noted in 1999, this has now spread across the country impacting every state with the exception of Alaska and Hawaii. The reason for the rapid spread is not because of the mosquito it is because of the birds that carry the virus. Mosquitos feed on the birds and then become the vector.
For West Nile there is a large spectrum of illness. 80% of people who have been infected will actually not know they have it nor will they develop any symptoms. This fact is one of the issues that will possibly slow the work on a vaccine. Those who do get symptoms will find the symptoms similar to other illness we have discussed, fever, headaches, body aches, joint pain. Most Individuals will have these symptoms for a few days and need no medical treatment. Unfortunately there are some where the virus can get into the brain and cause coma and paralysis, this is very rare but can occur. If individuals start to notice neck pain, confusion, continued fever, worsening headache, get in to be evaluated. The treatment is supportive with fluids and close monitoring.
Like many viruses the thought is that once you have been exposed you have some protection going forward, however there is not enough data to know how long or how good that natural protection is. Blod tests can be done to see if you have been exposed to West Nile but are rarely done as they are expensive and the results really add no value.
Probably the biggest message is be aware of insect borne illnesses, wear insect repellent when out and monitor for any bites or ticks.