Dr. Kevin Most: Nurses Week and Bugs

Steve Cochran

Dr. Kevin Most

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It’s the kick off to Nurses Week so thank all the nurses in your life for all that the do!

It was only a few weeks ago and we were still hearing wind chills during the weather forecast, and now we are going to talk about summer insect bites? Time is flying by!!

With the big change in weather, we all want to get outside as much as we can right now. Being cooped up inside all spring has made us a bit stir crazy and ready to do anything outside. Kids summer sports are now in full swing, with baseball, soccer and lacrosse practices being held outdoors. With the warm weather we unfortunately have to remember what comes with it. We will make sure we set aside a complete segment for skin care and skin cancer.

Last week The New York Times took to the front page to remind us of what to look for, what to do, and what is changing with insect borne illnesses. We all remember the Zika concern in 2016, this virus is carried by a specific mosquito which the CDC expects to see expanding well into the United States, including into southern Illinois this year. This is not saying that the mosquitos will bring Zika but as the vector for the illness that certainly will be monitored closely.

So what is going on? It is unclear but it certainly appears that global warming is having an impact on the spread of many illnesses that were at one time limited to tropical areas to spread to other areas and survive. We are also seeing environmental changes impacting the spread, be it the expansion of homes into areas that were once rural, the increase of rodents in the urban areas, each of these also helps the expansion of many illnesses. The CDC reported that insect borne illnesses has tripled over recent years and shows no sign of slowing down.

Before we discuss some of the illnesses we need to be concerned about this season, lets discuss what we can do to prevent the illnesses. The most important thing to know is that with the exception of a few illnesses from insects, like Lyme disease, the vast majority are viral and there is no treatment. Since there is no treatment for these viruses our goal should be in prevention. Prevention comes with avoidance and protection. We can minimize our chances by avoiding being out early in the am or at dusk when mosquitos are out in abundance. Plan your outdoor activities when the chance of an insect bite is low. If you need to be out at this time, wear clothing that will protect you by having less exposed skin and make sure you are using insect repellent with DEET. The key things to know about DEET, it has been proven to be safe in children, however infants under 2-3 months old should not be exposed to DEET. When using it on children, do not spray it on their hands as a way to spread it, like we often do with sunblock, as it is an irritant to the eyes and can make children ill. Do not use DEET on the face.

DEET is very effective as a mosquito repellant and is fairly good as a tick repellant. Spraying your clothes before a walk in a field or woods is a great idea, however coupling that with changing your clothes after that walk, checking your skin for ticks, in combination with DEET is ideal.

What about the strength of DEET, I try to keep it simple for parents, remember the number 30. Sunblock beyond SPF of 30 is waste of money, DEET spray above 30% should not be used. So when thinking outside protection be it sun or insect, 30 is the number.

It is also important to know that the vast vast vast majority of insect bites are nothing but an inconvenience. We all know that mosquito bites are not fun, they are uncomfortable and the itching is uncomfortable. So just a few tips on insect bites, as much as they itch, try not to itch them. Actually physical pressure to the bite causes the release of more histamine and thus more itching. So the more you itch it the worse it will itch in the future. The scratching also increases the chance that you will break the skin and that increases the chance for infections. If you want to decrease the itching sensation a simple paste made of baking soda and water applied to the bite often helps. If you want you can also taking antihistamines like Claritin or Benadryl. Although the area will often be red and warm, the chance that it is a skin infection is very low and the symptoms are actually due to histamine.

Let’s not forget about the unknowing vector and that is your dog, make sure they are protected with tick medication regularly. Dogs may bring ticks into the home and cause exposure to an illness without the individual even stepping foot outside. Especially if you have spoiled dogs that are allowed to sleep in the bed. Tick medication and frequent brushing of your dog will minimize the dog spreading the illness.

Things you can do around your yard include minimizing any standing water. This often happens in empty planters or catch basins, mosquito’s quickly breed in the water and next thing you know you have your own home grown stock of mosquito’s.

So what illnesses are we concerned about. If you look at this area the most common is West Nile Virus, but we also have cases of many other mosquito and tick illnesses some of which are new to the Midwest.

Let’s quickly discuss a couple of common mosquito borne illnesses, West Nile Virus, for many of us here in the Midwest who spend any time outside, there is a good chance you have had West Nile Virus and not even known it. 80% of individuals with the disease do not have any major symptoms that are even noted. 20% will have fever and other symptoms and a small number, less than 1 % will have serious brain or nervous system issues, this is seen in individuals with poor immune system or other chronic illness such as diabetes or cancer. There is no treatment for West Nile, the body’s immune system will fight to eliminate the virus. Those that are unable to fight the disease may end up with brain infections will certainly receive treatment in the hospital.

Although Lyme Disease was first identified in Lyme, Connecticut it quickly has been identified in every state with the exception of Hawaii. We have 350,000 new cases of Lyme disease a year. This is an illness that can be debilitating and knowing how to avoid it as well as knowing what to look for is important as it is one of the few insect borne illnesses that are caused by a bacteria and can be treated. We all have probably heard of the bulls eye rash that is seen with Lyme disease. It is actually a rash with concentric circles that looks like a bulls eye. If that rash is noted, please follow up with a doctor, even if you don’t recall being bitten. Some patients will never get the rash and they just get the common symptoms that go along with many viral illnesses like headache, fever, muscle pain, lack of energy. Because of this, physicians and patients have to have a level of suspicion. Blood tests and treatments when done early can eliminate the bacteria and the symptoms that come with Lyme disease.

One of the problems with this disease is that many patients may go undiagnosed for years, they do not ever recall being bitten and up to half of them never had the bulls eye rash or never noted it. If left untreated Lyme disease can go on to cause debilitating problems that affect the heart, the brain, joints and the nervous system. Prevention and early detection are the key.

International travel has led to more exposure to diseases we never think or thought about in the past. Before 2016 Zika Virus was always thought of an illness of South America and Africa, Yet now it is into the US. Last year we had close to 450 cases of Zika virus in the US, The majority of these cases were from travelers who caught the illness in another country and returned to the US with the Virus. Thirteen cases were actually thought to be local transmission cases in Florida and Texas. Both states had increased their mosquito abatement plans last year, it is unclear if funding will be available this year or will we need a spike in cases to get the attention again.

Malaria is also interesting. When you hear Malaria you probably think of Africa, yet we have malaria in Mexico, Central America as well as the Dominican Republic. Recently we had a physician and his family travel to the Dominican Republic and weeks later both he and his daughter became ill, as it was a long time from his trip and during the tail end of influenza season they thought, as well as the docs they saw, felt it was probably influenza. However his daughter became extremely ill, they were unsure what she had as her flu tests were negative. She was placed on a ventilator and airlifted to Lurie Children’s Hospital where the diagnosis was made and she was treated.

The main message here is for patients as well as doctors, the world is getting much smaller and travel is getting easier. Travelers need to know what illnesses they may be exposed to when traveling as well as the time frame for those illnesses to develop. We need doctors to ask travel questions more regularly so that our choices for diagnosis will be expanded. Diseases we would never think of need to come into our thought process for diagnosis. There is a famous saying in medicine, “When you hear hoof beats, think horses, Not Zebras” Meaning look for the most common diagnosis first, don’t jump to the exotic. In the infectious disease world, we may need to rethink this and say, “When you hear hoof beats think horses but there may be a Zebra closer than you think”

The world is getting warmer, it is getting smaller and with this we need to look at infectious insect borne illnesses a bit differently.

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