Healthy Communities

Tickborne Diseases in Arkansas

Lyme Disease

According to the CDC case definition for Lyme disease, Arkansas is considered a low-incidence state, meaning there are less than 10 confirmed cases per 100,000 people for the previous three reporting years. Ninety-five percent (95%) of Lyme disease cases come from 14 states. They are concentrated heavily in the Northeastern, Mid-Atlantic,and upper Midwestern states. Verified cases reported from other US states are usually associated with travel to states with high rates of infection. Lyme disease is caused by the bacterium Borrelia burgdorferi, and it is transmitted to humans through the bite of infected blacklegged ticks.

Lyme disease testing and interpretation is complicated. CDC currently recommends a two-step process when testing blood for evidence of antibodies against the Lyme disease bacteria. Both steps can be done using the same blood sample. The two steps of Lyme disease testing are designed to be done together. CDC does not recommend skipping the first test and just doing the Western blot. Doing so will increase the frequency of false positive results and may lead to misdiagnosis and improper treatment. Some laboratories offer Lyme disease testing using assays whose accuracy and clinical usefulness have not been adequately established. New tests may be developed as alternatives to one or both steps of the two-step process, but before CDC will recommend new tests, their erformance must be demonstrated to be equal to or better than the results of the existing procedure, and they must be FDA approved.

Number of cases between 2015-2016 Confirmed Probable
Associated with travel 2 1
No travel 0 5

Northern vs. Southern I. scapularis

  Northern Southern Reference
Found on humans? Frequently Rarely Stromdahl and Hickling 2012
Collected by drag sampling Frequently Rarely Diuk-Wasser et al. 2006
Most common host of larvae Mice Lizards Apperson et al. 1993
Questing behavior On stems In leaf litter Arsnoe et al. 2015

For more information, click here to view our Grand Rounds presentation "Does Arkansas Have Lyme Disease?"

Symptoms:

tick bite

If left untreated, infection can spread to joints, the heart, and the nervous system.
Most cases of Lyme disease can be treated successfully with antibiotics. The ticks that transmit Lyme disease can transmit other tickborne diseases as well.
 
For Health Care Professionals: Diagnosis, Treatment and Testing

Because Arkansas is categorized as a low-incidence state, healthcare professionals should consider other diagnosis first, like: viral infections, STARI, fibromyalgia, or arthritis.

For Health Care Professionals: Case Definition

The Arkansas Department of Health utilizes the Centers for Disease Control and Prevention (CDC) case definition for Lyme disease for reporting and surveillance purposes. Current case definitions for all tickborne diseases can be found on the CDC website.

In low-incidence states, like Arkansas, a case of Lyme is classified as confirmed with a case of EM rash with laboratory evidence of infection and a known exposure, or any case with at least one late manifestation that has laboratory evidence of infection.

Points for Patients

The Arkansas Department of Health is not responsible for diagnosing and testing for Lyme disease. ADH is mainly responsible for reporting laboratory and health care professional confirmed cases for surveillance purposes. It is important to recognize cases of Lyme when they occur, so ADH examines every Lyme disease related lab result that is reported.

It is possible to get Lyme in the state of Arkansas, but it is not common because of the apparent process of transmission in the state. 

The blacklegged tick can be found in parts of Arkansas. To avoid all tickborne illnesses, you can take these measures to prevent tick bites.

 

Heartland Virus

Heartlandvirus is a newly identified phlebovirus that was first isolated from two northwestern Missouri farmers hospital­ized with fever, leukopenia, and thrombocytopenia in 2009. It belongs to a family of viruses called Phleboviruses. Viruses in this family are found allover the world. Some of these viruses can cause people to get sick. Most of the phleboviruses that cause people to become ill are passed through the bite of a mosquito, tick, or sandfly. People become infected with Heartland virus through the bite of the Lone Star tick. 

 
In 2009, two people admitted to a Missouri hospital (Heartland Hospital—hence the name) were later found to be infected with this virus. Both recovered, but following this Missouri Department of Health and Senior Services began working with the Centers for Disease Control and Prevention (CDC) to learn more about this virus. To date, more than 20 cases of Heartland virus disease have been identified in several states in Southeast and South Central United States. Arkansas identified its first case in June 2017.
 
Patients diagnosed with Heartland virus disease generally become sick from May-September. They have a flu-like illness fever, headache, muscle aches,diarrhea, appetite loss, and feel very tired. Most have low numbers of white blood cells that fight infection and low numbers of platelets that help blood clot. Most patients required hospitalization for their illness but fully recover. One patient (out of 20 that have been diagnosed) has died.
 
People who work or do activities outside, where they are exposed to ticks or insects,are more likely to be infected. There is no vaccine or drug to prevent or treat the disease. Preventing bites from ticks and mosquitoes may prevent this and other infections.
  • Use insect repellents
  • Wear long sleeves and pants
  • Avoid bushy and wooded areas
  • Perform thorough tick checks after spending time outdoors
For more information, click here to access the CDC.
 

Bourbon Virus

Bourbon virus is a novel RNA virus in the genus Thogotovirus (family Orthomyxoviridae)that was recently discovered in Bourbon County, Kansas. Bourbon virus is the only thogotovirus known to cause human disease in the United States. However,other thogotoviruses, such as Thogotovirus and Dhori virus, are known to cause human disease in other parts of the world.

We do not yet fully know how people become infected with Bourbon virus. However, based on what we know about similar viruses, it is likely that Bourbon virus is spread through tick or other insect bites. Most related viruses that cause human disease are transmitted through the bite of a mosquito, tick, or sand fly.

There have only been a few cases of Bourbon virus disease identified but their distribution is similar to that of Heartland virus (e.g.,Kansas, Missouri, and Oklahoma). It is unknown at this time if these viruses may be found in other areas of the United States.

As of June 27, 2017, a limited number of Bourbon virus disease cases have been identified in the Midwest and southern United States.Some people who have been infected later died. At this time, we do not know if the virus might be found in other areas of the United States.

Because there have been few cases identified thus far,scientists are still learning about possible symptoms caused by this new virus.People diagnosed with Bourbon virus disease had symptoms including fever,tiredness, rash, headache, other body aches, nausea, and vomiting. They also had low blood counts for cells that fight infection and help prevent bleeding.

People likely become infected with Bourbon virus when they are bitten by a tick or other insect. Therefore, people who do not take steps to protect themselves from tick or insect bites when they work or spend time outside may be more likely to be infected.

There is no vaccine or drug to prevent or treat Bourbon virus disease. Therefore, preventing bites from ticks and other insects may be the best way to prevent infection. Here are ways to protect yourself from tick and other bug bites when you are outdoors:

  • Use insect repellents
  • Wear long sleeves and pants
  • Avoid bushy and wooded areas
  • Perform thorough tick checks after spending time outdoors
Because there is no medicine to treat Bourbon virus disease, doctors can only treat the symptoms. For example, some patients may need to be hospitalized and given intravenous fluids and treatment for pain and fever. Antibiotics are not effective against viruses, including Bourbon virus.
 

Rocky Mountain Spotted Fever

Rocky Mountain spotted fever (RMSF) is the most common tick-borne disease in Arkansas. RMSF is caused by the bacterium Rickettsia rickettsii. This bacterium is carried mostly by the American dog tick, Dermacentor variabilis, but also by the brown dog tick, Rhipicephalus sanguineus. Not all ticks are infected. It takes an infected tick four to six hours to spread disease after attaching to the host. Adult ticks look for large hosts such as dogs, but they also feed on humans. Ticks are often found in overgrown lots and along weedy roadsides, paths and hiking trails. Most RMSF cases occur between June and August when tick populations and outdoor activities are highest. Half of all people with RMSF do not remember being bitten by a tick.

  • RMSF Symptoms and Treatment
    • Symptoms of RMSF generally appear suddenly, about one week after an infected tick bite. However, there may be symptoms any time between 2 and 14 days after a bite.
    • Symptoms can include:
    • High fever
    • Headache
    • Muscle pain
    • Non-itchy, pink rash usually starting on the wrists, forearms and ankles

It is important to get medical care as soon as possible if you think you have RMSF. Blood tests are required to diagnose RMSF, but treatment should begin as soon as symptoms and/or recent tick exposure suggest RMSF.  

 

Ehrlichiosis and Anaplasmosis

Ehrlichiosis is the name used to describe several bacterial diseases that affect animals and humans. Human ehrlichiosis (formerly called human monocytic ehrlichiosis or HME) is caused by Ehrlichia chaffeensis (first recognized in 1986 from a patient infected at Fort Chaffee, AR) and Ehrlichia ewingii. These bacteria are spread to humans by the bite of the lone star tick, Amblyomma americanum.

Anaplasmosis is a tick-borne disease caused by the bacterium Anaplasma phagocytophilum. It was previously known as human granulocytic ehrlichiosis (HGE). Anaplasmosis is spread to humans by tick bites primarily from the blacklegged tick, Ixodes scapularis. In Arkansas, these ticks are commonly found in shady areas along roads, meadows and woods. The risk of picking up these ticks is greater in wooded or brushy areas and in the edge area between lawns and woods.

Ehrlichiosis and Anaplasmosis Symptoms and Treatment

Symptoms of these diseases are similar and may appear up to 10 days after a tick bite.

Symptoms can include:

  • Mild to severe fever
  • Headache
  • Muscle pain
  • Vomiting and general discomfort

Blood tests are used to aid in diagnosis of these diseases. Both Ehrlichiosis and Anaplasmosis respond to antibiotics, and treatment should be based on symptoms and/or history of tick exposure.

 

Tularemia

Tularemia is a disease of animals and humans caused by the bacterium Francisella tularensis. Rabbits, hares and rodents are especially susceptible and often die in large numbers during outbreaks. Humans can become infected through several routes, including:

  • Tick bites, including the American dog tick, Dermacentor variabilis, and the lone star tick, Amblyomma americanum.
  • Deer fly bites
  • Skin contact with infected animals, especially hunting and skinning infected rabbits
  • Ingestion of contaminated water
  • Inhalation of contaminated dusts or aerosols
  • Contact as a result of bioterrorism

Tularemia Symptoms and Treatment

Symptoms vary depending upon the route of infection. Although tularemia can be life-threatening, most infections can be treated successfully with antibiotics. Reduce the risk of getting tularemia by following these steps:

  • Use an insect repellent
  • Wear gloves when handling sick or dead animals
  • Avoid mowing over dead animals

Southern Tick Associated Rash Illness (STARI)

A rash similar to the rash of Lyme disease has been described in humans following bites of the lone star tick, Amblyomma americanum. The rash may be accompanied by fatigue, fever, headache, muscle and joint pains. This condition has been named southern tick-associated rash illness (STARI). The cause of STARI is not known.

Arkansas Department of Health
© 2017 Arkansas Department of Health. All Rights Reserved. | www.healthy.arkansas.gov
4815 W. Markham, Little Rock, AR 72205-3867 | 1-800-462-0599