Lyme Disease Study and Hikers Along AT

Perhaps not news to those of us all-to-familiar with Lyme Disease, but good information just the same for us all to keep in mind.

http://doi.org/10.1016/j.wem.2013.09.009

Abstract

Background
Lyme disease is the most common vector-borne infectious disease in North America. With nearly 2,500 Appalachian Trail (AT) hikers entering the endemic area for as long as 6 months, exposure to the disease is likely. The characteristic exanthem of erythema migrans (EM) should be a trigger for seeking medical treatment, and its recognition in this relatively isolated environment is important.

Objective
The purpose of this study was to determine the ability of AT hikers to identify EM, the exanthem of Lyme disease.

Methods
Hikers were administered a photographic stimulus in this Internal Review Board-approved pilot study. Historical hiking data, basic demographics, and self-reported treatment and diagnosis were collected.

Results
In all, 379 responses were collected by 4 researchers at 3 geographically separate locations at or proximate to the AT from June 2011 to May 2012. Fifty-four percent of respondents (206 of 379) were able to recognize the photographs of EM/Lyme disease; 46% could not. Of those who did recognize EM, 23 (6%) had seen it either on themselves or on another hiker while on the AT. A total of 37 hikers stated that they had been diagnosed with Lyme disease while hiking, and of these, 89% were treated with antibiotics. Thirteen of these 37 hikers (35%) diagnosed with Lyme disease had visualized an embedded tick. Nine percent of all respondents reported they had been diagnosed with Lyme disease by a healthcare practitioner, whether from EM, symptomatology, or by titer.

Conclusions
This study suggests that hikers are poorly able to recognize the characteristic exanthem of Lyme disease but have a high exposure risk.

http://doi.org/10.1016/j.wem.2013.09.009

Always good to know. That said, at least hiking on the more popular stretches of the AT (those that climb hills and mountains) the trail has been wide enough so I've rarely had to brush up against much grass. Higher up, some spruce and fir trees of course.

Fishing has been my worst place for ticks, something about standing in grass around ponds. (maybe why my brother surf fishes....) Some of the smaller state parks and nature conservancy properties don't get as much use so they may be a bit overgrown.

So is this year going to have cold enough weather to impact the ticks?

Even though the trails may be wide enough, this is a good warning to not sit anywhere! I think ticks are just going to keep on coming at us.

Mike P. said:

So is this year going to have cold enough weather to impact the ticks?

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The ticks can get you any time of year. That said, they move slowly in cold weather and are thus less likely to get you in the cold. Supposedly, you are pretty safe when there is snow on the ground.

Summer droughts probably have a greater direct effect on tick survival than cold. Populations of hosts, eg small rodents and deer, have a significant effect on tick populations too.

Doug

FWIW, it's been months since Gryffin has picked up a tick. The last hurrah before winter (late October into November) there were days with 5-10 ticks per day...

Tim

Of course, the "characteristic exanthem of erythema migrans" - AKA a bulls eye rash - doesn't always appear w/Lyme and other tick-borne diseases. In fact, many times it does not appear at all.

After two serious tick scares - one in the Shenandoahs, one in Missouri - there is no way I'd attempt a long-distance hike, or even one of just a week's duration, without a few doses of doxycycline in my pack.

Also, I heard an entomologist on NPR just this morning talking about how the cold temps would have no negative effect on tick populations. Damn!

Stinkyfeet said:

Of course, the "characteristic exanthem of erythema migrans" - AKA a bulls eye rash - doesn't always appear w/Lyme and other tick-borne diseases. In fact, many times it does not appear at all.

After two serious tick scares - one in the Shenandoahs, one in Missouri - there is no way I'd attempt a long-distance hike, or even one of just a week's duration, without a few doses of doxycycline in my pack.

Also, I heard an entomologist on NPR just this morning talking about how the cold temps would have no negative effect on tick populations. Damn!

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True about the rash. I didn't notice I had one, but tested positive through Igenix. We all have to be so careful about this and not being casual with regard to all of the details for us and our companions.

It is also important to know how to identify deer tick.

Stinkyfeet said:

After two serious tick scares - one in the Shenandoahs, one in Missouri - there is no way I'd attempt a long-distance hike, or even one of just a week's duration, without a few doses of doxycycline in my pack.

Click to expand...

I've been treating my clothing with Permethrin fairly religiously and DEET or Picaridin on my skin somewhat less religiously for the past several years (3-season) and haven't found any ticks on me. Maybe I should consider a 4th season...

Doug

I was one who never saw the bulls-eye when I contracted Lyme. It was likely buried somewhere under the raised red rash I had but it was nowhere to be seen.

Regarding doxycycline, don't make the mistake of eating shellfish on that stuff like I did.

There must be a way to make biofuel from ticks.

Speaking as a person who has been graced with Lyme Disease on TWO Separate occasions I would like to suggest a few tips.

-1st Occasion: Tick on overnight; a week after bite noticed the area was moderately itchy on and off (thought it was just an unlucky mosquito bite in the same spot); 2-3 weeks after bite I would sometimes wake up at night with pretty bad back pain as well as knee pain (I unluckily had moved the same week and again stupidly assumed it was from moving and Not Lyme); 4-5 weeks after bite I notice a huge Bull's Eye rash behind my knee (a hard place to see and common place to find them). 3 week Doxycycline Regiment

-2nd occassion: I again found a tick that had been on me overnight and thoroughly removed it; this time when the bite area started getting inflammed and itchy roughly a week after I got it I just immediately went to the doctor and got tested for Lyme. The test came back positive, although upon telling my doctor I had previously had Lyme he was not sure if a false positive may be resulting from old residual Lyme antibodies in my blood from my first infection. A more detailed and very expensive assay wouldve been able to differentiate. Anyways, this time I wasn't going to take any chances. 3 week Doxycycline Regiment

-I still experience ongoing "Post-Lyme" symptoms (11 years later...) mainly involving joint pain in my ankles, knees and lower back. I know there are various arguments in the medical literature as to whether Post-Lyme symptoms or bacterial coinfections actually exist. Well either way, my joints are not the same as they used to be. It is a terrible experience and I do not wish this to happen to anyone.

-So now here are some TIPs

-Both times the Deer Ticks were on me overnight, this seems to be a key part of the transmission of Lyme Disease. Before going to sleep if I was outdoors, I strip completely naked and check every square inch of my body for ticks, even trying to run my fingers through my hair. I have my significant other check my non-viewable side. (This may sound silly or like overkill but it has helped us spot one on multiple occasions).

-You can get Lyme Disease in ANY month. The first infection I got in early May and the second infection in late September. If there is not snow on the ground and your able to wear a T-Shirt at the warmest point in the day, I would assume they could be on you.

-Both times I got Lyme Disease I was hiking in mixed forests/broadleaf forests of Southern New England (neither case was in the typical tall grass people associate with Lyme). Deer ticks really like to live in leaf litter on the forest floor as well as grass.

-DEET helps significantly in repeling Deer Ticks I have noticed. I suggest just coating your boots, ankles, lower pants or the leg portion of your socks.

-Lighter colors help you identify ticks much more easily (especially with regards to pants). I try to wear light tan or even white colors when I feel the ticks may be risky.

-Deer Ticks themselves can be tested for Lyme Disease. When you remove the tick save it in a small jar and bring it to your Doctor's Office. This will prevent you from an unnecessary 3 week course of Doxycycline, a nasty and potent antibiotic.

-Regarding Doxycycline: I suggest not eating a big meal 90 mins before or after taking a pill, otherwise I would just vomit it all up. That being said, sometimes Doxycycline on a totally empty stomach is just as bad. Some crackers and a little non-water beverage may be helpful.

-Symptoms to watch for if you suspect a tick has been on you for an extended period: Within 1 Week- Itching, Slight Inflammation/Light Redness. Within 2-3 Weeks- Joint Pain Developing especially on joints near the bite site, Occasional Headaches, Occasional Night Sweats. Within 4-5 Weeks- Bull's Eye Rash Development and Expanding Joint Pain.

Please be careful everyone. I now fear Ticks and Lyme Disease more than anything else outside. Even hiking a trail leading to a ridge that I saw a Grizzly Sow and her two cubs descending in Montana did not make me as anxious....

Happy Hiking

I caught Lyme disease this past summer while working on Storm King Mountain, not too far from the AT. I was only really sick for a day or two, but I still had occasional feelings of lethargy for the rest of the summer. I never felt any symptoms until I saw the bulls-eye rash.

Glad you were one of those who had a rash. Lethergic is my middle name. Chronic Insomnia are my nick-names.

I'd like to share a link regarding ticks on the Appalachian Trail. Back in July I was hiking on the AT in Vermont and met this guy doing a study of tick populations at shelters and campsites. He was very interesting to talk to and interviewed myself and a couple other hikers at Stoney Brook Shelter about finding ticks on ourselves. He was the only person I've ever met wearing a complete suit of bug-netting. His results are surprising. Very few ticks were found in shelters and the areas around them.

http://www.whiteblaze.net/forum/sho...sk-to-Appalachian-Trail-Hikers-Karl-Ford-Ph-D

Another Tick born disease http://www.thedailybeast.com/articl...-tick-borne-illness-heartland-virus-grow.html