By Eric Holaday, MD, Infectious Disease Specialist, Virtua Infectious Disease

Planning some spring adventures outdoors? It's also time to think about protecting yourself and your family from ticks.

From 2019 to 2022, New Jersey had more than 16,000 reported cases of tick-borne disease. Lyme disease is the most common tick-borne disease in America. It’s caused by the bacterium Borrelia burgdorferi, which is carried by the black-legged deer tick, commonly found in New Jersey and nearby regions.

People often encounter deer ticks after spending time in heavily wooded areas, but you don't need to be a hiker to be bitten by one. Those with pets should know that a cat or dog can easily bring a tick into the house. This means you should be alert even if you don't spend much time outdoors.

How can I prevent tick bites?

To protect yourself from ticks, spray your skin with an insect repellent that contains DEET or picaridin, or treat your shoes and clothing with a permethrin-based insect repellent. Additionally, wearing long sleeves and pants, a hat, and light-colored clothing can help you spot ticks more easily and make it harder for them to latch onto your skin.

What to do if there's a tick on you

If a tick crawls on you outside and you brush it off, try not to worry too much about Lyme disease. A tick must typically be attached for at least 36 hours to transmit the bacteria. This is why those tick checks are so important!

After spending time in a high-risk environment, check your body and clothes for ticks. If you find a tick attached to you, remove it with tweezers to reduce the risk of contracting Lyme disease.

Remember, ticks are good at hiding. Check your scalp, back, and skin folds, especially the backs of your knees, underarms, and between your legs.

What are the symptoms of Lyme disease?

Early Lyme disease symptoms include:

• The tell-tale "bullseye" rash: A bullseye rash is one of the most recognizable symptoms of Lyme disease. It can start any time from a few days to two weeks after the tick bite. The rash begins as a small spot that expands outward, turning into a red outer ring with a red “bullseye” area at the center. Most people will experience some degree of redness and sensitivity at the site of a tick bite, which may resemble reactions from other insect bites. It's important to note that this rash usually isn't tender to the touch. 
• Flu-like symptoms: This can include fever, headache, neck stiffness, nausea and fatigue.

Symptoms of advanced Lyme disease can appear months after infection if left untreated. These include:

• Joint pain with swelling: This often affects large, weight-bearing joints like the knee and hip. It mimics arthritis, except it's usually accompanied by swelling.
• Cranial nerve inflammation: This symptom is less common but usually affects facial nerves, leading to difficulties in facial movements. If you experience this, you should see your doctor right away.
• Encephalitis (brain inflammation) and confusion: Encephalitis can result from an infection or when the immune system attacks the brain. In more severe cases, it can cause confusion, severe headaches, high fever, stiff neck, and other symptoms.

How Lyme disease is treated

Generally, Lyme disease is easily treated with 10-14 days of oral antibiotics. Depending on the type of Lyme disease and the area of the body affected, this will determine how long you're treated and whether you require intravenous versus oral antibiotics for a longer course.

If you’re bitten by a deer tick, talk to your doctor, as taking a single dose of doxycycline shortly after the bite can help prevent Lyme disease.

If you're not feeling any better after two to three weeks of oral antibiotics, there's a good chance you don't have Lyme. In this case, continuing to take doxycycline likely won't help, and other diseases should be ruled out with the expert guidance of an infectious disease specialist.

What to know about other tick-related diseases

The same tick that carries Lyme disease can also transmit other diseases, including:

• Ehrlichiosis and anaplasma can cause a flu-like illness that may be mild or cause symptoms such as headache, chills, fever, rash, and fatigue. These symptoms can develop for up to two months after the tick bite. Like Lyme disease, this is treatable with the oral antibiotic doxycycline, but you should see your physician.
• Babesiosis can cause symptoms for one to six weeks after a tick bite. These include fatigue, fever, joint aches, and abdominal pain. People at risk for severe disease include those who have had their spleen removed, are over age 50, are on immunosuppressive drugs, or have HIV. This is usually treated with a combination of antibiotics.
• Alpha-gal syndrome is technically an allergy, not an infection, but some individuals may develop an allergy to red meat after a tick bite. People usually experience hives, itching, and swelling after eating beef, pork, or other meat from mammals. This can be diagnosed by a blood test.
• Powassan virus is spread by ticks that also carry Lyme disease and can infect people of all ages. Common symptoms include fever, headache, muscle aches, and a mild rash. Currently, there’s no antibiotic treatment or vaccine for this virus. If you think a tick has bitten you or someone in your family and you have these symptoms, especially if you experience a change in mental status, please go to the nearest emergency room for evaluation.
• Other tick-borne diseases: Despite our location in the Northeast, we've seen Rocky Mountain spotted fever. This disease is characterized by fever, muscle aches, headache, and rash. Other illnesses include the Heartland virus and tick-borne relapsing fever caused by Borrelia miyamotoi,which exhibit symptoms similar to those of other tick-borne diseases. As always, it’s essential to consult your primary care doctor. They can refer you to an infectious disease specialist for further evaluation if necessary.  

If a tick has bitten you and you have the above symptoms and risk factors, you should speak to your primary care provider.

Get expert treatment for tick-related illness at Virtua

• Call 856-247-7730 to schedule an appointment with a Virtua infectious disease doctor.