Beware of ticks

2008-07-11 00:00

There are two types of tick bite fever in South Africa, according to Dr Rob Brown*, a local GP. “One is more benign and one is aggressive,” says Brown.

According to an article from SA Family Practice, “only recently has it been established that there are two aetiological agents. Rickettsia conorii infections resemble the classical Mediterranean spotted fever, and patients are sometimes at risk of severe or even fatal complications.

“On the other hand, African tick bite fever is a separate entity caused by Rickettsia africae and it tends to be a milder illness with a less prominent rash and little tendency to progress to complicated disease.”

According to Brown, “The more aggressive type can make you very ill. It can be very dangerous and can cause multiple organ problems and a fever, headache and rash. Some are more toxic and can cause kidney and liver failure, etcetera.”

Asked about the worst-case scenario, he replied, “I have had people on ventilators in the ICU from tick bite fever with renal failure and multiple organ challenge. They made it.”

Recently, six-year old Jared Staley was diagnosed with tick bite fever for the second time. The Staleys are outdoor types who enjoy holidaying in the bushveld at places like the Kruger National Park and the Eastern Cape.

The first time Jared had tick bite fever was 10 days after a family holiday in the Eastern Cape. “There were ticks all over him,” says his mother, Heather Staley.“Tiny red ticks.”

He had the typical symptoms of an eschar (the black mark at the site of the tick bite), a headache, swollen glands and a temperature. The second time he acquired tick bite fever Staley did not find any ticks on him, which suggests they may have been minuscule.

In their larval stage, ticks are trivially called pepper ticks and can be as inconspicuous as a pepper granule, or as invisible as a pinprick.

According to SA Family Practice, “larval and nymph-stage ticks typically transmit the disease; larvae [pepper ticks] are often unnoticed on the body because they are so small.”

Brown, who treated Jared, says: “I look for evidence of where the bite was. Blood tests are not particularly helpful as you

may only get results two weeks into the

illness.”

He typically looks for a bite mark and swollen glands near the bite.

“A typical clinical picture of tick bite fever is a high fever, headaches and a rash on the hands and feet.”

In Jared’s second case of tick bite fever, there was no bite mark, but he had a raging headache and a temperature that reached 39,5°C.

Fortunately, tick bite fever is effectively treated with “a flu-like course of anti-biotics,” says Brown. “Rickettsia only responds to the tetracycline family.”

Staley observed that this antibiotic is foul tasting and bad for the teeth, and suggests rinsing afterwards.

“It is a special dose,” says Brown. “You weigh the patient and put him or her on a seven-day course.”

According to the doctor, it does not turn teeth brown if the dosage is correct. “Fever can do more damage to teeth.”

Brown says that the worst time of year for tick bite fever is the end of summer when “ticks are moving”, but you can get it all year round.

“It is linked to outdoor living, places like the wild coast where you get cattle on the beach and then ticks on the beach. Humans are accidental victims.”

Staley also contracted tick bite fever on a previous holiday in northern KZN and remembers sleeping uncharacteristically for hours on end.

What are outdoor types like the Staleys to do when these blood-sucking parasites, belonging to the arachnid family, seem to lie in wait for carefree hikers?

These crafty critters can climb on stealthily and crawl into your sweaty crevices (and not just between the toes).

• Dr Brown is a local general practitioner who wishes to remain anonymous.

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