Daniel Cameron MD, May Awareness Guest Blog – What to Look Out for if Bitten by a Tick

May Awareness LDA Guest Blogger

Daniel Cameron, MD, Circle PNG

Daniel Cameron, MD, MPH, is a board-certified internist and epidemiologist and a nationally recognized expert in the treatment of tick-borne diseases.

He has lectured at numerous medical and scientific conferences in the United States, Europe and Canada and is often interviewed by the news media, including nationally syndicated radio and television programs. In addition to his clinical background, Dr. Cameron has been actively involved in research and is the lead author of the International Lyme and Associated Diseases Society’s (ILADS) treatment guidelines for tick-borne diseases.

Dr. Cameron received his M.D. degree from the University of Minnesota Medical School and a Master’s in Public Health from the University of Minnesota and completed residencies at Beth Israel Medical Center and Mt. Sinai Medical Center. For more than 25 years, he has been treating patients with Lyme and other tick-borne diseases through his private practice in Westchester County, New York. He also is affiliated with Northern Westchester Hospital in Mount Kisco.

What to Look Out for if You are Bitten by a Tick

­­­­­Most of you may be familiar with the deer tick, also known as a black-legged tick or Ixodes scapularis. However, you may not be as familiar with other ticks, such as the Lone Star tick, American Dog, and Wood ticks.1  It can be challenging to identify the type of tick that bites you. 

The length of time a tick must be attached to cause disease varies.  The Powassan virus can be transmitted in minutes. Babesia can be transmitted in hours.  However, the length of time to transmit Lyme disease remains controversial.

The decision to treat a tick-bite prophylactically remains controversial. The single 200 mg of doxycycline after a tick bite has not been shown to prevent neurologic, neuropsychic or other chronic manifestations of Lyme disease.  Neither is the 200 mg of doxycycline effective at preventing other tick-borne infections. The International Lyme and Associated Diseases Society (ILADS) guidelines advised a minimum of three weeks of doxycycline with follow-up if treating a tick bite prophylactically.2 

Ticks can carry viruses, bacteria, and parasites. Over half of ticks in a study in Wisconsin harbored disease organisms. The most common infections were Lyme disease, Anaplasmosis, and Babesiosis.  Over one in ten ticks harbored multiple pathogens.3

The CDC has identified a growing number of diseases/conditions following a tick bite. The list includes:4

The CDC does not consider Bartonella as a tick-borne disease because it has not been shown to be transmitted by ticks to humans. However, Bartonella has been reported in ticks5 and in case reports.6,7 Some doctors are reluctant to consider Bartonella a tick-borne infection.8

A tick bite can also lead to other conditions.  Individuals bitten by the Lone Star tick can develop an allergy (IgE) antibody to alpha-gal.  Red meat (beef, pork, lamb, venison) can contain alpha-gal. Some individuals with tick-borne illnesses also present with Mast cell activation disease (MCAD).  Borrelia burgdorferi spirochetes can induce Mast Cell Activation and Cytokine Release in rats and mice cell types.9  Mast cell activation disease MCAD) been described as a comorbid condition with post Lyme disease.10  These finding should encourage further research into the association.

A tick bite can lead to more than one condition. A 74-year-old woman was diagnosed with three tick-borne illnesses – babesiosis, anaplasmosis, and Lyme disease.11 Krause and colleagues described individuals with evidence of both Babesia and Lyme disease.12

The tests for these tick-borne infections remain a problem.  There may be a false positives and false negatives.  There may be positive tests for one tick-borne infection but negative tests for other tick-borne infections. The test may remain positive after resolution of the tick-borne infection.  Alternately, the tests may become negative even if the tick-borne infection persists.

The treatment varies for each tick-borne infection.  Doxycycline can be helpful for Lyme disease. Some individuals with Lyme disease respond better to drugs such as amoxicillin, cefuroxime, azithromycin, or clarithromycin.  Other individuals respond to a combination of antibiotics. For example, individuals with Babesia benefit from a combination with atovaquone and Zithromax­­. Finally, some individuals benefit from treatments known to be effective for Bartonella in cats. The list of antibiotics effective against Bartonella in cats contains doxycycline, azithromycin, trimethoprim/sulfamethoxazole, and Rifampin.

Your doctor will work with you to determine the best treatment for you.

  1. Tickborne Diseases of the United States. CDC Lsst accessed April 23, 2022.
  2. Cameron DJ, Johnson LB, Maloney EL. Evidence assessments and guideline recommendations in Lyme disease: the clinical management of known tick bites, erythema migrans rashes and persistent disease. Expert Rev Anti Infect Ther. Sep 2014;12(9):1103-35. doi:10.1586/14787210.2014.940900
  3. Westwood ML, Peters JL, Rooney TP. Prevalence and Coinfection of Three Tick-Borne Pathogens in Questing Adult Blacklegged Ticks Ixodes scapularis (Vilas County, Wisconsin). Vector Borne Zoonotic Dis. Aug 2020;20(8):633-635. doi:10.1089/vbz.2020.2619
  4. Tickborne diseases of the United States. A Reference Manual for Healthcare Providers. Last accessed 4/24/22.
  5. Maggi RG, Toliver M, Richardson T, Mather T, Breitschwerdt EB. Regional prevalences of Borrelia burgdorferi, Borrelia bissettiae, and Bartonella henselae in Ixodes affinis, Ixodes pacificus and Ixodes scapularis in the USA. Ticks Tick Borne Dis. Feb 2019;10(2):360-364. doi:10.1016/j.ttbdis.2018.11.015
  6. Nelder MP, Russell CB, Sheehan NJ, et al. Human pathogens associated with the blacklegged tick Ixodes scapularis: a systematic review. Parasit Vectors. May 5 2016;9:265. doi:10.1186/s13071-016-1529-y
  7. Angelakis E, Billeter SA, Breitschwerdt EB, Chomel BB, Raoult D. Potential for tick-borne bartonelloses. Emerg Infect Dis. Mar 2010;16(3):385-91. doi:10.3201/eid1603.081685
  8. Telford SR, 3rd, Wormser GP. Bartonella spp. transmission by ticks not established. Emerg Infect Dis. Mar 2010;16(3):379-84. doi:10.3201/eid1603.090443
  9. Talkington J, Nickell SP. Borrelia burgdorferi spirochetes induce mast cell activation and cytokine release. Infect Immun. Mar 1999;67(3):1107-15. doi:10.1128/IAI.67.3.1107-1115.1999
  10. Theoharides TC, Tsilioni I, Ren H. Recent advances in our understanding of mast cell activation – or should it be mast cell mediator disorders? Expert Rev Clin Immunol. Jun 2019;15(6):639-656. doi:10.1080/1744666X.2019.1596800
  11. Single tick bite leads to 3 diseases in elderly woman.  Lsst accessed April 23, 2022.
  12. Krause PJ, Telford SR, 3rd, Spielman A, et al. Concurrent Lyme disease and babesiosis. Evidence for increased severity and duration of illness. JAMA. Jun 5 1996;275(21):1657-60.