Every spring and summer, many children present to the clinic with tick and other insect bites. While most bites are benign, some are not.
This week: Bites and the prevention mechanisms to employ to reduce secondary issues.
Next week: Infections as abscess lesions.
Ticks are eight-legged creatures that live on animals in the woods and then grab onto us when we come into contact with a plant or animal on which they were waiting — or “questing” — for a “sucker” to pass by.
Ticks can migrate via birds that can carry them miles away from their previous location. They travel with all kinds of animals but seem to be on mice, deer, livestock and birds predominantly.
Ticks feed only on blood and utilize special mouth adaptations to cut the skin and suck out the blood. They keep from clotting by releasing anti-coagulants into the blood as soon as they suck it out.
While the amount of blood that a given tick removes from us is minimal to almost undetectable, they have a nasty habit of leaving behind dangerous pathogenic microbes in our blood stream.
The most troublesome tick-borne illnesses are caused by a bacteria called Rickettsia which causes Rocky Mountain Spotted Fever, as well as the Borrelia bacterium which causes Lyme disease. Tularemia, babesiosis, tick paralysis and ehrlichiosis are a few other diseases that are tick-borne in the United States.
We do know that lyme disease is coming south. I grew up in the hotbed of Lyme disease in the Hudson Valley of New York. It appears that mouse overpopulation is making things worse — a result of shrinking predator populations as forest space is reduced in urban and suburban areas.
Mice are highly efficient transmitters of Lyme and are responsible for infecting the majority of ticks carrying Lyme in the Northeast. A mouse can have up to 100 ticks covering its ears and face.
The next insect trouble-maker is the mosquito. This little annoyance follows the same survival principals as the tick by feeding on blood to survive. Unfortunately, it has adapted a flying lifestyle to go along with its six legs, making it vastly more irritating than the tick.
The adaptation has allowed it to essentially touch most humans in the world. This matters because mosquitoes can carry pathogens long distances.
The most dangerous pathogens cause diseases like malaria, chikungunya, yellow fever, Eastern equine encephalitis, dengue fever, West Nile virus, tularemia and now zika. These pathogens are bacterial, parasitic and viral in nature.
The third blood sucking player in the insect world is the flea — a small flightless insect that can jump 50X its body length in distance. Fleas carry many of the same pathogens as ticks but differentially cause plague and typhus by carrying the respective bacterial pathogens. Flea-borne disease is rare but increasing in the United States.
Prevention is the key to avoiding exposure to these creatures. Here are some tried and tested methods to keep your family free of insect borne disease.
1) Perform tick checks on your children daily after outdoor play. Check behind the ears, nape of the neck, groin, armpit and between the toes.
Ticks in general need to be attached for roughly 36 hours to transmit the spirochete that causes Lyme disease and Rocky Mountain Spotted fever. Remove them with tweezers by gently pulling — not squeezing.
2) Mosquito and chigger bites can leave a nasty itchy bump or bumps. Kids will often scratch them open and leave a place for infection to occur.
We are seeing a lot of MRSA (a resistant bacterial skin bacteria) abscesses from these bites. Prevent them by using insect repellents and long clothing. Also, reduce outdoor time at dawn and dusk when these bugs are most active.
3) Treat all domesticated animals for fleas if they have them. Prevent flea infestations by having your animals wear flea collars or take flea and tick medicine.
4) Use topical products with DEET or oil of lemon eucalyptus 30 percent to prevent tick bites (not for kids under 3 years old).
5) Apply all repellents by hand to avoid inhalation by your child (same with sunscreens. Aerosolized chemicals are no good, period).
6) Shower after outdoor activity, especially if repellents are used.
7) I like creams like Calendula, aloe vera and cortisone for itching. Also, rubbing a moist tea bag on bites can help with itching and swelling. The tannins act like an astringent.
8) Avoid having standing water in your yard — a mosquito haven.
9) Keeping mice and deer away from your living area is a great prevention strategy. Having an outdoor cat, using fences to keep deer out and treating your domesticated animals for tick prevention are solid choices.
10) Treating your hiking clothing with 0.5 percent permethrin is an effective prevention strategy if you are going to be out for days.
Pray that you have a lot of bats nearby so that they can ping the mosquitoes with their radar and swoop in for meals.
Stay insect free,
Dr. Chris Magryta is a physician at Salisbury Pediatric Associates. Contact him at firstname.lastname@example.org