More ticks in Indiana could mean more Lyme disease

Say what you will about winter in Indiana; at least it doesn't bring insect-borne diseases. But summer is coming, and it's not just flying pests such as mosquitoes that pose a threat.

Ticks and the pathogens they carry also can lead to serious illness, and evidence suggests that ticks and those diseases are growing more common here, starting with Lyme disease.

Indiana still counts as a "low incidence" Lyme disease state, especially when compared with New England and the mid-Atlantic states. But statistics indicate that may be changing.

From 2004 to 2013, the number of Lyme cases per 100,000 people here tripled, from 0.5 to 1.5, according to the Centers for Disease Control and Prevention. Again, that's nowhere near the number for states such as New Hampshire and Vermont, which each saw more than 100 cases per 100,000 population.

Still, in 2013, there were 101 cases of Lyme disease in Indiana, a significant increase from the 60 or so in previous years, said Dr. Stanley M. Spinola, chair of the Department of Microbiology and Immunology at the Indiana University School of Medicine.

"Whether that's a trend or not remains to be seen," Spinola said.

Some of the increase may stem from improved awareness about the risks associated with tick bites. And some of those diagnosed with the disease may have contracted it elsewhere.

But it's increasingly possible to be infected without ever leaving Indiana. A 2012 study in the American Journal of Tropical Medicine and Hygiene listed Northern Indiana and Illinois as an emerging risk area for Lyme disease. Most of Wisconsin, just to the northwest, was listed as one of the few high-risk areas west of Pennsylvania.

Although a bite from an infected tick can cause a red rash — in the case of Lyme disease, the rash often takes the telltale shape of a bull's-eye — sometimes people don't even realize that they have been infected.

Laura Gordon was diagnosed with Lyme disease in December 2012 after about five years of seeking a diagnosis for several strange symptoms, such as repeat sinus infections, fatigue, muscle aches and swollen glands. During that period, she gave birth to a son, now 6, who a few months later was diagnosed with Lyme, which she probably gave him in utero.

To this day, Gordon has no idea where she encountered the ticks. She didn't travel to any of the hot-button Lyme areas. A few years before she first felt ill, she and a friend worked together at a construction site. That friend, too, has tested positive for Lyme.

But pinpointing the source isn't of much concern to Gordon, a painter and mother of two. She just wants to clear up the infection.

Since her diagnosis, she has been on antibiotics for all but a few months this winter, when she enjoyed a brief remission. Her son spent two years on antibiotics and now seems mostly better, but she has no idea what the future holds. She has spent thousands of dollars on alternative treatments to augment the antibiotics.

"There is so little known about how to attack it," said Gordon, 45, who lives on the Northeastside. "It's devastating."

As the weather warms and heavy tick season begins, doctors and others caution that the best response to Lyme and other tick-borne diseases is preventing tick bites in the first place. If that fails, early detection and treatment with antibiotics can ward off more serious illness.

Dr. Christopher Belcher understands the concern. "There's nothing good that you can get from a tick," he said.

But he sees many patients concerned about tick bites each year, and Lyme disease still tends to be an unusual finding, said Belcher, head of the pediatric infectious disease division at Peyton Manning Children's Hospital at St. Vincent.

Other experts fear that may be changing.

"Tremendous shifts" occurred in the nearly three decades that Robert Pinger, professor emeritus of physiology and health science at Ball State University, studied ticks in Indiana. In 1982, when he began his work, almost all of the ticks he found were dog ticks.

As the population of white-tailed deer blossomed, though, so did the variety of ticks. Lone star ticks, which can transmit Rocky Mountain spotted fever and ehrlichiosis, became more abundant in the southern part of the state.

And those black-legged ticks that can transmit Lyme? Back in the early 1980s, Pinger and his colleagues had to look for a few years before they found one. By 1987, he had found them in many northwestern counties. In the following years, the critters spread across the state.

When he stopped testing ticks for disease in 2005, Pinger had not found a black-legged tick in Marion County. But he did find them in many neighboring counties, including Hamilton, Boone and Hendricks. And he has little doubt that he could find one in Indianapolis if he looked, he said.

"There are probably some of those in all 92 counties," Pinger said. "They were spreading west through Pennsylvania and Ohio and were spreading south and east" from Wisconsin.

Keith Clay, a distinguished professor of biology at Indiana University-Bloomington, has done his own studies of tick-associated microbes. In the 15 years he has worked in the field, he has noted a similar transformation.

When he began, he rarely saw lone star ticks in Southern Indiana. Now, it's the most common tick in the neighborhood, and it's moving north. He, too, has started seeing more black-legged deer ticks where 15 years ago he would never see them.

The good news is he has not found any black-legged ticks infected with the pathogen that causes Lyme disease.

"It may be somewhere, but we just haven't come across it," he said.

Near the Indiana Dunes, however, there's a much higher percentage of Lyme-infected ticks, and Clay sampled one area in Erie, Pa., where 60 to 70 percent of the ticks were infected.

About 1 to 3 percent of the lone star ticks he has found have been infected with a disease-causing microbe. Lone star ticks, also known as seed ticks, derive their name from the white spot the female has on her back. They are fast compared with their tick cousins, easily scrambling up a person's leg in a few seconds, and prefer areas with shrubby, scrubby vegetation.

Many factors affect the percentage of infected ticks in an area, scientists know. Infected ticks and their mouse hosts often cluster together in a relatively limited area, studies have shown. Belcher has seen a few cases of Lyme disease in which a number of people in the same neighborhood fall ill.

Such clusters also can occur with Rocky Mountain spotted fever, a rarer disease transmitted by dogs or lone star ticks. If it goes untreated, it can have a 10 percent fatality rate, Spinola said.

Since falling ill, Gordon has a heightened awareness of ticks. She now regularly checks herself and her children for ticks, which in certain life stages can be the size of a grain of pepper.

And she's constantly reminded of their presence. One day, she appeared on television to talk about her struggles with Lyme disease. When she came home from the taping, she found a tick sitting on the window screen.

Call Star reporter Shari Rudavsky at (317) 444-6354. Follow her on Twitter: @srudavsky.

TIPS TO AVOID LYME DISEASE

June and July tend to be the heaviest months for tick activity, with another peak in November for deer ticks, experts say.

Ticks like to hang out in woods and tall grass, so experts recommend that you check yourself and your children carefully after you have gone into nature. If you have grass, keep it mowed.

When you go outside to an area that may have ticks, take the same precautions against ticks as you would for mosquitoes. Wear long pants and sleeves and apply insect repellent.

If you do find a tick, remove it with tweezers and grasp as close to the skin as you can, pulling it out with a steady motion. Then wipe down the spot and keep in mind where you were bitten. Ticks need to stay attached for 24 to 26 hours to transmit Lyme disease.

If you develop a rash in that area within the next few weeks, see a doctor. Keep in mind that some Lyme infections can occur without that rash, so if you experience fever, malaise, headaches and joint pain a few days or weeks after the bite, seek medical care.