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Consult a qualified Lyme ( Borreliosis ) Disease literate doctor for medical advice if Lyme Disease is suspect.
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http://www.missoulian.com/articles/2004/03/30/news/top/news01.txt
Through the years, Lyme disease in Montana has been an open-and-shut case. To Montanans who thought they had it, the response from health officials has been the same: You couldn't.
Montana has the wrong kind of ticks. It's deer ticks that carry Lyme disease, and Montana's ticks are Rocky Mountain wood ticks.
"We've told people, 'We don't know what you have, but we know what you don't have, and that's Lyme disease,' " said state epidemiologist Todd Damrow.
But Damrow and others were troubled by a nagging repetition of a similar set of symptoms reported by patients and by physicians: fever, severe fatigue and a bull's-eye rash at the site of a tick bite on the patient. A couple of years ago, Damrow got a photograph of a perfect bull's-eye rash from a public health worker in Montana. The rash was on a patient who had not left the state. At the same time, the Centers for Disease Control and Prevention were investigating a connection between Lone Star ticks in the Southeast and similar symptoms. They found a Lyme disease-like agent in the tick.
"So I thought, 'Well, gosh, maybe I should not be so cavalier when we get these reports,' " Damrow said.
The result was a study that began last tick season. The hypothesis is this: Could Montana have a similar phenomenon in its ticks, a Lyme disease-like agent that has adapted to the wood tick and is causing this similar illness?
"We know we don't have Lyme disease, because we don't have the right kind of tick," said Pam Goldberg, an infectious disease specialist at the Missoula City-County Health Department. "But we might have a cousin to it."
The study is a collaboration among local health departments around Montana, the state Department of Public Health and Human Services and the federal Rocky Mountain Laboratories in Hamilton.
"We're real excited about it," Damrow said. "Doctors are concurring with this, and they think we're right on line."
With western Montana's warmer weather in the past couple of weeks, ticks have appeared. Around Missoula, they've been picked up on Waterworks Hill, Mount Sentinel, Mount Jumbo and Blue Mountain. Hikers and bikers who extract blood-sucking ticks should think twice before crushing or flushing them.
"When you get bitten by a tick," Damrow said, "don't throw it away because it may be of scientific value."
Here's how it works: People who find ticks actively biting themselves or other people - not pets - should carefully remove it using tweezers or protected fingers. Pull steadily up and out; jerking may break off pieces of the tick's mouth under the skin, which can cause infection. Disinfect the bite and wash your hands. Put the tick in a plastic bag or jar, label it with your name and phone number, where it was found on the body and where it was picked up and take it to your local health department. Local health officials will send the ticks to the state.
If you develop a bull's-eye rash around the tick bite, see your doctor. The doctor will draw a blood sample for state scientists to look at. Two months later, another blood sample will allow scientists at the state and at Rocky Mountain Labs to check for an antibody the patient may have developed to fight the illness. The health department will also want to take a photograph of the rash.
Ticks that bit a person who developed a rash will be tested for evidence of infection at Rocky Mountain Labs, said Tom Schwan, a senior investigator and acting chief of its laboratory of human bacterial pathogenesis.
"We'll try to detect the DNA from the bacteria that we suspect will be in them," Schwan said. "That could lead to an association between an infected tick and the symptoms in the human."
The labs, which Schwan said are still waiting for official approval of the study from their parent agency, the National Institute of Allergy and Infectious Diseases, will use a test to amplify the DNA in the organism taken from the tick and map its sequence. Scientists will then compare that sequence to other organisms in a database, looking to prove the suspicion that illness is being caused by bacteria related to the Lyme disease spirochete.
"We will either make that link or not make that link," Schwan said.
If that link is solidified, then it can be said there's a public health risk, he said.
With help from the University of Montana and UM professor Mike Minnick in the Department of Biological Sciences, the study's protocol has been approved by the Investigation Review Board, Damrow said.
Another benefit of the study will be the ongoing look at the Lyme disease-like illnesses people develop. Because these cases haven't been followed, it's not known if they go on to the neurological and arthritic involvement characteristic of Lyme disease, Damrow said.
"It's significant," he said, "because we really haven't characterized these cases."
Last year, 345 ticks were collected around the state. Six of them were definitively linked to a photographed or physician-documented rash. For those six cases, paired blood samples were also collected.
All this is not to say that people should try to attract tick bites for the advancement of science. Montana's own wood ticks can be infected with the bacteria that cause Rocky Mountain spotted fever. One or two cases occur in Montana every one or two years, Damrow said.
"Untreated, it can be fatal," he said. "It is a potentially serious illness that is transmitted by our ticks here."
The risk of infection is reduced if an embedded tick is found and removed before three hours have passed, Goldberg said.
It's a good idea to check your dog, too, after you've been outdoors, she said. While ticks on dogs are not being studied, dogs can bring ticks into the house that can migrate to humans.
The best defense outside is to keep covered with clothes that fit snugly around the wrists and ankles. Ticks wait on bushes and plants with their front legs ready to grasp anything that brushes against them. Right now, they are out in force.
"The temperature's just right," Goldberg said. "It's warm. We have the sun. Right now it's the peak."
Reporter Ginny Merriam can be reached at 523-5251 or at gmerriam@missoulian.com
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