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El Dorado Hills Telegraph
Folsom CA
August 23, 2006
Tick-borne Relapsing Fever: A Tahoe Tale
By: Dr. Jason Eberhart-Phillips, MD
Tuesday, August 22, 2006 4:18 PM PDT
Steve Fernald knew something was amiss when he conked out on the living room sofa one Friday evening in June.
The 53-year-old culinary arts instructor at Lake Tahoe Community College was taking a moment to rest his feet at home during his daughter's graduation party. He had done all the cooking for the party and had spent much of the evening climbing up and down stairs to serve his guests.
When he awoke later on the sofa he felt unusually weak and quite chilly. Not one to spoil a party, he said good night and headed off to bed.
A survivor of two heart attacks, Steve doesn't usually get too bothered when he isn't feeling right. "I'm a bulldozer kind of guy," he says, when it comes to minor illnesses.
But by the next morning his illness was anything but minor. His temperature was 102 degrees and rising. "I felt punk," he said. When his fever reached 104.5 degrees, his wife Madeline brought him to the local emergency room.
"It was like being in another realm. It was out of my control. I was just praying for survival. There was not a lot I could do," he said.
What Steve had was tick-borne relapsing fever (TBRF), a bacterial infection caused by the seemingly innocuous bite of a soft-bodied tick.
Lucky for him, Steve's emergency room doctor recognized his illness and confirmed it with a simple blood test. The doctor himself had suffered from TBRF the previous summer. He gave Steve an antibiotic and kept him in the hospital until the worst symptoms resolved.
"It was very scary, believe me," Madeline said. "We had no idea these little critters even existed."
She was referring to the reclusive soft-bodied ticks that transmit this disease. Unlike the more familiar hard-bodied ticks - like the ones dogs get or those that pass on Lyme disease - these ticks feed at night, when their victims are sleeping. Their bite is painless and they drop off after 15 to 20 minutes.
Most people never know they were bitten.
That was the case for Steve. A week before he became ill, he and his wife were sleeping in a Tahoe-area summer home where they serve as caretakers. Some time while they slept a tick had a late-night snack on Steve's blood, which gave him the infection.
Soft-bodied ticks usually feed on mice, rats, chipmunks and other small animals. These creatures are the natural hosts for the bacteria that cause TBRF. Humans only get infected by accident, when a hungry tick can't find one of its usual furry victims.
Fortunately, TBRF is rare, with only a few dozen cases reported each year in the 14 western states where it occurs.
But the Tahoe basin is becoming a hotbed for this disease, with five cases reported there last year, in addition to Steve's case last month. Incidence peaks during the summer.
Most cases occur when summer visitors come to the mountains and sleep in cabins or vacation homes where rodents had made their nests during the colder months. An inspection of the old, rambling home where the Fernalds were staying found ample evidence of rodent infestation. In fact, a dead mouse was lying in a trap right under the bed where Steve slept.
Preventing TBRF is a matter of eliminating the breeding and nesting places of rodents in and around cabins and vacation homes in wooded, mountainous areas like Lake Tahoe. This means removing rubbish, including excess firewood and building materials, from areas near the home.
It also means rodent-proofing buildings, to prevent easy access to the inside of the house. All holes in a building's exterior should be sealed, including openings around pipes and conduits.
Any existing rodent nests should be removed from walls, ceilings and floors, and fumigants should be used to eradicate ticks.
Bottom line: If you aren't sure that your vacation retreat hasn't got a rodent problem, don't sleep there.
It's been a month since Steve became ill, and now his health is back to normal. During that time he has been doing a lot of reading about ticks and tick-borne diseases, including TBRF. He is glad his story will be told, if it helps others avoid becoming sick.
"This was a big surprise. I really wasn't aware of this disease before," he said.
- Dr. Ebert-Phillips is the El Dorado County Health Officer.
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