Well Wisconsin Radio

Preventing Tick Bites and Associated Diseases with Dr. Gregory DeMuri 

The information in this podcast does not provide medical advice, diagnosis, or treatment. It should not be used as a substitute for health care from a licensed health care professional. Consult with your health care provider for individualized treatment. or before beginning any new program.  

Host: Hello and welcome to Well Wisconsin Radio, a podcast discussing health and wellbeing topics with experts from all around the state of Wisconsin. I’m your host, Julie Cruz, and today my guest is Dr. Gregory DeMuri. Dr. DeMuri is a pediatric infectious disease doctor with UW Health Kids, and a professor in the department of pediatrics at the University of Wisconsin School of Medicine and Public Health. Dr. DeMuri treats patients with a wide range of infections, including Lyme disease, a bacterial infection caused by ticks. Dr. DeMuri, thank you for joining me today to discuss preventing tick bites and associated diseases.   

Guest: Thank you. It’s a pleasure to be here.  

Host: And, I’m going to ask if you can start our conversation off by sharing with us what your experience is treating patients with tick borne diseases, and specifically patients with Lyme disease? 

Guest: Well, um, Lyme disease, you know, is endemic in Wisconsin. It’s been here for many, many years, as far as we know. And, it’s a very common, um, infection in children, uh, there’s, uh, kind of two peaks of when people get Lyme disease. One is in childhood. Um, the other is older adulthood, right around that 60 to 70 year, uh, range. 

So, we do see a lot of children with, uh, Lyme disease in, uh, Wisconsin. Most of it is actually handled by primary care physicians. Um, I tend to see the more complicated cases of Lyme disease, um, those, uh, unusual or rare ones, the ones that need to be hospitalized.  

Host: Okay. Hmm. Interesting. Thank you for sharing that. I was not aware of kind of those two different stages in life where you are more likely to get Lyme’s disease. Thank you.  What are the most common, um, tick borne diseases in Wisconsin? And, um, you know, tell us a little bit more about what is Lyme disease and how likely is it to occur from a tick bite? 

Guest: So, in Wisconsin, Lyme disease is by far and away the most common cause of tick-borne illness. Uh, the two other ones that are carried by the, uh, black legged tick, or deer tick, are Anaplasia and Ehrlichia and, uh, Babesiosis. Uh, those are, um, also bacterial infections carried, um, by the, uh, tick.  

There’s some other rare ones that are, uh, can occur like Powassan virus, which is actually a virus. And then, um, the other major tick species, one of the other major tick species we have in Wisconsin, the, uh, wood tick can carry Rocky Mountain Spotted Fever. Um, it’s fairly rare, but we do see cases of that here in Wisconsin.   

Host: Hmmm. Interesting. And how likely would you say it is that, um, someone could get Lyme disease from a tick bite? 

Guest: Well, it’s quite common, particularly in certain counties of the state. If you look, uh, at the state, uh, Department of Health website, uh, they have a map of which counties it tends to be kind of central, northwest traditionally. And then down along the, following the Wisconsin River mostly. And a lot of that has to do with, uh, where the hosts are for, uh, for the tick, what it can, uh, live off of. 

Host: Yeah. Can you also tell us, um, or explain to us what is Lyme disease? You know, like we hear people talk about it. You hear it in the news, right? You give us a little bit more information about what, what is the disease itself?   

Sure. It’s, um, an infection. It’s caused by a bacteria. Uh, the bacteria is called Borrelia burgdorferi. Um, um, Borrelia, like northern lights, aurora borealis means, uh, just means north, right? So, it’s a north infection. Uh, the, the, the species, species name Burgdorferi is named after, uh, Willie Bergdorf, who was the discoverer of the bacteria. This bacteria is a unique bacteria. It’s called a spirochete. So, it’s a, um, corkscrew shaped bacteria that lives in the gut of the, um, of a tick and then is basically regurgitated when that tick bites you. And then the, um, the, um, bacteria gets into skin, uh, initially and can be spread through the bloodstream to other parts of the body.  

Uh, the infection itself, the most common manifestation is the rash that I think many people are familiar with in the state. It’s sometimes described as being like a target, so a ring with a clear center.  And, uh, but it can really, the rash can be kind of subtle sometimes too. It can look a little bit like hives occasionally. You can have one spot, two spots, or even many spots all over the body. And then it can affect, um, the heart, um, it can infect the brain, which is more serious, um, even the eyes, uh, unusually. 

Host: Wow. It’s amazing that such a little creature can have such a large impact on the body, right? Like, that’s just. 

Guest: No, it really is. I mean, both the tick, which is little, and then the bacteria, of course, even smaller, microscopic.   

Host: That’s amazing. Um, let’s discuss how we can prevent tick bites. So, are there certain times of the year that ticks are more active and we’re more likely to get tick bites? And what can we do before we spend time outside to help prevent the tick bites?  

Guest: Yeah, there sure are. Um, you know, we’re right in the heart, uh, the peak of, of, uh, tick season right now. Uh, the, uh, late spring, early summer tends to be the worst. Um, but any time there’s basically not a hard freeze, um, humans are vulnerable to, to tick, to tick bites. 

Uh, the ticks are pretty hardy. Um, they do, they do survive in colder temperatures, but they’re not as active. So, when it’s warmer, they’re, they’re, uh, they’re more active. The other thing is the, um, the little forms of ticks, the nymphs, the, um, the immature tick are, uh, more likely to carry the Lyme disease bacteria, and they’re also harder to detect, and they’re more prevalent this time of year and this in the late spring. Um, so this is the worst time really for Lyme disease, this late spring, uh, uh, time of year.  

Host: Oh, wow. So, before we go outside in late spring and early summer, what kinds of things can we do to help prevent that?   

Guest: Yeah. So, there are a number of things, you know, uh, first and foremost, um, it’s more after you go out, but tick checks. Um, we know it takes, probably up to 72 hours for the tick to bite and cause an infection. So, if you catch that tick right away, um, and pull it out, remove it from the body, you won’t get Lyme disease. And, uh, so if you’re, if you’re out, if you’re out with your kids, your family member, everybody come in, do a thorough full body, uh, tick check. 

Uh, don’t forget to look in the little cracks and crevices where the tick can, can crawl. Ticks usually land on your lower part of your body because they’re, they live in long grasses and, um, you pick them up as you walk through the grasses, the lower part of the forest, and then crawl up your body, um, and, and so they’re more likely in the lower part of the body. But you need to check hair, um, you know, go through hair thoroughly because, um, ticks that are often in the scalp are undetected for a longer period of time because it’s more difficult to see them. 

And I think anybody who’s had a dog or a cat who has had a tick, you’ll know how hard it is to sometimes find them.  

Host: Yeah. Yeah. That’s great advice. And, speaking of pets, you know, a lot of times people have their pets outside with them, right? Whether it’s in their backyard or they’re taking them hiking with them or whatever it might be. Um, if pets are outside with us and end up with ticks on them, can they transfer ticks to humans?  

Guest: Yeah, they sure can. Most of those ticks are not embedded in the dog, in the animal. But they can be crawling on the animal. You bring them into your house and the tick will find any warm, you know, blooded host that’s, it’s acceptable that they like that and they find tasty and they find humans quite tasty.  

So, the, the it can be transportation of ticks into the household, um, from dogs, which I know we’re talking prevention. So, you know, a good element to that is talk to your veterinarian about a good tick prevention, uh, medication, uh, for your dog.  

Host: Great. Thank you. Thank you.  

Guest: So, let me talk a little bit more about, um, before you go out, you know, what you, what you can do. Uh, first of all, long clothing is best. Um, yeah, you, if you really want to look nerdy, um, wrap your, the bottom of your, your pant legs in, uh, in your socks. Uh, you know, a great look, I think from the 1950s, but it is very effective. Uh, but paratroopers used to do this, right? When they jump out of airplanes, they, they tuck their, their pants in their boots. And that’s an effective way of keeping the tick on your clothing rather than allowing it to get in your skin and crawl up your, your pant legs. Of course, in the summer, we all like to wear shorts. So sometimes that’s not real practical. Um, and short sleeve shirts, those kinds of things.  

Um, you know, next is, um, insect prevention, um, uh, sprays or, or compounds. And there are really, um, three, uh, major ones that you can put on skin. Um, one is DEET, um, D E E T. Uh, this, the other one is Picaridin. And those are both, um, found in commercial bug sprays, bug prevention sprays, and those can be, um, sprayed, as I said, directly onto skin. 

Um, there is also, um, oil of lemon eucalyptus, which is a little bit more natural if you’re opposed to, um, putting something more chemical on your skin, that’s, uh, can be effective somewhat in preventing, um, uh, tick bites. And oil of lemon eucalyptus can be placed on the skin.   

Then, lastly, there’s Permethrin. Permethrin is sold oftentimes in backpacking stores, outdoor stores, and it is sprayed on clothing, not on the skin itself.  So, you impregnate your clothes with Permethrin, and it’s very effective against both, um, tick prevention and mosquito prevention as well. It, uh, you have to follow directions closely for how to do it on the, on the bottle. Um, it lasts, uh, you know, it has, it has a persistent effect, which is somewhat useful. It might even last through a few washings, but you do have to reapply, uh, occasionally. 

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Host: And let’s say we’ve taken, you know, these steps to prevent tick bites and we still find a tick. Is there a way to tell how long the tick has been attached and what is the best way to remove it? 

Guest: Sure. So, to tell how, uh, how long it’s been there, really the, the most accurate way is knowing where you’ve been and what you’ve done, right? Uh, for instance, uh, last summer I was out, um, uh, clearing woods and chopping wood with some friends up north. And, you know, we started about 8 in the morning, uh, ended up about 5 in the afternoon. 

We did tick checks about 5 p. m. and I had a deer tick on me. So, I know that tick was there, you know, not more than eight, nine hours, uh, total just because of my own behavior. So that’s a good way to, that’s the best way to really measure it, knowing when you went out, when, uh, when you were clear from ticks and when you could have possibly been exposed. 

Um, if the tick is engorged, so if it’s fat. And it looks sometimes kind of white, sometimes you squeeze it, it could be bloody, there could be blood in there, that’s human blood. Then you know it’s been there for a while and, um, we’ll talk about what measures you can take at that point. That’s really the best way to know on the timing of the tick. 

Host: Yeah, that’s good. Um, and then how, like, what is the best way to remove it if you do find it?  

Guest: Yeah, so, um, the Infectious Disease Society of America recommends removing it with tweezers, um, and to grab at the, at the head of the tick. You don’t want to pull on the body of the tick, um, because you can actually remove the, the body or the abdomen and leave the mouth parts. And, uh, the mouth parts can still transmit, um, uh, ticks. So, you need to make sure the mouth parts, the, uh, the proboscis, if you will, uh, are, are removed from the skin. Tweezers seem to be the best way to do that.  

Um, smothering methods such as Vaseline, um, and butter, I think I’ve heard of all kinds of things, don’t work and are not recommended. Um, burning the tick, which I know we did as kids, um, growing up in the UP of Michigan, um, we used to do that all the time. It’s really not effective and can cause harm to human skin, you know, from a collateral burn. So that’s also not recommended. There are tick removal tools that are available on, on, uh, you know, various, um, websites and, and at stores and such. Um, they have variable effectiveness. I haven’t found them to be that great, and certainly in my experience, not better than a tweezers.  

Host: Okay. So, it sounds like from what you said, using the tweezers and removing it by the head is really the best way to remove the tick then.   

Guest: That is. Yes.  

Host: Okay. Thank you. 

Guest: Sometimes you get a little piece of skin when you’re pulling with the tweezers and, and that’s okay. Then, you know, you got the mouth parts.  

Host: Yeah. Then it’s a hundred percent for sure. You’re, you’re good, right? 

Guest: A hundred percent for sure.  

Host: All right. Um, so let’s say, you know, the tick was on me and, um, I’m thinking, okay, now this tick has bit me. Right. And so, cause it was engorged. Um, what can I do or what should I do to, to, I’m going to treat a tick bite at home and when should I be concerned about it and see my doctor after I remove it?  

Guest: Sure, the first thing is, uh, to really know the species of the tick or identify the species of the tick. Uh, we have three tick groups in Wisconsin. 

The, um, the Lyme disease tick, which is called the deer tick or, black legged tick. Um, then we have the wood tick, which is actually probably more common in many areas, particularly northeast part of the state. Um, and then, um, pretty rare, but, um, recently found in Wisconsin, the lone star tick. They all have different, um, uh, structures and color, uh, to them. And there are lots of websites out there, um, including the State Department of Health website, which I’ll certainly plug today, uh, because it’s the Lyme disease section. If you, if you type in Lyme disease DHS in Google, you’ll, Wisconsin DHS, it’ll pop right up. That website is very helpful. Um, it does show pictures of ticks, uh, so you can have it identified. 

Um, Uh, various clinics and hospitals will have a, uh, sometimes be able to identify the tick for you. If you call your, uh, your primary care provider, uh, that can be done as well. If it’s a, uh, wood tick, then you’re really out of the woods. Um, no pun intended. Uh, the, although, uh, I said, uh, wood ticks can cause Rocky Mountain Spotted Fever. 

That’s a very rare infection and wood ticks are very common. A lot of humans get bit with a bit by them. If it’s a deer tick and it’s been on for more than 72 hours and you’re pretty sure it’s been more than 72 hours, we, uh, do recommend antibiotic prophylaxis or prevention. This involves taking a single dose of an antibiotic called doxycycline. Just one dose afterwards and then you’re done. This has been shown to be quite effective in preventing Lyme disease after a known deer tick bite.  The antibiotic needs to be prescribed from a primary, your primary care provider or, or, um, emergency department, urgent care clinic, et cetera.  

Host: Great. Thank you. And it sounds like there’s some good resources out there to help identify what kind of tick it is. And, um, and then even just contacting your primary care physician’s office and getting their help too. Great. Thank you.  

Guest: Absolutely.  

Host: Um, we talked about Lyme disease being the most common tick-borne disease in Wisconsin. Um, can you tell me a little bit about you know, when does a person experience symptoms of Lyme disease after a tick bite if they’ve gotten it? And what symptoms are those? Like what, what types of symptoms are associated with Lyme disease?  

Guest: Sure. There’s, um, really, we divide Lyme disease up into kind of two groups, early disease and later disease. 

And early disease occurs anywhere from two to three days after infection to a few weeks. And those symptoms typically are the rash. Um, and it’s that round, circular rash I mentioned earlier. Pretty characteristic. One, you know, a great thing I tell patients to do if you see the rash, take a picture of it, because sometimes they come and go, and it’s good to have that photo documentation of it when you go to your provider, healthcare provider, you can show them the picture and try to figure out together if the rash is from Lyme disease. 

Um, also in the early group is the, um, uh, facial droop, or we call it facial palsy or Bell’s palsy. And this is a, um, temporary paralysis, usually temporary, of one side of the face. So, you’ll see, um, a drooping of the mouth. Um, uh, uh, eyelids don’t close all the way, um, and it’s, it’s very characteristic, it’s, it’s a little disturbing when, when it happens, um, and in Wisconsin, anybody with a Bell’s Palsy should be investigated for possible Lyme disease. There are other causes of Bell’s Palsy, you know, including strokes, so it’s really important if you see, uh, a Bell’s Palsy, if you have a Bell’s Palsy, you need to be seeking care, uh, quite quickly. 

Host: Okay, that’s good information to have.  

Guest: Yeah. Um, and then the late forms of Lyme disease show up, um, weeks to months later. Um, so I’ve seen some of the late forms in February, right? So, you know, in February that there hadn’t been ticks around, the active, since probably, you know, October, November. So, uh, this was, these were in children. The most common one we see is arthritis. Um, and in fact, that’s how Lyme really came to be discovered, um, out in Connecticut. In Lyme and Old Lyme, Connecticut, the two cities, um, out there. Um, was because of this outbreak of arthritis that was occurring in the city. Arthritis is joint inflammation. When it happens, it’s quite clear. There’s swelling, tenderness of a joint. It tends to involve the larger joints, so knee, ankle, hip, sometimes elbows, uh, rather than the small joints which would be like the wrists and, uh, and fingers. 

Um, joints are painful. They’re red, sometimes hot. Typically, there’s not fever associated with them, but there can be, um, and there can be fever with the rash I mentioned earlier, uh, as well.  And then, um, the, the, other two major manifestations are when it gets into the central nervous system, and it can cause meningitis and inflammation around the brain, or, um, involvement of the brain itself, and that can lead to, uh, either temporary or permanent brain damage, particularly, um, um, if not treated, but even with treatment. 

And then, carditis, which is, uh, inflammation of the heart, uh, the, uh, rhythm of the heart is sometimes disturbed. It causes, the Lyme disease bacteria causes the heart to slow down. What we call bradycardia, or heart block. And, uh, it’s the most common manifestation of, uh, heart disease. And that too can be very, um, serious and requires, uh, immediate medical attention. 

Host: Wow.  So, you know, my next question is, is this, these symptoms, is Lyme disease going to go away on its own or are there special treatments for these symptoms, for the disease itself that people can receive?   

Guest: Um, Lyme disease most of the time goes away, you know, it has been around for a long time, right? And many people, most people, would recover if not treated. 

However, if left untreated, there is a risk of the long-term complications, the carditis, arthritis, and the brain infection that can occur. And, the brain infection is really the most serious, and some people have become quite disabled from it. So, the key here is treating it as early as you possibly can. 

There are good treatments for it. I mentioned doxycycline, which is one antibiotic. There are other antibiotics that are sometimes used in the courses for for Lyme disease we know anywhere from 10 days to 28 days of of an oral antibiotic, occasionally we use an IV antibiotic for short term, but we know you don’t need prolonged antibiotics. 

Um, antibiotics no more than a month are effective at treating Lyme disease.  

Host: Okay, thank you.  Now, I’ve read that Lyme disease could be linked to some autoimmune diseases. Can you share with us if and how Lyme disease and autoimmune diseases are connected, and are there any other diseases that might be connected to Lyme disease as well? 

Guest: I think the association between Lyme disease and autoimmune disease is controversial. Um, I don’t think it’s well established or well accepted by, uh, the Infectious Disease Society of America, which tends to be the, the major issuer of, of, uh, guidelines and, and knowledge about, uh, about Lyme disease. Um, people who have immunodeficiencies, uh, who have, are immunosuppressed might be more um, susceptible, uh, to Lyme disease and should take, um, extra care. 

Uh, in terms of associations with other diseases, um, mainly we worry about the other tick-borne infections. So if you have, if you’ve been bitten by the deer tick and you have Lyme, um, if, uh, the, uh, treatment wasn’t effective, if you’re still having symptoms, then, um, physicians sometimes will check for the other diseases, Anaplasma and Ehrlichia and Babesiosis. 

Host: Thank you.  Um, what resources do you recommend to our listeners if they’re looking for more information about preventing tick bites and associated diseases?   

Guest: Well, the, uh, Wisconsin Department of Health website, if you’re in Wisconsin, or actually if you’re anywhere, is super, um, uh, uh, readable, knowledgeable, and very, very accurate about, uh, Lyme disease. 

The CDC has a great, uh, webpage on Lyme disease as well, with very accurate, up to date information. If you want to get into the weeds a little bit more, you can go to my organization, the Infectious Disease Society of America or IDSA.org and type in Lyme disease and you’ll see some of the medical guidelines. These are designed for healthcare providers, but some people really like to get into the science nerdy part of it and there’s a lot of background information there. It goes over clinical trials, uh, you know, which antibiotics are effective, treatment durations, all those types of things. Um, and, and backs up a lot of what I’m saying with, with the scientific evidence.  

Host: Great. Sounds like there’s a couple good resources online that any of our listeners can go to and access and get and get more information. Fantastic. And it sounds like, you know, not only are you a physician who’s, you know, treating infectious diseases and have experience with Lyme disease, but that you like to get outside yourself. Um, so I’m just wondering if you have any final words of wisdom to share with our listeners about preventing tick bites and Lyme disease that we haven’t talked about yet? 

Guest: Uh, you know, uh, tick checks, tick checks, tick checks, really, because that’s the easiest thing to do. It’s nontoxic. Uh, you know, hopefully you have a good friend who can help you, uh, a good safe friend who can help you look, uh, in most parts of your body. Uh, so that’s, that’s first and foremost. Second of all, I think there’s a lot of worry about, uh, Lyme disease, um, and with good reason, you know, it, it, it can cause severe infections, but, um, overall, you know, Wisconsinites spend millions of hours outside, you know, we’re, we’re an outdoor people, right? We like to hunt fish and camp and hike outside. And the, and yet people don’t have serious complications from Lyme disease. There was a, um, an article about Lyme disease that came out in the nineties, uh, in a magazine, back when we had paper magazines and it had a picture of the deer tick on it and said the deadly tick. 

Well, Lyme disease really is not deadly. Um, there have been really very, very few, only maybe a handful, less than five deaths documented from Lyme disease. Most people, when they’re treated, um, do really quite well with Lyme.   

Host: Great. Thank you so much for all of that wonderful information, Dr. DeMuri. And hopefully our listeners are inspired to get outside, but also to do those tick checks once they get back in during this time of the year. So, thank you so much.   

Guest: Thanks. Can I, um, just bring up one more pedantical thing?  

Host: Yes!  

Guest: I don’t, I don’t know if you want to use this or not. So, the, the name, uh, the name for Lyme disease, as I mentioned earlier, comes from two cities in Connecticut, Old Lyme and Lyme, Connecticut. And so, when we talk about Lyme disease, when, um, when we write it, the word, it’s L Y M E, and there’s no S on the end. 

It’s not an eponym and disease named after a person, um, you know, like Wilson’s disease or, you know, Down’s syndrome, so we don’t, uh, we don’t put the apostrophe S on it, so we just call it Lyme disease.  

Host: Yeah. And I, I think I probably said Lymes a couple of times today, and I know our list, our listeners probably can identify with that too, of like, oh wait, I didn’t know that. 

Guest: You’ll get, you’ll get letters. 

Host: Yeah, exactly. Exactly. Well, thank you so much. I appreciate that little extra tidbit of wisdom to share today.  

Guest: Oh yeah.  Yeah. You bet. We’re, uh, ID people tend to be pedantical.   

Host: Thanks so much, Dr. DeMuri.   

Guest: Oh, my pleasure.   

Host: Thanks for listening today. I hope you enjoyed the show. You can find our survey in the Well Wisconsin portal and our transcripts of previous episodes at webmdhealthservices.com/wellwisconsinradio. If you’re listening to this podcast on your platform of choice, please be sure to subscribe so you’ll never miss an episode. 

It is that wonderful time of year in Wisconsin! Time to get outside and enjoy all the beauty and recreation our state offers during the summer. As we do so, it is also a good idea to review the steps we can take to prevent tick bites and educate ourselves about tick-borne illnesses.  Our guest, Dr. Gregory DeMuri, is a pediatric infectious disease doctor with UW Health Kids and a professor in the Department of Pediatrics at the University of Wisconsin School of Medicine and Public Health. Dr. DeMuri will share with us what we can do to protect ourselves and our families as we venture outdoors and delight in the wonders of Wisconsin.

Resources Referenced in Podcast:

• WI DHS, Illnesses Spread by Ticks
• CDC, Lyme Disease
• Infectious Diseases Society of America

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