More Bad Bugs in the Backyard
by Ken Rude, PT

"It started out in the morning." Debbie tells me of the sudden onset of illness in 1999. "I felt fine. I went to work. Around noon, I started getting chilled, where I just couldn't seem to get warm. I went home, was so cold that I was shivering violently. I went and I took a hot bath just to try to warm up. Still couldn't get rid of the chills, and I went to bed."

Lyme disease is the tick-bite disease everybody in the Hudson Valley knows about. It's a serious sickness that can make you acutely ill, and can debilitate you for years or decades with symptoms affecting the joints, the brain and the heart. Once a person is infected with Lyme, it can sometimes be exceedingly difficult to eradicate from the body. And there have been fatalities, as Lyme disease has left a trail of devastation across the country and around the world.

But it may not be the most dangerous disease ticks can pass on to us. That dubious distinction could go to ehrlichiosis, a disease that lives here in the Hudson Valley. Ehrlichiosis is not one single disease, but actually the general name for diseases caused by four bacteria in the genus Ehrlichia. There are two American forms of the disease. Human monocytic ehrlichiosis (HME) is found more commonly in the southern and western United States. Human granulocytic anaplasmosis (HGA) is the ehrlichiosis most commonly found in New York State. It's caused by Anaplasma Phagocytophilia (write it down, kids—it's on the test), and it's transmitted to us through the bite of an infected deer tick.

To be precise, then, what we're mostly seeing in the Hudson Valley is a disease called "anaplasmosis," not "ehrlichiosis." The two illnesses are almost identical, aside from being caused by different bugs, so this article will simply refer to them as "ehrlichiosis." Actually, we're not the only animals being affected by this illness. Veterinarians were fighting the bug in our dogs before doctors began finding the disease in us. The sickness has also shown up in deer, mice, cattle, horses, goats and sheep.

Debbie again: "I had a fever of 105°. I had severe chills, which would alternate with sweats, where the water was just running off me and would saturate the bed sheets so that I would have to change the bed 'cause it was so wet, unless I laid on towels. I had nausea but no vomiting. I would try to position myself with pillows to get comfortable. But I couldn't get the pressure off my joints. They just hurt so badly. It was an ache that I had never experienced in my life."

Ehrlichiosis/anaplasmosis is found not only in New York and the Northeast, but in the Southwest, in Texas, in California, and in places all over the world. Not everybody infected becomes seriously ill; some infections cause only mild sickness. It can be treated by antibiotics, most commonly with the same doxycycline used to treat Lyme disease. Fortunately, it seems to be more easily controlled than Lyme sometimes is and, if antibiotics are started early, the prognosis in healthy persons is excellent.

But it would be drastically wrong to underestimate this illness. For one thing, it can be difficult to diagnose because it shows no physical signs such as the rashes seen with Lyme disease or Rocky Mountain Spotted Fever. Basing a diagnosis on the symptoms only—the fever, aches and nausea—could lead to any number of possible illnesses. A blood test can diagnose ehrlichiosis, but it is a fast-progressing disease that should be treated as soon as it is suspected—without waiting for test results. The reported hospitalization rate for HGA (the local strain) is 28 54 percent. The rate of fatalities is 7 10 percent. Even considering that many milder cases likely go unreported, this disease may be more deadly than flying bullets.

"I got sick on a Friday, and I was in the hospital by Monday. (The doctor) diagnosed it right sitting in her office. She said 'You have ehrlichiosis,' and I was a direct admit to Sharon Hospital (in Connecticut)."

The quick-thinking diagnosis in absence of a blood test probably saved Debbie's life. "The comment from the doctor was that they really didn't expect me to be discharged. At least, not walking out. They expected me to go by way of the mortuary. "I was told that if I had waited one more day, that I probably would have bled to death internally at home. With your platelets being so low, you just hemorrhage internally."

The affected tissues in anaplasmosis, our home-grown neighbor, are the granulocytes—one of several types of cells that make up our white blood cells. Comprising the main part of our immune system, the white cells attack and kill germs that invade our bodies. HME, less common in the Hudson Valley, attacks monocytes, which are another component of our white cells. These, along with two other forms of ehrlichiosis found overseas, all look pretty much the same in an infected person. Hemorrhage, which Debbie mentions, is a complication affecting only the most severe cases. Another complication of this immune system infection is that, if not treated promptly, the body becomes susceptible to deadly viral super-infections.

How common is ehrlichiosis in our region? This is a difficult question to answer, because many mild mild cases go unnoticed and untreated. In 2002, 727 cases of HME and HGA were reported nationally, with 84 cases in Dutchess County. In 2003, that numbers were 683 nationally, with 61 in Dutchess County. The Hudson Valley and Long Island are the regions of New York State where the illness is most prevalent.

Official data released by the Dutchess County Department of Health show that 186 cases of ehrlichiosis/anaplasmosis were reported in the county in 2005, 138 cases in 2006, and 85 cases in 2007. Data on fatalities in Dutchess County were not available to this publication at press time. Of these cases, it is estimated that about 80 to 90 percent were anaplasmosis, with the rest being ehrlichiosis. Again, the two diseases are nearly identical in the clinical picture they present. It is not clear that the number of new cases of the illnesses will continue to decline, as that number will track, among other things, the tick population, which will vary from year to year. What should be clear is that a large portion of the nation's cases of ehrlichiosis occur right here in Dutchess County. The bad bugs are indeed in our backyard.

This is one case where your best defense is a good defense. If you can keep from being bitten by a tick, you won't get the disease. If you're outdoors in woods or fields, you should wear a white-colored, long-sleeved shirt and pants, with everything tucked in. Insect repellent is a good idea, but make certain you apply it exactly as directed so the repellent won't make you sick. Your final line of defense is a visual inspection (get a friend or a mirror) every time you come back inside after visiting a possible tick habitat. You can get more specific advice on tick disease prevention by visiting a reputable web site, such as the Centers for Disease Control (www.cdc.gov/Features/StopTicks/).

Debbie has the final word: "It scared me. I was frightened. I really realized how close I was to death, and I was foolish to remain at home (for three days) and not seek medical attention earlier. The children tried on numerous occasions to get me out of bed and to the emergency room, but I refused. I've told the children that if I ever show symptoms the way I did with ehrlichiosis, that they are to bag me and carry me out of the house, no matter what I say.... I would say it was a month before I recovered fully. I've had Lyme since then, but not the ehrlichiosis, thankfully."