Tag Archives: tick borne disease

Not All Lyme Rashes Are Created Equal

by Jennifer Crystal

Lyme disease: that’s the illness you get when you find a bulls-eye rash, right?

It very well could be, but here’s the catch. The bulls-eye rash isn’t the only sign of Lyme disease. Nor does every Lyme rash (Erythema Migrans or EM) present as a target with red rings around it. To assume that Lyme always comes with a bulls-eye rash is, in fact, to be way off target and—worse—poorly informed when it comes to diagnosing the disease.

In fact, less than 50% of Lyme patients ever find a bulls-eye rash, or any rash at all. But that doesn’t mean they don’t have Lyme. It means they, and their doctors, will need to look a little further.

I found a rash on my forearm in the summer of 1997 while working at a camp in Maine. It wasn’t a bulls-eye shape. It was a series of red dots, sort of stippled, that extended from my wrist almost to my elbow. It wasn’t raised and it didn’t itch.

“It’s probably from your sleeping bag or something,” the camp nurse said. In 1997 Lyme disease was not on the public health radar or mine, which is ironic since I grew up in Connecticut where the disease was first discovered.

That same summer I developed hypoglycemia, which I later learned is a common symptom of the tick-borne disease babesia, a co-infection of Lyme. That fall I was bedridden with flu-like symptoms. Had I presented these symptoms, and my rash, to medical professionals today, they might have seen a pattern and tested me for tick-borne illnesses. Lyme literacy is improving, but not all doctors look at individual symptoms in a big picture way—and that pesky myth of the bulls-eye rash, especially if you don’t have one, still persists, which is why I continue to share my story.

Sample Em-RashEM rashes present in many different ways. Some are small. Some are big and blotchy. Some are spotted. Some are pink and some are bright red. If these sentences are starting to sound like a Dr. Seuss book, it’s because the lesson they contain is simple. If you find any type of rash at all, especially during the summer months, and if you subsequently experience symptoms of tick-borne illness, do not assume your rash is nothing. Show it to a Lyme Literate Medical Doctor (LLMD), who you can find here.

If you, your children, or your pets spend time outdoors, it’s important to do nightly tick checks of everyone exposed. As you are looking for culprits, also keep your eye out for rashes of all kinds. They don’t always appear in obvious places. A rash could be on your back—have someone else look!—in your groin, between your toes, behind your ears, or on your scalp.

And a rash might not be there at all, but you can have Lyme disease without ever getting one. Therefore, in addition to checking yourself for ticks and rashes, it’s important that you keep an eye out for typical Lyme symptoms. If you experience flu-like symptoms such as fatigue, joint aches, headaches, neuropathy, Bell’s palsy, or any other unusual symptom, do not brush it off as a summer flu.

Maybe you’ll get lucky, and that’s all it will be, the summer flu. But it’s better to be safe than sorry; let an LLMD make that call. You will also want to keep an eye out for symptoms of co-infections, like the hypoglycemia which I experienced.

Of course, if you are lucky enough to find a bulls-eye rash, take it as an unequivocal sign: you have Lyme disease. Do not wait to see if you develop symptoms. That can take months. By which time the disease, and possibly co-infections, will have spread further into your system and may cross the blood-brain barrier. Then the disease(s) will be much harder to treat.

In a way, finding a bulls-eye rash is like winning the lottery. If you’re smart, you have a ticket to immediate diagnosis and treatment. Moreover, it’s unlikely that you won’t have to deal with chronic symptoms and long-term treatments. If you aren’t so lucky as to win a bulls-eye, keep looking for ticks, atypical rashes, and symptoms of tick-borne disease.

I wish you all a Lyme-free summer!

Opinions expressed by contributors are their own.

Jennifer Crystal is a writer and educator in Boston. She has written a memoir, One Tick Stopped the Clock, for which she is seeking representation. Contact her at: [email protected]

tick threats

Taking Stock of Tick Threats

by Mayla Hsu, Ph.D., Director of Research and Science, GLA

“Tickpocalypse!” “The Year of the Tick!” “A Tick-ing Time Bomb!” These are all recent clickbait headlines that cause us fear and anxiety. But how do we realistically and reasonably know the risk of acquiring tick-borne diseases? How can we anticipate that ticks will be in our neighborhoods?

There’s no doubt that Lyme disease and other illnesses spread by ticks are on the increase. As might be expected, climate change, land and habitat management, and human behavior are all variables that affect the degree of risk. The Centers for Disease Control and Prevention (CDC) has found that the geographic range of ticks is expanding, with the principal vector of Lyme disease, Ixodes or black-legged tick, now found in 49% of all US counties. The CDC has also shown that the number of counties with high Lyme disease incidence is growing. If areas previously unknown for ticks become suitable habitats for them, which is now occurring, we will need surveillance strategies that will dependably inform public awareness and prevention programs.

More than 40 years after Lyme disease was first identified, we now know that the life cycle of ticks depends on host species that provide the three blood meals needed for a tick’s major life transitions: (1) from larva to nymph, then (2) nymph to adult, and (3) so adult females can lay eggs. Small mammals like mice and chipmunks, as well as birds, deer and other animals are all host species for ticks. When not “questing”, or awaiting passing hosts from the tops of blades of grass, and when not attached to host animals, ticks are on the ground, where they spend most of their time.

We can measure tick abundance by directly counting ticks caught in traps or by cloth dragging, and identifying the tick species caught. Advantages to this are relative ease and lack of expensive technology. However, cloth dragging on the ground may be obscured by dense vegetation or trees. Another obvious limitation is that dragging may not sample large enough geographic areas. In addition, transient environmental variables like weather changes or time of day can affect tick trapping and drag capture outcomes.

Surveying animals is another way to measure tick prevalence. This can include counting ticks from domestic livestock or pets, or trapping wild animals such as mice. Wild host species can potentially serve as “sentinel” species, indicating tick abundance in the host’s native habitat. Generally, a good sentinel species would be an animal that can be caught and sampled readily, has a predictable geographic range, and is attractive to ticks. An example is the white-tailed deer, in which tick burden and pathogen load has been successfully studied in hunted animals.

Another example is wild pigs, whose large range can span various habitat types, and who can host varying species of ticks. In a recent study of 316 wild pigs in Florida, 1,023 adult ticks and only one nymph tick were collected. In contrast, 39 adults, 150 nymphs, and 2,808 larvae were found from dragging. This difference is likely because immature stages of ticks tend to quest lower than adults. Thus, larvae and nymphs are more likely to found than adults by dragging survey. In contrast, adult ticks may be more likely to be detected on hosts that have a medium to large body mass. Overall, these results suggest that complementary information was available from the two sampling methods. Together, cloth drags and sentinel species gave more complete information about tick abundance than each done separately.

With field data from cloth dragging and sentinel species, mathematical models can be built to predict whether tick populations in local neighborhoods are expected to be high or low. These calculations add data on elevation and weather patterns, including humidity, daily and seasonal temperature fluctuations, and precipitation. The type of habitats, whether agricultural, grassland, or forest, all composed of varying vegetation types, are also included in models.

Mathematical models were used to identify the highest densities of host-seeking nymph ticks in Minnesota. The study’s authors found that tick density increased as the proportion of agricultural land decreased, with the highest risk of host-seeking nymph ticks in the Minneapolis-St. Paul metropolitan area. Large swathes of western and southern Minnesota were found to be unsuitable for ticks, perhaps because such large rural areas are lacking in potential tick hosts. They also found that extremes of temperature and precipitation were identified as predictors of tick density.

Climate change will play a big role in tick habit expansion, with reports of ticks now emerging in Canada. Specialized mathematical models known as climate envelope models predict suitable new habitats for species. This type of model was used to determine whether a newly invasive tick, Haemaphysalis longicornis, would be predicted to expand in New Zealand. It was calculated that 75% of cattle farms in North Island and 3% of those in South Island will be suitable habitats for this tick, a concern because it transmits cattle anemia. This information will be important for gearing policy toward tick surveillance and reduction.

Ticks are an important concern for public health, environmental management, and agriculture. Only with reliable and valid research will we be able to accurately describe and anticipate future tick threats. This will be a rational first step toward effective control.

mayla hsuMayla Hsu, Ph.D.
Director, Research and Science
Global Lyme Alliance

Mayla manages GLA’s research grant program, working with the Scientific Advisory Board and creating viable partnerships to help advance the development of a reliable diagnostic test, effective treatments and ultimately a cure for Lyme.


tick table

patient laboratory

New test for Babesia approved by the FDA

by Mayla Hsu, Ph.D.
Director, Research and Science
Global Lyme Alliance

Screening the blood supply for infectious microbes should be an obvious and ongoing health sector priority, especially for those microbes known to cause disease. Although donor blood and organs are tested for viruses like HIV and hepatitis, screening for other pathogens is limited.

One such pathogen is the parasite called Babesia microti, which causes an infection known as babesiosis. Transmitted by the bite of black-legged ticks, babesiosis either causes no symptoms in healthy people, or mild self-limiting symptoms. However, in the very young or old, or in the immunosuppressed, babesiosis can cause a malaria-like disease that can be life-threatening.

Because B. microti replicates in red blood cells, an infected, non-symptomatic donor can harbor it in blood, tissue or organs. Worryingly, it’s not screened for, and until now, there has been no FDA-approved test to detect it.  Last week, however, the FDA approved two new tests from Oxford Immunotec to detect Babesia. One test looks for antibodies against the parasite in blood plasma, indicating evidence of infection. In whole blood, a second test uses sensitive nucleic acid detection to directly identify the presence of the parasite. These tests will be performed in-house at Oxford Immunotec facilities in Norwood, MA. They are not intended to be used for diagnosis of babesiosis in patients.

There is evidence that screening blood is effective in preventing transfusion-acquired babesiosis. In 2016, the American Red Cross published a study of babesia screening in states with a high incidence of tick-transmitted diseases. They found 14 reported cases of transfusion-transmitted babesiosis per 253,031 unscreened donations. In contrast, zero cases were reported from 75,331 screened donations. Moreover, a recent case report linked transfusion-transmitted babesiosis in three premature infants who received blood from one donor. Thankfully, all three infants were treated and have recovered.

The FDA is planning to issue draft guidelines with recommendations to reduce babesiosis acquired by transfusions later this year. It is expected that testing the blood supply as well as donor tissues and organs will become an important part of these guidelines, which will greatly help to protect the public. We also hope that this increased awareness of babesiosis will lead to greater vigilance among healthcare authorities as well as the general populace. Such increased awareness will be especially important in geographic areas where tick-transmitted diseases are endemic and are increasing.

Mayla Hsu, Ph.D.
Director, Research and Science
Global Lyme Alliance

Mayla manages GLA’s research grant program, working with the Scientific Advisory Board and creating viable partnerships to help advance the development of a reliable diagnostic test, effective treatments and ultimately a cure for Lyme.

Fear of Lyme Reinfection

by Jennifer Crystal

Hoping you don’t get another tick bite and Lyme reinfection this spring.


This time of year always makes me happy: the tulips come out, everything blooms, and the world feels hopeful again. It also makes me nervous, because I know spring brings an influx of my worst enemy: ticks. Articles and newscasts from The Boston Globe to CBS warn that a warmer winter will make tick season especially bad this year.

“But isn’t the horse already out of the barn,?” a friend asked me when I voiced my concern. She meant that since I already have Lyme and babesia, what would be the harm in getting a new tick bite? A lot, it turns out.

Getting a new tick bite ranks up there with relapse in terms of my worst fears. My Lyme and babesia are currently in remission, well-controlled and well-maintained by specific medication, supplements, dietary restrictions, and lifestyle limitations. A new infection could spur a relapse, and engender new symptoms that I did not experience with my initial infection.  It could also re-infect me with ehrlichia, a co-infection I previously beat, or give me several new co-infections. One bite could send me back to square one.

I know the danger of this because I watched a friend go through it last summer. Like me, she had been in remission, and was out living her life: raising her children, taking spin classes, working and socializing. Then one day she sat on a blanket under a tree at her child’s lacrosse game, and a few days later, woke up sicker than ever. A tick had bitten her while she sat watching that game, reinfecting her not only with Lyme but with co-infections she’d never had before. She ended up in the hospital.

Besides the physical toll these new infections took on her body—she went from attending spin classes to grimacing in pain when a physical therapist tried to stretch her legs in her hospital bed—the illnesses also took an emotional toll. The isolation and pain of tick- borne illness can cause depression and anxiety, but those feelings are much worse when you’ve survived the illness before, tasted freedom and suddenly had it stripped from you again. My friend felt hopeless.

Who can blame her? Remembering the devastation of my relapse, I can only imagine how distraught I’d feel if I were to get a new bite, especially since there are so many new tick-borne illnesses on the rise. A recent story on CNN warns of a rise in tick-borne Powassan virus, a potentially deadly encephalitis. Symptoms can include fever, headache, difficulty maintaining consciousness, cognitive impairments and seizures. A recent NPR report speaks to a rise in newer tick-borne illnesses, such as anaplasmosis and Heartland virus. Other prevalent tick-borne illnesses include Bartonella, Borrelia miyamotoi, Bourbon virus, Colorado tick fever, mycoplasma, relapsing fever, Rocky Mountain spotted fever, Southern Tick-Associated Rash Illness (STARI), tick paralysis, and tularemia.

Fear of a new bite can make a Lymie want to hide. Short of that, here are some tips for preventing Lyme disease while enjoying the great outdoors. These are important for everyone to follow, whether you’ve already had a tick-borne illness or not:

  • Use insect repellent that contains DEET, or the more natural components of picaridin and oil of lemon eucalyptus, and treat clothing and outdoor gear with permethrin.
  • Carry repellent with you at all times. You never know when you’re going to be at a friend’s house and they’ll suggest going for a walk or taking their kids out to play.
  • Wear light-colored, long-sleeved clothing. Tuck pants into socks, no matter how geeky that sounds. Wear close-toed shoes.
  • Stay away from grassy areas, wooded areas, brush and leaves. Stick to the center of gravel and dirt paths. One patient said she’s so afraid of leaf piles on the sidewalk that she walks in the street. I do this, too! (Just make sure it’s safe!)
  • Do a tick check immediately after spending time outdoors, remember to look in tick hiding spots such as the groin, the belly button, behind the ears, and on top of the head. Do a check every night before bed.
  • Remember to check your pets, too! One man in West Hartford, CT recently pulled 30 ticks off his dog after a walk around the reservoir. Dogs tend to run into the woods and roll in the grass, and then they bring whatever they pick up into your home.
  • Shower immediately after spending time outdoors. If you have small children, be sure to bathe them and check them for ticks every single night. Kids are at greater risk of getting tick bites and associated illnesses because they are closer to the ground and spend more time playing outside than adults.
  • Put clothes in the dryer as soon as you come inside for 10-15 minutes. High heat kills ticks.
  • Carry a mini lint brush with you, and periodically swipe it over your body and clothes. Remember that ticks are sometimes hard to see so they may get picked up and be noticeable on sticky lint paper.

Most important, we can’t let ourselves be blocked by fear, because then the ticks have won. Spending time outdoors will always make me nervous, but I believe that using these preventive measures will keep me safe. I wish everyone an enjoyable and tick-free season!

Opinions expressed by contributors are their own.

Jennifer Crystal is a writer and educator in Boston. She is working on a memoir about her journey with chronic tick-borne illness. Contact her at [email protected]

Podcast: Tick-Borne Co-Infections, Bartonella and Powassan Virus

Bartonella is a tick-borne co-infection. As with Lyme disease, its symptoms can be debilitating.


While the most common tick-borne infection is Lyme disease, infected ticks may carry more than one kind of microbe or disease producing organism that can make humans very sick. The microbes are called co-infections, the simultaneous infection of a host by multiple pathogenic or disease-producing organisms.

Dr. Mayla Hsu, GLA’s Director of Research and Science, and Dr. Harriet Kotsoris discuss Lyme and its co-infections in a recent podcast. Below is an excerpt of the podcast that focuses on Bartonella and the Powassan virus.

CLICK HERE to listen to the entire podcast.

Host: I’ve heard there’s a new tick-borne infection that’s somewhat controversial called Bartonella. Mayla would you like to tell us more about that?

Dr. Hsu: Sure. Bartonella is a bacterium that’s controversial in discussions of tick-borne illnesses because there is quite a lot of debate about whether it is actually spread by ticks and causes human disease. Now we know that it’s spread by fleas and body lice and sand flies, but ticks are a somewhat new idea that is gaining traction in some quarters. Bartonella is in domestic and wild animals and it causes various illnesses that we know about, such as cat scratch disease and trench fever, where people get bitten by fleas that are feeding on animals or by body lice. Now in recent years, Bartonella bacteria has been found in ticks in many countries around the world. The ticks do feed on host animals that carry Bartonella so it’s not surprising to find the bacterium in the ticks.

Humans with tick exposure, like hunters, have been found to have antibodies against Bartonella so that indicates they’ve been exposed, but whether Bartonella actually causes illness in healthy people is under debate. There’s no question that Bartonella is a big problem for people who are immuno-compromised and they can get sick, but even there we don’t know how much of it is acquired from tick bites versus flea bites. Now, if people do get Bartonella it’s diagnosed by looking for the DNA of the bacteria or by growing or culturing the bacteria, and then it is treated with antibiotics. Often the first symptom is striations or lines that look like stretch marks on the skin and it can progress into fever and lead to very serious illnesses including things like heart inflammation or endocarditis.

Host: A new class of microbe that is very different from the bacteria and parasites we’ve been hearing about are the viruses spread by ticks. Since they can’t be treated with antibiotics, should we be worried about them?

Dr. Hsu: The virus that is spoken about as transmitted by Ixodes or black-legged ticks, is the Powassan virus, which is also sometimes called deer tick virus. Powassan virus or deer tick virus are actually two different genetic lineages of very similar virus so let’s just call it Powassan virus. It was first described in the 1950s. Powassan virus can be very serious because in half of cases, 50% of cases, people have continued long-term neurological consequences and disability due to encephalitis, or inflammation of the central nervous system. The virus actually infects the brain. The fatality rate can be 10 to 20%, especially in the elderly, the immunocompromised or people with other health conditions.

The symptoms for Powassan virus are fever, vomiting, weakness, memory loss, and seizures. The diagnosis is made by doing a blood test or a spinal tap looking for antibodies against the virus. The treatment for Powassan virus is, as you said, it can’t be treated with antibiotics. They don’t work against the virus, so the treatment is mostly supportive. That is providing respiratory support, fluids, drugs to reduce brain swelling. Now, luckily Powassan virus is rare. There were 13 cases that were reported in 2013 to the CDC, so it’s actually not a really prevalent disease. It is found in actually a very low percentage of ticks, maybe three to 5% of ticks are co-infected with Lyme disease and Powassan virus, so it is there. It is present so we have to be concerned about it. Now overseas there are many more cases of a brain infection caused by ticks, there is tick-borne encephalitis, and that is also caused by a virus, a tick-borne encephalitis virus, that has been recorded and associated with serious illness.

Host: Obviously a lot of people haven’t heard of these co-infections spread by ticks, can you tell us about some of the major problems and how we cope with tick-borne diseases?

Dr. Hsu: One of the biggest issues is probably awareness. There are medical professionals who have heard of Lyme disease but may not have heard of these others.

Dr. Kotsoris:  Health authorities may not test for some of these if they’re unaware of them and then ordering the right diagnostic tests has to be done. The Lyme disease diagnostic by itself is highly inaccurate and so even getting that diagnosis is problematic. Without reliable molecular diagnostic techniques some tests are only available experimentally or at limited federal or state levels. Initial diagnosis is very difficult and you can’t sit around and wait for an antibody response, so physicians have to be better diagnosticians. They can not, as I said before, they can not sit around and wait for convalescent titers, antibody titers to indicate that the patient has had the infection. That’s four to six weeks after the initial infection. Until the FDA approves some of these experimentally available techniques, makes them more widely available to the frontline physician, we have to rely on clinical diagnosis.

Host: What about the treatment of tick-borne illnesses?

Dr. Kotsoris: It’s important to note the treatment for Lyme disease doesn’t cure the others necessarily, so proper diagnosis is critical to getting proper treatment that is specific for the co-infecting microbe. Also having two infections might make the symptoms tougher to treat. There are some research studies that indicate that co-infections actually make the illnesses more powerful individually. For example co-infections of Babesia and Lyme disease may make it harder to treat the patient than if he or she had only one of those.

Host: Are there other issues we should be thinking about with regard to tick-borne co-infections?

Dr. Hsu: I think there’s a lot we simply don’t know about the biology of co-infecting pathogens. For instance, we don’t understand a lot about how they grow in their host animals, more than one microbe. We don’t really understand how they get into a tick and how they survive in the tick, and very basic questions like infection of humans, from ticks to humans.

Host: Given all the lack of awareness, what kind of studies are needed to better understand and treat tick-borne diseases?

Dr. Hsu: There are some emerging illnesses now that are suspected of being caused by ticks but we don’t know for sure. We need more research. For instance, there’s a new illness that’s emerging called stari, S-T-A-R-I, and what that stands for is Southern Tick-Associated Rash Illness. We know that this is caused by a tick bite but we still don’t know what the pathogen or the microbe is that is responsible for the illness. Diagnosis, which we talked about is sometimes complicated. Some of the technology to diagnose some of these co-infections, like really sensitive molecular biology, looking for the DNA of the organism, is not readily available in some parts of the world.

Dr. Kotsoris: Travelers to other parts of the world may come home to the United States where the best of medical care is apparently available and doctors here may not know about those tick-borne illnesses, so education has to be a big part of it.

Host: Tick-borne diseases are a very big problem. Let’s hope that public health officials and the funding organizations take them seriously, especially since climate change is going to mean more sick people, more school and work absences, less productivity, and have a huge economic impact. Thank you for all the discussion today and thank you to all of you listeners.

CLICK HERE to listen to the entire podcast.

Locking Up the Obstacle of Guilt

by Jennifer Crystal

Patients with a chronic illness, like Lyme disease, can carry more guilt than symptoms.


The holiday season is, as the Andy Williams song goes, “the hap-happiest season of all.” While many people feel this joy, others struggle to be of good cheer. Depression and anxiety can run high during the holidays. As we reflect on the year just passed, many people wrestle with feelings of guilt.

That’s one I know well.

Patients with Lyme or any long-term illness can carry more guilt than symptoms. We feel guilty for being sick, for not getting well fast enough, for being a burden on caregivers, for not being able to work, for being dependent on others. We have guilt about our guilt, a vicious cycle that can make us want to crawl in a cave.

I experienced all of these feelings when I first got sick. I went from leading a completely independent life—teaching, ski instructing, taking care of my own needs—to being bedridden and dependent. I felt intense pressure from others and from myself to get out of bed, get well, and get back to my life. How badly I wanted to do all of those things! But with increasing symptoms and only half a diagnosis—of Epstein-Barr virus, the treatment for which was “just rest”—my ability simply didn’t match my desire.

Guilt gnawed at my stomach when people asked, “So are you thinking of getting a job?” or “When are you planning to get well?” Even a simple “What did you do today?” made me cringe because I didn’t have much to report besides “sleep” and “eat”. The implication was that my illness was something I could control, and the fact that I couldn’t will myself to get well, sent me into a tailspin. I started thinking that getting sick was all my fault. Maybe I had pushed myself too hard during those years of teaching and intense exercise. Maybe I hadn’t taken good enough care of myself. Maybe some of my symptoms were all in my head, as a few doctors suggested.

It turned out that none of that was true. My intractable illness was the fault of an insect tinier than a poppy seed, which had bitten me many years earlier and thus made it impossible for me to get over Epstein-Barr. After two bedridden years, I was finally accurately diagnosed with Lyme and other tick-borne diseases. Once I had a concrete explanation for seemingly idiopathic symptoms, many people who had pressured or not believed me laid off the guilt trips.


Laying off myself was another story. Recovery from Lyme is a long, zigzagging process. It took a year of intravenous antibiotics and intense anti-malarial medication for me to start feeling better. Guilt stayed with me on that journey. I felt bad that I wasn’t steadily getting well, that I often didn’t have the energy to do dishes or laundry or help around the house. I felt terrible that I was still so reliant on others.

When I finally was well enough to move out on my own and work part-time, I dove in head-first, wanting to escape the life of illness and prove to myself and others that I still was a motivated and capable person.

Unfortunately, the illness wasn’t escapable. Because I’d taken too large a leap, I quickly relapsed, landing right back where I’d started: bedridden, under my parents’ care, too sick to function.

I couldn’t stand it.

I felt guilty for taking too large a leap, for getting sick again, for being a burden. This time the guilt didn’t just gnaw at my stomach. It consumed me.

“You’ve got to stop this,” my stepmother said one day as I cried hysterically. “This guilt is going to block you from getting better.”

She stopped me in my tracks.

I realized in that moment that while I didn’t have control over my illnesses, I could control how I reacted to them. My therapist had been telling me this for years, reiterating that being sick was not my fault, that I was making myself worse by adding anxiety and guilt to the situation. But I didn’t really hear the message until that day at the kitchen table with my stepmom.

A physical therapist had once suggested I picture a wooden chest or trunk, and imagine myself locking all my worries inside. I didn’t have to throw them away. I could store them and take them out if I needed them, but I held the key. I got to decide when or if they came out.

Remembering that imagine, I suddenly felt like I held the key to allowing myself to get well. My guilt was still there, of course. But I acknowledged it and then locked it away, because keeping it out would only prolong my recuperation.

After I locked up my guilt, a funny thing happened. I started to get well. Not right away, of course—if only antibiotics worked overnight! But I transitioned to a calm acceptance of my situation rather than a nervous frenzy over it, and my body responded well to the shift. My symptoms abated much faster than expected.

Now that I am in remission, I still sometimes feel guilt. When I do, I ask myself if it’s over something I can change, or if it’s something that’s out of my control. If it’s the latter, I store the guilt in my wooden chest. Maybe one of these days, I’ll even throw away the key.

jennifer-crystalOpinions expressed by contributors are their own.

Jennifer Crystal is a writer and educator in Boston. She is working on a memoir about her journey with chronic tick-borne illness. Contact her at [email protected]

What Failure to Control Ticks in Uganda Teaches Everyone

by Hannah Staab

Tick populations across Africa have negatively impacted many communities by carrying and spreading one of the most frequent bacterial diseases in Africa, tick-borne relapsing fever (TBRF).


In addition to infecting humans, ticks in Africa are known to spread disease amongst cattle, resulting in both agricultural and economic consequences. Uganda is one of the countries hardest hit by the presence of ticks and tick-borne diseases (TBD), with over 30% of the calf crop lost to TBDs  such as theileriosis, babesiosis, and anaplasmosis.  Farmers have used acaricides, pesticides that target ticks and mites, as a tool to combat the diseases they carry. But recently many farmers have been reporting more instances of acaricide failure.  Acaricide failure places a tremendous financial burden on the Ugandan farmers; not only does it lead to a high loss of their cattle to TBD, but the costs of the acaricides themselves account for about 90% of an average farmer’s total disease control budget, making non-functional acaricides a major budgetary loss for farmers. The frequent occurrence of acaricide failure has raised the possibility that certain ticks are becoming resistant to them.

A study conducted by Vudriko et al. in 2016 set out to uncover the reason behind the increasing reports of acaricide failure in Uganda.  Of the 54 farms tested, 94.4% of them had complaints of acaricide failure, which prompted questions about tick resistance as well as acaricide application methods. To address these questions, Vudriko et al. examined the acaricide application techniques used by farmers and also tested the tick larvae they found on the cattle for acaricide resistance. The results showed that 93.5% of the larvae population they tested was resistant to at least one acaricide. The resistant larvae were identified as Rhipicephalus genus ticks. This was the first study in Uganda to report the emergence of multi-acaricide resistant ticks. Ticks’ resistance to multiple acaricides increases the danger of cattle being infected with TBD, because these ticks can survive even a combination of tick-attacking techniques.

Vudriko et al. also found that many farmers were guilty of misusing their acaricides.  When certain acaricides started to fail, farmers often try to find a quick fix by mixing chemicals, and creating their own acaricide application methods. These farmer-created errors could be partially to blame for the dramatic rise in multi-acaricide resistance. When a mixture of acaricides is applied surviving ticks carry a gene that allow them to resist all of the acaricides in that mixture. After they reproduce, future generations of ticks, harboring the resistance genes, will be resistant to multiple acaricides.


Tick-borne diseases are the number one constraint of cattle production in Uganda. Acaricide failure has been spreading through farms, causing more and more cattle to fall ill with disease, and costing farmers time and money. The development of multi-acaricide resistant ticks could have possibly been delayed or even avoided if farmers had not taken tick control into their own hands. Therefore it is important to educate farmers around the world on how to properly manage and control ticks. Since a large portion of the ticks are now resistant to current acaricides, alternative tick control options are needed.

Witnessing how tick-borne diseases have affected Ugandan cattle farming demonstrates the impact ticks can have on society. In addition to spreading tick-borne diseases to humans across the world, ticks that prey on cattle have implications not only for the food supply but for economic growth in many countries.

The case of acaricide failure on farms in Uganda is a reminder of the importance of tick prevention, and following strict protocols when controlling tick populations. As climate change continues to make an increasing amount of habitats suitable for tick growth and reproduction globally more farms will start running into the problem of tick-borne disease among their cattle. Further research on this topic is necessary to help farmers and those of us who rely on their food around the world.


For more on Lyme disease and climate change, click here.