Ticks are tiny blood-sucking arachnids that feed on deer, birds, rabbits, squirrels, rodents and lizards. During bloodmeals, Arkansas ticks may absorb pathogens naturally carried by wildlife, with strange names like Tularema, Rickettsia, Anaplasma, Ehrlichia, and Borrelia. So when ticks feed on people, they regurgitate bacteria into the bloodstream.
Borrelia burgdorferi causes Lyme disease, endemic in Wisconsin and New York. Lyme is transmitted by infected juvenile black-legged or deer ticks, which are common in Arkansas. In recent years, more Arkansans are claiming to be Lyme positive. In February the Arkansas Department of Health, based on U.S. Centers for Disease Control protocol, confirmed two “probable” cases in the state. The case identities, disclosed by family and not the department, were two little girls bitten by Lyme-infected ticks in northwest Arkansas last summer. In response to growing concern, Arkansas Governor Asa Hutchinson has proclaimed May Lyme and Tick-borne Diseases Awareness Month.
The mother of the Lyme-stricken girls, Alarie Bowerman, is behind the declaration. She, along with Amy Rose in March co-founded Arkansas Lyme Foundation to raise awareness about the presence of Lyme disease in Arkansas.
"The signs and symptoms are flu like," Bowerman says, "headaches, fever, sometimes high, sometimes low grade."
A Lyme-infected tick bite in many but not all cases may present as a red bulls eye rash, a bruise caused by bacterial spirochetes radiating out, just under the skin, into the body. The disease is typically treated with an aggressive course of antibiotics. But left untreated, or mistreated, the infection can lead to long term chronic fatigue, joint pain, memory loss and in rare cases heart and brain dysfunction. There is no definitive blood test to detect Lyme disease bacteria, only the presence of antibodies, Bowerman says.
"You must have two Centers for Disease Control confirmed blood tests, two tiers, the ELISA and the second is the Western Blot. If you do not pass the ELISA, you will not get the Western Blot which shows the banding of antibodies you are making for Borrelia burgdorferi specifically."
Diagnostics, experts say, can miss up to 60 percent of acute cases, given it may take weeks to develop measurable antibodies resulting in false negative results.
"We need doctors to come forward to open Lyme disease clinics in Arkansas," Bowerman says.
After signing his tick proclamation earlier this month, Governor Hutchinson, on May 22, met with representatives from the Arkansas Lyme Foundation and several dozen individuals suffering with various tick-borne illnesses. The Governor mostly listened, then spoke briefly. “Hopefully this will increase awareness and training at UAMS," he said, "and of our doctors who really need to be upgraded and modernized.” Alarie Bowerman says she's encouraged by the Governor’s attention and formal proclamation.
"We actually have a document now that says that tick-borne illnesses are a danger, and that physicians are encouraged by the governor to take them very seriously."
Public funding for Lyme disease research is scant. No vaccine exists. Bowerman, who struggled for months to get her two daughters diagnosed and treated, says physicians do not understand that complex symptoms of untreated Lyme infection may mimic the symptoms of arthritis, chronic fatigue, fibromyalgia, and even multiple sclerosis.
Arkansas scientists are beginning to collaborate on research to understand the variety of tick disease pathogens present in Arkansas, including, they say, novel strains of Borrelia which could be responsible for Lyme-like symptoms people are reporting. Dr. Jon Blevins at the University of Arkansas for Medical Sciences with entomologists at the University of Arkansas Fayetteville are conducting a tick survey funded by a $10,000 dollar CDC/Arkansas Department of Health contract issued in March, initiated last year with $6,000 dollar discretionary lab funding. Arkansas residents are being asked to submit ticks for sampling. Blevins also recently completed a $400,000 dollar National of Institutes of Health grant investigation to identify specific genes required by Borrelia burgdorferi to thrive in wildlife and ticks.
The University of Arkansas Division of Agriculture Research and Extension Service, on May 23, launched its own tick survey, funded by the Arkansas Biosciences Institute. Neither survey, scientists warn, are intended for human tick-disease diagnostics. The Arkansas Lyme Foundation also encourages residents to send ticks to the Bay Area Lyme Foundation in California, which is conducting a national survey. Lyme disease is one of the fastest growing infectious diseases in the U.S. affecting more than 300,000 Americans annually, a conservative number given the last count was in 2015. And more Arkansans, according to the Arkansas Lyme Foundation, claim to be positive for Lyme but fail to meet rigorous CDC testing standards, or end up seeing physicians who diagnose unspecified tick fevers. Nearly 5,000 confirmed cases of Ehrlichiosis, Spotted Fever, Anaplasmosis, and Tularemia have also been confirmed by CDC in Arkansas, since 2012, resulting in 16 deaths.
Story Update: In March, staff from the U.S. Centers for Disease Control conducted a site visit to the Arkansas Department of Health, reviewing more than 900 tick disease cases. The department now reports five cases of Lyme disease in the state. Of those one individual in 2015 was bitten out of state. In 2016 three individuals contracted Lyme disease in Arkansas, with one individual bitten out of state. According to a department media source, staff are continuing to sort through reports, which may yield even more cases of Lyme disease in Arkansas in the coming months.
On May 25, Dr. Susan Weinstein, State Public Health Veterinarian conducted Public Health Grand Rounds at the Arkansas Department of Health at department headquarters in Little Rock informing physicians, veterinarians and the public about the status of Lyme disease in Arkansas.
This story is produced by Arkansas Public Media, a statewide journalism collaboration among public media organizations. Arkansas Public Media reporting is funded in part through a grant from the Corporation for Public Broadcasting, with the support of partner stations KUAR, KUAF, KASU and KTXK and from members of the public. You can learn more and support Arkansas Public Media’s reporting at arkansaspublicmedia.org. Arkansas Public Media is Natural State news with context.