The Things They Carry
Lyme disease has persisted on the Cape and Islands for decades. But in recent years other tick-borne diseases have taken hold, too. In the third installment of our series, Sean Corcoran reports on the remarkable increase in tick-borne infections, and what could be happening in the ecosystem to account for it.
Part 3 of 5
Earlier this year during the month of May, bright green bows began appearing all over Upper Cape Cod. They were on houses, in parks and wrapped around trees. Mashpee resident Pamela Gangemi was one of the people who really embraced the idea of using the ribbons to alert people about Lyme Disease.
"We really wanted to bow every town on the Cape," she said, "but we don't have the manpower. We're small. I think I was working on adrenaline. And then I crashed."
Gangemi is part of the group, Lyme Awareness of Cape Cod. In her case, the disease went undiagnosed for about 14 years, and she's presently being treated for 10 different medical conditions related to Lyme and her weakened immune system.
Gangemi says the ribbons were an effort to prevent others from the same fate.
"I was in Mashpee," she said, "and I had a mother walk up to me -- I was getting my volunteer ready to de-bow Mashpee -- and she just came up and said, 'Thank you so much. My daughter was just diagnosed and the only reason she got diagnosed was because I saw the Lyme tick stuff at the ball field. Read about it, because she had very mild symptoms. She had shin splint pain.'"
Getting parents to pay attention to Lyme Disease is one of Gangemi's goals. Another is to get people to understand that it's not just about Lyme.
Ticks often carry more than one infection -- co-infections such as tularemia, anaplasmosis and Babesiosis. In fact, Babesiosis is exploding both on the Cape and Islands and state wide. From 2010 to 2011, the confirmed Babesiosis cases in Massachusetts more than doubled, from 79 to 191.
Larry Dapsis is the entomologist for Barnstable County. He says that last year surveyors on Cape Cod found Babesia-carrying ticks at 10 out of 14 sample sites.
"What has our full attention is that over half the cases of Babesiosis occur on Cape Cod and the Islands," Dapsis said. "So from that standpoint, Lyme is clearly the horse is out of the barn. It's everywhere. Is Babesiosis potentially the next lyme?"
While also passed from ticks, Babesiosis is a very different illness than Lyme Disease. It can be quickly fatal. It's not a bacteria like Lyme but a protozoa that gets into the red blood cells to mature and multiply. It's usually easier to diagnose than Lyme, but as Dick Young of Yarmouthport now knows, that's not always the case. The 83-year-old says he just woke up one morning feeling unsteady, and his wife noticed he was drenched in sweat.
"I had some sort of rash," Young said. "I didn't know what it was. But when she put her hand on my shoulder, I was soaking wet, in bed, upstairs here. Soaking wet. And I wasn't sick to my stomach or feeling… I was just rocky on my feet of walking. I knew something was wrong."
This happened last Labor Day weekend. Young went immediately to his doctor and for two days they did tests.
"The third day he gave me all the paperwork," Young said. "He gave it to me and he said, 'Get out of here. Go to the emergency room, and give them the paperwork. I can't find out what's wrong with you.' He said, "Don't even stop at your home.'"
At Cape Cod Hospital, two doctors interviewed Young about how he was feeling.
"They took the paperwork, disappeared. Twenty minutes later they're back, and he said, 'Mr. Young, I know exactly what's wrong with you. Tick babesiosis.' And they admitted me immediately there," Young said. "Went upstairs for three weeks. They were checking on me. And I was going downhill.
Frankly, Young's friends and family thought he was going to die. His protoza-filled red blood cells were bursting, and he was bleeding internally. Doctors rushed him into surgery, and his wife was told he may not survive the night.
"Lungs were going downhill," he said, "heart was going downhill, kidneys were failing. So they knew that they had to find out where this bleeding was coming from because they were giving me blood all the time. I didn't know that, but they were."
Young credits Cape Cod Hospital with saving his life. But his and the 56 other confirmed cases in Barnstable County last year raises the question: What's infecting these ticks with Babesia, and why is the disease coming on so rapidly?
Dr. Richard Ostfeld is a senior scientist at the Cary Institute of Ecosystem Studies and author of the book "Lyme Disease: The Ecology of a Complex System." Ostfeld notes the timing of the arrival of different tick-borne diseases as compared to Lyme.
"What has happened is that the ticks show up in new areas in the Northeast and Lyme Disease was right there," Ostfeld said. "As the tick population went, so went Lyme disease. Well, it took about a decade after the occurrence of Lyme Disease before anaplasmosis showed up. And then it took about another decade for babesiosis to show up."
Ticks are born disease-free. They get infected by the different hosts they bite.
"So what do we know from that? Well we know it was not just the ticks," Ostfeld said. "The ticks were here, but there was very little if any Anaplasmosis or Babesiosis. Something needed to move the pathogen to infect the tick."
Ostfeld's hypothesis is that different animals -- different tick hosts -- may be spreading babesiosis more slowly to ticks than what happened with Lyme.
"One possibility is that, for instance, song birds play a stronger role in lyme disease than these other tick borne disease," he said. "Song birds move more quickly and have larger ranges than some of these other hosts. So they might have moved Lyme infected ticks, whereas it took the slower mammals more time to move the other tick-borne diseases into the tick population."
Researchers at the Cary Institute are working on a comprehensive list of the hosts that transmit babesiosis and anaplasmosis. Once that basic science is complete, decisions can be made about how to interrupt the spread of co-infections like babesiosis from the animal world to us.