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Tick Awareness

Here is some information compiled from former GRP staff member, Olivia Campbell, who completed her Master’s at Yale, focusing on ticks.

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Ticks and tickborne diseases have been in the news a lot lately, and many of these can be transmitted in North Carolina. At GRP, some infections we might want to be aware of include Lyme disease, ehrlichiosis, alpha-gal syndrome, STARI, and Rocky Mountain spotted fever. The blacklegged tick (Ixodes scapularis) carries Lyme disease. Research shows that blacklegged ticks do not live in Translyvania County (Eisen et al., 2016). However, individuals have occasionally reported identifying these ticks in nearby counties, and researchers have established that the geographic range of blacklegged ticks is expanding (Eisen et al., 2016). Still, it is highly unlikely that someone would encounter a blacklegged tick (or Lyme disease) at GRP. In laboratory experiments designed to determine Lyme disease transmission time, Lyme disease has never been transmitted in less than 24 hours (Eisen et al., 2018). This means that a tick needs to bite you and remain attached for 24 hours or more before you could catch the infection. Lyme disease is a bacterial infection that is commonly treated with doxycycline or other antibiotics. Symptoms include erythema migrans (a bulls-eye shaped rash), fever, facial paralysis, and arthritis (CDC). Symptoms begin 3-30 days after a tick bite occurs. Lyme disease rarely causes death (Kugeler et al., 2011).

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The lone star tick (Amblyomma americanum) carries several diseases throughout different regions of the US. Lone star ticks are frequently found on the preserve. Ehrlichiosis. Although prevalence varies by region, it is estimated that about 20% of lone star ticks carry ehrlichiosis (Saylor et al, 2016). Transmission usually requires 36 or more hours of tick attachment (Katavolos et al, 1998). Symptoms often include fever, headache, fatigue, and muscle aches, and can also include nausea, vomiting, diarrhea, cough, joint pain, confusion, and rash. Symptoms begin 1-2 weeks after tick bite (NC DOH). Up to 50% of cases require hospitalization, and about 2% are fatal. Ehrlichiosis is a bacterial infection and is treated with antibiotics, usually doxycycline (CDC). Alpha-gal Symdrome. Little is known about this syndrome, although the development of alpha-gal allergy has been reported in NC. Current theory suggests that individuals bitten by lone star ticks sometimes develop severe allergic reactions to alpha-gal, a type of sugar molecule commonly found on red meat (Platt-Mills et al., CDC). The allergy may develop several weeks after exposure to a lone star tick bite, and symptoms include a delayed anaphylaxis reaction within 24 hours of consuming red meat (Commons and Platt-Mills, 2013). Cases of this condition have been increasing in recent years, particularly in children (Commons and Platt-Mills, 2013). STARI. Southern tick-associated rash illness (STARI) is a disease that is similar to but less severe than Lyme disease, and it has been reported in North Carolina. Symptoms include a bulls-eye rash, fatigue, fever, headache, muscle, and joint pain (NC DOH). It is caused by bacteria related to the Lyme disease pathogen and is treated with antibiotics.

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The American dog tick (Dermacentor variabilis) is found throughout the Southeast and can transmit Rocky Mountain spotted fever (RMSF). RMSF is reported more often in North Carolina than in most other states. Symptoms include fever, headache, a rash that develops several days after fever onset, nausea, vomiting, stomach pain, and muscle pain (CDC). It is a bacterial infection often treated with the antibiotic doxycycline. Less than one in 200 people who get RMSF will die from the disease. RMSF can be transmitted in as little as 6 hours of tick attachment (Richards et al., 2017).

The CDC’s website contains helpful information about preventing tick bites. Campers might want to bring an EPA-registered insect repellant to use before hikes and other outdoor activities. They should know how to perform tick checks and should also shower after potential tick exposure.


Platt-Mills, A. E. T., et al. Characterizing the geographic distribution of the alpha-gal syndrome: relevance to lone star ticks (Amblyomma americanum) and rickettsia. J Allergy Clin Immunology. 141:2.

Richards S. L., et al. Do tick attachment times vary between different tick-pathogen systems? Environments 2017:4:37.

Commins, S. P., & Platts-Mills, T. A. E. (2013). Delayed Anaphylaxis to Red Meat in Patients with IgE Specific for Galactose alpha-1,3-Galactose (alpha-gal). Current Allergy and Asthma Reports, 13(1), 72–77. https://doi.org/10.1007/s11882-012-0315-y

County-Scale Distribution of Ixodes scapularis and Ixodes pacificus (Acari: Ixodidae) in the Continental United States | Journal of Medical Entomology | Oxford Academic. (n.d.). Retrieved June 2, 2018, from https://academic.oup.com/jme/article/53/2/349/2459744

Eisen, L. (2018). Pathogen transmission in relation to duration of attachment by Ixodes scapularis ticks. Ticks and Tick-Borne Diseases. https://doi.org/10.1016/j.ttbdis.2018.01.002

Eisen, R. J., Eisen, L., & Beard, C. B. (2016). County-Scale Distribution of Ixodes scapularis and Ixodes pacificus (Acari: Ixodidae) in the Continental United States. Journal of Medical Entomology, 53(2), 349–386. https://doi.org/10.1093/jme/tjv237

Katavolos, P., Armstrong, P. M., Dawson, J. E., & Telford, S. R. (1998). Duration of tick attachment required for transmission of granulocytic ehrlichiosis. The Journal of Infectious Diseases, 177(5), 1422–1425.

Kugeler, K. J., Griffith, K. S., Gould, L. H., Kochanek, K., Delorey, M. J., Biggerstaff, B. J., & Mead, P. S. (2011). A Review of Death Certificates Listing Lyme Disease as a Cause of Death in the United States. Clinical Infectious Diseases, 52(3), 364–367. https://doi.org/10.1093/cid/ciq157

Sayler, K. A., Loftis, A. D., Beatty, S. K., Boyce, C. L., Garrison, E., Clemons, B., … Barbet, A. F. (2016). Prevalence of Tick-Borne Pathogens in Host-Seeking Amblyomma americanum (Acari: Ixodidae) and Odocoileus virginianus (Artiodactyla: Cervidae) in Florida. Journal of Medical Entomology, 53(4), 949–956. https://doi.org/10.1093/jme/tjw054

Article written by Olivia Campbell