1. Rocky Mountain Spotted Fever Caused by the bacteria Rickettsia ricketsiae Carried by Dermacenter (hard or dog) ticks Untreated, the mortality is very high The disease is usually characterized by a fine skin rash, high fever, headaches and muscle pain Doxycycline and chloramphenicol are very effective in treating the disease Is less common on Nantucket than previously, probably because the dog ticks are less common

3. Babesiosis Caused by the intracellular parasite Babesia microti Carried by the black legged (deer) tick The babesia are inoculated into the skin by the bite of the tick and then get into the bloodstream The organism multiplies within red blood cells in a manner similar to malaria Most cases are self limited in otherwise healthy persons but may be severe in those who are immunosuppressed or without a spleen May be life-threatening Symptoms include fever, chills, muscle and joint pains, nausea, vomiting and fatigue Treatment includes atovaquone plus azithromycin or clindamycin plus quinine

5. Anaplasmosis ( Ehrlichiosis ) Caused by Anaplasma phagocytophilum Carried by the black legged (deer) tick Enters the bloodstream after a tick bite and concentrates in the neutrophilic white blood cells Causes fever, nausea, headache, muscle pain, reduced white blood cells and platelets and liver inflammation Rarely fatal (<1%) and responds well to treatment with doxycycline or rifampin Diagnosed by finding a rise in antibodies to the organism or rarely by observing the organism in white blood cells

7. Lyme disease Caused by Borrelia burgdorferi Carried by the black legged (deer) tick The bacteria are inoculated into the skin by a tick bite, replicate locally and then disseminate The organism may localize in joints, the nervous system or heart causing symptoms in these organs May cause a skin rash (often a target-shaped lesion),fever, chills, muscle pains, facial palsy, or heart irregularities It may also lead to immunologic reactions that can cause symptoms of arthritis

8. Lyme disease continued The arthritis is rarely if ever destructive The disease rarely if ever causes mortality Diagnosis of early disease is usually made by observing the typical skin rash in the presence of the above symptoms Antibody titers don’t rise until later in the disease (weeks) Diagnosis is made by identifying several different antibodies to bacterial components on a “Western blot test” later in the course Treatment with doxycycline, amoxicillin or other drugs is highly effective in early disease. Ceftriaxone is usually used for disease in the central nervous system and is often used to treat suspected treatment failures