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Deer and a "new" disease; we would like to think we're immune to nasty little organism in the great out-of-doors, but a tick-borne newcomer from Connecticut has shown how vulnerable we can be.

DEER AND A "NEW" DISEASE

On the morning of July 4, 1984, a semiretired scientist named William Shurcliff cut the meadow grass in back of his summer home for a celebration later that day. For several decades, his family had given a kite-flying party on Independence Day in the coastal town of Ipswich, Massachusetts, 30 miles northeast of Boston. The party, mainly for children, had become a tradition in the community, and the 1984 version was a success. A couple of weeks later, however, in his office at Harvard University, where he writes books on solar energy and housing insulation, Shurcliff began to feel strange sensations. First he became so cold that he began to shiver. Then he felt "awful" all over, as if he were coming down with the flue. Then he started to feel so hot that he began to sweat. He went home and became so drowsy he could hardly keep his eyes open.

Shurcliff discovered he had an illness that has become commonplace in Ipswich in recent years. It was Lyme disease, a bacterial infection named for the town in Connecticut where it was first recognized a little more than a decade ago. It had been transmitted to him by the bite of an infected deer tick. The proof was a skin rash near his elbow, where a tick had probably attached itself while he cut the field in back of his house.

After a few days of taking antibiotic pills, Shurcliff was pleased to see the rash disappear, and he felt fine. That August, however, tiny intermittent pains began to flash through his muscles. In September, his heart was found to be beating irregularly. That fall and winter his ailments became more severe. Sometimes, for no apparent reasons, his heart would start hammering in his chest, as if he had just climbed steep stairs. He had chronic intestinal gas. He lost weight. He tried different remedies, including dietary changes, rest, and more antibiotic pills, but nothing worked. Though blood tests were ambiguous, his cardiac irregularities fit the pattern of one of Lyme's known longterm effects. He entered a hospital. For ten days he received penicillin directly into his veins.

Today Bill Shurcliff has recovered, but he stays away from his Ipswich country house in the May-through-July peak of the tick season. He goes there only rarely the rest of the year, and he has canceled the traditional kite-flying party.

In many parts of the country, the simple act of venturing outside involves a certain amount of risk these days, and Lyme disease is not the only reason. In the upper Midwest and Florida, mosquitoes are transmitting viruses that cause encephalitis, a potentially serious inflammation of the brain. In the Rocky Mountains and elsewhere, ticks are still carrying the disease known as Rocky Mountain spotted fever. Even in unspoiled mountain wildernesses, drinking stream water can give hikers Giardia, a microscopic intestinal parasite. We Americans like to think we're immune to nasty little organisms in the great out-of-doors, but whenever some "new" illness like Lyme disease comes along, we are reminded once again of how vulnerable we really are.

Lyme disease is a curious phenomenon. It has been called a "suburban disease," because--at least in the Northeast--it usually occurs where houses are near areas in which deer have been allowed to proliferate. So far it has showed up in 24 states, though about 90 percent of the cases occur in just seven: New Jersey, New York, Connecticut, Rhode Island, Massachusetts, Wisconsin, and Minnesota. Clusters of cases have occurred as far south as Georgia and Texas and as far west as California and Oregon. In the opinion of certain medical observers, the disease is clearly spreading. The federal government's Centers for Disease Control (CDC) in Atlanta lists 1,498 confirmed cases nationwide in 1984 versus only 599 in 1983 and 266 in 1980. According to CDC researchers, these cases are just a fraction of the real total, because doctors in most states are not required to report the cases they find.

Though the infectious agent itself is known--a cordscrew-shaped microorganism classified as a spirochete--the effects of the disease on humans are variable and rather baffling. Some people who have been bitten by infected deer ticks, for example, do not seem to get the disease. Their bodies' natural immune systems overcome the microbes invading their bloodstreams--sometimes temporarily, sometimes permanently. Most, however, develop the reddish skin rash along with other first-stage symptoms, including headaches, fever, chills, drowsiness, aches, and a flulike or meningitislike condition.

Treated promptly with antibiotics, the majority of these people recover quickly. If they are not treated--and for a small percentage of people like Bill Shurcliff, even if they are treated--some develop such second-stage effects as meningitis, paralysis, or cardiac irregularities, or third-stage effects, usually arthritis but occasionally chronic skin disease or neurological disorders. To top it off, constant fatigue and lethargy make it impossible for some people to carry on.

Lyme disease is hardly ever fatal. If it seldom kills, if it is treatable, and if it has no long-term effects on most of the people who get it, then how concerned should we be? My own answer to this question is biased. My family comes from Ipswich, and though I have never lived there year-round, I spent summers there as a child and continue to visit there as often as I can.

Bill Shurcliff is a highly regarded Ipswich neighbor. A white-tailed deer, carrying ticks infected with the disease, could run from his place to mine, or from my place to his, in less than a minute. The house of another neighbor who has been hospitalized for Lyme disease is even nearer. Of the residents of this rural road, 25 percent have had Lyme disease at some point in recent years. A spot nearby is said by a professor at the Harvard School of Public Health to have the highest concentration of deer ticks in the world.

I stand a good chance of getting Lyme disease myself. For the past few years I have been clearing my patch of woods in Ipswich of brush. During that time, I supposed I have picked a dozen of the tiny deer ticks, Ixodes dammini, off my skin. The adult females, about half the size of the ticks commonly found on dogs, have a fringe of scarlet around their hind parts. The adult males are all black and smaller. The immature ticks, the nymphs and larvae, are not much larger than the period at the end of this sentence. They are the primary transmitters of the disease.

Prevention of Lyme disease is simple: If ticks don't bite me, I won't get the disease. After working in the woods I inspect my skin, every square inch of it. I have been told that if an infected tick bit me, and about half of them are infected, I would have only a few hours to remove it before the disease entered my bloodstream. This threat doesn't keep me from doing what I want to do. Still, my mind is never entirely at ease in the spring and summer.

I often see white-tailed deer when I walk into the woods. They abound now in this part of Massachusetts, where the mixture of openings and woods with dense underbrush provides a perfect habitat. Earlier in this century, when my father and Bill Shurcliff were young, deer were rare, and my woods was a field used as a place to stack saltmarsh hay. When the hay harvesters stopped using the field, such early succession plants as cedars, sumac, and a shrub honeysuckle sprang up, followed by oaks and hickories.

Hunting was forbidden on a 2,100-acre block of land nearby, the Crane Memorial Reservation and the Crane Wildlife Refuge, and this gave the local deer herd a haven in which to multiply. By the 1970s, when I began to go back to Ipswich, deer had become commonplace. I felt protective of them, and most of my neighbors did, too. We didn't allow hunting on our land. I now believe that was a mistake.

By the early 1980s, the deer population of Ipswich was greater than the land could support. On the Crane properties, deer began to die from starvation in the winters. At the same time, tiny deer ticks began to proliferate, many of them carrying the Lyme-disease spirochete.

In 1985, with nearly 250 deer occupying land that could support perhaps 50, a limited public hunt was held on the Crane properties. By that time, nearby private-property owners had already reversed their earlier stands and given selected hunters permission to shoot. On my recent trips to my Ipswich woods I have usually seen only one doe. I do not look at her with any affection. If she fits the normal profile, she carries the Lyme-disease microorganism in her bloodstream. In the fall, she might have dozens or even hundreds of adult ticks fastened to her, swollen to the size of raisins.

About 150 miles to the southwest of Ipswich, in Lyme, Connecticut, the fields around Polly Murray's house had also grown up to brush and trees by the 1970s. White-tailed deer had made a comeback there, too, and Mrs. Murray enjoyed watching them from her windows. She did not enjoy the unexplained illnesses her family began to suffer more than a dozen years ago. She was hospitalized for skin problems, fever, and arthritic problems in her neck, her jaw, and various joints. For a time, one of her sons became paralyzed in his facial muscles and developed joint swelling. The doctors said he had juvenile rheumatoid arthritis.

Mrs. Murray, who had a solid lay knowledge of science from her college days, went to the library to read the technical literature. She came away confused. If, as the books said, juvenile rheumatoid arthritis were both rare and noninfectious, what was happening to her family? For eight years she kept careful records and eventually found that more than 30 of her neighbors seemed to have the same problems. Mrs. Murray repeatedly telephoned state medical authorities to report her findings and request an investigation. At the same time, another woman from the same area, Judith Mensch, was reporting similar observations to the same authorities.

At first, doctors wouldn't take the two mothers seriously. Confined within their narrow specialities, the rheumatologists didn't want to hear about skin rashes, and the dermatologists weren't interested in swollen joints. Finally, Mrs. Murray came into contact with sympathetic researchers, including Dr. Allen C. Steere, a rheumatologist who studied at the CDC and teaches at the Yale Medical School. He looked at the notebook she kept of her neighbors' ailments, contacted local physicians, and invited affected residents to Yale for evaluation. Some of those neighbors remembered getting a reddish, bull's-eye type of skin rash before a feeling ill. The rash, Dr. Steere learned, was similar to something that had been described in Europe as early as 1909, a lesion called erythema chronicum migrans, which results from tick bites. Some of the patients from Lyme saved the ticks that had bitten then, and it wasn't long before Dr. Steere made a definite connection between the deer ticks and the disease. His pioneering articles in the medical literature prompted immunologists, epidemiologists, wildlife ecologists, and other "ologists" to take a serious look into Lyme disease.

During that same period, still other researchers were investigating another new tick-transmitted disease called babesiosis. An infection of red blood cells, resembling malaria, babesiosis is found in a much smaller area than Lyme disease--mainly Cape Cod and the islands of Nantucket and Martha's Vineyard in Massachusetts, plus the outer parts of Long Island in New York. Dr. Andrew Spielman, a medical entomologist with the Harvard School of Public Health, identified the tick species that spreads boths diseases in the Northeast, Ixodes dammini. (He named it for a retired colleague, Dr. Gustave Dammin, who later caught Lyme disease.)

In 1981 Swiss-born Dr. Willy Burgdorfer was looking through a microscope for organisms that cause Rocky Mountain spotted fever when he noticed some odd, filamentlike, spiral-shaped bacteria he identified as spirochetes. The smaple under his microscope was from a part of Long Island where Lyme disease had appeared. Burgdorfer, a medical research entomologist in Montana and an expert on both spirochetes and tick-carried diseases, realized he had found the Lyme-disease agent. The spirochete was named for him: Borrelia burgdorfer.

Other researchers found that dogs, like humans, can suffer from Lyme disease; that migrating birds have carried ticks infected with Lyme disease to the Southern states; and that other tick species besides I. dammini can transmit Lyme disease. Alarming cases began to show up, such as a New York City surgeon who was paralyzed in both arms by Lyme disease. After several years of therapy he has recovered 90 percent of the use of his arms, but he has had to change specialties within the medical profession. Pregnant women have been found to pass the Lyme-disease spirochete to their unborn babies; a few of those fetuses have died or become deformed, and researchers are trying to determine whether the spirochete was actually the cause of the problem.

Lyme disease is now known to exist in at least 19 countries, including France, Sweden, Italy, the USSR, and Australia. The earliest reported case in the United States seems to have occurred in 1962 on Cape Cod. Did the disease spread fairly recently to this country from someplace else, such as Europe? Nobody knows.

For all the uncertainty, researchers have managed to find out how people get the disease. The answer, at least for the Northeast and the Midwest United States, lies in the interaction of several different creatures. The first of these, the spirochetes, which have neither head nor tail but simply rotate their microscopic corkscrew-shaped forms to propel themselves, find mammalian bloodstreams a favorable environment for living and multiplying. But the spirochetes are not able to get into bloodstreams on their own. They have to be injected there by the deer ticks, thousands of times larger than the spirochetes.

The ticks grow through several stages, from larvae to nymphs to adults, before they are able to reproduce. At each stage, they need one blood meal, for a total of three meals during their two-year lives. The larvae tend to feed on white-footed mice. The nymphs feed primarily on mice, birds, or humans. The adult ticks usually feed on white-tailed deer, though any other warm-blooded animal, including people, will do. If the host animals already have the infection in their blood, the nymphs and ticks relay it to their next blood source. Mice, deer, and other creatures seem to be unaffected by the spirochetes. Why people suffer from them is still unknown, although the human immunological system certainly plays a major role. For one other important question--How can we stop the disease?--scientists have no sure answers. It is unlikely they will find a vaccine anytime soon to keep humans from getting the disease in the first place. Most researchers believe it is impractical to try to stop Lyme disease by wiping out the ticks and the field mice that act as infection carriers. Deer are probably the weak link in the chain. In theory, if all the deer in a given area were removed, a few adult ticks would find other mammals to feed on, but most ticks would eventually die without reproducing. The number of cases of Lyme disease would then dwindle. In practice, however, scientists and wildlife managers are cautious about recommending the removal of deer, both because they lack the data to back up their theories and because "removing" deer essentially means shooting them. The idea of shooting deer--especially in suburban areas--is anathema to animal-rights activists; they tend to respond with lawsuits and other forms of protest. I can certainly understand their feelings. After all, I used to like deer myself.

For the time being, prevention is the best way to help reduce the disease. Posted warning signs can discourage people from venturing into brush or woods in tick-infested areas, particularly in the May-through-July peak of the Lyme-disease season. Brochures and public meetings can help teach people in tick-infested areas to inspect their bodies carefully every day and to see a doctor at the first signs of the characteristic skin rash or other symptoms. But the prevention approach has its drawbacks. Warning people about ticks in areas where the disease rate is low is like crying "Wolf!": After a while, people stop paying attention. Moreover, many people, especially children and the elderly, have trouble finding the nymphal ticks even if they look. And in perhaps 25 percent of the Lyme-disease cases, the skin rash does not appear, meaning that these victims might not realize until later that they are infected--if they ever realize it.

In Ipswich, where the danger is better recognized than in most places, a combination of deer hunting and public education seems to have stabilized the situation. In 1985, there were nine confirmed cases of Lyme disease on the road where Bill Shurcliff and my family have houses, roughly the same as in previous years. Without the preventive countermeasures already mentioned, the number would undoubtedly be higher. The bad news is that even this "progress" comes at a cost--the cost of canceling outdoor activities like yard work, hiking, and kite-flying parties. Furthermore, the recent research findings underscore the extreme seriousness of the later stages of Lyme disease: Last fall, Dr. Steere and other doctors reported a death from Lyme disease--the sudden heart failure from pancarditis, or spirochete involvement throughout the heart muscle, of a man from Nantucket. This is only the first known death of its type. It is not a cause for hysteria, but it is definitely a reason for concern.
COPYRIGHT 1986 Saturday Evening Post Society
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Copyright 1986 Gale, Cengage Learning. All rights reserved.

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Title Annotation:Lyme disease
Author:Warner, Roger
Publication:Saturday Evening Post
Date:Jul 1, 1986
Words:2962
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