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Across much of Europe and Russia, various tick species regularly transmit
a serious infection called tickborne encephalitis. It is a viral infection with
longterm neurological complications and a mortality rate of about 20
percent. Fortunately, there are very effective vaccines against this
summertime menace. Here in the U.S., the situation is a more complicated,
"good newsbad news" kind of story.
The good news is that most of the tickborne infections in the U.S. are
bacterial (such as Lyme and Rocky Mountain spotted fever) or parasitic
(such as Babesia), and easily treated with common antibiotics and anti
malarial drugs. But there is also an obscure tickborne virus called
Powassan that may occasionally cause encephalitis. The bad news about
Powassan is that it's probably underdiagnosed in the U.S., it can cause
significant morbidity and mortality, and there is no preventive vaccine or
effective treatment for it.
Powassan virus is a flavivirus similar to the viruses that cause Japanese
encephalitis, West Nile, and St. Louis encephalitis. It was first discovered in
a fatal encephalitis case in Powassan, Ottawa, in 1958. Since then, about
40 cases have been described in Canada and the northeastern U.S.
Between 1999 and 2005, nine cases were identified in Maine, New York,
Michigan, Vermont and Wisconsin. The latest national tally in Morbidity and
Mortality Weekly Reports listed six cases in upstate New York and one in
Wisconsin during 2007.
Four different tick species are known to transmit the virus, and 38 mammal
species have been identified as possible sources of the virus. Groundhogs
seem to be major sources of both Powassan virus and the tick that
transmits the virus, Ixodes cookei.
Powassan virus may cause little overt illness unless it invades the central
nervous system. Once there, it can cause headache, fever, nausea, a stiff
neck, meningitis, and of course, encephalitis. Tremors, mental confusion,
seizures, coma and death also may occur. The fatality rate is 10 to 15
percent.
Complete recovery following infection may be prolonged or impossible.
Persistent and debilitating symptoms can include headaches, muscle
weakness, cognitive and memory difficulties, and other neurologic defects.
A recent review of nine cases found the average length of hospitalization
was 18.6 days. Six of those nine patients had to undergo "prolonged
inpatient rehabilitation" due to "impaired ability to perform (the) activities of
daily living."
Treatment tends to be aimed at relieving the symptoms of infection. Fluids,
ventilators to aid breathing, and steroids to reduce brain swelling are
commonly used. These infections probably are made worse by the delay in
diagnosis. There are no commercial tests for Powassan virus, so testing
often is done at special laboratories run by the Centers for Disease Control.
The lack of specific and readily available diagnostic tests also means many
cases are probably missed and the actual number of cases in the U.S. is
underestimated. Some of the recently reported cases, for example, were
identified only after initial tests turned up negative for West Nile virus.
A dangerous virus that is carried by four different ticks, circulates among
three dozen animal species and is hard to diagnose presents real
challenges to developing effective prevention and treatment measures. The
situation is made even more difficult by the finding in 1997 of a related
Powassan virus called the "deer tick virus." Laboratory studies suggest the
deer tick virus is less infectious than the classic Powassan virus, but the
consequences of human infection are still unknown. It may cause a mild
infection or like its Powassan cousin cause a lifethreatening
encephalitis.
It's important to find out more about it. A few years ago, scientists at New
York's Department of Health discovered the deer tick virus also could be
transmitted by the same tick (Ixodes scapularis) that transmits Lyme
disease. Most bacterial and parasitic pathogens carried by this tick require
2448 hours to move from the tick into a human host. In other words, there
is a grace period between tick attachment and disease transmission, which
sometimes allows people to find and remove the tick. That's not the case
with the deer tick virus (or perhaps Powassan virus). Experiments with mice
show virus transmission in as little as 15 minutes.
Given the tiny size of some ticks and the likely absence of a grace period
for some ticktransmitted viruses, it is especially important to practice "tick
hygiene." So use tick repellents and check for ticks after being in areas
where ticks are likely to be found.
Dr. Edward McSweegan has a Ph.D. in microbiology and lives in Crofton. He works on and
writes about infectious disease issues. He may be contacted at mcsweegan@nasw.org.