Anaplasmosis can range from no noticeable effects, to flu-like symptoms, to meningitis.

In 2001, most Mainers didn’t give Lyme disease much thought. Just 108 people in the state were diagnosed with the tick-borne illness that year — hardly any of them in Androscoggin,  Franklin or Oxford counties — and it barely made a blip on the public’s radar.

Over time, those cases doubled. Then doubled again. Last year, 1,200 people were diagnosed with Lyme in Maine, 11 times what had been reported 14 years before. 

Today, Lyme is so prevalent in Maine that more than a dozen support groups have formed to help sufferers, a statewide nonprofit was founded to educate people about the disease, and the state has an officially proclaimed Lyme Disease Awareness Month.

Now another tick-borne disease is starting to mirror Lyme’s rise.

Anaplasmosis is carried by the same tick. It has similar symptoms and, in some situations, more serious ones. Four years ago there were 52 new cases in Maine. 

So far this year: 206.

Could it end up like Lyme?

“At the rate we’re going,” said Jim Dill, pest management specialist with the University of Maine Cooperative Extension, “probably.”

A dramatic rise

Anaplasmosis is caused by a bacterium that infects white blood cells. Symptoms typically appear a week or two after the bite of an infected deer tick and range from virtually unnoticeable to life-threatening.  

Mild symptoms can be vague and cold- or flu-like: fatigue, fever, headache, muscle pain, chills, nausea, stomach pain, cough and confusion.

“If you have sort of a quote ‘summer flu’ with some of those kinds of symptoms, maybe you need to consider a tick-borne illness and go to your health care provider and have it checked,” said State Epidemiologist Siiri Bennett.

Severe symptoms may include difficulty breathing, hemorrhage, kidney failure and neurological problems. In rare cases, anaplasmosis can lead to encephalitis or meningitis, causing brain inflammation. 

“The positive thing here is unless you’re immunocompromised, it’s one of those things that is not often fatal,” Dill said.

In many ways, anaplasmosis and Lyme are similar. Both are transmitted by a deer tick attached for at least 24 hours. Both are are caused by bacteria. Both are treated with antibiotics.

But anaplasmosis and Lyme differ in some key ways — most notably the kind of bacteria that causes them. Lyme’s bacterium burrows into the body while anaplasmosis’ bacterium does not, making anaplasmosis easier to treat and less prone to cause the chronic symptoms experienced by some Lyme patients.

Despite a likely reduction in the deer tick population this summer — deer ticks can’t survive in the kind of hot, dry weather Maine is experiencing and the Cooperative Extension has seen a drop in the number of ticks sent to its tick identification lab this summer — cases of anaplasmosis are going up. 

As with Lyme when it was first seen in Maine, anaplasmosis is most heavily concentrated along the southern coast. Knox and Lincoln counties have seen the most cases so far this year with 42 each, followed by York County with 37 and Cumberland County with 30.

Androscoggin County has seven cases and Oxford County has two. None has been reported in Franklin County.

Over 80 percent of cases are in people over 45, many in people over 65. 

“I think that’s probably because a lot of those people, these are the ones who are outdoors. You’re out in the garden, you’re retired,” Bennett said. 

It’s unclear why anaplasmosis cases have risen so dramatically in recent years when other tick-borne diseases haven’t.

Babesiosis, which is also transmitted by the deer tick, grew only slightly from 35 cases in Maine in 2013, to 42 cases in 2014, to 55 cases in 2015. There have been 40 cases reported so far this year.

Lyme numbers are not available for 2016, but that disease’s surge seemed to have settled in the past few years, with 1,384 cases in 2013, 1,409 cases in 2014 and 1,200 cases in 2015. 

Experts say the increase in anaplasmosis cases could be due to more doctors testing for it. It could be that more deer ticks are carrying both Lyme and anaplasmosis. It could be the disease is just becoming more prevalent.

It could be a mix of all of the above. 

Experts do believe anaplasmosis numbers may be under-reported, particularly when a tick transmits both anaplasmosis and Lyme at the same time. 

“If we treat Lyme early with (antibiotic) doxycycline, then we’re going to cover the anaplasmosis,” said Happy Dickey, a nurse and president of the nonprofit Lyme disease education and advocacy group MaineLyme. “So I think there’s probably more people than we ever know about that have it and are successfully treated.” 

With more than four months left in the year — including fall, when deer ticks are among their most active — Maine’s anaplasmosis count is expected to go higher for 2016.

Prevention and testing

Lyme disease and anaplasmosis have something else in common: They can both be prevented.

“Prevention is always our main goal because everything after that becomes more difficult,” Dickey said.

Experts say Mainers should stay away from tick-infested areas when possible, should wear protective clothing when they may be around ticks and should use EPA-approved tick repellent. They suggest maintaining tick-safe landscaping, with short grass, raked leaves and a barrier of wood chips or gravel between lawns and wooded areas.

And since scientists believe ticks can’t transmit either Lyme or anaplasmosis until they’ve been attached for 24 hours, experts also recommend looking for ticks on pets and family members every day.

“If you’re in an area where you know there are ticks, every night when you come in, when your kids come in, before you go to bed, do a tick check. That’s probably the No. 1 way to prevent it. Look and see,” Dill said.

“I recommend you do the same thing when you get up in the morning . . . when you’re in the shower check again, because by then that tick may have been on you all 12 hours and now it’s beginning be a size where it’s easier to see (because it’s been feeding), but it might be not enough time to have actually transmitted an organism.”

While blood tests are notorious for missing Lyme disease, experts say the tests for anaplasmosis are more accurate. Because the ticks that transmit anaplasmosis are so tiny — sized between a poppy seed and a sesame seed — Dill recommends getting tested if symptoms appear, whether a tick bite was noticed or not.

“I would say that  if you’ve been in a tick area or you live in a tick area and you come down with these symptoms, I’d be saying to my doctor, ‘Look, there’s a lot of deer ticks where I am and I’m concerned about Lyme disease or anaplasmosis or any of them,'” he said.

At the Maine CDC, Bennett, too, recommends talking to the doctor about testing.

“People should be aware that there are other things you can catch from a tick other than just Lyme disease,” she said. “Don’t just check for Lyme disease.”

ltice@sunjournal.com

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