The Truth About Tick-Borne Illnesses

Ticks can be active whenever the temperature is above 40 degrees, meaning the tick-borne illness is more than a seasonal worry limited to a portion of the summer. And Connecticut is seeing more types of ticks, and more than just Lyme disease.

Dr. Kevin Dieckhaus, chief of UConn Health’s Division of Infectious Diseases, explains all this, plus how to recognize, treat, and reduce the risk of tick-borne illness, and says some potentially promising Lyme disease news is on the horizon.

(Dr. Kevin Dieckhaus, Carolyn Pennington, Chris DeFrancesco, September 2025, studio and production support by Ethan Giorgetti and Ryan Bernat)

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Transcript

Chris: Lyme disease, yes, but now anaplasma and babesia? Today on the Pulse, we get the latest on what ticks are bringing us.

This is the UConn Health Pulse, a podcast to help you get to know UConn Health and its people a little better, and ideally leave you with some health information you’ll find useful.

With Carolyn Pennington, I’m Chris DeFrancesco. We’ve known about Lyme disease, but ticks can deliver other illnesses, including some newer ones we may not have heard much about.

Carolyn: So, which illnesses are most worrisome, and how can we reduce their risk or deal with them if we end up being infected? Joining us today is Dr. Kevin Dieckhaus, chief of UConn Health’s Division of Infectious Diseases. Thank you for being here!

Dr. Dieckhaus: Great to be here.

Carolyn: Well, let’s start with what you’re seeing when it comes to this year’s tick-borne illnesses.

Dr. Dieckhaus: Well, certainly this year is typical of most years. We’re seeing a summertime incidence increase in Lyme disease, but also in these newer illnesses that you’ve alluded to, both in babesiosis and something called anaplasmosis, and with global warming and introduction of new ticks, we’re starting to see some introduction of other illnesses that are kind of unique to Connecticut that we’re just starting to see.

Carolyn: Let’s talk about those then.

Dr. Dieckhaus: Sure. So a couple of new illnesses that have kind of hit the horizon, one is a viral illness called Powassan virus. That is transmitted by the same tick as the Lyme disease tick is transmitted. Also with a couple of new ticks, we have had introduction of a new tick vector called Gulf Coast tick, and that has led to transmission of something called Rickettsia parkeri. So there are these rare instances of other illnesses, a couple of other Lyme disease-related types of infections, one called Borrelia miyamotoi, which causes a febrile illness.

So Connecticut, like I say, is the tick-borne capital of the world and a center for tick-borne illnesses. So we have Lyme, Connecticut, which was the epicenter of Lyme disease. And of course, Lyme disease is still the most prevalent illness that we see related to ticks. Lyme, interestingly, has been fairly stable in Connecticut, but it has been expanding across the U.S., and northern into Canada, west into the Appalachians and upper and Midwest, as well as south. So the geographic spread of Lyme disease certainly is continuing. I think in Connecticut, the incidence is about where we’ve had it the last several years. There’s approximately 60,000 plus cases of Lyme disease described in the United States per year, and that’s probably an underreport. It’s probably closer to about four times that number.

Carolyn: But why is Connecticut considered such a haven for ticks? Is it because we’re so wooded we have so many?

Dr. Dieckhaus: Well, absolutely. So we’re a wooded area and we also have coastal lowlands and grasslands, and our flora and fauna basically support that. The deer tick, as you might imagine, deer is an important part of that. Mice are the other piece, and as global warming happens, it’s more conducive for the ticks and the mice. We have increasing deer populations. And then the other important factor is that human encroachment on spaces. So we’re building houses in previously wooded areas, hiking and biking, and actually invading these areas with our human presence. And so we’re more likely to come across ticks.

Chris: How do these diseases spread? I mean, you mentioned they were in other parts of the country that we haven’t historically seen a whole lot of. So are the ticks moving? Are the, are the mice and the deer moving? Are the people moving? How does this–

Dr. Dieckhaus: Well, certainly, deer move around, but I think that the latest introduction with this Gulf Coast tick was probably a bird vector. So it was brought in by birds. And we’re on the East Coast Flyway, so we have birds that come through the area seasonally. And so we may see introduction of new illnesses from the flyway.

Carolyn: So they’re different ticks? They’re each, all these illnesses there, it’s a different type of tick? Or is it the same, like deer tick or dog tick or whatever you call them?

Dr. Dieckhaus: It gets really confusing. Certainly there are a number of new ticks that are being introduced. But Ixodes scapularis, which is the common tick in Connecticut and the dog tick, Dermacentor, those are the ones that are predominant in Connecticut, and the deer tick can actually transmit a number of different illnesses so it can transmit Lyme disease that we all know about. But it can also transmit Powassan virus, this new one, as well as anaplasma and babesia. And we are seeing increasing cases of anaplasma and babesia in particular, in Connecticut these days.

Carolyn: So what are the symptoms for these different illnesses? Do they share kind of common symptoms?

Dr. Dieckhaus: There is definitely overlap. These tend to be summertime or at least warm weather, febrile, or fever, illnesses. Lyme disease, as we may or may not know, is often associated with a circular rash characteristic of Lyme disease. But anaplasma and babesia can be simply a febrile illness. So one of the things that we always say is, if you have a suspicion for Lyme disease, especially if that’s a more severe case, you might want to be checked for one of these other illnesses.

Now, fortunately, anaplasma is responsive to the same antibiotics that Lyme disease would respond to. Babesia requires a different antibiotic set, different antibiotic combination, and so co-infection with these agents, it’s possible to have Lyme, babesia, anaplasma, or all three. We have seen people coming in with all three, and that generally leads to more serious illness. It’s important to recognize that so you can apply the right antibiotics for this patient.

Carolyn: So it seems that antibiotics, that is the treatment.

Dr. Dieckhaus: Correct, antibiotics are effective. And there’s a misconception with Lyme disease, that it often goes into a chronic state with chronic symptoms. And that occasionally can happen, but the big message is that Lyme disease is typically a time-limited illness, especially if it’s diagnosed properly and treated. There’s a small chance that it may go on to more chronicity of symptoms, but by and large, the majority of cases of Lyme disease are a one-time event. You have your symptoms, you’re identified, you’re treated and resolve without having long-term symptoms.

Carolyn: So the people that say they have chronic Lyme, suffer from chronic Lyme, do they have something else? Has, has it morphed into a different type of illness or what would you say?

Dr. Dieckhaus: So that’s a really good question. We certainly know there’s an association with chronic symptoms and prior Lyme disease, and now why that is, often chronic symptoms can be associated with a variety of infectious insults and Lyme disease may be only one of those things. So other infections such as Epstein-Barr virus, COVID now, have all been associated with long-term chronicity of symptoms. So it’s important for the patient or the provider to certainly rule out Lyme disease, but also look for other treatable illnesses that might be hiding in the background.

One important point is that there’s a fallacy that if someone has prior Lyme disease that this must be Lyme disease, and they anchor on that diagnosis. We see this all the time and often it leads down a pathway of kind of more and more antibiotics and more and more kind of non-standard therapies, which can in themselves be dangerous. So I want to caution people that really a good evaluation to look for other potential etiologies other than Lyme disease often will lead to an answer that is treatable. The treatment for chronic symptoms, regardless of the source, whether it’s Lyme or COVID, or any other infection, is typically managing those symptoms. It’s not really treating the underlying or previously existing infectious agent.

Carolyn: Well, speaking of antibiotic use, I think now it’s pretty common if someone finds a tick on themselves and maybe they think it’s been there for a while, that then they go see their doctor and ask if they should be put on antibiotics even before any symptoms or anything has happened.

Dr. Dieckhaus: Right, that’s a really good question, and actually that happened to me last week. So it’s a very common occurrence in Connecticut. If one has a high incidence state, which certainly Connecticut is, and it’s warm weather, and you find a tick embedded on yourself, if it’s been embedded for more than a day — and you can get that by your story; so if you’ve been in the woods like the previous day, it may have been embedded for more than a day — at that point, taking a single dose of doxycycline prescribed by your doctor has been shown to be effective in reducing the, having coming down with Lyme disease. So yes, if you find a tick, and especially if it’s been embedded for a while, you may want to consider antibiotics. Now, if you’re just coming out of the woods and you find a tick that’s embedded, and it’s been kind of stuck for less than a day, remove it, but antibiotics are probably not going to be very helpful in that situation.

Carolyn: And what about removing it? That’s a whole other thing. You’ve got the special tick tweezer kits and, is it so terrible if you remove the tick and maybe you don’t get it all?

Dr. Dieckhaus: Yeah, very good question. So nobody wants to have part of an embedded tick remaining in them. So you basically, you pull, you use tweezers, you go down to the head as closely as you can, you pull, can kind of slow, gentle traction, you pull it out. If there’s a little piece that remains, you basically leave it there. Your body will eventually get rid of it. And if you dig around, you actually increase the rate of having a more standard infection just from, just from messing with it.

Carolyn: Now another, I walk in the woods a lot, because I have a beautiful hiking trail near my home. So I slather on or spray on a ton of DEET. Is that the best way? And I rarely find a tick, if ever; I don’t even remember the last time I found a tick. So is DEET safe to use?

Dr. Dieckhaus: Absolutely. So DEET is probably the most important ingredient that you can use. There are some other ways you can prevent tick bites. There’s permethrin for clothing, but others, just wearing long sleeves and long pants, tucking your pants into your socks, and then, importantly, when you’ve left the environment, is to check yourself. So if you’re out working in lawn, going in, changing your clothes, getting a shower, doing a tick inspection, that is very useful.

From an environmental standpoint, if you have lots of ticks in your yard, there’s actually lawn treatments that you can use, so acaricides, professionally done, that can reduce the amount of ticks on your property. This is something that a lot of suburbanites do, ‘cause you’ve got your children out in the yard and it’s a way to potentially reduce tick exposure for humans in that setting.

Carolyn: And that’s safe. Whatever the chemicals they’re using, that’s OK?

Dr. Dieckhaus: Correct, it reduces the number of ticks. It’s an acaricide, reduces the number of ticks and reduces the chance of coming across Lyme disease in that setting. It’s usually for kind of peri-urban applications.

Chris: If I recently had an excursion in the woods and I come down with symptoms, there’s a reasonable chance that I have been bitten by a tick or I’ve seen the tick and I’ve removed it, that’s one thing. But if I don’t know, I’ve been bitten by a tick. And now how, how much time needs to go by before I start showing symptoms if I have something. And how do you kind of like determine whether we’re dealing with something that requires antibiotics versus something else if we don’t have like the tick event?

Dr. Dieckhaus: Good question. So only about half of people with Lyme disease will have the classic skin symptoms. So the classic, it’s called erythema migrans, it’s the target type of rash. It may be missed, it can sometimes be hiding in the scalp or something, but only about 50% of people have that. So the important thing is, febrile illness, muscle aches, fever, no other explanation, especially with an exposure history — so someone who certainly is out in the woods and maybe has tick exposures — is going to be high risk of that. Now, doctors, internal medicine doctors in particular, family medicine doctors in Connecticut, are very good at diagnosing Lyme disease. And the the test is very simple. First of all, it could just be clinical judgment. Coming in with fever and a rash is enough to make a diagnosis of Lyme disease and start therapy. In the setting that you describe, we would probably get a blood test, and blood tests are highly accurate nowadays in showing evidence of Lyme disease.

Carolyn: So they’re more accurate than they used to be? Because people would always complain about that.

Dr. Dieckhaus: Yes. So the Lyme testing has always been a little fuzzy, I would say. It’s been a two-step process. At UConn Health, we’ve recently upgraded our protocol to our newer method that increases the accuracy. This is becoming a national standard now. So the tests nowadays are certainly better than they were a few years ago. There was a lot of subjectivity to previous testing.

Carolyn: Oh, that’s good to know.

Chris: At what point does a suspected tick bite or possible Lyme disease go from being a primary care situation to an infectious diseases physician- and Dr. Dieckhaus-type situation?

Dr. Dieckhaus: Sure. There are some unusual manifestations of Lyme disease, and so those can include neurologic problems, Bell’s palsy, or cardiac problems with some conduction, arrhythmia types of issues, or sometimes can get into the central nervous system. In those situations, occasionally patients would require a more intensive course of antibiotics or hospitalization. Intravenous antibiotics would certainly be a need to come in to see the ID doctor. The other reason, honestly, is patients who have had Lyme disease and there’s concern for other illnesses going on, so this concern for babesiosis or anaplasmosis or things like that. Often it’s a diagnostic question, not so much that you know the answer and are looking for treatment.

Carolyn: And I think we’ve always thought that, oh, with ticks, you just have to worry about it in the height of summer. But now with the warmer temperatures, I mean, can ticks be around a lot more?

Dr. Dieckhaus: Absolutely. The season is expanding. So generally ticks are active whenever the temperature is over about 40 degrees. And so we’re seeing that earlier.

Carolyn: Just 40 degrees? Uh-oh.

Dr. Dieckhaus: Just 40. So you can see, in an afternoon in the late winter, you can see ticks out, even in the late autumn. So the tick season, if you want to call it that, is actually expanded quite a bit. And then also with travel, now that Lyme disease has moved and expanded to more southern states, we do get a lot of travelers who go to warm weather and then come back to Connecticut in the middle of wintertime.

So we have made diagnoses of Lyme disease, you know, in the, in the dead of winter.

Chris: Are there other types of illnesses that we might see this time of year that might have nothing to do with ticks that could mimic that, or perhaps things that we should be paying attention for?

Dr. Dieckhaus: Well, certainly, I mean, a lot of things can cause fever, illness, certainly, the big one right now is COVID. So fever without another explanation, especially with if there’s respiratory symptoms, we want to think about COVID. But generally, Lyme disease and its associated tick-borne infections — babesia, anaplasma — those are the classic summertime febrile illnesses for adults.

Chris: Alright, is there anything else before we say goodbye? Things that you find yourself often telling your patients or things that maybe you just wish more people would know?

Dr. Dieckhaus: Well, one thing that’s I think new and exciting on the horizon is that we do have a Lyme vaccine for humans that is in development, and very likely we’re going to get some data on how effective that is in the next couple of months. Those of us with animals know that we can vaccinate our dogs for Lyme disease. So there is a vaccine out there; and there is now a human vaccine that’s in trials, and so over the next few months to a year or so, we expect to get some good data to see how effective this is. So this may be something that we can offer our patients who are certainly high-risk for prevention of Lyme disease.

Chris: Oh, that’s terrific. I wasn’t aware of that.

Carolyn: Yeah, that’s exciting.

Chris: Alright, Dr. Kevin Dieckhaus, thank you for being with us.

That is our time for today. Thank you to Ethan Georgetti and Ryan Burnett for their studio support. For Dr. Dieckhaus and Carolyn Pennington, this is Chris DeFrancesco, thanking you for listening to the UConn Health Pulse. Be sure to subscribe so you can catch us next time, and please share with a friend.