Last weekend I traveled to Roanoke, Va., and celebrated a college graduation at a home in the mountains.
As I talked to my friend Teresa, she brushed a hand across her hairline. "Oh, look. A tick," she said calmly.
Teresa, a hospital infectious disease nurse manager, had no trouble identifying the tiny culprit, slightly smaller than a grain of rice. She suggested everyone check themselves for deer ticks, common in the woods there.
Deer ticks and the potentially serious disease some of them spread, Lyme disease, are not as plentiful in Florida as in points North. But it's worth knowing how to identify them and what to do about them, particularly if you travel in the summer, the height of tick season.
According to the U.S. Centers for Disease Control and Prevention, in 2011, 96 percent of Lyme disease cases were found in just 13 states including New Jersey, New York, Maine, Wisconsin, Pennsylvania, and, yes, Virginia. Some of those states report thousands of cases.
In Florida, we had 78 confirmed cases of Lyme in 2011. Last year in Pinellas there were three cases, with slightly more in Hillsborough. "Very few of those are acquired in Florida," said Michael Wiese, epidemiologist with the Florida Department of Health in Hillsborough County.
Some but not all people infected with Lyme disease develop a distinctive skin lesion that looks like a bull's eye target: a small red dot in the center at the site of the bite, surrounded by a clear area, then a red ring. It can take days or weeks for this bull's eye rash to appear. It may start out small and get larger as the infection spreads and may appear on several different areas of the body. Other symptoms include fever, headache, stiff neck, body aches and fatigue.
Without proper treatment, some people may develop facial drooping, memory issues, numbness, tingling and heart rhythm problems.
Since many symptoms mimic the flu, diagnosis can be difficult, and so official statistics may underestimate the problem. Without the skin lesion, it's important to tell your doctor if you've been to wooded areas where ticks, deer or Lyme disease are common.
"Half to two-thirds of those infected will develop that skin rash. If you get that and you've been in the woods, there's a good likelihood that it's Lyme's," said Dr. Douglas Holt, director of the Hillsborough County Health Department and director of the infectious disease division of USF Health.
Two blood tests are given that check for specific antibodies to the bacteria that causes Lyme disease. It can take a few weeks for the antibodies to develop.
"You need both tests, plus tick exposure and recollection of the other symptoms to confirm a diagnosis," said Dr. Holt. "It can be challenging. Without the skin rash, it's not easy to diagnose."
According to the CDC, the tick must be attached to its human host for at least 36 hours to transmit Lyme disease. But unless you find the tick, you may not be aware of its painless bite — so check yourself.
If you may have been exposed, watch for Lyme disease symptoms. Promptly caught, the usual treatment is oral antibiotics; more serious cases may require intravenous antibiotics.
While we don't have a lot of Lyme disease in Florida, Dr. Holt says, it's still important to be aware of it, especially if you visit the forested areas of Central and Northern Florida.
"Our biggest problem here is mosquitoes," he said. These critters can be worse than annoying when they carry diseases such as rare-but-serious Eastern equine encephalitis.
So, yes, be aware of Lyme disease, he said, but also "use your insect repellent when going outdoors."
Irene Maher can be reached at firstname.lastname@example.org.