Additional information is available on the CDC’s page for Tickborne Diseases of the United States and their manual for healthcare providers.

Anaplasmosis

Anaplasmosis is the second most reported tickborne disease in Vermont. Confirmation of diagnosis is based on laboratory testing, but antibiotic therapy should not be delayed in a patient with a suggestive clinical presentation. People with anaplasmosis may also develop anemia, low white blood cell counts, low platelet counts, and elevated liver enzymes. Anaplasmosis can be a serious illness. Thirty-six percent of cases in Vermont are hospitalized for their illness. If not treated correctly, anaplasmosis can be fatal.

Signs and Symptoms:
▶ Fever, shaking, chills
▶ Severe headache
▶ Malaise
▶ Myalgia
▶ Gastrointestinal symptoms (nausea, vomiting, diarrhea, anorexia)
▶ Cough
▶ Rash (rare cases – only 10% of Vermonters with anaplasmosis report having a rash)
▶ Confusion

Babesia

Babesiosis is the third most commonly reported tickborne disease in Vermont.

Signs and Symptoms:
▶Fever, chills, sweats
▶ Malaise, fatigue
▶ Myalgia, arthralgia, headache
▶ Gastrointestinal symptoms, such as anorexia and nausea (less common: abdominal pain, vomiting)
▶ Dark urine
▶ Less common: cough, sore throat, emotional lability, depression, photophobia, conjunctival injection
▶ Mild splenomegaly, mild hepatomegaly, or jaundice may occur in some patients

Erlichiosis

More than half of the ehrlichiosis cases reported to the Health Department were in Bennington and Rutland county residents. Almost 25% of reported cases were hospitalized for their illness.

Signs and Symptoms:
▶ Fever
▶ Headache
▶ Chills
▶ Malaise
▶ Muscle pain
▶ Gastrointestinal symptoms (nausea, vomiting, diarrhea, anorexia)
▶ Confusion
▶ Conjunctival injection
▶ Rash (more commonly reported among children)

Powassan Virus

The last reported case of Powassan virus infection in a Vermont resident occurred in 1999, but infected ticks were recently found in Vermont. According to the Vermont Department of Health, “This disease can be difficult to diagnose and is likely underreported.”

Signs and Symptoms:
▶ Fever
▶ Headache
▶ Vomiting
▶ Generalized weakness
▶ Seizures
▶ Usually progresses to meningoencephalitis. May include meningeal signs, altered mental status, aphasia, paresis, movement disorders, or cranial nerve palsies

Borrelia miyamotoi

Borrelia miyamotoi is closely related to the bacteria that causes tickborne relapsing fever.

Signs and Symptoms:
▶ Fever
▶ Chills
▶ Muscle aches
▶ Fatigue
▶ Joint pain
▶ Headaches.
▶ Relapsing fever

Lyme Disease

Lyme disease is the most commonly reported tickborne disease in Vermont and in 2016, Vermont had the second highest rate of reported Lyme disease cases in the U.S.

Signs and Symptoms:
Localized Stage:
▶ Erythema migrans rash (not present in all cases)
▶ Flu-like symptoms – malaise, headache, fever, myalgia, arthralgia
▶ Lymphadenopathy

Disseminated Stages:
▶ Multiple secondary annular rashes (not present in all cases)
▶ Flu-like symptoms
▶ Lymphadenopathy
▶ Rheumatologic Manifestations
▶ Transient, migratory arthritis and effusion in one or multiple joints
▶ Migratory pain in tendons, bursae, muscle, and bones
▶ Cardiac Manifestations
▶ Conduction abnormalities, e.g. atrioventricular node block
▶ Myocarditis, pericarditis
▶ Neurologic Manifestations
▶ Bell’s palsy or other cranial neuropathy
▶ Meningitis
▶ Motor and sensory radiculoneuropathy, mononeuritis multiplex
▶ Subtle cognitive difficulties
▶ Encephalitis, encephalomyelitis, subtle encephalopathy, pseudotumor cerebri
▶ Conjunctivitis, keratitis, uveitis
▶ Mild hepatitis
▶ Splenomegaly

Symptoms in Children and Adolescents
source: Children’s Lyme Disease Network

▶ Fatigue
▶ Migratory Joint Pain
▶ Muscle Pain and Weakness
▶ Fevers
▶ Problems Sleeping
▶ Upset Stomach
▶ Irritability
▶ Impulsivity
▶ OCD-type Behaviors
▶ Brain Fog
▶ Bursts of Aggression/Rage
▶ Sensitivity to Light, Sound or Touch
▶ Slow Processing Speed
▶ Vision Difficulties/Double Vision
▶ Memory Problems
▶ Mood Disorders
▶ Encephalopathy
▶ Facial Paralysis (Bell’s Palsy)
▶ Skin Rash Sometimes only one symptom will be present, or a child may experience multiple symptoms.

79% of children with [complex] Lyme disease experience a decrease in their number of friends 41% have suicidal thoughts, and 11% made a suicide gesture source