Upstate lab can test a tick to see whether it carries a disease

Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient, with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith.

As the weather turns warmer in Central New York, and we start spending more time outdoors, we start thinking about ticks.

Today I am talking with an expert in vector-borne diseases. Dr. Saravanan Thangamani is a SUNY Empire Innovation professor in the department of microbiology and immunology at Upstate, and he directs the SUNY Center for Environmental Health and Medicine.

Welcome back to "The Informed Patient," Dr. Thangamani.

Saravanan Thangamani, PhD: Thanks for having me. It's a pleasure to meet again and then share some information about the ticks and tick prevention and what my lab is doing to help the public, to educate the public not to have tick bites.

Host Amber Smith: Now, your website at nyticks.org provides a lot of data about ticks in New York state.

You found 14 species of ticks here so far, is that right?

Saravanan Thangamani, PhD: Yes, that's right. So 14 species of ticks. Humans are encountering those ticks. These are not the ticks that we collected from the field. These are the ticks that humans actually have encountered. So those are epidemiologically relevant.

Host Amber Smith: And they've sent them into your lab. That's how you've discovered them.

Saravanan Thangamani, PhD: Yes, exactly. So we run the Citizen Science Program, where when someone encounters a tick, they actually send the tick to the lab. We have instructions posted on nyticks.org website. And as soon as the ticks are received in the lab, we surface-decontaminate the lab.

We identify the tick species under our microscope, and then we have our proprietary tick pathogen assay (test for disease-causing agents) that we perform on each tick, and then we send the results back to the tick submitter. And then, the data that we use, we actually developed a dashboard, also called a stick map. That's what you can see in ny ticks.org, where any (member of the) public can actually use the dashboard to find what kind of tick species are emerging in their own county, what kind of tick-borne pathogens are actually emerging in their own county as well.

So it's a very useful interactive tool to understand what is really happening in their own neighborhoods.

Host Amber Smith: So if someone finds a tick on themselves or their dog, they can go to nyticks.org and learn how to send it in. What is the cost to have it analyzed?

Saravanan Thangamani, PhD: So, beginning this year, we have a three-tier system for testing the ticks.

The first one is Lyme disease-causing agent test, which is, like, about $10 for Onondaga County residents. And the second tier is the basic test, which covers Borrelia burgdorferi -- the Lyme disease agent -- anaplasma and babesia. The anaplasma, babesia and Lyme, those are the three primary tick-borne pathogens that cause human illnesses in New York state, so we kind of divided that as a priority. And the third tier is comprehensive. As the name suggests, you test 16 different tick-borne pathogens.

So these three tiers have different pricing structure, and for the residents of Onondaga County, we are providing tick testing as low as $10 per tick.

Host Amber Smith: And you have instructions on there about how to send them in. There's also a form that you have to print out, and can you talk us through what type of information is needed on the form?

Saravanan Thangamani, PhD: So when someone goes to our tick submission page, it opens up a questionnaire. That's where they will be providing information on when they encountered the tick, where they encountered the tick. And they will provide information like location and also email ID, because that's the only way we communicate with the tick submitters, with an email ID. Also, the result of the tick testing assay will be sent to that email.

And as soon as they complete that form, it'll probably take about two minutes to complete, and then once they submit that form to us, we then provide a unique tick ID. So each tick is provided a unique tick ID, and the submitter then sends the tick back to the lab in a small zip-lock bag with a moist tissue paper and writes the tick ID on top of it, and then sends it in an envelope, and I recommend them to write the tick ID on the envelope as well, so we can make sure that we do not miss the tick ID, because that's the only connection for us to the submitter and also correctly identify what tick is being submitted.

Host Amber Smith: Now, which ticks are the most prevalent in New York state?

Saravanan Thangamani, PhD: Deer ticks, obviously, are the most prevalent. However, there are two other species that are slowly emerging in Central New York, I should say, that is the lone star tick and the dog tick. But generally, throughout New York state, deer ticks are the highly prevalent ticks.

Host Amber Smith: And deer ticks are known for carrying the Lyme ...

Saravanan Thangamani, PhD: Yes. Deer ticks are known to carry the most obvious pathogens of Lyme disease, Borrelia burgdorferi agent. In addition to that, it also transmits the agents that cause anaplasmosis, babesiosis, ehrlichiosis and Powassan encephalitis. So deer ticks can transmit multiple disease-causing agents from a single bite.

Host Amber Smith: Now, what about the lone star tick? What does that carry, typically?

Saravanan Thangamani, PhD: So lone star ticks carry Ehrlichia, (which) cause ehrlichiosis, and also transmit two viruses, called a Heartland virus and Bourbon virus. They cause acute febrile illness. And in immunocompromised patients, it can be fatal, as well. It's very rare, but it can be fatal as well.

In addition to that, it causes meat allergy, allergy to a particular carbohydrate, in humans, as well. So yes, they may not be transmitting as many tick-borne agents as deer ticks, but they are equally clinically relevant in actually causing humans sickness.

Host Amber Smith: And you mentioned the dog tick. Does that favor dogs?

Saravanan Thangamani, PhD: Not necessarily. Maybe, historically, they found these ticks prefer to feed on the dogs. However, we now know that pets live within our close proximity. They tend to sleep in our beds. So humans are mostly like an accidental host, not the primary host, but they're accidental hosts. Ticks can transmit rickettsiae that can cause Rocky Mountain spotted fever and rickettsiosis as well.

Host Amber Smith: What percent of the ticks that come into your lab are carrying a pathogen?

Saravanan Thangamani, PhD: I should say 38% of the ticks carry at least one disease-causing agent. And (of those) 33% to 35% of them are the Lyme disease-positive agent.

Host Amber Smith: So about a third ...

Saravanan Thangamani, PhD: ... carry the Lyme disease agent, unfortunately.

Host Amber Smith: On your chart, on your website, why are the majority of the ticks that are sent in for testing female?

Saravanan Thangamani, PhD: Well, I think it has to do with the ecology, and also the female ticks tend to feed on hosts for longer periods of times, like five to seven days.

Males tend to feed only for short duration, so humans may not notice that male ticks are feeding on them. That's one. And the size. Female ticks are larger than the male ticks, so that's another thing. So the larger tick is easy to notice on a human body and report it, compared to the smaller ones.

And also the primary purpose, in nature, if you see the male/female ratio, there are more females, and primarily because it's how the perpetuation should happen, right? Females feed on mammalian blood, and they convert the blood proteins to lay thousands of eggs. Those thousands of eggs become thousands of larvae, right? So for its perpetuation. It needs more females. So that's the reason why there.

So size, human encounter and their aggressive behavior. Female ticks have more aggressive behavior because they need to find blood meal for their survival. Adult ticks, their primary role is to mate with the female.

That's about it. They are not playing a major role in the ecology of the tick population.

Those are many reasons, but these are the primary reasons why we encounter more female ticks than male ticks.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host Amber Smith.

I'm talking with Professor Saravanan Thangamani about ticks.

Is spring when you start getting tick submissions, or do you get them year-round?

Saravanan Thangamani, PhD: I do get year-round, however, the number spikes up during the spring and fall, followed by summer. In winter, we do get ticks in the lab for testing, however the numbers are very low. Pets are tick magnets, actually, so humans may not be going out in winter, however, pets go to do their business in the backyard and other things, so when they're going around there, they try to lift up the litter, and that's where the ticks hide during the winter, right? They try to hide underneath the litter.

So when these ticks latch onto the pets, and the pets come in, that's how the humans actually get tick bites during the winter as well. And people do snow walking, people do hiking in the woods during winter, or the hunters, those kind of encounters actually increases the chance of someone getting tick bites.

As soon as the weather kind of thawed out a little bit, we started getting a flood of tick submissions. We have, within like three to four weeks, I would say, since the ground started to thaw out, 200-plus submissions.

And it actually makes me speculate that, more and more, encounters will be happening between humans and ticks. And I attribute that to a really cold winter because we are, like, in the house for three months, and suddenly, it's "Hey, I need to get out!"

This was a true winter, at least since I arrived at Upstate, this is the longest, really. We had snow for, like, two months on the ground. So I think it is more of a human behavior that actually makes it more prone to have tick encounters. All they (ticks) need, as long as they find suitable hosts, they're going to go for it. So I don't think that (the weather) impacts them at all, but definitely I would say there will be a surge in the tick population if there is a wave of humans going for outdoor activity after a long cold season, right? So that actually encounters more ticks. It's more of an artificial spike.

Technically it'll happen over the year. It spreads out over the year. But because of this cold season, maybe there's a spike.

Host Amber Smith: You're involved in quite a bit of research relating to vector-borne diseases. I'd like to ask you about the work you're doing on Lyme disease and what happens when someone is infected with another infection at the same time they're infected with Lyme. How common is that?

Saravanan Thangamani, PhD: We do epidemiology research. We do the tick testing. That's the public-facing research, right? That helps the public on a daily basis. However, we do basic science research in our lab, where we try to understand how a single tick bite delivers more than one pathogen. For example, the deer tick that transmits the Lyme disease agent also transmits Powassan virus.

So in our lab, we try to understand what if a single tick transmits both the Lyme disease agent and the Powassan virus, how does it impact the clinical outcome in a small animal model? But then we will translate that to human clinical outcomes as well. So currently, one of my graduate students is investigating that, and maybe in a year or two we will have a good understanding of the clinical consequence of co-infections, particularly between a virus and a spirochete bacterium that causes the Lyme disease.

In addition to that, our lab is interested in developing anti-tick vaccine and also antivirus vaccines, so we have made good progress, and it's rather slow, I should say, because of the complexities involved in developing a vaccine against ticks and tick-borne viruses. But we have identified a few potential candidates that currently my lab is evaluating.

So hopefully the next time I meet with you, I may be able to provide you additional information.

Host Amber Smith: So at this time, we really don't know for sure whether, if you have both infections, whether one is worsened by the other or if it complicates treatment or recovery, right? That's what we're trying to find out.

Saravanan Thangamani, PhD: Exactly. We don't know. We don't know anything, actually, because it's a rare infection, and people, when they think about tick-borne disease, they often associate it with Lyme disease. However, there's other diseases, other co-infection that actually can worsen the clinical outcome, maybe worsen the clinical treatment process as well.

They may not be responding because they are multiple agents in them. And also, you know, we are only talking about a single human getting a single human disease. But there are a lot of comorbid conditions: diabetes, hypertension, other viral infections, right? Those are the things that we are trying to tease apart one at a time, but it's something that I'm interested to understand, how diabetes can influence infections, tick-borne infection, and how obesity can influence tick-borne infections. So we have ideas, we have plans to work on, but we are trying to kind of prioritize based on what the federal governmentt is funding.

Host Amber Smith: Well, you mentioned also an anti-tick vaccine. Doesn't something like that exist for dogs at this point? Don't veterinarians have ...

Saravanan Thangamani, PhD: There is a Lyme disease vaccine for dogs. However, there is, no anti-tick vaccine thus far because ticks are very smart. They secrete a saliva that actually neutralizes our human immune responses.

So it's researchers, including us, we are trying our best to develop anti-tick vaccine, but it is still a long way to go. Yes, there is a vaccine for dogs and cats, but it cannot be used on humans.

Host Amber Smith: Well, before we wrap up, I'd like to ask you to go over, give us some reminders about what's most important for people who want to avoid ticks when they're outdoors.

Saravanan Thangamani, PhD: Springtime is always a time where humans would like to do outdoor activities, and then ticks are also waiting there to find a suitable house to feed on and get the blood and then perpetuate their life cycle. So it is very important that before going outdoors, where the risks are, know where the ticks are. So you can go to our nyticks.org, find out from our tick map where the ticks are, and then do appropriate precautions like, spraying your body with the DEET-based chemicals or maybe eucalyptus or eco-friendly sprays, and also you can treat your outdoor wear with permethrin.

You can go to the CDC (Centers for Disease Control and Prevention) website -- cdc.gov -- and it'll tell you what are the chemicals you can actually use to prepare your outdoor clothing in such a way that they repel the ticks, or when ticks come in contact with those chemical, ticks die.

And, once you complete your outdoor activity, but before you start to do your business at home, I would encourage everybody to do a tick check. First, take off your clothes and put them in the dryer for 10 minutes at a high temperature. And then do a tick check daily. If you are an avid gardener, if you are an avid outdoor activity person, you may have to do a daily tick check.

And if you find a tick, it's easy. No need to panic. You can just pull the tick off. Go to our website, send the tick to the lab, we'll send the results back in two days, and you can take the result to a clinical health care provider. And then you are giving additional information to the health care provider to make informed decisions.

So that's what I would say. Even if you get a tick bite, people don't need to get anxious about it. They can just pull the tick gently and then send it to the lab for testing. Our turnaround time is two days, so we try to get the results back to them as soon as possible, so they can seek expedited health care solutions.

Host Amber Smith: That's good to know. Well, thank you, Dr. Thangamani.

Saravanan Thangamani, PhD: Thanks for having me. I really appreciate talking to you about ticks and our tick-borne disease program.

Host Amber Smith: My guest has been professor Saravanan Thangamani.

He's a SUNY Empire Innovation professor in the department of microbiology and immunology at Upstate, and he directs the SUNY Center for Environmental Health and Medicine.

"The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe, with sound engineering by Bill Broeckel and graphic design by Dan Cameron.

Find our archive of previous episodes at upstate.edu/informed.

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