Illinois clinicians demonstrate gaps in understanding of tick-borne co-infections

Carson and colleagues surveyed clinicians between August 2020 and February 2022 and reported their findings in the article “Knowledge, attitudes, and practices of Illinois medical professionals related to ticks and tick-borne disease.” ¹

The respondents included RNs (61.3%), physicians (21.4%), and APNs/PAs (17.3%).

The authors found that clinicians were best at identifying Lyme disease. Out of 346 respondents, 80% correctly identified Lyme disease as endemic to Illinois, while 95% were familiar with diagnostic testing for the disease.

Clinicians’ knowledge regarding the presence of co-infections, however, was poor. “Lyme disease was the only [tick-borne disease] TBD that most respondents (79.5%) reported as endemic to Illinois.”

“Clinicians’ knowledge about vector ticks and TBDs in their area may influence whether patients are questioned about potential tick exposure and the consideration of diagnostic testing for TBDs.”

“The diseases physicians most frequently reported as present were Lyme disease (77.0%), [Rocky Mountain spotted fever] RMSF (25.7%), tularemia (17.6%), ehrlichiosis (16.2%), and rickettsiosis (12.5%),” wrote the authors.

Furthermore, their knowledge regarding diagnostic testing for co-infections was also poor. “Among physicians, 97.3% were familiar with Lyme disease testing, but fewer were aware of testing for anaplasmosis (35.3%), B. miyamotoi (28.4%), B. mayonii (27.0%), and Powassan disease (8.1%).”

Knowledge about Alpha-gal syndrome was also low across all clinician types despite its presence in Illinois. Alpha-gal syndrome is a food allergy to red meat and other products made from mammals. The condition is most often caused by a Lone Star tick bite.

“The allergic response in Alpha-gal syndrome is typically delayed by hours after consuming meat, and over 51% of cases involve anaphylaxis, making this condition both challenging to diagnose and life-threatening,” wrote the authors.

“These findings suggest that TBDs may be underdiagnosed and undertreated in Illinois, though further study is warranted both on a state and national level,” the authors’ concluded.

The CDC lists the following tick-borne illness in the U.S. as of 10/29/22.

1. Anaplasmosis
2. Babesiosis
3. Borrelia mayonii
4. Borrelia miyamotoi
5. Bourbon virus
6. Colorado tick fever
7. Ehrlichiosis
8. Heartland virus
9. Lyme disease
10. Powassan disease
11. Rocky Mountain spotted fever (RMSF)
12. STARI (Southern tick-associated rash illness)
13. Tick-borne relapsing fever (TBRF)
14. Tularemia
15. 364D rickettsiosis (Rickettsia phillipi, proposed)

The number of tick-borne illnesses vary by state and country. The authors suggest that educating the medical community may be helpful. “Based on our results, frequent training for clinicians highlighting TBDs endemic to their region is critical to address this growing public health issue.”

Editor’s note: The authors did not explore clinicians understanding of acute and chronic manifestations of Lyme disease and co-infections.