ALBANY COUNTY — One Friday night in June, Edith Abrams came down with a fever of 104 degrees.

“I just thought it would pass,” she said.

She kept sweating, and changing her sheets two or three times a night for four nights when, on Tuesday, her husband took her to the emergency room at St. Peter’s Hospital in Albany.

“I was very lucky,” said Abrams this week. “I had an ER doctor that gave me tests right away for tick bites and put me on intravenous antibiotics immediately.” Still, she was in the hospital for a week and had to battle sepsis.

She didn’t have Lyme disease, which affects about 7,500 New Yorkers each year and is familiar to most.

Abrams had the second-most common tick-borne illness in New York: anaplasmosis, which infects about 500 New Yorkers annually, according to Bryon Backenson, with the state’s Department of Health.

Anaplasmosis is hard to diagnose, can be fatal, and is on the rise.

Backenson had worked with tick-borne diseases for 25 years, watching as they spread, primarily from Long Island, north and west along the Hudson Valley. Columbia and Dutchess counties still have the highest rates of tick-borne illnesses but, said Backenhouse, “You can get them anywhere in New York State.”

The other most frequent tick-borne illnesses in New York, he said, are babesiosis, which infects about 400 New Yorkers a year; ehrlichia, with about 150 cases a year; and Rocky Mountain spotted fever, with only a dozen cases annually in New York.

Lyme disease, anaplasmosis, and babesiosis are all carried by the black-legged tick, also known as the deer tick.  Ehrlichia is carried by the lone star tick, and Rocky Mountain spotted fever is carried by the American dog tick, he said.

Most ticks go through four stages — egg, larva, nymph, and adult, eating blood at each stage to progress to the next. From egg to adult can take several years and most ticks die since they lack a host for the next stage.

Ticks sense body odors, body heat, moisture, and vibrations to find their hosts, according to descriptions by the Centers for Disease Control and Prevention. Many ticks wait in a position called “questing,” holding onto leaves or grass by their third and fourth pair of legs, stretching out their first pair to climb on to the host.

Once on its host, a tick can take anywhere from a few minutes to a couple of hours to start to feed, when it cuts the surface of the skin to insert a feeding tube. Ticks often go unnoticed when feeding because they secrete saliva that acts like an anesthetic.

A tick can slowly suck blood for several days and may transmit pathogens during this process. After feeding, the tick drops off its host.

The numbers

In 2010, anaplasmosis was made reportable as its own unique disease, according to an email from the state’s Department of Health. The rise in New York has been rapid, mirroring the nationwide trend.

The CDC reports the highest rates, ranging from 3.1 to 136 cases per million people in Delaware, Maine, Minnesota, New Hampshire, New Jersey, New York, Rhode Island, Vermont, and Wisconsin. Some states have no reported cases.

In New York State, cases have more than doubled in three years: In 2012, there were 315 upstate cases and 20 in New York City; in 2015, the last year for which provisional data was available, there were 727 upstate cases and 56 from New York City.

Similarly, numbers in the Capital District have increased rapidly.

In Albany County, 11 cases of anaplasmosis were reported in 2012; there were 35 in 2013, there were 21 in 2014, and there were 68 last year.

Backenson noted that the tick population plays an important role in the number of tick-borne diseases in any year. For example, he explained the dip in 2014 by saying it “was not a good year for ticks.” This is because ticks dry out in the cold of winter if there is little snow to protect them; such was the case in 2014.

“Without snow, ticks get exposed — they desiccate and die,” he said.

Asked about the effects coyotes or foxes may have on tick-borne diseases, Backenson said, “It’s really complicated…Small mammals play an important role in tick-borne disease.” The vast majority of illness comes from nymphal ticks, he said, which feed on small animals like mice, shrews, and chipmunks.

Some scientists, he said are “teasing apart” the “predator impact,” in other words, how lack of foxes, for example, may increase small-mammal populations and also tick-borne illnesses, but, said Backenson, “There is not a real good answer.”

Asked if climate change has had an effect, he said, “It may play a role but we don’t know how much…It’s easy to say, with the warmer temperatures, tick-borne illnesses are moving north and west but you can’t tell what else benefits, in terms of prey, from the warmer temperatures.”

He also said that pesticides aren’t used as much now as in the last century and farmlands are being built up into neighborhoods. Also, people’s lifestyles have changed. “We spend more times outdoors,” he said, pursuing activities like hiking and biking.

The increase in the number of anaplasmosis cases in recent years may also be due to increased patient and physician awareness of the disease.

“There’s been a strong push in the past several years in the Capital District to educate others about anaplasmosis,” said Backenson.

“The general public knows about Lyme disease,” he said because of campaigns by the CDC, state and county health departments, and advocacy groups. The other tick-borne diseases are not so well known.

“Physicians have the responsibility to keep up with scientific literature,” said Backenson. He also conceded they are “busy folks” and noted there had been speakers at St. Peter’s and Albany Medical Center presenting cases of anaplasmosis to raise awareness.

The state’s health department and county health departments have also sent out mailers to physicians, he said.

“You can’t guarantee it’s going to stick,” he said.

Anaplasmosis can be fatal. The CDC says the highest proportion of fatal cases were reported in 2003 when more than 3 percent of those with anaplasmosis died. In other years, the fatality rate was around half a percent, that is, one person out of 200 with anaplasmosis died.

Backenson said “a few” people with anaplasmosis in New York State had died but that it would be difficult to come up with an exact number.

Anaplasmosis is difficult to diagnose, said Backenson, because the symptoms can vary from one patient to the next and are similar to those in many other illnesses, including fever, muscle aches, chills, headaches, nausea and abdominal pain, coughs, and confusion.

Diagnosis

“If it’s serious enough to bring the patient to a hospital, we usually get the right diagnosis,” Backenson said.

He said doctors would be wise to ask their patients about their lifestyles. If the patients are active gardening or hiking, for example, that can help lead to a diagnosis.

According to national statistics gathered by the CDC as well as statewide statistics from the department of health, reported anaplasmosis cases are typically higher among older people like Abrams, who is 66. “This is primarily because the more serious manifestations of anaplasmosis are seen in older individuals,” the health department emailed when The Enterprise asked why incidence increases with age.

Many patients, like Abrams, never realize they have been the host to a tick. She said she had “no idea” she had been bitten by a tick.

With anaplasmosis, there is no telltale red bull’s eye ring that frequently accompanies the onset of Lyme disease.

The CDC stresses that treatment of anaplasmosis should not be delayed pending the result of laboratory tests or withheld because of an initial negative lab result. The gold standard serologic test, the CDC says, involves taking two blood samples several weeks apart to look for an increase in antibodies.

The first line of treatment, administering doxycycline, should be started right away whenever anaplasmosis is suspected. Abrams said she received doxycycline immediately, first administered through an IV and then later taken orally. She continued taking the antibiotic orally for a week after she returned home. “That was no fun either,” she said.

Cautionary tale

On her arrival home, Abrams, an avid gardener said, “I wanted to see what had bloomed when I was gone.”

Although she was weak — “I lost my appetite and taste. I hadn’t eaten” — she walked around her New Scotland yard.

Then, on her homecoming day, she discovered a tick crawling on her.

“I love my garden but now I’m afraid…The days you could feel the grass between your toes — no more,” said Abrams.

When Abrams was in a doctor’s office recently, she heard a woman say her husband had anaplasmosis. He had had a fever of 103 degrees, she said. “She insisted he go to the doctor who said, if he hadn’t, he could have died.”

Now, Abrams has this advice for others, “Take all the precautions. Even if you’ve just been out on a stroll. When you get inside, take off your clothes and put them in the washing machine. Take a shower and examine yourself.”

With anaplasmosis, according to the state’s health department, if an attached tick is removed within 12 hours, the risk of infection is minimal.

Backenson gave specific directions on removing a tick and said a short video on the his department’s website (https://www.health.ny.gov/diseases/communicable/lyme/) clearly illustrates the proper technique. “You have to pull it off the right way,” he said, advising keeping fine-point tweezers on hand. “Get as close to the skin as possible around the head of the tick and steadily pull straight up. It works every single time.”

He said a lot of products are for sale that “cost a pretty penny” and may not work; simple tweezers are best, treated first with rubbing alcohol.

Backenson strongly advised against folk techniques like applying dish soap, mayonnaise, or kerosene to the attached tick, or trying to burn it out with a lit match or cigarette. “It may back out because it irritates the tick,” he said. But irritating the tick also makes it salivate. “That’s where the pathogen is,” said Backenson; the pathogen is then pumped into the host.

Asked if the removed tick should be brought to a doctor’s office for analysis, Backenson said, “We don’t recommend it. Just because a tick is infected doesn’t mean the person is.”

Treatment is based on symptoms, he said.

Advice for tick prevention

The health department advises avoiding ticks by avoiding contact with soil, leaf litter, and vegetation. Deer ticks, the department notes, live in shady, moist areas at ground level, clinging to grass and brush not two feet off the ground.

For those who garden, camp, hike, or work in the outdoors, the department advises wearing tightly-woven, light-colored clothes, covering arms and legs. Pant legs should be tucked into socks, and shoes should be enclosed. Hair should be tied back.

The CDC advises using repellents that contain 20 to 30 percent DEET (N, N-diethyl-m-tolumide) on exposed skin and clothing for protection that last several hours; clothing and gear should be treated with products that contain permethrin.

The CDC also recommends a bath or shower within two hours of coming indoors and to “conduct a full-body tick check using a hand-held or full-length mirror to view all parts of your body.”

Finally, the CDC says, clothes should be tumble-dried on high heat for 10 minutes, longer if the clothes are damp.

Lyme disease is named for the place it was first noted, in Lyme, Connecticut and the Connecticut Agricultural Experiment State has developed a “tick Management Handbook” that includes simple landscaping techniques to reduce tick populations: removing leaf litter, clearing tall grasses and brush around a home, placing a yard-wide wood-chip barrier between lawns and wooded areas, stacking wood neatly in dry areas, Keeping playgrounds and patios away from yard edges and trees, and removing old furniture and trash that may give ticks a place to hide.

Backenson also advises pet owners to purchase products for their cats or dogs that repel ticks, both because animals can get tick-borne illnesses and because  “it minimizes hitchhikers getting into the house.”

“I’m always surprised,” he said, “when people seem more concerned about their pets than themselves.”