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Unmasking the Tiny Terrors: Ticks, Fleas, and Other Insect Concerns in Pediatrics · Pediatrics Now: Cases Updates and Discussions for the Busy Pediatric Practitioner

• 0:01
  I'm Holly Wayment and this is Pediatrics Now.
• 0:05
  And back on the show is Dr. Tess Barton. She's our pediatric infectious disease expert.
• 0:11
  Tess, thank you so much for being back on Pediatrics Now. Thanks for having me.
• 0:16
  So what about tics? Do you want to say anything there about tics?
• 0:21
  I know I went, I was on the East Coast and staying with one of my friends from
• 0:25
  Northwestern when I was in graduate school. She has two kids now.
• 0:28
  They have this beautiful backyard, all these gorgeous trees.
• 0:31
  But I got the sense they avoid going outside at all.
• 0:35
  Like even, she was so worried about ticks that we stayed inside at their house.
• 0:42
  Yes. So ticks also transmit some diseases. They can transmit some diseases.
• 0:49
  And some of those Those are also, you know, fairly serious diseases.
• 0:54
  The one that people always worry about is Lyme disease.
• 0:58
  Although we are lucky in Texas that we really don't have Lyme disease.
• 1:04
  Like it's quite rare here.
• 1:06
  We have the ticks and we have the deer, but that particular bacteria is not abundant here.
• 1:16
  We have its cousins. So we have other species of that that's not Lyme disease
• 1:25
  that can sometimes cause a fever illness or a rash illness.
• 1:30
  A variety of different things can be transmitted by ticks.
• 1:34
  And so, yes, if you've been in a wooded area or doing a lot of outdoor stuff,
• 1:41
  particularly in the country or in long grasses,
• 1:45
  It's a good idea to do a tick check after you've been and just make sure that
• 1:51
  you try to pick off any ticks that you see.
• 1:55
  And again, if you have household pets, if they're getting ticks because they
• 1:59
  go outside and stay there a little bit more frequently, that's usually a sign
• 2:04
  that you need to do some tick control.
• 2:06
  The good thing is that DEET actually repels both mosquitoes and ticks. Yes.
• 2:11
  So, and when you were talking about fleas, if we're doing flea prevention with
• 2:16
  our animals, though, it still could be in the grass because of other animals.
• 2:20
  It could be, but, you know, for animals, there's a variety of different flea
• 2:24
  preventions that are available.
• 2:25
  And the ones that, usually it's the ones that are by mouth, but even some of
• 2:29
  the drops, the way that they work is actually by sterilizing the fleas.
• 2:33
  And so if you do them for a month or two, you
• 2:36
  actually reduce the overall flea population on your
• 2:39
  property because even if there are fleas that are
• 2:42
  there they they become sterilized so
• 2:45
  of course you can't control the fleas that are
• 2:48
  on the raccoons or whatever but but you will actually decrease the flea infestation
• 2:52
  just by doing the like the oral flea treatments of course you can yeah and of
• 2:58
  course you can double that up with having you know a pest control company come
• 3:02
  out and spray your grass and and if you you know you spray the grass for a couple of months
• 3:07
  and do the flea control on your animals for a couple of months,
• 3:11
  you'll get rid of your fleas.
• 3:13
  And do that if you're noticing the bites on the ankles?
• 3:16
  Yeah. Yeah. Or if you notice that your animal has fleas.
• 3:20
  Do you want to talk about tests? What about the cousins of ticks or anything
• 3:24
  else in the next few minutes that we haven't covered? The cousins of Lyme disease?
• 3:30
  No. No. No, maybe, maybe what I'll, yes.
• 3:37
  So, so we, so Lyme disease is caused by a bacteria called Borrelia burgdorferi,
• 3:43
  and it is seen in other parts of the country very commonly.
• 3:46
  So in the Midwest and the Northeast are kind of the hotspots for Lyme disease.
• 3:51
  And, and it, it is, it's this sort of, you know, complex life cycle where that
• 3:57
  involves a deer and a tick and a human.
• 4:01
  And so And so we get it transmitted from the tick bite.
• 4:09
  As I mentioned, we don't really have endemic Lyme disease in Texas,
• 4:14
  but we do have other Borrelia's.
• 4:18
  And the most common one causes a thing that's called STARI, which is S-T-A-R-I,
• 4:26
  is the acronym, which is a Southern Tick Associated Rash Illness.
• 4:31
  So starry will freak everybody out because they'll think that they have Lyme disease.
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  Because starry, where the tick bit you, you get that same ring around the bite
• 4:43
  that you get with Lyme disease.
• 4:47
  And so it looks like the rash of Lyme disease, but it doesn't usually have all
• 4:51
  of the systemic illness, the
• 4:54
  fever and the joint pains or the brain infection or any of those things.
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  So it's usually a very limited illness, but it looks in the initial stage just
• 5:03
  like the Lyme disease rash.
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  And one of the reasons that's important is because we don't have a test for that illness.
• 5:12
  But when somebody freaks out and they test for Lyme disease,
• 5:16
  the tests for those bacteria are cross-reactive.
• 5:19
  So if you've been exposed to one of these other Borrelia's that we do have here
• 5:28
  in Texas, your Lyme disease testing can be false positive.
• 5:33
  And it usually gets sort of sorted out with the sort of next round of testing
• 5:37
  that we do to be more specific.
• 5:40
  But people will waste a lot of their money and a lot of their time on chasing
• 5:46
  down an inappropriate test for Lyme disease.
• 5:53
  Well, and I remember as a child switching to chiggers. So I remember we did
• 5:57
  a lot of camping when I was a child.
• 5:59
  And I would worry about, because my parents would tell us about chiggers and
• 6:02
  I was so worried about getting them.
• 6:04
  And I remember getting them one time and it seemed like these like small bumps, a lot of them.
• 6:09
  And then if I'm remembering correctly, I think my parents put clear nail polish on them.
• 6:15
  Is that still a good, was that terrible to do? Or what do you say there? No, that's fine.
• 6:22
  Chiggers are also quite common and we do see chiggers in the sort of deep of summer.
• 6:27
  Chiggers are a mite. It also lives in the grass.
• 6:31
  They don't jump, they crawl. So again, they usually start on your feet.
• 6:36
  Or if you've been, you know, sitting in the grass to have your picnic or something,
• 6:40
  they may start on your behind or your back.
• 6:44
  Chiggers are similar, similar in some ways to scabies. So they actually burrow into your skin.
• 6:52
  And that's where they, yeah, so they basically just get right underneath your
• 6:55
  skin and they start sort of crawling around, looking for places to,
• 7:00
  you know, lay their eggs and make the babies.
• 7:03
  And they're almost microscopic. You can actually sort of see them.
• 7:09
  If you really look close, you can see these, you know, little teeny,
• 7:13
  teeny, tiny, you think they might be a tick, right?
• 7:15
  There's these little teeny, tiny, like, spots that crawl around.
• 7:19
  So and they're extremely extremely itchy
• 7:22
  and so yeah the treatment for chiggers traditionally
• 7:27
  is to you you can use you can use insecticide like treatments like creams that
• 7:33
  you would the same things that you might use for scabies but you can also smother
• 7:37
  them which is what the nail polish was about right so you basically trap them
• 7:42
  underneath you know where they are so that they They can't keep,
• 7:46
  you know, coming out and eating. And then they die because they're smothered.
• 7:51
  My grandma was a fan of using like ivory soap and Vaseline.
• 7:57
  And that's how, yeah, and that's how she cured the triggers.
• 8:00
  And the ivory soap is very drying.
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  So I think it like clean, you know, you clean off, you know,
• 8:05
  you clean off any bacteria or whatever.
• 8:07
  You dry up the areas and then Vaseline sort of smothered them under the skin.
• 8:13
  But you can also use the same types of permethrin creams that you use for scabies
• 8:20
  on triggers and that will probably get rid of them more quickly than all these other remedies,
• 8:25
  well yes and and my mom who's a grandma now of course but a lot of these old-fashioned,
• 8:31
  recipes so to speak can be really helpful sounds like oh i love grandma medicine.
• 8:38
  Medicine on that grandma medicine yeah medicine
• 8:42
  is is is great you know like the
• 8:45
  the chicken soup and all those things they're they're they're valid yes we need
• 8:51
  that when we have a virus and i remember the giant when the smoke like playing
• 8:55
  in the backyard not the the smoke isn't the right word but the mosquito truck
• 8:59
  would come and spray the fog of mosquito repellent,
• 9:04
  I don't see that much anymore in the United States and the places I've been in.
• 9:08
  Yes, they do it. They do it when there's a West Nile.
• 9:13
  But they don't do it routinely anymore. But yeah. Because it's probably harmful
• 9:19
  for our lungs, I'm guessing.
• 9:22
  Yeah, very irritating. We did go inside. Yeah, that.
• 9:27
  So anything else, Tess? This has been so wonderful. Thank you for sharing your
• 9:31
  knowledge. Anything else you want the pediatric practitioner to know about if
• 9:35
  you see this particular sting or bite?
• 9:40
  No, I think, I mean, I think for the, for the pediatrician, probably just,
• 9:45
  you know, familiarizing yourself with the, with the patterns that can help you
• 9:51
  to distinguish from the bites.
• 9:53
  So, you know, like I mentioned, mosquito bites are on exposed areas.
• 9:57
  Bed bug bites are not on, like they, they will be on any area,
• 10:02
  including your face and under your clothes.
• 10:06
  Flea bites are you know usually if
• 10:09
  you pick them up in the grass they're on your ankles but
• 10:12
  they're also in exposed areas whereas chiggers
• 10:15
  chiggers actually they you know
• 10:18
  they they crawl somewhere and then they they actually like little
• 10:21
  tight spaces so they'll make they'll make
• 10:24
  their rash in the like in
• 10:27
  your sock line or your underwear line so there'll
• 10:30
  be like a line of of all the bites
• 10:33
  in those places and that's where chiggers will sort
• 10:36
  of congregate you know ticks
• 10:39
  ticks will crawl under your under your clothing and
• 10:43
  and so they can be anywhere including the scalp
• 10:46
  which most of these other things don't usually bite you on your scalp and and
• 10:51
  scabies you know most most pediatricians are super familiar with scabies but
• 10:58
  you know the scabies rash very typically between in the webbing of the fingers or the toes.
• 11:04
  And usually other people have it because it's quite contagious from person to person.
• 11:10
  And spiders...
• 11:12
  Usually have, because if it's a venomous spider, particularly,
• 11:16
  they will have a large reaction with that sort of blackening center where the
• 11:24
  tissues are getting destroyed by the spider venom.
• 11:27
  So there's, you know, there's little clues that you can use if the parents are
• 11:32
  asking, what bit my child, to try to get an answer.
• 11:37
  You may never know, but that, you know, Trying to do some pattern recognition
• 11:43
  can sometimes be the key.
• 11:45
  And for the venomous spider, if it's looking like that, what would you advise to do next?
• 11:51
  So interestingly, I mean, usually it's just wound care to keep things clean.
• 11:57
  If it is turning into a larger blackened thing or there's a lot of redness around
• 12:04
  it, they should go to the emergency room or the urgent care.
• 12:08
  And they may need antibiotics and they definitely may need some wound care as
• 12:15
  far as, you know, potentially debriding.
• 12:19
  Although mostly for spider bites, we say to leave it alone and not to do a lot of stuff to it.
• 12:25
  It will look terrible, but will eventually get better.
• 12:29
  The time to be worried is that both brown recluse bites are the ones that give
• 12:36
  you kind of a big, you know, blackened, horrible-looking lesion.
• 12:41
  But their venom can also get into the bloodstream and cause fever and other systemic signs.
• 12:50
  And those kids actually need to be seen because there is an anti-venom that's available.
• 12:55
  Available black widow and venomations there's not usually much of a impressive
• 13:00
  bite but they also can be in in the bloodstream and and cause you know up,
• 13:06
  paralysis and other neurologic symptoms
• 13:10
  so wow so if yeah so those
• 13:13
  are those are the those are the kind of bites that that
• 13:17
  you know should should warrant emergent attention and again with pattern recognition
• 13:23
  spider bites because they are bites and not stings they typically have their
• 13:28
  fang marks so if you see those two little dots as a fang mark then then that's
• 13:34
  a a clue that you're dealing with a spider bite.
• 13:36
  And then if there's a lot of swelling that's happening, then that could be urgent.
• 13:42
  Yes, yes. Swelling or definitely if you're having feelings of illness, right?
• 13:48
  So fever or dizziness or headaches or weakness or something like that,
• 13:53
  those are signs that the spiders not only caused a little local skin problem,
• 13:58
  but actually has injected its venom into your blood.
• 14:01
  Okay. And I get the sense that a lot of parents come in very worried.
• 14:06
  And it's, is it a lot though, like the, the saying in medicine,
• 14:10
  if you hear hoof beats, it's, you know, think horse.
• 14:13
  If it looks like a mosquito bite, it's probably a mosquito bite.
• 14:17
  Yes. Yes. Do you want to say anything just really quickly about hand, foot and mouth disease?
• 14:22
  I know that our listeners are seeing a lot of that. I know it has nothing to
• 14:25
  do with insects, right? Right. But it's about washing hands.
• 14:30
  Yeah, I mean, we have been seeing little outbreaks of hand, foot,
• 14:35
  and mouth, often associated with daycares.
• 14:40
  And it can look really variable.
• 14:44
  Some kids have stuff in the mouth and some don't. Some have spots,
• 14:49
  a few spots, and some have tons of spots.
• 14:52
  So there's sort of a wide variety of what that looks like.
• 14:57
  And i don't know what to say about it but yeah
• 15:01
  so i yeah so i think i think you
• 15:04
  know practicing the other you know i mean this is a virus that gets transmitted
• 15:07
  from person to person so all of the usual things that we do to prevent viruses
• 15:11
  from getting transmitted from person to person are the key to not getting hand
• 15:14
  foot mouth so yes good good hand washing if if a child has as hand, foot, mouth,
• 15:22
  they should not go to daycare.
• 15:24
  They should stay home with another caregiver so that they don't infect others around them.
• 15:30
  Don't go to the children's museum. Yeah, don't go to the children's museum. Exactly, exactly.
• 15:36
  So, yeah. And rest, or is there anything new treatment-wise?
• 15:42
  Yeah, it's just, you know, let it run its course of the treatment.
• 15:46
  Is there any type of insect that makes you worry the most? Is it a mosquito?
• 15:51
  So here, here in the United States, in Texas, the insect that actually worries
• 15:58
  me the most are, are fleas.
• 16:01
  And because they're, because they are the ones that are transmitting,
• 16:05
  you know, the, the most, the most significant illnesses, that's also fairly
• 16:09
  common. And, you know, traveling abroad, absolutely the mosquito, right?
• 16:15
  So if I'm in a place where dengue is a thing that occurs or malaria,
• 16:24
  then it becomes imperative to do the mosquito protection.
• 16:30
  Dr. Tess Barton, thank you so much for being back on Pediatrics Now today.
• 16:35
  I really appreciate it. Thanks, it was lots of fun.
• 16:40
  Okay. Thank you, Tess.
• 16:44
  I'm Holly Wainnett. You're listening to Pediatrics Now. Thank you for the honor
• 16:50
  of your time. I'll see you next time.