Like most toddlers, Carla Trinidad is always on the move.
The 16-month-old climbs on her mother, bounds across a couch and peers over the side in pursuit of treasure in her Southampton home. It’s hard to imagine this curious little girl as a 1-month-old infant fighting off Lyme disease, its distinctive bull's-eye rash marring her face and chest.
“I was surprised, she was so little,” said Janeth Guaman, Carla’s mother. “I thought it was just something on her skin.”
Experts at Stony Brook Children’s Hospital believe Carla, who has fully recovered, was one of the first documented cases of an infant contracting Lyme disease after being bit by a tick in the United States.
Around the same time in the summer of 2018, the hospital treated a 6-week-old baby boy for babesiosis, a potentially severe disease transmitted by a tick bite. He, too, was from Long Island.
The cases were so rare that doctors at Stony Brook Children’s Hospital and Hampton Community Healthcare chronicled them in the medical journal Pediatrics, published last month.
“Seeing infections in this unusual population, babies who are so young, really underscores the extent of the spread of ticks and infections that they carry,” said Dr. Andrew Handel, a pediatrician and infectious disease fellow at Stony Brook Children’s Hospital, who helped treat Carla and is the lead author of the article.
Doctors believe the cases emerged on Long Island because the area — along with southern Connecticut — is the historic epicenter of Lyme disease.
Long Islanders are all too familiar with ticks and the diseases they spread. Children and adults alike are urged to check their clothes and bodies for ticks after a hike, playdate in a grassy field and other outdoor activities.
While summer is prime tick season, the hearty parasites are extending their stays.
“With the warmer winters and less snow each year, the tick season has been expanding,” Handel said. “There are shorter cold periods between the summers, so we are seeing tick infections later in the winter and starting earlier in the spring.”
Lyme disease, which the U.S. Centers for Disease Control and Prevention says is the most common disease spread by vectors such as ticks, has symptoms that include headaches, fatigue and fever. If it is not treated, the disease can cause infection in a person’s joints, heart and nervous system.
Babesiosis, a disease caused by parasites that infect red blood cells, is less common but also can be severe if not treated. People who contract it may experience flu-like symptoms including fever, chills and headaches.
The state Health Department estimates there were 2,966 cases of Lyme disease in Suffolk County between 2014 and 2018, according to data on the Suffolk County government website.
And the U.S. Centers for Disease Control and Prevention said there were 2,446 confirmed cases and 1,192 probable cases of Lyme disease in New York State in 2018.
Of the 23,558 confirmed Lyme disease cases in the United States in 2018, 986 cases were in children 4 years of age and younger, according to the CDC.
But Janeth Guaman didn’t think her daughter, who wasn’t even old enough to crawl, was at risk. Then her mother found a tick in Carla’s thick brown hair.
She took Carla to Dr. Harriet Hellman at Hampton Community Healthcare, who evaluated her symptoms of fever and rash before referring them to Stony Brook Children’s Hospital.
“I was worried,” Guaman said. “They told me she had Lyme disease or meningitis.”
Guaman said she spent two weeks at the hospital with Carla in August 2018, while the infant received treatment, including a course of antibiotics.
No one is sure how Carla or the baby boy with babesiosis came into contact with ticks, but the doctors believe an adult or family pet inadvertently brought them into the homes.
“I think in general, there’s a need for more research into Lyme disease and tick-borne diseases all around,” said Dr. Saul Hymes, a pediatric infectious disease specialist at Stony Brook Children’s Hospital, who treated Carla and wrote the journal article with Handel and Hellman. “Selfishly, I’m a pediatrician, so I really want to see more research into cases involving young kids.”
Hymes said babies contract certain diseases, like babesiosis, in utero through their mothers.
“These are among only a handful of reported cases in the medical literature that babesiosis and Lyme disease have been transmitted by a tick bite to an infant," he said.
Handel and Hymes said they don’t want these cases to cause parents of newborns to panic, but make sure checking for ticks on clothes and skin is a regular habit.
Guaman said she is determined to make sure Carla doesn't get another illness from a tick bite.
"I check her all the time," she said. "And I just don't take her outside a lot."
BEWARE OF TICKS
Ticks are most active between April and September, but you can encounter ticks year-round.
Here are some tips to avoid tick bites:
- Ticks live in grassy, brushy and wooded areas. If you are walking or hiking, stay in the center of trails.
- Use insect repellent on your clothing as well as exposed skin. Since ticks can be carried into the house on clothing, put dry clothing into a dryer on high heat for 10 minutes. Wet clothing should be dried completely or washed in hot water and then dried.
- Ticks can ride into the home on clothing and pets. Check pets, coats, backpacks and other items for ticks after you have been outdoors.
SOURCE: U.S. Centers for Disease Control and Prevention