Doctors treat Holub for suspected tick disease
Staff reporter
Mike Holub didn't know what had happened.
He and wife Pauline were enjoying a meal June 1, when he started having chills, a high fever, and stiff joints.
Holub was examined by a doctor on Monday and the symptoms indicated he had the flu. By Tuesday evening, Holub was in the emergency room and admitted to St. Luke Hospital, Marion.
Wednesday noon, the 58-year-old Marion County resident was on his way to Via Christi Medical Center-St. Joseph campus in Wichita, and was admitted to the hospital's intensive care unit Thursday where he remains.
The otherwise healthy man was suffering from pneumonia and was placed on a ventilator. Medications have placed him in a comatose state to make the ventilator more tolerable.
According to Pauline, it took doctors a while to determine that her husband had tularemia, an illness caused by exposure to ticks.
"The doctor determined the cause when a culture was examined June 12," Pauline said.
Since no visible tick bite was found on Mike, doctors suspect that he may have inhaled dust from an animal, such as a rabbit, that had been infected with tularemia by a tick.
A Kansas Department of Transportation employee, Mike spent much of his days cleaning industrial mowers which is where he may have come in contact with an infected animal.
Pauline said the family was relieved to know the cause of Mike's illness but doctors were having a tough time battling it. The Holub family was told June 12 that Mike probably wouldn't make it through the night and if he did, he probably wouldn't make it through the next day.
The news spread around the Marion area of Mike's grave condition.
According to Pauline, by the grace of God and prayers from everyone, Mike survived and actually showed signs of improvement.
"His oxygen level, heart, and blood pressure are doing good, and his kidneys are doing better," Pauline said. He will probably remain on the ventilator for at least another week.
She asks friends and family to continue sending good wishes and prayers their way because "they're not out of the woods yet."
Mike probably will have a long road to recovery and then physical therapy to regain the muscle mass he is losing each day he lies in the hospital. A long-term prognosis was not known but Mike is known as a fighter and is otherwise a healthy man.
Doctors have never seen cases
Dr. Don Hodson of Marion Family Physicians had never seen any cases of tularemia, an illness caused by ticks, and now so far this summer, he has seen two confirmed and one suspect cases.
"This is very unusual," Hodson said.
Through the years of treating Marion County residents he has seen cases of Rocky Mountain Spotted Fever and Lyme Disease which are caused by tick bites.
Dr. Randolph Whitely of Heritage Medical Associates, Peabody, has seen a few suspect cases but nothing confirmed.
"I've treated Rocky Mountain Spotted Fever in my Emporia office," he said, but none in Marion County.
Dr. Randal Claassen of Hillsboro Family Practice Clinic has been practicing in Hillsboro since 1984 and has never seen a case.
"It's a very unusual disease," he said.
His office has seen the occasional tick bite, however "Most people take care of them on their own," he said. Some patients become concerned about Lyme Disease but he hasn't seen any of those cases either.
Tularemia is not only a human disease. Animals can contract it, too.
Veterinarian Brendan Kraus of Spur Ridge Veterinary Clinic of Florence has not seen any cases so far this year, but has seen them in the past.
"I saw two cases last year in cats and one two years ago in a cat," he said. "Ticks can transmit some diseases but in livestock it's not as typical."
When asked if he's seen any more cases of ticks this year than previous years, Kraus said "no."
"It can stress livestock if there are a lot of ticks on them," he said. Chemicals are available to treat and kill the ticks. If livestock or family pets do get sick, it cannot be transmitted from animal to animal just like it can't be transmitted from human to human.
Veterinarian Jessica Lauren of Animal Health Center of Marion County, said she hasn't seen any cases but Rebecca Irwin of her practice has.
Irwin treated a suspected case of tularemia in a cat about a month ago. It was an outdoor cat and family pet, and exhibited the traditional symptoms.
"The cat was treated and is doing very well," Irwin said.
She said she has seen tick outbreaks in dogs and Lauren said in some cattle. Topical treatments are available to combat the pests in household pets. Tags with pesticides are used in cattle's ears.
What is tularemia and what are the symptoms?
Also known as "rabbit fever," it is a disease caused by a bacteria typically found in animals, especially rodents, rabbits, and hares. It is considered to be a rural disease and has been reported in all U.S. states except Hawaii.
People can become infected through the bite of infected insect, most commonly ticks and deerflies, by handling infected sick or dead animals, by eating or drinking contaminated food or water, or by inhaling airborne bacteria. It is not known to be spread from person to person.
The disease requires treatment as soon as possible with antibiotics and can be fatal if not properly treated.
It takes three to five days before symptoms usually appear but can take up to 14 days.
"Symptoms usually are a sudden onset of fever and chills, headache, and feeling like you were hit by a Mack truck," Hodson said. "The problem is it can have the same symptoms as a common virus," which was the case of Mike Holub.
Other symptoms associated with the bacterial infection are diarrhea, muscle aches, joint pain, dry cough, progressive weakness, skin ulcers, swollen and painful lymph glands, inflamed eyes, sore throat, mouth sores, or pneumonia.
According to the Centers for Disease Control and Prevention, people with pneumonia can develop chest pain, bloody sputum, and respiratory failure.
The mortality rate is low — only one to three percent, but treatment must be sought.
Is there more of a chance of contracting other illnesses from ticks?
"Rocky Mountain Spotted Fever is rare in this part of the state," Hodson said, but then so is tularemia.
Only about 200 human cases of tularemia are reported each year in the U.S. — with Kansas reporting a total of three or four each year.
"I've already seen two confirmed and maybe a third case so far this summer," Hodson said with amazement.
What is a tick?
Ticks are members of the spider family. There are hundreds if not thousands of species, not to mention the population of each of those species.
However, not all of them feast on humans. Many are specific to only animal hosts.
The life span of ticks is longer than insects but generally no more than a few months. Unfortunately, during that time, females can lay thousands of eggs.
Most ticks have an oval-shaped, flat body that becomes engorged after feeding on a host's blood. Unfortunately, if the tick is of a specific variety that injects toxins into the host's blood stream, the results can be catastrophic. If a human is the host or comes in contact with a contaminated animal, illness and sometimes death can result from the bite.
Use caution, don't panic
With the recent case of tularemia being reported, residents need to prepare themselves for going outdoors.
— Use insect repellent that has a minimum of 20 percent DEET. The insecticide premethrin can be applied to camping gear and clothing to deter pests from making human contact.
— Tuck pants in socks and wear long sleeves. Light-colored clothing also is recommended so the dark arachnids can be seen and removed.
Marion County Public Health Administrator Diedre Serene advises parents to check children and pets after being outdoors.
It is always a good idea to check behind ears, along waste bands, and other body crevices.
Dogs and cats are common carriers of ticks. Inspect household pets on a regular basis.
If a tick is found, follow these simple instructions.
— Do not remove with your fingers. Grasp it by the head with fine-tipped curved tweezers and pull slowly, straight out.
— Do not squash the tick. The tick's intestine can be filled with bacteria that can cause illness. By squashing the tick, the bacteria could be spread.
— Do not try to burn or smother it. When the tick is firmly fastened in place, it takes time for the tick to detach itself and depart. No matter how badly the tick may wish to leave quickly, it simply can't.
A burning cigarette may kill the tick but won't make it fall off.
Ticks can live without air for a long period of time, so attempts to smother it allow disease transmission to continue for hours.
— Do not twist out the tick. Ticks aren't threaded. Your best chance of removing the head is pulling straight out with steady traction. Twisting invariably leaves the head behind.
And, finally
The most important thing to remember is it doesn't take a long period of time for a tick to attach itself to a host. It's a good idea to check yourself and family members, including family pets, for the pests.
If flu-like symptoms occur, see a doctor. If they continue or worsen, return to the doctor to make sure it is only the flu.
Antibiotics are successful in treating the disease but the sooner they can be administered the better.
