Most every day, Marge Agin bikes 10 miles in the morning and plays 18 holes of golf in the afternoon. Later, she and husband Norm walk their two black labs a couple of miles along Palmetto Bluff's nature trails.
The tanned, muscular 70-year-old eats healthy and stays fit. Aside from the aches and pains associated with her rigorous exercise schedule, she's had few problems with her body.
Then last month, just before going to bed, her knee began to bother her.
"I must have been a pulled ligament, I thought. No big deal." she said.
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She went to the doctor and started anti-inflammatory medication for the swelling and to ease the pain.
The next day, she could hardly get out of bed. Her whole body ached. She had a headache and a severe fever. Even brushing her teeth was taxing.
To her doctor, Jack Frost, it appeared to be a classic case of a medication allergy. He ordered more tests and pulled her off the medication.
A few days later, she still hadn't improved. Her whole body was itchy. A rash developed on her feet, and later, on her stomach and back.
"I was very, very nervous at that point," Agin said. "I was beginning to think, `Oh my God, maybe I have some terrible disease.' I was beginning to think that (age) 70 was finally catching up to me."
Two weeks and a battery of blood tests later, she was diagnosed with ehrliciosis, a rare bacterial disease transmitted by ticks. Only 12 South Carolinians were diagnosed with the disease in 2005, the last year data were available.
Though rare, the highest incidence rate of ehrliciosis and another tick-borne illness, Rocky Mountain Spotted Fever, are in mid-Atlantic and Southeastern states.
Three types of ticks in South Carolina -- the Lone Star, dog and deer -- transmit the ehrliciosis, which can take up to two weeks to produce symptoms. Most common symptoms include sudden high fever, fatigue, muscle aches, headaches and, in some cases, a rash. About half of patients require hospitalization.
If treated early with an antibiotic, the disease can be cured within a couple of weeks, said Dr. Robert Ball, an infectious disease consultant for the South Carolina Department of Health and Environmental Control.
If misdiagnosed, patients can develop low counts of bacteria-fighting white blood cells and platelets, and kidney failure. In rare cases, the disease can cause death.
Because it's so rare, it's also difficult to diagnose.
Unlike maladies that show up clearly in blood tests or other screenings, ehrliciosis diagnoses rely on a combination of laboratory findings and physical examinations.
"One of the key things you need to look for is the rash, but that doesn't always appear right away, and in some cases not at all," Frost said. "It's really a multi-factored diagnosis. You've got to put together all the pieces, and I was lucky I was able to put them all together."
Diagnosing other tick-borne illnesses can be equally challenging.
Rocky Mountain Spotted Fever, for example, is often overlooked here because of its name, doctors said.
"Frankly, Rocky Mountain Spotted Fever was misnamed," Ball said. "The only reason it got that name is because they found it in the Rocky Mountains first."
The highest incidence rates of the disease, the most commonly diagnosed tick-transmitted illness, are between Maryland and Florida, according to the Centers for Disease Control and Prevention. It's also the most diagnosed in South Carolina, with 119 confirmed cases in 2005.
Its symptoms are similar to ehrliciosis, but are generally more severe. A majority of patients require hospitalization.
The most severe and perhaps well known of tick-borne disease is Lyme disease. Like Rocky Mountain Spotted Fever and ehrliciosis, most cases can be cured with antibiotics if treatment begins early enough. In some cases, however, symptoms can last months or years. Infections can spread to joints, the heart and nervous system.
Ninety cases were reported in South Carolina in 2005.
"The key thing here is whenever you find any kind of tick, you need to be mindful of any signs and symptoms that can occur in the next few weeks," Frost said.
For Agin, who's "almost 100 percent" after a month on the mend, that won't be an issue.
When she was first diagnosed, she said she vaguely remembered pulling a tick off her body after a walk, and thought nothing of it.
"Like my doctor told me, I'm back to doing pretty much everything I did before," she said. "But now, I'm always sure to put on some DEET."
HOW TO DEAL WITH TICKS
- Only a small percentage of ticks have transmittable disease. Even so, a few simple precautions can help prevent transmission of disease.
- Ticks live in woods, brushy areas and areas with tall grass and weeds. After outdoor activities, check body and hair closely. Ticks must be removed as soon as possible to prevent transmission of disease.
- If found, ticks should be pulled out with tweezers or with fingers covered by a piece of tissue. They should not be jerked or twisted, but pulled out with a steady motion. Do not use heat, solvents, nail polish or lubricant to cause the tick to release. Apply antiseptic to the bite area and wash hands with soap and water.
- Use insect repellent that can be sprayed on clothes and exposed skin. Follow label directions and use extra precautions for children.
- Wear protective, light-colored clothing tucked in around ankles and waist if venturing into high grasses and marshy woodland areas when possible.
- Pets are also susceptible to tick-borne diseases. They should be checked for ticks at least once a week. Flea and tick repellents are recommended.