It began five summers ago for Jennifer Diefendorf, a physician's assistant from Westminster.
"I got very sick, I felt like I had the flu. I had some panic attack symptoms," she said. "We went to the doctor and she couldn't figure out what was wrong."
Eventually, a specialist gave Diefendorf a blood test that confirmed she had been bitten by a tick, which in the course of obtaining a blood meal at her expense, had tipped her with Lyme disease.
"I started seeing a Lyme doctor, a Lyme expert and got treated over the course of a year or two," she said. "I am about 75 percent better now."
Ticks, and the infectious diseases they can carry, are expected to be particularly numerous this year, in part due to warmer temperatures and a larger than usual mouse population in 2016 — mice, as reported by NPR, pass Lyme to ticks, which can then bite humans. This risk, along with the risk of mosquito-borne illnesses, led the Carroll County Health Department to campaign hard with its "Fight the Bite" messaging.
"The messages are important because there are many things that people can do to 'fight the bite,'" said Maggie Kunz, health planner with the health department. "Using EPA-recommended repellent and tucking pants into socks, and shirts into pants, and wearing light-colored, long-sleeved clothing will help prevent both mosquito and tick bites."
You can do a lot to protect yourself from a lot of different illnesses with the same precautions in other words, and this has been a priority for public health officials in Maryland — much of the funding that went into the Fight the Bite campaign came to Carroll as part of the state health department's response to the threat of Zika virus, according to Kunz.
Zika is predominantly a threat to women who are, or might become pregnant, and are traveling in areas — such as parts of south America — where the virus is endemic, Kunz said.
Zika infection can cause microcephaly, a condition where children are born with smaller heads than normal, and can be sexually transmitted in addition to being passed through mosquito bites. The Centers for Disease Control and Prevention report at least 91 known U.S. cases of Zika-related birth defects.
And while the probability of Zika being transmitted from an infected person in Carroll County, to a mosquito, to another person in Carroll is likely very low, it is not impossible. A community in Texas recently reported confirmation of just such a local transmission of Zika.
But even with a low probability of Zika infection in Carroll, taking steps to avoid mosquito bites is a good idea, said Dr. Henry Taylor, deputy health officer at the health department. Mosquitoes can carry other diseases, such as West Nile Virus, which he suspects is under-reported in Carroll.
Plus, the bites are itchy.
Tick bites, on the other hand, are often much harder to detect, Taylor said, and Lyme disease is not the only threat carried by the tough little blood suckers.
"There are diseases with all sorts of weird names, babesiosis and Rocky Mountain spotted fever," Taylor said. "The name Rocky Mountain spotted fever implies it's out west — well, we have some here."
When Diefendorf's daughter, Emma, was 9 years old, she came back from camp with what looked like a spider bite on her head and flu-like symptoms and a fever. Although blood tests did not immediately indicate Lyme —it can take some time for the antibodies to develop and be picked up by the test — Diefendorf got Emma treatment proactively based on her earlier Lyme experience.
"She got better initially but then six months later she was very sick with fevers, just felt very fatigued, had shortness of breath," Deifendorf said. "We couldn't figure out what was going on."
Another blood test confirmed the presence of babesiosis and today, at 12, Emma is still not fully well.
"We're learning more about how some of these infections that we get linger in the body, causing prolonged symptoms," Taylor said.
One problem is that scientists still have a lot to learn about Lyme and similar infections such as babesiosis. It may be the case that other species of bacteria beside the Borrelia burgdorferi spirochetes can cause Lyme disease.
"The way the research articles make it appear is that Lyme disease is caused by potentially another organism," Taylor said. "My suspicion is that there is another disease that looks like Lyme that is caused by another organism. That's something for biologist to continue researching."
But while biologists research Lyme, there is an opportunity for the interested citizen to get involved. If individuals, college professors, teachers or any group of people in Carroll County would be interested in counting and identifying ticks in a systematic way, Taylor said, he would be very interested in helping to curate and analyze that data.
"We know that our official reporting systems, while they are very reliable, are just the tip of the iceberg," Taylor said. "We need to be creative about looking in specific ways for other ticks, the different diseases, what different types of ticks we have."
"It would be great if there were somebody in the community that was tracking from year to year, the density of ticks in a particular location," Taylor said. Anyone interested in launching such a project can reach Taylor at the health department at 410-876-2152.
Taylor's interest in Lyme stems in part from a personal experience in 2010: After clearing brush with a family member, they both developed symptoms of fever and aches and pains, and even a rash, but not the classic "bull's-eye" rash associated with Lyme disease.
One week later, however, Taylor noticed the bull's-eye rash while stepping out of the shower. His family member had a similar experience, the rash revealing itself after a swim in a cold mountain stream. In what he believes to be a unique observation, Taylor believes changes in temperatures may make blood vessels contract, or dilate, making the rash more visible and early diagnosis of a tick bite easier.
"That's where I think we are missing lots and lots of cases and we know a stitch in time saves nine," he said. "Early treatment makes a difference."
The key messaging however, is not that there are ticks and mosquitoes and new diseases out to get you, Taylor said. As people build more home and buildings in wooded areas, such as Carroll County, they will inevitably encounter more ticks.
"The recommendations that are out there work," Taylor said. "My big push is being aware before you go out, taking preventative actions as soon as you come in, and also being very aware of if you have been bitten and watching for the rashes."