Summer Health Watch

July and August bring two of the most consistent clinical challenges of the year — heat-related illness and tick-borne disease. Both are preventable, both are underdiagnosed, and both are worth a proactive conversation with your patients before they show up in your exam room.

Heat-Related Illness: Know the Spectrum

Heat-related illnesses range from mild presentations — heat edema, heat rash, and heat cramps — to more serious conditions including heat exhaustion and exertional rhabdomyolysis, with heat stroke representing the most severe and potentially life-threatening end of the spectrum.

More than 60,000 people visit the emergency department each year for heat-related illness, and over 13% require hospitalization, according to the CDC. Heat exhaustion frequently develops over several days in unacclimatized patients and is often misdiagnosed as “summer flu,” given overlapping findings of weakness, fatigue, headache, dizziness, nausea, and diarrhea. Keep it on your differential.

Heat stroke is the line that cannot be missed. A presumptive diagnosis should be made when a patient presents with body temperature at or above 41°C (104°F) and marked alteration of mental status — including delirium, convulsions, or coma. Rectal temperature is the most reliable measurement in suspected cases. Many complications, including liver and kidney damage and abnormal bleeding, occur in the first 24 to 48 hours.

Your Patients on Medications Face Added Risk

This is a clinical detail that often goes undiscussed. Commonly prescribed medications that increase risk from heat include diuretics, anticholinergic agents, and some psychotropic medications. Certain combinations — such as an ACE inhibitor or ARB with a diuretic — may significantly increase risk of harm from heat exposure.

Counsel patients not to leave medications in places that can get excessively hot, remind them that insulin can be degraded by heat and must be refrigerated, and note that inhalers can malfunction or burst in extreme heat. The CDC’s Heat and Medications guidance for clinicians is a practical reference for structuring these conversations. The CDC also offers condition-specific clinical overviews for patients with cardiovascular disease, asthma, and pregnancy.

Your highest-risk patients: Children with asthma, pregnant women, older adults, and those with cardiovascular disease are among the groups most vulnerable to heat-related illness.

Tick-Borne Disease: 2026 Is a Bad Year

Maryland is an endemic state for Lyme disease, and this season is tracking worse than recent years. Emergency rooms across the country are seeing more patients for tick bites than at any comparable point in nearly a decade, and 2026 is shaping up to be one of the worst tick-borne disease years on record. Johns Hopkins Bloomberg School of Public Health reported 25% more hospital visits for tick bites in April 2026 compared to the same point in 2025.

In Maryland, Lyme disease is the most common tick-borne illness, but anaplasmosis, babesiosis, and ehrlichiosis also occur in this area. Keep co-infections in mind when the clinical picture doesn’t fully resolve with standard treatment.

Diagnosis and Treatment

Per the CDC, a recognized bull’s-eye rash in a patient with endemic area exposure is sufficient to initiate treatment — no blood test required. When testing is used, a two-tiered antibody approach is recommended, but tests can be falsely negative in the first two weeks after exposure, so early diagnosis relies on the rash and exposure history.

CDC-recommended treatment regimens align with IDSA guidelines: 10 to 14 days of antibiotics for early Lyme disease, 14 days for Lyme carditis, 14 to 21 days for neurologic Lyme disease, and 28 days for late Lyme arthritis. Doxycycline is the treatment of choice and also covers ehrlichiosis and anaplasmosis. Note that doxycycline is contraindicated in children under age 8 due to risk of permanent tooth staining, except in life-threatening cases.

Maryland providers are also required to report diagnosed or suspected Lyme cases to the local health officer under COMAR regulations. The University of Maryland tick identification service is available to help with species confirmation when needed.

What to Tell Your Patients

For heat: stay hydrated, seek air conditioning during peak afternoon hours, know the warning signs of heat exhaustion, and call their physician if symptoms don’t resolve quickly with rest and fluids.

For ticks: use DEET-based repellents (20 to 30%) on skin and clothing, check for ticks after outdoor activity, remove ticks promptly with fine-tipped tweezers, and watch for rash or flu-like symptoms in the weeks following a bite.

For complete clinical guidance on both topics, visit the CDC Heat Health page for clinicians and the CDC tick-borne disease resources.