From the Minneapolis Start Tribune, by Paul Levy
CROSSLAKE, MINN. -- As a Crow Wing County deputy, Jan Mezzenga has had more than his fair share of close calls.
But the nemesis that brought him closest to death -- and sent experts scurrying for medical record books in the process?
A tiny deer tick.
A tick bite last June caused Mezzenga's spleen to rupture, sending him to the emergency room and sending pathologists to research labs. Mezzenga, 57, had three tick diseases diagnosed at once -- Lyme disease, ehrlichiosis and the rare babesiosis -- making his case highly unusual, and perhaps unprecedented.
Mezzenga may be the first known victim to have a spleen rupture because of a tick disease, said a Brainerd pathologist who hopes to have a report of the ordeal published in a national medical journal.
"He hit the trifecta of tick diseases," said Dr. Nick Bernier, director of medical affairs at St. Joseph's Hospital in Brainerd, where Mezzenga's spleen was removed. "He should buy a lottery ticket every day, because this just doesn't happen.
"But the big mystery is why Jan's spleen ruptured from babesiosis. That's never happened before anywhere, as far as we know."
Babesiosis is a tick-borne illness caused by a parasite that lives on some ticks. The disease is a cousin of malaria, said Bernier, who said he sees only a handful of such cases in the Brainerd area each year. But babesiosis can be contracted anywhere in wooded areas from New England to Minnesota, said Dr. Dianne Kendall, a St. Joseph's pathologist.
Crow Wing County's wooded lake areas are paradise to lovers of the outdoors, and tick havens.
"You just pick 'em off, the ones you can see," said Mezzenga, who grew up in northeast Minneapolis, but whose family has owned property in Crosslake, 20 miles north of Brainerd, since the 1970s.
Mezzenga's duties as a deputy require him to comb through wooded areas. He hunts. He owns three dogs. His rural home, which he heats with wood, is on Fawn Lake and across the street from Cross Lake. Between the trees are cages housing the 100 pheasants he raises, along with peacocks, doves and two dozen chickens.
"I never thought ticks were a big deal," he said.
Progressively weaker
He didn't think at all about ticks while recovering from hernia surgery last year. A veteran of four knee surgeries, Mezzenga prides himself in being a quick healer. But after the hernia surgery, he grew progressively weaker.
"He'd complain he was tired, fall asleep and wake up with chills -- and this was three weeks after his surgery," said Doris Mezzenga, his wife and a dispatcher for the Crow Wing County sheriff's office.
It wasn't his first brush with danger. Mezzenga once responded to a domestic dispute and was greeted by a drunk who aimed his double-barreled shotgun and warned, "If you don't kill me, I'm going to kill you."
He talked that man into surrendering his weapon, but he hasn't always dodged misfortune. Mezzenga has been injured wrestling with a psychiatric patient and gored by a buck. And during last year's search for Erika Dalquist's remains, the grandfather of murder suspect William Myears plowed into Mezzenga's squad car with a manure spreader, covering Mezzenga's car with manure.
"Wrong place, wrong time, that's my history," Mezzenga said.
Doris Mezzenga said she's prepared for the perils of being married to a sheriff's deputy. "I once took a call, was told, 'We have an officer down,' and knew they were talking about my husband, who hurt his knee fighting with the guy at the state hospital," she said. "You're prepared for things like that. But not for what Jan went through last year."
Mezzenga, who had complained of pain in his midsection, was told by his wife to get to the hospital, or she'd have his colleagues escort him there. By the time he got there, his blood pressure was "zero," Bernier said.
Physicians, suspecting a ruptured aneurysm, instead found a spleen that had grown unusually large -- the size of a liver -- and was leaking blood. The spleen was surgically removed by doctors who still don't know why it ruptured so suddenly, but they now know that the cause of the rupture was babesiosis.
"Think of the spleen as a giant lymph node that may be inflamed because it's surrounded by a tissue capsule," said Dr. Johan Bakken, an infectious disease specialist at St. Luke's Hospital in Duluth who is considered a national authority on tick-related diseases. "In this case, the capsule comes under too much pressure and erupts, and that's most associated with babesiosis."
The other tick diseases found in Mezzenga's system had nothing to do with his symptoms of last summer. Bakken agreed that it's highly unusual to have three tick diseases at once. Lyme disease and ehrlichiosis may have been in Mezzenga's system for years, but his immune system was able to combat them, Bakken said.
While pathologists Kendall and Dr. Kent Froberg, an assistant professor at the University of Minnesota Duluth try to have published a report of Mezzenga's ruptured spleen in a national medical journal, Mezzenga reminds others that tick season has arrived.
"I'm trying to be careful, but ticks are part of living in Minnesota," he said. "I've been involved in six, seven, maybe eight shooting situations. I can't worry about ticks."
