INFORMATION ON TICKS
for further help and advice on ticks please visit
www.bada-uk.org

Diseases and Symptoms in People:

Lyme disease
Probably the most recognised tick-borne disease in the UK is 'Lyme disease'. It is just one of several diseases present in the UK. Lyme disease gets its name after a cluster of cases that were discovered in Old Lyme, Connecticut, in the US. It is caused by a spirochaetal bacterium called 'Borrelia burgdorferi' but there are hundreds of differing strains and sub-types which result in varying symptoms. These can range from more dermatological and rheumatological symptoms, to more serious neurological manifestations.
Borreliosis (as the disease is more correctly termed to cover the differing strains) can be extremely debilitating. European strains generally have more neurological complications, presenting as 'viral-like' meningitis, encephalopathy, facial palsy, peripheral neuropathy and other nerve inflammation. This can lead to pain, altered or loss of sensation, and loss of co-ordination. In severe cases paralysis may occur.
Often a target-shaped expanding rash (called an 'Erythema Migrans' or' EM rash') is associated with Lyme disease. However, different strains can produce rash variations, and some patients never present with one. Rashes can also be hidden under hair, or in inaccessible places. This can make diagnosis difficult because the only indication of infection may be flu-like malaise. An EM rash can also resemble other dermatological conditions, such as ringworm, cellulites or an allergic reaction, and misdiagnosis can occur as a result.
Borrelia bacteria are related to the syphilis spirochaete but are more complex. They are pleomorphic (meaning they can change their physical form). This aids them to evade the body's immune system and can make indirect methods of detection (such as serologic testing) difficult.

A cocktail of infection
In addition to Borreliosis, ticks can carry a cocktail of bacterial, viral, rickettsial and protozoal diseases concurrently. Anaplasmosis (a rickettsial disease) is the most common co-infection. Multiple infections can complicate both diagnosis and treatment.

A threat to travellers abroad
Tick-borne diseases occur worldwide but, for the European traveller, Tick-borne encephalitis (TBE) is probably the greatest concern. This Flavivirus has spread from central to north-west Europe. It is closely related to Russian spring-summer encephalitis (RSSE) and Louping-ill (which is generally recognised as a disease of sheep in the UK but can affect other animals and people). TBE can cause serious inflammation of the brain and spinal cord which, in some cases, can be fatal.
As of mid 2006, no TBE cases have been reported to the UK's Health Protection Agency (HPA), although it is possible that some cases have occurred but not been reported or recognised.
The TBE group of viruses are the only tick-borne diseases for which there are vaccines. The vaccines are available from GP surgeries, health centres and MASTA clinics. As there are currently no vaccines against other types of tick-borne disease, the only defence against infection is knowledge about ticks and how to remove them.

Diagnosis
Early diagnosis and treatment of a tick-borne infection can help to prevent potentially serious complications, such as cardiac damage, meningitis-type syndromes and even paralysis.

Rashes
Be particularly aware of patients presenting with an expanding red rash (which may be surrounding a possible bite wound), as this could be an Erythema Migrans (EM) or 'bull's-eye rash', which is one of the early signs of Borreliosis (Lyme disease). However, an EM may be atypical, or it may be hidden or absent.

Early onset
Be aware of patients presenting with flu-like symptoms (fever, swollen lymph nodes, headache, stiff neck, general aches and pains) during late spring through to autumn. These symptoms combined with an obvious bite wound, or known tick bite, or rash, warrant immediate medical assessment.

Correct tick removal
Correct tick removal is essential in helping to avoid disease transmission. Removal should take place at the earliest opportunity as the longer the tick remains attached the greater the chance of transmission. Recent studies indicate that transmission can occur in less than 12 hours of the tick attaching.
Tick removal should be performed with a bespoke tool (O'Tom hooks were favoured in a comparison study1), or with fine-tipped tweezers used in an upward, levering motion (do not twist when using tweezers).
Applying solutions to an attached tick, or burning, freezing, crushing or scratching it off, can result in it regurgitating or spilling its stomach contents, which may contain infective organisms.
Never handle a tick with bare hands as some infective agents can enter breaks in the skin or the mucous membranes (touching eyes, nostrils or mouth).

For further information, please visit www.bada-uk.org

Produced by Borreliosis & Associated Diseases Awareness-UK (BADA-UK). Registered Charity No. 1113329
1. Reference: Zenner L, Drevon-Gaillot E, Callait-Cardinal MP. Evaluation of four manual tick-removal devices for dogs and cats. Vet Rec 2006; 159: 526–529.