Lyme Disease (and other tick infections including Anaplasmosis and Neoehrlichiosis)

A bacterial infection transmitted to humans via tick bites, from infected ticks of the genus Ixodes.

• The infected tick must remain attached to your body for at least 24 hours

(It takes hours for the tick to attach fully, and experimental studies have indicated that in most cases, the tick must feed for 36-48 hours to transmit B burgdorferi because the blood meal has to trigger the reproduction of Borrelia to a number large enough to be infective).

Stage 1 is also known as primary or early localized infection.

• It generally occurs within 30 days of the tick bite.
• Most patients present with a characteristic expanding rash (erythema migrans) at the site of the tick bite 7-14 days after the tick is removed.

Stage 2 Lyme disease usually develops 3-10 weeks after inoculation.

• Systemic (widespread symptoms) manifestations may include fever and malaise (tiredness)
• One or more organ systems become involved as hematologic or lymphatic spread disseminates spirochetes to distant sites.
• Musculoskeletal (aches and pains)and neurological symptoms are the most common
• Less common are symptoms from cardiac (heart) disturbances, such as dizziness, syncope(balance and dizziness) , dyspnea (breathing difficulties), chest pain, and palpitations.
• In patients with cutaneous (skin) involvement, multiple erythema migrans lesions are present.
  • These are relatively small erythematous macules (1-5 cm) that are often oval.
  • Unlike primary single erythema migrans rash, these lesions can be evanescent and do not show the typical expansion over days.
• Ophthalmic (eye condition) manifestations vary by disease stage. In stage 1 Lyme disease, the ocular manifestations are conjunctivitis and photophobia (sensitivity to light) . These are mild and transient, and ophthalmologists usually need not be consulted.
• Significant ophthalmic (eye condition) complications may appear during stage 2 Lyme disease.
  • Blurred vision can be noted during stage 2, secondary to papilledema (swelling of eye), optic atrophy, optic or retrobulbar neuritis, or pseudotumor cerebri.
  • Optic nerve disease may be unilateral or bilateral, and solitary or associated with other neurological or neuro-ophthalmologic manifestations.

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Diagnosis Tests

• Serological testing – examines a patient’s blood serum for the presence of specific substances, such as antibodies or antigens, to diagnose infections, assess immune status, or detect autoimmune diseases.
  • Western blot and enzyme-linked immunosorbent assay, which provide indirect diagnosis by detecting antibodies against Borrelia burgdorferi.

Removing a tick:

When dealing with a tick, the main aims are to remove the tick promptly, to remove all parts of the tick’s head and body, and to prevent it from releasing additional saliva or regurgitating its stomach contents into the bite wound.

The risk of infection increases the longer a tick remains attached to the skin.

Do:

• Use an approved tick removal tool (available from Lyme Disease Action or many vets and pet shops), and follow the instructions provided. There are two common types of removal tools available — the hook and the loop — that are designed to be twisted to facilitate removal (see Figure 2). These tools will grip the head of the tick without squashing the body;
• Use alternative methods if the tick removal tools are not available:
  • With pointed tweezers (not blunt eyebrow tweezers) grasp the tick as close to the skin as possible. Without squeezing the tick’s body, pull the tick out without twisting (it is difficult to twist tweezers without separating the tick’s head from its body). There may be considerable resistance;
  • If no tools are available, use a fine thread (e.g. cotton or dental floss). Tie a single loop of thread around the tick’s mouthparts, as close to the skin as possible, then pull upwards and outwards without twisting;
• Start by cleansing the tweezers/tool with antiseptic. After tick removal, cleanse the bite site and the tool with antiseptic;
• Wash hands thoroughly afterwards;
• Keep the tick in a sealed container in case a doctor asks for evidence (label it with date and location). Public Health England is also currently running a tick surveillance scheme to record tick distributions on a national scale (ticks can be posted to them as per instructions on their website).

Do not:

• Squeeze the body of the tick, as this may cause the head and body to separate, leaving the head embedded in the skin;
• Use your fingernails to remove a tick. Infection can occur via any breaks in the skin (e.g. close to the fingernail);
• Crush the tick’s body, as this may cause it to regurgitate its infected stomach contents into the bite wound;
• Try to burn the tick off, apply petroleum jelly, nail polish or any other chemical. Any of these methods can cause discomfort to the tick, resulting in regurgitation, or saliva release.

Source: Lyme Disease Action. 2017. Available at: https://www.lymediseaseaction.org.uk
(accessed October 2018)