LYME DISEASE – 10 TOP TIPS!

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By Julia Knight, Press & Community Outreach Manager

Tick next to a couple of different extractors — (Istock)

1. Lyme disease is a bacterial infection and spread by ticks infected with the bacteria Borrelia. Infected ticks can be found throughout the UK. Some areas are known to be higher risk including the Highlands of Scotland, South and Southwest England and parts of East Anglia but infection can occur in any area. Ticks are mainly found in grassy areas, woodland and heathland but are becoming more common in urban parks and gardens.

2. Ticks live in grassy areas and look for food by questing. The tick waits on a blade of grass/bracken for a host to brush by, transfers onto the host and finds somewhere warm to embed to feed. Ticks can feed for 3 and 6 days if undisturbed. Ticks are usually most active from early spring to autumn. However, due to climate change and the UK now having milder winters with more rainfall, ticks now appear to be active in some areas throughout the year.

3. Always prevent a tick bite if possible. Always use tick repellent and carry a tick tool. Wear long sleeve tops and trousers and tuck trousers into socks. Lighter colour clothing makes ticks easier to spot. Consider pre-treated clothing if engaging in high-risk activities or occupations. Check yourself, your children, and your pets regularly for ticks. Shower when returning home and do a thorough tick check.

4. If you find an embedded tick it should be removed correctly with a tick removal tool or fine tipped tweezers. Never stress the tick by covering it with anything e.g., oil or Vaseline. A stressed tick can regurgitate the contents of its stomach into the hosts bloodstream. If a tick tool is available, slide the fork-like part of the tool underneath the tick, twist the tool and pull upwards.

There should be instructions with the tool. If using fine tipped tweezers, grasp the tick as close to the skin as possible and pull upwards. Clean the area with an antiseptic wipe and monitor the site. If the tick is not removed cleanly and the mouthparts remain, the body will dispel them like any other foreign body. However, monitor the site for any signs of localised infection (redness/swelling) that might need treating. Retained mouthparts do not increase risk of Lyme disease.

5. Preventative treatment after a tick bite is not usually recommended by the NHS but the Royal College of General Practitioners Lyme disease toolkit does suggest that it can sometimes be considered for certain high-risk cases. It is estimated that only about 10% of ticks carry the bacteria that causes Lyme disease. However, a tick bite should be prevented if at all possible to minimise risk of contracting Lyme disease.

Tick climbing up a blade of grass — (Skyler Ewing)

6. The most obvious sign of Lyme disease is an Erythema Migrans (EM) rash sometimes referred to as a bullseye rash. However, it is estimated that about 30% of people infected with Lyme disease do not develop a rash. As well as the typical bullseye presentation, the rash can have a solid or bruise like appearance and can appear very differently on darker skin tones and be harder to spot. The behaviour of the rash is very important when considering diagnosis. It is always delayed in appearance (from 3 days after a bite, up to 3 months), is generally not itchy or painful and slowly spreads outwards. The spreading is the tell-tale sign of an EM rash. In some cases, EM rashes can become huge. Any redness, itchiness or swelling immediately after a bite is likely to be a histamine reaction.

7. If an EM rash is diagnosed, treatment with antibiotics should begin straightaway with no need for a blood test as an EM rash is diagnostic for Lyme disease. Antibiotics should be prescribed as per the NICE guideline for treating Lyme disease. It is important to note that antibiotic dosages for children with Lyme disease are much higher than for other infections and are based on the child’s age and weight. The guideline should always be consulted if the clinician is not familiar with prescribing for Lyme disease.

8. Other symptoms to look out for are flu-like symptoms, headache, neck ache, sore muscles and joint pain, particularly if the pain is migratory in nature, fatigue, malaise, brain fog, paraesthesia (pins and needles) and feeling generally very unwell.

9. If Lyme disease is suspected but no EM rash develops, your GP can do a blood test. Testing for Lyme disease in the UK is a two-tier system. An Elisa test is done initially and if this is positive a second test, an Immunoblot, is carried out. Both tests look to see if the immune system has made antibodies to the bacteria that causes Lyme disease. It can take some time for these antibodies to be made, possibly up to four weeks or more. Therefore, testing straight after a bite is likely to return a negative result even if the person has been infected. If a test is carried out during this early window, it should be repeated. The NICE guideline states that treatment should be started straight away if there is high clinical suspicion of Lyme disease, while waiting for blood test results.

10. Early recognition and treatment of Lyme disease is very important with Lyme disease. Always prevent a tick bite if possible. Know how to remove a tick safely and be aware of signs and symptoms of Lyme disease. Seek advice promptly if you think you have been infected. Lyme Disease UK are happy to provide free awareness talks to any organisations that feel they would be useful. Contact media@lymediseaseuk.com to arrange a free talk.

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