World cup fans could be returning from Germany with a souvenir they didn’t bargain on.
Tens of thousands of England supporters are camping in fields and forests where ticks find them easy prey. The problem of tick bites and the diseases they spread is so great in Germany that the British forces there carry out buddy-buddy checks at least every 24 hours.
Ticks can be so small that they often go undetected. Some can be the size of a poppy seed.
Infected ticks can inject several pathogens including the spirochaetal bacteria Borrelia. Co-infections such as Babesia can complicate diagnosis and treatment.
Not all ticks are infected but if you are unlucky enough to be bitten by a tick carrying the disease you could end up with a severely debilitating illness if not treated promptly.
Symptoms of early disease may include any of the following:
An expanding rash, ‘flu-like illness, pins and needles, numbness, aching joints, muscle pain and chronic fatigue.
In nearby Poland, public warnings have been given out due to a plague of ticks in the Opolskie region.
Ticks are small, blood sucking arthropods (related to spiders, mites, & scorpions). There are many different species of ticks living in Britain, each preferring to feed on the blood of different animal hosts. If given the opportunity some of them will feed on human blood too.
There are 3 stages of the life-cycle: larva, nymph, & adult.
To the naked eye, the larvae look like specks of soot, while nymphs are slightly larger, pinhead or poppy seed size. With their 8 legs, adult ticks resemble small, black spiders.
Once an adult tick has started to feed, its body will become filled with your blood. As the blood sac fills it generally becomes lighter in colour & can reach the size of a small pea, generally grey in colour. The tick bite itself is totally painless & most people will only know they have been bitten if they become aware of a feeding adult tick attached to them. However, it is the pinhead size nymph that is the most likely to bite you.
There are ‘hotspot’ locations throughout Britain, but the problem is known to be worse in Germany.
Many people are unaware that they have been bitten because the ticks are tiny & their bites are usually painless. Ticks can attach anywhere on your body. However, on children, ticks are frequently found on the head at the hairline. For adults it is particularly important to check armpits, groin, navel, neck & head.
There are ongoing debates as to how long a tick must remain biting you before transmitting a disease. The minimum length of time is not known, but it is certainly an outdated fallacy that a tick must remain attached for two days. It makes sense that the longer a tick is attached, the more chance you have of being infected by any disease that it carries. However, some research has shown that at least one of the tick-borne diseases, ‘Ehrlichia’ can be transferred almost immediately.
The majority of people who are bitten by a tick, do not experience disease symptoms. In some instances this will be because the tick was not infected. In other cases people can remain asymptomatic (without symptoms) although they do actually carry the disease. Some of these people may never have symptoms, while others can start to experience illness at a later time in their life. However, some victims can start feeling noticeably ill within days or weeks of being bitten. The majority of people may never make the link between their illness & the tick bite.
Three of the diseases that can be caught from a tick bite in Britain , are Lyme borreliosis, Babesiosis, & Ehrlichiosis. Globally, the list of diseases is much longer.
Lyme disease or Borreliosis [bore-EL-ee-OH-sis] is caused by bacteria called Borrelia. Early symptoms can develop within weeks. They include tiredness, chills & fever, headache, muscle and/or joint pain, swollen lymph glands, & blurred vision. A characteristic skin rash called erythema migrans can appear. It is generally a circular rash that may clear in the centre, resulting in a "bulls-eye" appearance), it can expand & move around the body.
If early symptoms are not recognised, serious complications can develop weeks, months, or even years later. Later stage symptoms include arthritis in the large joints, which can recur over many years. Nervous system problems are common, e.g. numbness, meningitis (fever, stiff neck, & severe headache), Bell's palsy (paralysis of the facial muscles), & memory problems. Some people experience irregularities of the heart rhythm.
Lyme disease should be diagnosed by a physical examination & medical history. This clinical diagnosis may in some cases be supported by laboratory testing. Diagnosis based on tests alone is not reliable - a negative result does not mean that the disease is not present. Symptoms can mimic those of other diseases. Diagnosis is easiest when there is a skin rash but this occurs in under 50% of patients.
Babesiosis [bab-EE-see-OH-sis] is caused by the Babesia parasite, an organism similar to that causing malaria. This attacks the red blood cells & its existence can only be shown by laboratory identification of the parasite. Symptoms, if any, begin with tiredness, loss of appetite, & a general ill feeling. As the infection progresses, fever, drenching sweats, muscle aches, & headache can follow, leading to complications such as very low blood pressure, liver problems, severe haemolytic anaemia (a breakdown of red blood cells), & kidney failure. Other people usually have a milder illness & often get better on their own. The symptoms can take from 1 to 12 months after the tick bite to appear & can last from several days to several months.
Ehrlichiosis [air-LICK-ee-OH-sis] is a bacterial attack of the white blood cells. Symptoms usually appear 3 to 16 days after a tick bite. The most common symptoms are sudden high fever, tiredness, major muscle aches, severe headache, and, in some cases, a rash. Diagnosis is difficult, even in severe cases. Because diagnostic tests are not widely available, the diagnosis of Ehrlichiosis is usually based on symptoms & a history of exposure to ticks. Severely ill patients can develop abnormally low numbers of white blood cells, or platelets, & kidney failure.
Some ticks carry all 3 of the above diseases at the same time, & can transfer them to you in a single bite. The resulting symptoms can be extremely confusing & liable to misdiagnosis. Treatment in such cases is very difficult.
There is a general lack of knowledge in the British medical community regarding tick borne diseases, & many people with typical symptoms will not actually be tested for the presence of even the most common of the diseases. For those who are tested for one or more of the possible diseases, a negative (and thus inconclusive) test will generally result in further investigation being abandoned. Few people will be lucky enough to see a GP with sufficient knowledge to give a clinical diagnosis, i.e. based on symptoms, knowledge of a tick bite event, etc.
For many years, criticism has been aimed at the inaccuracy of laboratory tests. It is suggested that official statistics for prevalence of tick borne diseases in Britain are a gross underestimate of the true picture.
It is likely that the majority of people suffering from tick-borne diseases do not receive treatment at all because they remain undiagnosed, or misdiagnosed.
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In Britain, medical education is highly variable regarding diseases transmitted by ticks. Much reference literature about diagnosis & treatment protocols requires updating. It may be left to you, the patient, to continue to emphasise that you have linked your symptoms to a tick bite.--------------------------------------------------
Lyme Disease Action, Registered Charity Number 1100448, Registered Company Number 4839410
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