Don't be ticked off by Lyme disease!

This time of year, many of us like to make the most of the warmer weather and lighter evenings. A nice long country walk is a great way to unwind - the exercise benefits the body and the sights, smells and sounds of nature help to clear the mind and promote mental wellbeing. Given this, it can be easy to overlook a growing risk posed by this seemingly harmless activity -  Lyme disease.

What is Lyme disease?

Lyme disease is a bacterial infection caused by the bacterial species Borrelia burgdorferi. It is transmitted via tick bites. Ticks are tiny arachnids (in the same class as spiders) which feed on the blood of several different animals, depending on the species of tick. In the UK, the species most likely to transmit Lyme disease to humans is the sheep tick - as the name suggests, this tick feeds primarily on sheep’s blood, but will feed on the blood of other animals and birds if it needs to. Ticks will wait on tall grass or other shrubs for an animal or human to brush past them, allowing the tick to attach itself to the skin of the animal or human. If the animal is infected with Lyme disease, this is transferred to the tick when it feeds, then the infection can be passed onto the next animal or human that the tick bites. (1, 2)

Usually, the earliest symptom of Lyme disease is a characteristic red rash with the appearance of a bull’s eye on a dartboard. At the centre of the rash is the tick bite. The edges may feel bumpy or raised to the touch. This rash most often develops within a month of being bitten, but it can take as long as three months, and in some cases it may not appear at all. Other symptoms of Lyme disease include flu-like illness (headache, bodily aches and pains, raised temperature, chills and lethargy). (3)

Occasionally, Lyme disease may cause symptoms which persist for years after infection and treatment. These symptoms include aches and pains, low energy and lethargy and are known as post-infectious Lyme disease. There is no known treatment for this post-infectious condition, but speak to your GP if you are still suffering with symptoms after treatment for Lyme disease, as they may be able to help you with arrangements to make your everyday or working life easier. (3)

If Lyme disease is left untreated or if treatment is unsuccessful, it may lead to arthritis and complications in several organs including the heart and brain. (1)

Figures released by Public Health England from 2017 demonstrated an increase in cases of over a third compared to the previous year. (4)

How do I know if I’ve been bitten?

Tick bites are rarely painful, so the main way to tell whether you’ve been bitten by a tick is by seeing the tick attached to your skin. This is why it’s important to check your skin thoroughly after walking in rural or grassy areas - particularly after walking in tall grass. Ticks are very small - ranging from the size of a full stop on this page (a tick larva) to a small pea (an adult female tick after a large feed). (2, 3)

If you spot a tick on your skin, you should carefully remove it as soon as possible. Using clean pointed tweezers (not regular hair plucking tweezers) a tick removal tool or looped fine thread, get hold of the tick at the closest point to the skin as possible and slowly, carefully pull the tick upwards and outwards. Take care not to squeeze or crush the tick’s body, as this can cause the body to detach from the head, leaving the head attached to the skin, or cause the tick’s stomach contents to enter the bite, increasing the risk of infection. (3, 5)

Once you’ve removed the tick, throw it away and wash the bite and the tweezers or tool with soapy water or antiseptic. (3, 5)

You don’t need to visit your GP after removing a tick unless you develop a rash or illness. (3)

How is Lyme disease treated?

If you do feel ill or develop the characteristic bull’s eye rash, visit your GP who may arrange a diagnostic blood test. The usual treatment is a two to four week course of oral antibiotics, namely doxycycline, amoxicillin or cefuroxime. Other antibiotics may be used if the first choices are unsuitable for the patient, and antibiotic injections may be prescribed by a specialist for particularly severe cases. (3, 6)

How can I avoid tick bites?

The best way to prevent tick bites when out in the countryside, woods or in parks is to stop ticks from reaching your skin - by wearing long trousers tucked into your socks and long sleeved tops. Apply a DEET- based insect repellent to your skin and clothes. Avoid wearing dark clothing when out walking as this can make any ticks you’ve picked up harder to spot. Also, avoid walking through tall grass and shrubs and walk along paths where available. Remain responsible and vigilant and continue to enjoy our abundance of beautiful countryside and green spaces this summer! (3)

References

1. Lyme Disease Action. About Lyme [cited 24 May 2018]. Available at: http://www.lymediseaseaction.org.uk/about-lyme/
2. Lyme Disease Action. About Ticks [cited 24 May 2018]. Available at: http://www.lymediseaseaction.org.uk/about-ticks/
3. NHS Choices. Lyme disease [cited 27 April 2018]. Available at: https://www.nhs.uk/conditions/lyme-disease/
4. Lyme Disease Action. Significant rise in cases of Lyme disease [cited 24 May 2018]. Available at: http://www.lymediseaseaction.org.uk/press-releases/significant-rise-in-cases-of-lyme-disease/
5. Lyme Disease Action. Tick Removal [cited 25 October 2017]. Available at: http://www.lymediseaseaction.org.uk/about-ticks/tick-removal/
6. British National Formulary (version 2.0.2) [Mobile application software]. Retrieved from: www.bnf.org

Author: Gabby Gallagher MPharm

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 30/05/18