Frequently Asked Questions
A tick is an insect right?
Strictly speaking the tick is in the class of arachnids, similar to spiders & mites. Tick larvae have six legs like an insect but once they mature into nymph & adults they have eight legs like a spider. Ticks cannot fly or jump so they move around on blades of grass, reaching out with their front legs in a questing position to enable them to grab on to a passing animal. They are unable to see & become attracted to their host by heat & carbon dioxide (the host may be a small rodent, ground feeding bird, hedgehog, squirrel, dog, sheep, cattle, horse, deer, or a passing human!)
So how do I tell the difference between a tick & a spider?
Spiders typically have a rounded abdomen whereas unfed ticks are very flat. This means they can often be hard to detect, especially at the larval or nymph stage where they are only 0.5 – 1.5mm in size. Adults can grow to 2-3 mm, about the size of a sesame seed. See our page on ticks for some pictures.
What is the first sign that I may have Lyme disease?
A percentage (50-80%) of people may have a rash known as a bulls-eye rash or erythema migrans. If you have a tick bite which goes red within a day, do not worry too much. This may just be some minor irritation from the tick bite. If a rash appears 3 days or more after the bite (can sometimes take weeks to develop) & begins to expand outwards then this is a positive sign of Lyme disease. This requires prompt treatment even if no other symptoms are present.
Some folks may not develop a rash but go on to develop summer time flu symptoms such as headache, muscle aches & joint pains. If these symptoms appear within 1-4 weeks after the tick bite seek medical advice, as early treatment is vital.
In some patients stage one of the disease can be missed and the patient can remain asymptomatic for a period of time. An illness or stressful period may affect the immune system which could trigger the disease to take full hold. This can happen months to years after the initial infection & is known as ‘late Lyme Disease’. Neurological symptoms are classic for late stage Lyme as well as profound fatigue & migrating joint pains. Please click here for further symptoms.
A bulls-eye (erythema migrans) rash may have redness, be larger than a coin, continue to migrate outwards & can produce a central clearing. Not all EM rashes follow the typical pattern of a bulls-eye & in some cases multiple rashes can occur.
How can I tell the difference between a tick bite & a mosquito bite?
A mosquito would land on the host, bite into the skin & fly off very quickly. You may even hear them coming! The bite soon becomes very itchy & can occasionally become swollen & red. Ticks are very stealthy. They will inject an anesthetic into the skin as well as an anticoagulant & will feed typically for several days. They are able to anchor themselves under the skin with a cement type plug making it hard for them to be brushed or washed off. They are initially very flat before feeding, so you may not notice them at all unless you do regular tick inspections. Once the tick is removed they may leave a small mark which can be a little irritated, but generally do not itch like a mosquito or gnat bite. Mosquitoes & biting flies ‘may’ be able to transmit Lyme however more studies are needed.
I didn’t see a tick bite but I do have an expanding rash, what should I do?
Ticks inject an anesthetic into the skin so the patient may not be aware of the bite. Ticks are also very small & tuck themselves away in hard to spot places. If you do have an expanding rash (they may not always be at the site of the bite) &/or summertime flu symptoms it may be wise to seek medical help as a precaution. Take photos of your rash if you can.
What is the treatment for a tick bite?
Typically doxycycline or amoxicillin is used. If this treatment is administered early the chances of recovery are good. If treatment is delayed repeat courses of antibiotics may be necessary. If the symptoms are severe, particularly where neurological symptoms are involved then IV treatment may be initiated.
Can Lyme Disease become a chronic, persistent illness?
Sadly, there are many reasons why Lyme may become hard to treat causing chronicity in patients. Firstly, ticks carry multiple infections, some of which may be parasitic/protozoan, for instance babesiosis. Co-infections can prolong the illness for the patient until all infections are successfully treated. The Lyme bacteria itself is ‘pleomorphic’ meaning it can change form from spirochaete to cyst form (cell wall deficient) & can hide itself away in a slime layered bio-mass. This ability to hide makes it much harder for antibiotics to penetrate. Antibiotics used for the motile form (ie spiros) is different to the antibiotic used for the cell wall deficient form. A recent study shows the effect of each type of antibiotic on the various forms of borrelia. A specialist with knowledge of Lyme (Lyme Literate Medical Doctor) will be able to design an optimal treatment & management protocol for their patient.
For studies on persistence go to: http://ticktalkireland.wordpress.com/lyme-links/chronic-lyme/ http://www.lymediseaseaction.org.uk/resources/off-the-shelf/ http://ticktalkireland.wordpress.com/2010/07/28/persistence-seronegativity
What is a herxheimer reaction?
The herxheimer reaction occurs when large quantities of toxins are released into the body as bacteria (typically spirochaetes) die during antibiotic treatment.
Typically the death of these bacteria and the associated release of endotoxins occurs faster than the body can remove the toxins. It is manifested by fever, chills, headache, myalgia (muscle pain), and exacerbation of skin lesions. The intensity of the reaction reflects the intensity of inflammation present.
It is classically associated with syphilis. The reaction is also seen in other diseases caused by spirochetes, such as borreliosis (Lyme disease and tick-borne relapsing fever) and leptospirosis, and in Q fever.A herx typically occurs from hours to days after treatment begins & can be very debilitating.
How many cases are there in Ireland?
The HSE are currently reporting the number of LABORATORY CONFIRMED cases of between 50-100 cases PER YEAR. Unfortunately Lyme cases can be on the low side for several reasons including:
- The doctor may not be aware that Lyme is a problem in Ireland, therefore testing for Lyme isn’t requested.
- Symptoms can mimic ME/CFS & MS; some patients may therefore be diagnosed with another illness.
- A bulls-eye rash is very specific to a Lyme infection. Treatment may therefore begin after clinical observation rather than serological investigation, so a lab request may not be initiated / recorded.
- False negatives can occur, particularly in early Lyme (as it may take several weeks for the antibodies to be produced in sufficient numbers to be detected). Early antimicrobial treatment can affect results & some manifestation of late Lyme can result in false negative serology, so underreporting may occur.
Where are the particular hotspots in Ireland?
Studies in the 90’s cited Counties Kerry, Wicklow & Galway as particular hotspots. A study in 2010 identified Connemara as being very endemic for Lyme disease (151 cases per 100,000 over a 5 year period). Cases ranged from 2 per 100,000 in the West of Ireland, with some parts of Connemara reaching 181 cases per 100,000. In comparison the Highlands of Scotland (another endemic area) have an average of 81/100,000 in peak season. Vigilance is needed in other counties, as cases have been known in Kilkenny, Kildare, Cork & Mayo among others. A study in Killarney National Park, Co. Kerry cited tick infection rates as being between 11-29%. Further studies report the Republic of Ireland as having one of the highest rates of Lyme disease in Europe.
Check out our article 'Does Lyme Exist in Ireland?'
How many cases are there in Europe?
There are about 85,000 new cases per year across Europe. The highest rates are in Slovenia at 206 cases per 100,000. This may be underestimated due to some patients being mis-diagnosed with another illness. In the UK 250,000 patients have ME, in Ireland it is 12,000. Due to the similarity in symptoms there is a potential for a significant proportion of these to be harbouring an untreated tick-borne infection.
Who is most at risk?
Anyone using the great outdoors where tall grasses & heathland is abundant, as well as in forested areas, are most at risk. Examples of high risk pursuits include rambling, camping, fishing, hunting & farming. Children & pets may need to be checked often, due to their tendency to explore in grassy areas.
Are my pets in danger of contracting Lyme Disease?
Horses & dogs are able to contract tick-borne diseases. Symptoms often include lameness & joint inflammation as well as lethargy. Treatment & testing is similar to that in humans.
What other terms is Lyme known by?
Lyme can be known as Lyme Disease, Borreliosis or Neuroborreliosis. There are also different strains of the disease including Borrelia sensu stricto (US & Europe), & Borrelia afzelii / Borrelia garinii (Europe).
What about the blood bank, is it safe?
Infection rates of 100 samples taken in 4 areas in Ireland ranged from 5–15%. The potential from transmission via blood donations must be taken seriously as a possible danger.
I found a tick on me, now what do I do?
DO: remove the tick gently with fine tipped tweezers or a tick twister ensuring you keep the twister/tweezers as close to the skin as possible. This helps to remove the mouth parts as well as the body.
DO: use an antiseptic wipe in the bite area to prevent secondary infection from germs.
DO: place the tick in a Ziploc bag & record the date it was removed. Look out vigilantly for symptoms including an expanding rash or summertime flu. Remember that the rash may take weeks to develop, so keep checking over the course of several weeks.
DON’T: squeeze the body of the tick or use fingernails as the tick may burst causing more risk of infection.
DON’T: use flames, methylated spirits or Vaseline on the tick. This causes great discomfort & may cause the tick to regurgitate its stomach contents, where all the Lyme bacteria may be hiding.
Why does it say not to twist ticks on removing but tick twisters are advised?
The advice for NOT twisting a tick is useful when using a pair of tweezers. The advice is to keep the tweezers parallel to the skin & pull gently UPWARDS. If the tweezers are twisted this could accidentally squish the body of the tick or break the mouth parts off. It's usually better to keep the tweezers still in the position horizontal to the skin whilst removing the tick. When using a tick twister however, the tool is designed in such a way that the pulling part of the tool remains parallel to the skin. Twisting it then loosens the ticks grip but you are not squishing the body or twisting the body sideways, just in a rotational movement. If tweezers were rotated in a similar manner to the tick twister this may cause problems as it would be difficult to rotate whilst keeping them parallel to the skin!
How can I minimize risk of infection?
Being aware provides a much greater chance of minimizing the risks. Some simple tips include:
- Use DEET as a tick deterrent (this will not kill the tick so tick checks are always advised as a precaution). Also ensure your pets are treated with flea & tick repellant.
- Stick to footpaths as tall grasses may be where ticks are hiding.
- Check yourself, family & pets on return from trips out in the country. Remember to check in tucked away places such as under the arms, back of the knee, in the groin area, nape of the neck & behind the ears.
- Ticks may be low on the ground & crawl up trouser legs. Tucking trousers into socks while out hiking can help prevent the ticks getting onto the skin.
- Wear light coloured clothing so that ticks can be spotted easily. Check yourself before returning to the car for any loose ticks on outer clothing. Do a tick check underneath clothes as soon as you are able!
I’ve read that the tick must be attached for 72 hours to transmit infection, is that true?
Unfortunately, different reports have shown different timings when it comes to Lyme transmission. What is universally agreed is that the longer the tick is attached, the greater the chance of infection. Some studies say 24 hours is more accurate than 72 hours. Some other studies say that a tick may have spirochaetes in their salivary glands so could transmit infection much sooner. I believe that the best message is to remove a tick as SOON as it’s discovered & keep an eye out for symptoms. Also you may have had bites that have gone unnoticed, so an infection, although small, may still be possible. If a tick is engorged (begins to take on the shape of a raisin) then this is a sign that the tick has been feeding for some while & the chances of infection may be greatly increased*.
*NB: It is important to point out that not all ticks will be infected with Lyme.
Is Lyme transmissible to the fetus?
Studies have shown babies born to Lyme infected mothers are at greater risk of complications. Babies may have borrelia detected in the spleen, kidneys & bone marrow & some may be still-born. Congenital Lyme is where a baby is born to a Lyme mother. However not all congenital Lyme babies go on to develop the disease & many carry the disease without symptoms.
For various studies on transmission please see our blog site
Some say that Lyme is similar to syphilis – is this true?
Syphilis is caused be a spirochaete with a tail called a flagellum which enables the bacteria to penetrate into organs, tissue the heart & the brain. Lyme disease also has a spirocheate form although very slightly different in shape. Spirocheates are very fast moving, allowing the bacteria to disseminate throughout the body soon after infection. Both types of bacteria have the ability to evade antibiotics (as they can hide out in hard to reach areas such as joints, tissue & brain matter) & both have 3 stages to the disease, 1st, 2nd & 3rd stage with each stage becoming more serious & more difficult to treat.
Pictures courtesy of CDC
If I was infected could I pass this to my sexual partner?
Spirochaetes have been found in breast milk, vaginal fluids, urine & semen. It is therefore possible, although not yet proven, that Lyme can be transmitted to a partner. Some folks can carry Lyme without succumbing to the disease (for instance test positive without any symptoms) so transmission may not necessarily cause severe illness, however some protection may be required as a precaution.
What’s the difference between IgM & IgG in blood tests?
IgG and IgM are two types of antibodies that are found in the blood. Antibodies are part of the body’s immune system that is used to identify, neutralize, and destroy foreign objects and organisms, such as bacteria, parasites, and viruses. IgM antibodies usually are associated with the early onset phase of an infection (acute), while IgG is generally associated with long-term immunity or reactivity towards a pathogen (chronic).
The best window of opportunity for IgM test is from 3-6 weeks & IgG 1-6 months after the bite.
If the test is taken too soon not enough antibodies may have been produced, if tested too late a diminished immune system can affect the results. Early antimicrobials can also affect the results.
I’ve heard that the Elisa test can be false negative, what other tests can I try?
We have a few suggestions in our testing section. At the moment there is no 100% accurate method of testing for Lyme disease. A new test is being developed in Europe called Hilysen which may be promising. It is designed to pick up early Lyme cases to allow for prompt & effective treatment, but also sensitive enough to pick up cases of late & chronic Lyme, which may go undetected in the current method of testing.
Per Trinity Biotech:
Negative results (either first or second-tier) should not be used to exclude Lyme disease.
Can ticks survive freezing temperatures?
Laboratory studies have shown that ticks survive a couple of months at -5 °C (Fujimoto, 1994) and can resist air temperatures as low as -10 °C for up to one month, if not in direct contact with ice. Ticks overwinter in ground-cover vegetation. Deep snow conditions could be favourable for winter survival of the tick, since deep snow may increase the ground temperature by several degrees.
Nymphs and adults may resist freezing temperatures well below -7 ºC, whereas eggs and larvae, especially if fed, are slightly more sensitive to the cold.
How do ticks become infected with borrelia?
Borrelia spirochetes may be transferred directly from the female tick to its offspring, but such vertical transmission is rare. In general, less than 1% of host-seeking larvae are infected, compared with between 10% and 30% of the nymphs and between 15% and 40% of adults. The majority of the different tick stages become infected when feeding on blood from an infective reservoir animal.
Is there a way to control ticks from infesting the garden?
- Keep lawns short. Ticks prefer moist, dense vegetation to stop them from dehydrating.
- Choose plants that are not attractive as forage for larger hosts such as roe deer.
- Remove undergrowth & leaf litter. Store wood piles away from the house.
Spray tick repellants in a zone around the edge of the garden, where ticks, or animals with ticks may enter (take care as cats are sensitive to some types of sprays, be sure to read the bottle). The best time to spray is May & September. A natural alternative you can use is a home-made garlic spray which may help to deter ticks & mosquitoes.
What different strains of Borrelia do we have in Ireland?
Questing Ixodes ricinus ticks were collected from six locations throughout Ireland and 638 nymphs, Ill females and 118 males were investigated for infection with Borrelia burgdorferi (1995). The most prevalent B. burgdorferi genomospecies identified were VS 116 (34.6%), B. garinii (24.3%) and B. burgdorferi sensu stricto (18.4%). B. afzelii was uncommon (6.6%). Multiple infections were observed in 13.2% of the infected ticks.
B. garinii typically causes neurological complaints, B. afzelii skin manifestations such as ACA (acrodermatitis chronica atrophicans - a thinning of the skin) & B. sensu stricto can cause arthritic problems. VS 116 (B. valaisiana) has been found in EM & ACA patients as well as in spinal fluid. Due to the possibility of multiple strain infections, as well as co-infections such as bartonella, babesia & anaplasmsosis, diagnosis & recovery can be a huge challenge for patients & their doctors..
What other infections can ticks cause in Ireland?
Although rare, cases of other tick-borne infections have been identified in UK & Ireland (click on links below)
- Babesia divergens, a Bovine Blood Parasite of Veterinary and Zoonotic Importance (Ireland)
Babesiosis: under-reporting or case-clustering? (Ireland)
Babesia sp. EU1 from roe deer and transmission within Ixodes ricinus (Ireland)
Babesias of red deer (Cervus elaphus) in Ireland
- First detection of spotted fever group rickettsiae in Ixodes ricinus and Dermacentor reticulatus ticks (UK)
- The Common Shrew (Sorex araneus): A Neglected Host of Tick-Borne Infections? (UK)
- Coinfections Acquired from Ixodes Ticks (Europe)
In Europe, including the British Isles,I. ricinus is the primary vector for LD, HA [human anaplasmosis] and probably Babesiosis
- Transmission of Bartonella henselae by Ixodes ricinus (Europe)
.. new potential vectors are suspected of transmitting B. henselae, in particular, Ixodes ricinus, the most abundant ixodid tick that bites humans in western Europe.
- Bartonella henselae and the Potential for Arthropod Vector-Borne Transmission (Europe)
Although cat fleas are well-established vectors for B. henselae (7–10), transmission by other
arthropods, in particular ticks, has been suggested (11–13). Ixodes ricinus is the most widespread and abundant ixodid tick in western Europe and is frequently associated with bites in humans. It is a vector of emerging zoonotic pathogens including Borrelia burgdorferi sensu lato (14), Anaplasmaphagocytophilum (15), and Babesia spp. (16).
- Babesiosis: Babesiosis is an infection of rodents, cattle, wild animals and man and is spread by the bites of ixodid (hard-bodied) ticks which are also the vectors for Lyme disease (25% of babesiosis patients have both diseases). There are over a hundred different Babesia species; human disease is usually caused by B. divergens in Europe.
- Ehrlichiosis (Anaplasmosis):
Ehrlichiosis is a tick-borne infection of mononuclear cells and granulocytes that affects various mammals, including mice, cattle, dogs, deer, horses, sheep, goats, and humans. Ehrlichial pathogens are distributed globally, mainly in temperate regions, and have been reported throughout Europe.
We believe that more testing is needed of Lyme patients as existing co-infections can greatly hamper recovery from Lyme disease.
So what is needed for the future?
- We welcome new legislation that would place Lyme in the list of notifiable illnesses. This would ensure that clinical as well as laboratory diagnoses are reported, creating a more accurate system for tracking cases.*
*As from September 2011 Lyme is now a notifiable disease, however only lab confirmed neuroborreliosis cases are reportable to the authorities. This is insufficient in tracking true numbers of cases as early Lyme will not be recorded (ie those who present with a bulls-eye rash or flu-type symptoms) nor will clinically suspicious cases that are sero-negative (early antimicrobial intervention, poor immune response & strain of borrelia can affect sensitivity of testing). We feel strongly that as well as lab confirmed cases a recording of probable & suspected cases would be of more benefit in tracking trends in endemic areas..
- We would like to encourage doctors/consultants to consider tick-borne diseases in their analysis of chronic fatigue syndrome patients.
- We will encourage doctors/consultants to seek training to increase Lyme literacy in Ireland. A Physician training programme is available in the States, funded by the Turn the Corner Foundation. The training programme is open to any physician across Ireland.
- We would like to encourage much wider acceptance that Lyme is endemic in Ireland. A report by Counihan et al from University College Hospital Galway states that “Seroprevalence studies report the Republic of Ireland as having one of the highest rates of Lyme disease in Europe”. It is currently considered rare by many; however we feel this study show that Lyme MUST be taken very seriously in this country. It can affect anyone young or old & can be very disabling.
- We would like to raise awareness across the country of this disease, through posters, leaflets, presentations & radio interviews – not to discourage people from enjoying the great outdoors, but to encourage them to be aware that ticks maybe lurking, which could greatly affect their health & that of their children.
- We would like Lyme patients to be tested & treated for possible co-infections due to the danger of ticks carrying multiple infections, such as babesia, bartonella & anaplasmosis.
- Borrelia strain VS116 (B.valaisiana)is particularly high in Ireland at 50%. As this strain has been detected in spinal fluid, ACA & EM patients we feel that research is urgently needed in the study of clinical manifestations of this strain. Can Ireland lead the way in the research of this particular strain?
Please Remember, a Tick in Time Saves Lyme!
If you have any other questions or interesting topics you’d like to see feel free to let us know.