It Is Not “Just a Tick”
by Janet Fitzgerald
Tick Awareness Week in 2010 was April 12th thru the 18th. To mark this event Tick Talk Ireland presented, free for public viewing, the USA produced documentary “Under Our Skin,” at the Diseart Centre in Dingle Co. Kerry.
“Under Our Skin” deals with the risks, diagnoses, and treatment of Lyme disease. The documentary, which is of the highest standard, was short-listed for the 2010 Oscar awards. (As it deals with some stressful issues, this film is recommended for adult viewing only.)
Ticks are members of the spider family. They feed on the blood of a host (animal or human). In doing so, they can transfer a variety of diseases between species. The tick ingests the organisms when it feeds on an infected animal. Then, when it feeds off another animal or human, the organism is transferred from the tick’s saliva. Borreliosis, commonly known as “Lyme Disease,” can seriously disable animals and humans, and is one of the diseases that is transferred this way.
Being very small (about the size of a sesame seed) before engorged on the blood of a host, Ticks are often difficult to detect. They also secrete anaesthesia when they bite, so the victim will not feel anything. It is a subject of controversy regarding how long they must remain attached and feeding to transmit infection. However, as it is passed to the victim through the tick’s saliva, risk occurs at the moment of attachment.
Can you contract Lyme disease in Ireland? Yes. Although ticks are most prevalent from April to October, they are now active in Ireland year-round due, in part, to global warming. The heaviest infection rates seem to be along the west coast of Ireland. Kerry and Galway, in particular, appear to be hot spots.
The November 2009 newsletter, “Epi-Insight” (Health Protection Surveillance Centre– Ireland”) by Dr. Paul McKeown and Dr. Patricia Garvey HPSC states:
“Lyme disease is a diagnosis that is often overlooked by clinicians. Anecdotal evidence suggests that individuals displaying symptoms are much more likely to be tested for Lyme disease, in Ireland, if they give a history of recent travel to the north-eastern United States, despite the fact that there is considerable evidence that a significant proportion of cases seen in Ireland have been exposed locally.”
Everyone is at risk of coming into contact with Ticks. They can attach to pets and be brought indoors. Persons participating in outdoor activities, like camping, hill walking, gardening, children playing outdoors, or people with outdoor occupations like farming, or veterinary, are at significant risk of infection.
Although all ticks may not carry Lyme, they can carry other infectious disease. If you are bitten, care should be taken to remove the tick properly, and the date of the bite should be noted, as it may be needed for future reference. Do not squash, freeze, burn, or smother (with spirits, or nail varnish) the tick, as this can cause it to regurgitate its blood meal, which can actually result in an additional injection of infectious organisms. Remove the tick with fine tipped tweezers or a purpose built tick remover, as close as possible to the skin, to remove all mouth parts. Never handle a tick with your bare hands, as agents can enter through breaks in the skin. The tick can then be stored in an airtight jar or vial, saved for evidence of the event or disposed of when dead.
The first sign of infection (usually beginning within a week) is often an expanding pink rash, sometimes, but not always, at the site of the bite. It is important to note that not all Lyme victims will experience a rash or have any knowledge of ever having been bitten by a tick. Multiple rashes can occur, and they are a sign of disseminated Lyme. About a third of rashes will take on a bulls-eye pattern, but it is a common mistake in diagnoses to exclude rashes that don’t conform to this appearance. The rash might also be painful.
Other symptoms which can occur include fever, headache, chills, constant sore throat, dry cough, muscle pain (especially the upper back, shoulders, and neck area), pins and needles, tender soles of feet, joint aches, uncontrollable twitches, facial palsy, confusion, depression, vertigo, and profound weakness and fatigue. The symptoms of Lyme can present differently in different people, and medical practitioners are often inclined to suspect MS, ME, or auto-immune disease in some Lyme cases because the symptoms which present can be similar in nature and overlapping.
In its acute or early stage, Lyme disease can be effectively treated with a course of oral antibiotics. In cases where the diagnoses is delayed or overlooked, treatment can be less successful. Victims can find themselves disabled with “Chronic Lyme,” sometimes referred to as “Post Lyme” disease. At this stage, victims may suffer from ongoing neurological symptoms, pain, tingling, loss of sensation, and visual and cognitive problems. In severe cases, heart problems, blindness and paralysis can occur. Chronic Lyme can cripple and kill. So, if you get a tick bite take it seriously because it is not ‘just a tick.’
Because effective treatment in the advanced stages is so uncertain and expensive, it is in the best interest of patients and the Dept. Of Health, that cases be promptly diagnosed and early treatment pursued. Cases of late or disseminated Lyme are sometimes treated with prolonged antibiotic IV. This treatment is expensive and carries risks of its own.
Blood tests can confirm Lyme disease, but since current tests are infamously insensitive, a negative result should never be used to exclude Lyme infection. Instead, clinical observation, patient history, location, and activities should be carefully considered. The blood test given to detect Lyme disease tests for antibodies, which can take from four to six weeks to show positively in the blood. Test too early, and it may not show. However, since Lyme prefers to inhabit organs rather than blood, late testing for Lyme makes it difficult to detect in the blood. So, test too late, and it might not show up either. These are aspects of testing for Lyme disease that, unfortunately, many physicians in Ireland are not as aware of as they should be.
Currently Lyme is not a notifiable disease in Ireland. Therefore, the onus is not on practitioners to report cases to the HPSC. Critically, however, without such a statutory mandate to report, the actual incidence of Lyme in Ireland will remain unknown and often underestimated.
As the above cited article states, “Lyme disease is not currently one of the notifiable diseases stipulated in S.I. No. 707 of 2003. When there is not the legal onus on practitioners to report cases of an infectious disease, the knowledge we have about such disease is, accordingly, incomplete. Notification allows identification in a more systematic way, and facilitates following trends.”
It is a main objective of Tick Talk Ireland to rectify this situation. You can find us on Facebook. Tick Talk Ireland is a patient support group dedicated to engaging with members of the health care profession, politicians, and citizens, with the view of heightening awareness of the threat of Lyme Disease in Ireland, and promoting prompt, effective, sensitive treatment of this potentially debilitating disease.
To date, the HSE has chosen to sideline efforts of Tick Talk Ireland and other interested individuals to make Lyme a “Notifiable” disease. It is the Health Service Executive’s remit to protect the health of the citizens of the nation. Tick Talk Ireland asks how the public health can be protected from Lyme disease without any tracking or investigation on the part of the Health Protection Surveillance Centre?