Hill skills: tick alert

Posted by Janine Hall on 01/05/2016
The classic 'bull's eye' rash.
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There’s nothing quite like discovering a tick on your body to make you squirm with disgust. That head buried in your skin, those little legs wiggling contentedly as it feeds on your blood. It’s a natural instinct to want to rip it out immediately, but wait. Tick-borne diseases are on the rise in many climbing and walking areas - stack the odds in your favour by removing the critter properly.

What are ticks?
Ticks are small arachnids, about the size of a poppy seed. They are external parasites that live off the blood of birds and mammals – including you. They are second only to mosquitoes for carrying diseases to humans, and in the UK can carry such pleasures as Lyme disease, Ehrlichiosis, Babesiosis and Bartonella. Plus in the USA and parts of Europe they can be responsible for transmitting Tick Borne Encephalitis, Rocky Mountain spotted fever and Colorado tick fever. Global warming and changes in farming practices mean that across Europe there are now more ticks in the countryside.

How do they attack?
Ticks live in the soil and emerge to climb tall grass, shrubs, bushes and low level tree branches up to a height of 20-70cm in search of a blood host. They attack when you, or an animal, brushes past and look for an area of soft skin to insert their feeding organ and suck blood. They can attach themselves almost anywhere but prefer dark creases like the armpit, groin and back of the knee. You won’t feel a thing, as the tick injects a toxin to anaesthetise the bite area and once embedded they will steadily engorge as they feed on your blood. They can also leave you with a nasty farewell present.

Lyme disease
Lyme disease is caused by the bacteria Borrelia Burgdorferi (Bb), and many popular UK and European climbing and walking areas have Bb-infected ticks. But don’t panic, simply being bitten by a tick doesn’t mean you’ll contract Lyme disease.  However the risk is out there – the Lyme Borreliosis Unit at the Health Protection Agency has seen the number of infected people increase year after year, from 292 reported cases in 2003 to 684 in 2006. However, they estimate around 2000 cases per year go unreported.

The most famous symptom of Lyme disease is a bull’s eye rash (erythema migrans), consisting of a red ring-shaped rash which gradually spreads from the site of the tick bite, usually with a fading centre.  Kind of like a browny-red or pink expanding polo mint. It appears 2 - 40 days after infection and is the only sure-fire symptom of Lyme disease - so if you develop one take a photo immediately to show your doctor in case it disappears. Less than 50% of people with Lyme get this rash, and if left untreated a whole range of symptoms can develop, including a flu-like illness, facial palsy, viral-type meningitis, arthritic-like joint pains, nerve inflammation, disturbance of sensation or clumsiness of movement and encephalitis (swelling of the brain).

If you suspect you have Lyme disease then head straight to your GP. There is a blood test for Lyme but it’s acknowledged to have a very high rate of false negatives, so if your GP suspects Lyme, they should begin antibiotic treatment right away, without waiting on the results. Medical opinion is fiercely divided on the best antibiotics and dosages needed to eradicate symptoms, so it’s impossible to make recommendations. However taking antibiotics prophylactically (‘just in case’) is a bad idea: the risk of catching a nasty from a single tick bite is very small.

Areas where infection has been acquired in the UK include Exmoor, the New Forest, the South Downs, parts of Wiltshire and Berkshire, Thetford Forest, the Lake District, the Yorkshire moors and the Scottish Highlands. Two confirmed cases of Lyme Disease have also recently been reported in the Peak District by members of Glossop Mountain Rescue Team.

TBE
Another treat carried by some ticks in Europe is Tick Borne Encephalitis (TBE) - a viral disease that attacks the nervous system and can result in serious meningitis, brain inflammation and death. TBE incubation time is 6-14 days and at first it can cause increased temperature, headaches, fever, a cough and sniffles. The second phase can lead to neck stiffness, severe headaches, photophobia, delirium and paralysis. There is no specific treatment for TBE.

Climbers and walkers are again particularly at risk from TBE and ticks carrying the disease are found in many new destinations growing in popularity.  TBE is endemic in the forest and mountainous regions of Austria, Belarus, Croatia, Czech Republic, Estonia, Germany, Hungary, Latvia, Lithuania, Poland, Russia, Slovakia, Slovenia, Switzerland and Ukraine.

Tick Alert has produced a guide which gives clear and easy-to-understand information and advice about TBE in Europe. It highlights activities and locations that put people at greater risk of TBE, shows how the disease is contracted, explains the serious symptoms that can arise and what to do to protect against TBE.

Download ‘Protect yourself from TBE in Europe’

Prevention is better than cure
Taking steps to prevent tick bites is better than digging the things out of your legs:

  • Avoid unnecessary bushwacking and walk in the middle of paths.
  • Keep your arms and legs covered. Light coloured fabrics are useful since the ticks stand out.
  • Check clothes and skin frequently. Ideally do a buddy check every 3-4 hours. They’re large enough to be easily spotted in summer, but you need to look carefully in spring: they’ll be as small as the dot on this ‘i’.
  • Check that ticks are not brought home on clothes, pets and bouldering mats.
  • Check children carefully, especially along the hairline and scalp.

Janine Hall got bitten by a tick whilst bouldering in Fontainebleau and developed Lyme disease two weeks later. It was cured with four months of munching antibiotics. She no longer rattles with pills and now lives in the Highlands.

Download BMC funded advice booklet

Public Health England information issued April 2013

WATCH BMC TV: Ticks the movie

Watch this on BMC TV

EXPERT Q&A

This issue’s hill skills expert is Lynda Bramham. As a nurse adviser at MASTA Ltd, Lynda provides advice and training for doctors and nurses on travel health topics. MASTA run a network of travel clinics throughout the UK and maintain a website providing health briefs for those planning to travel abroad.

Q. What time of year am I most at risk?
A.
Ticks are most active in the spring and summer months - between March and October.

Q. Does insect spray work against ticks?
A.
Yes, good insect repellents will help to reduce the number of tick bites. Protective clothing can also be helpful, although ticks may spend several hours wandering around looking for a good feeding spot once they’ve managed to find you. Treating clothing with an insecticide could be helpful.

Q. How long do ticks remain on a person?
A. Some ticks will feed for a few hours. Others will suck blood for up to three weeks if they’re not removed. If you are camping or walking in infected areas, check your skin regularly - at least every evening. Pay special attention to warm areas like armpits, groin, and back of the knees.

Q. How do I remove a tick?
A.
This can be tricky as many ticks use a cement-like substance to glue their mouthparts into place whilst they’re feeding. The best method is to get a good pair of tweezers, grip the tick as close to your skin as possible and pull it straight out. Remove ticks as soon as possible to reduce the risk of infection and take care to remove all of the mouthparts. To reduce the risk of infected materials being injected in to you, avoid squeezing the body of the tick, applying substances like Vaseline or burning it - no matter how tempting it is. Consider retaining the tick in a sealed container in case you develop symptoms later.

Q. Can I be vaccinated against tick-borne diseases?
A. There is a vaccine available for TBE. Those camping and walking in the infected areas of Europe and Asia in the spring and summer months can get advice from their doctor or nurse or visit a travel clinic. Allow plenty of time; two doses at least two weeks apart are required to provide protection. This should be completed at least two weeks before going in to the risk area. There is no vaccine for many of the other diseases transmitted by ticks.

Q. Is the level of tick disease rising?
A.
A number of European countries have reported an increase in cases of TBE over recent years including Switzerland, Germany, Poland and Czech Republic. Other areas have reported a decline in the number of cases.


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1) Anonymous User
19/03/2013
There actually is a fully reliable test for Lyme Disease - a DNA PCR test. It is available via the NHS from the UK Lyme reference laboratory in Southampton. GPs are almost certain never to have heard of it but insist on them contacting the local Infectious Diseases Unit who certainly should be well aware of the availability of the test and should easily be able to find it if not.

A positive result is unequivocal and a negative means almost certainly negative (I can't recall the false negative rate but it's pretty insignificant). Note that just because a positive result is obtained, the thinking is that you may have actually cleared the infection, though almost certainly only with with antibiotic use - Doxycycline is the main one (100mg X2 a day for two weeks). Which, luckily, tends not to upset the gut so badly since it's absorbed very rapidly and doesn't make it to the large intestine. However a positive result means you either had it recently (months) or have it now.

How do I know all this? I've had Lyme and it gave me quite a kicking. I'm still recovering from aspects after two years - but whatever doesn't kill you makes you stronger! ;)

David Wood ( http://drw.me.uk/RedYeti/ )
2) Anonymous User
19/03/2013
Oh and come to think of it I posted on TBE myself a while back (well worth noting if in the European Alps)

http://drw.me.uk/RedYeti/2009/05/20/gr5-tick-borne-encephalitis/

David Wood
3) Anonymous
09/08/2014
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4) Anonymous
09/08/2014
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5) Anonymous User
15/06/2016
We have just come back from Devon, I have found 2 ticks on my little dog. One in the crevis under her front leg and chest, the other in her EAR. I am very worried!.
6) Anonymous User
31/07/2016
According to this BBC article, the Lyme disease test is *not* fully reliable - in the early stages of the disease it fails to detect its presence:
http://www.bbc.co.uk/news/magazine-36923336

If you have the tell-tale ring mark of a tick bite and have the symptoms of Lyme Disease make sure you press your doctor or ask for a specialist assessment.
7) Anonymous
03/10/2016
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8) Anonymous
03/10/2016
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9) Anonymous
25/11/2016
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