Tick bite case study
Even under the hot sun, southwest France in August was green and lush. It was the day of the village walk, a five-mile stroll around the parish perimeter.
For Stephen Hinckley it should be a doddle; after all, the 61-year-old freelance engineer had just walked the entire coast of Norfolk and he was as fit as a flea. He turned up in shorts and a t-shirt, sandals and no socks.
"There were maybe 20 or 30 people," he recalls. "I was a bit curious; in spite of the heat they were wearing long-sleeved shirts, boots and their trousers tucked into their socks."
A little later he began to realise why. "I noticed an insect bite on my left ankle," he says. "It wasn’t itching or hurting, but after a couple of days a curious kind of rash appeared, which I now know is called a 'bull's-eye' rash."
The rash faded but his ankle swelled and stiffened, and back home in England he began to suffer back pain. His GP prescribed an anti-inflammatory drug, but shortly afterwards he developed a high temperature and flu-like symptoms, what he calls "a general feeling of unwellness".
It was only then that he told his GP about the bite and the bull’s-eye rash. "I hadn’t connected that small bite with what had happened to my ankle. I thought I might have sprained it. I was fortunate that I had that rare thing, a GP who immediately spotted that the symptoms could be connected to the bite, that it could be something called Lyme disease."
Where are ticks usually found?
Stephen had been ambushed and bitten by a tick, Ixodes ricinus, which carries the borrelia bacterium. It’s commonly called a sheep tick but it’s carried on all manner of mammals, from mice to deer, and on birds too. Stephen spotted lots of deer during that stroll in France, and the long grass that brushed his bare legs was ideal territory for ticks.
But ticks can flourish in a wide range of habitats: woods, moorland, heathland, bracken and so on, even among fallen leaves. "There are cases that have been contracted in Hyde Park," says Stella Huyshe-Shires, chair of the charity Lyme Disease Action. "Some people have simply got it from their gardens."
She confirms the relative rarity of a GP who is clued up on the condition, a situation that Lyme Disease Action is working to alter. "Awareness among GPs is improving, but it is still quite low," she says. One problem is the failure of both patient and doctor to connect the bite with the infection because so much time may elapse between one and the other, before the symptoms drive the patient to seek medical help. In Stephen’s case it was about five weeks.
How Lyme disease is diagnosed
He had a blood test as soon as Lyme disease was suspected. "The local hospital will do what they call a 'screening test' to test for possible Lyme disease," says Mrs Huyshe-Shires, "and if that is positive it’s sent off to a specialist laboratory. There are only three in the UK: Southampton, Carlisle and Inverness."
Whatever the result of any tests, there is as yet no specific treatment, only antibiotics, and there’s an element of hit-and-miss in their use. "There have been no proper European trials," says Mrs Huyshe-Shires, "so we don’t actually know what’s the best length of treatment, and we don’t know which antibiotic is best, so the Department of Health are going along on the assumption 'let’s treat it how it’s been treated in the past'."
Is it on the increase? "Positive blood tests are recorded," says Mrs Huyshe-Shires, "so we know there’s a rise in those, but we don’t know how many cases are misdiagnosed or undiagnosed. So, yes, we think cases are rising." According to LDA figures, the first three quarters of 2010 were up 55% for the same period in 2009.
How to take precautions against Lyme disease
It’s worth emphasising that not all tick bites result in infections, and not all infections are severe, but it makes sense to avoid them in the first place. There is no vaccine against Lyme disease, but there are ways to prevent infection.
- Be aware of the likely presence of ticks in long grass and bracken, especially on warm, windless, humid days. Ticks are most active between April and October.
- Use an effective insect repellent.
- Tuck trousers into socks, and wear light clothing, so that ticks can be spotted easily.
- Carry a tick removal tool (LDA supplies them and so do pet shops) to prise the beasts from the flesh; never squeeze, crush or attempt to burn a tick because it’s likely to regurgitate its stomach contents into the site of the bite.
Stephen made a full recovery, though because of the relatively late diagnosis it took seven months on antibiotics to eliminate Lyme disease from his system. If only Stephen had realised immediately the significance of the vivid clue that his tick had left him: that unmissable target for rapid treatment, the bull’s eye rash.
Lyme Disease Action
PO Box 235
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