23 July, 2010
Bites from infected ticks can lead to a potentially chronic, life-limiting condition called Lyme disease, or borreliosis. Worryingly, it seems some GPs don't recognise early signs of this increasingly common problem, as this report by a colleague shows.
In 2008, two days after camping in the New Forest, my son Tim, then seven, complained of an itchy bite on his leg. The only visible mark was a small pink bump, which we treated with antihistamine ointment. This soothed the irritation, but the bump remained.
Ten days later, the mark became larger and darker and a red ring appeared around it, so my wife Jane took Tim to our GP practice. The locum GP said it was just a strong reaction to a normal insect bite, and prescribed high-strength antihistamine syrup. Within a few days, the rash and itchiness on his leg had almost disappeared and, although Tim - untypically - complained of feeling tired during the day, we blamed a summer cold.
Two weeks later on the Isle of Mull, Tim complained of pains "inside" his thumb and knee joints as well as the tiredness. Then, after a country walk, I noticed a sort of scab on his upper lip. It turned out to be a tick - firmly attached - which I carefully removed with tweezers. I found another embedded in the crook of my arm.
Advice at the health centre on Mull was very different. Tick bites are an everyday hazard there (as in many other rural places). The pinhead-sized ticks climb up long grass, attach themselves to a passing animal and feed on its blood, swelling to several times their usual size. Some ticks carry bacteria called borrelia, which are passed to the host. Although harmless to animals, borrelia can infect human hosts with borreliosis which, if left untreated, can cause an ME-like illness, arthritic joints and heart rhythm problems, or disturb the central nervous system (like meningitis).
The ticks that caused our bites weren't engorged (so probably hadn't started feeding), but I was advised to monitor the bites for changes, especially one of the earliest signs of infection - a red ring surrounding the site (like Tim's when he was first bitten), which usually develops over a few days. Flu-like symptoms, including fatigue, are another sign; joint pains suggest more advanced infection. For the first time, I understood the probable cause of Tim's original problems.
Back in London, our usual GP prescribed a one-week course of strong antibiotics. Thankfully, Tim's symptoms cleared swiftly. He was lucky (and my bite didn't develop further), but it's essential that doctors and families are aware of the possible consequences of these tiny bites.'
- Ticks are mostly active from April to October in shady grass, bracken, bushes or leaf litter in areas frequented by host animals (even in London deer parks). Stick to well-trodden paths, preferably with shorter grass.
- Wear boots or shoes (not sandals), long trousers tucked into socks, and long-sleeved tops in a pale colour so that the ticks show up: they look like a speck of soot, a pinhead-sized dark spot or a small spider.
- After walking, sitting on logs or leaning against tree trunks, check for ticks in warm spots such as armpits, groin, navel, neck and scalp.
- If you find a tick, don rubber or latex gloves and use a tick removal tool (from £4.99, from lymediseaseaction.org.uk) or sterilised tweezers to pull it away. If the tick is engorged, try to avoid squeezing its body as this can cause infection. If possible, keep the removed tick in a container for research, noting where and when it was found. Clean tools with antiseptic and wash hands thoroughly.
- If you've been bitten by a tick, and especially if you have the 'bull's-eye' rash, see your GP immediately. If they're unfamiliar with the implications, insist that they seek further advice.
- A testing kit is now available which can identify whether the tick that caused the bite is infected with borrelia. Care Plus Tick Test, £9.99, from stopthetick.co.uk.