Can I have Lyme disease even if I have not had the bullseye rash?
Yes. The bullseye rash, or Erythema migrans,53 is a useful diagnostic feature typically associated with Early Lyme disease. Estimates of the frequency of the EM rash vary widely. A recent study of patients with suspected Lyme disease in a Glasgow clinic showed that a mere 4% of patients had an EM rash54. The Health Protection Agency reports that for 2010 for England and Wales, 56% of laboratory-confirmed Lyme patients presented with an EM rash55. Even when it is present, it may be faint, or on the scalp or back and thus easily missed. Atypical rashes are sometimes seen in Lyme and these can be varied in appearance and thus difficult to recognise.
How common is Lyme disease in the UK?
Nobody really knows. The testing is thought to miss many cases, and a lack of awareness and understanding means it is often not diagnosed. Official estimates by the Health Protection Agency put the annual number of UK new cases at up to 3000. In 2011 for England and Wales, there were 959 laboratory confirmed cases. In Scotland for 2011, there were 229 laboratory-confirmed cases (provisional figures). In 2011 there were a minimum estimated 50-100 Irish cases.
Patient groups and GP’s consider these figures to be an underestimate, and the Health Protection Agency’s estimate of up to 3000 annual cases has not changed for many years, whilst the number of confirmed cases has steadily risen each year. Since patients often go undiagnosed and untreated for long periods of time, the total number of cases is accumulating.
How long does a tick have to be attached in order to transmit Lyme disease and other tick-borne disease?
It used to be thought that a tick needed to be attatched for at least 24 hours to transmit Lyme disease, however, some studies show that Lyme may be transmitted more rapidly than this56. Disease transmission is more likely as duration of attachment increases, so removing ticks early is recommended
How should I prevent tick bites?
Avoidance of ticks is best. Stick to paths, avoid tall vegetation and bracken, Wear long trousers, tuck trousers into socks. Smooth fabrics are harder for ticks to cling onto. Repellent applied to strategic points can help- ticks crawl and can get inside clothes, so repellent applied to the waist, wrists, ankles and neck can be useful. Clothes can be purchased which are impregnated with insecticide, but the effectiveness of these against ticks is not known. On returning from tick habitats, it is a good idea to check yourself all over and get someone to check the parts you can’t see. Pay particular attention to creases and hairline of children. For more information on tick avoidance, including advice for pets and gardens, see bada-uk.co.uk
What is Lyme Disease?
Lyme disease is a bacterial infection usually transmitted by the bite of an infected tick. Not all ticks are infected, and not all tick bites will cause disease. The bacteria which causes Lyme disease is Borrelia burgdorferi s.l. The “s.l.” means sensu lato (latin), as there are several related genospecies which also cause Lyme disease. The genospecies found in Europe are often different to those found in the USA 10, and they may result in slightly different symptoms. Chronic Lyme disease can also cause metabolic 17 and possibly hormonal disturbances, the immune system may be compromised18 19, auto-immune processes can occur20,21,22 and co-infections 23,24,25 and opportunistic infections may also occur.
What is Lyme often misdiagnosed as?
Lyme is a multi-system illness that can affect many different areas of the body. It often presents with vague, non-specific symptoms and is thus difficult to diagnose. Many doctors will be inexperienced in dealing with it. In addition, official information available to doctors does not adequately describe the variety of symptoms and patterns observed. It has been called the ‘new great imitator’43 as it can mimic other illnesses. Lyme is often misdiagnosed as Fibromyalgia, Arthritis, Chronic Fatigue Syndrome, M.E., Multiple Sclerosis, Dementia/Alzheimer’s, psychiatric disorders, Depression, Motor Neurone Disease (called ALS in the US), viral illness, and the Lyme rash can be mistaken for ringworm, a normal reaction to an insect bite or Cellulitis.
What is the best way of removing a tick?
A special tick twister removal tool can be bought from BADA-UK or Lymediseaseaction.org.uk and these are the safest way of removing embedded ticks57. Alternatively, fine nosed tweezers can be used, gripping the tick close to the skin and pulling upwards. Eyebrow tweezers or blunt-tipped tweezers are not suitable as they will squash the tick which is likely to cause it to regurgitate stomach contents back into the victim. In an emergency situation, a loop of cotton tied in a slip knot can also be used. The aim is to avoid stressing the tick as this can cause it to regurgitate. Do not cover the tick with Vaseline, alcohol, or burn it. These methods will increase the risk of disease transmission. For further info see www.bada-uk.org.
What is the evidence that Lyme is linked to Alzheimers/dementia/Autism/Multiple Sclerosis/Motor Neurone Disease?
There is increasing evidence that Lyme disease may be linked to these conditions. There is good evidence that Borrelia burgdorferi infection is associated with dementia/Alzheimer’s-like states in some cases, 44,45. It has been suggested that Autism may be, in some cases, linked to Lyme Disease 46,47. Some cases of Motor Neurone Disease may actually be misdiagnosed Lyme Disease 48,49,50. Lyme disease can mimic Multiple sclerosis and can present with similar findings on brain imagery 51,52