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After finding 6 ticks crawling on my dog this morning after a 45 minute walk in our local fields, I felt I should share some tick knowledge!

General Information:

The UK has ideal conditions for ticks – not too hot or dry, and generally plenty of rain. Ticks are found in towns, countryside and even gardens in the UK and are most active from March to October. The UK has about 20 different types of tick but luckily not all of them like humans. Ticks are very small and you don’t usually feel them attach to you so you need to actively check for them, especially in the nooks and crannies like armpits and groin, as well as checking children and pets (especially behind/inside ears of dogs).

The best way to remove a tick is using a specially designed tick remover (small and cheap – available online or from any good veterinary practice). The alternative is to use fine tipped tweezers to grasp the tick as close to the skin as possible and pull upwards steadily. It is important not to squash the tick or leave the tiny mouth-parts still attached to you.

Ticks sit and wait on low leaves and branches and attach to you when you brush past them, they do not jump. As with most things, prevention is better than cure. Avoid ticks attaching to you by wearing light coloured clothing, trousers rather than shorts, tucking trousers into socks and using insect repellent.

Lyme Disease:

Ticks can carry several infectious diseases; the most common disease in the UK is Lyme disease which is caused by Borrelia Burgdoferi, a spirochete bacteria. Transmission occurs when an infected tick bites a person.

Symptoms can include a ‘bulls eye rash’ (erythema migrans), or other less distinct rashes, plus flu-like symptoms such as headache, fever, muscle soreness, aching joints and fatigue. It is important to note that not everyone has the classic bulls eye rash, in fact most people probably don’t. Without treatment symptoms may not resolve for months or even years and chronic fatigue following untreated Lyme disease can have a hugely negative effect on quality of life, especially in a previously fit and active person. About 10-20% of people also develop cardiac and/or neurological complications which can be very serious so early treatment and recognition is key.

Luckily treatment is usually simple:

• Oral Doxycycline 100mg twice per day or 200mg once per day for 21 days
• 1^st alternative: Amoxicillin 1g three times per day for 21 days

However if there is any suspicion of central nervous system or cardiac involvement, admit the patient to hospital for further investigation.

Recent Data

Public Health England estimates that there are 3000 new cases of Lyme disease per year based on numbers of positive laboratory finding and cases reported to a central agency. However, a recent study concluded that this is likely to be a significant underestimate. The study analysed a large primary care database of 8.4 million patients to work out how many people had been diagnosed or treated for Lyme disease from 2001-2012. These are their main findings:

• From 2001-2012 the number of cases of Lyme disease increased rapidly, by a factor of 10!
• The total number of cases was more than double what was previously thought with 7738 cases were identified and treated in 2012. 
• The annual rate was 12.1 per 100,000 adults, with local variation – in Scotland the incidence was 37 per 100,000 compared to just 6 per 100,000 in Wales. 

Mountain professionals need to be aware of ticks and their risks in order to reduce the risk of Lyme disease (and others) in themselves and their clients. Anyone practising medicine in primary care, acute care or mountain medicine needs to be able to recognise Lyme disease and treat it appropriately in an attempt to reduce the duration and severity of symptoms and prevent life threatening complications.

Links for more information:

1. The Study referred to above: https://bmjopen.bmj.com/content/9/7/e025916
2. Lymediseaseaction.org.uk
3. Lymediseaseuk.com
4. NICE guidelines on management of Lyme disease.