Though less common locally than in some areas, tick bites pre and post removal do offer some concern to patients.
Targeted public health information regarding tick bites and Lyme disease means that there is more concern from members of the public about these presentations, and it is more likely that patients may attend with nonspecific concerns.
- Ticks are small, spider like creatures that feed on the blood of animals.
- Ticks are tiny, about the size of a poppy seed, but once they have fed, they can be as big as a baked bean.
- The most important tick species to human health is Ixodes ricinus, more commonly known as the sheep, castor bean, or deer tick.
- Ixodes ricinus is the principle vector of Lyme disease (LD).
- Ticks are found in areas such as woodlands, grasslands and moorlands – dense vegetation layer and a suitable range of hosts on which ticks can feed.
- Ticks can also be found in some urban parks and gardens where there are sufficient host species.
- Ticks feed for one continuous period over a few days during each life stage.
When ticks are active
In England, nymphal tick activity increases during spring, peaking during April to June. During this period, the risk of acquiring a tick bite is highest. Activity reduces during the summer months, but can then pick up again in early autumn. Activity continues over the winter months but at a reduced level. Adult ticks can be active at all times of year, but are more active in summer which is also the peak time for larval activity.
Although this article is not concerned with the diagnosis and treatment of Lyme Disease, it is important to have some understanding in order to offer reassurance and advice to patients. More detailed information can be found here
- Lyme disease is caused by the bacterium Borrelia burgdorferi, which is a spirochaete.
- Most tick bites do not transmit Lyme disease.
- It maybe that a tick bites, feeds and sheds without the patient being aware.
- Prompt, correct removal of the tick reduces the risk of transmission.
- Particularly high-risk areas are the South of England and Scottish Highlands but infection can occur in many areas.
- Evidence suggests that LD transmission risk increases the longer a tick is feeding.
Reassurance is important. Most ticks aren’t infected and not all infected ticks will cause a host infection in humans.
NHS Choices advices the following to patients
See your GP if:
you’ve been bitten by a tick or visited an area in the past month where infected ticks are found
and you get:
flu-like symptoms – such as feeling hot and shivery, headaches, aching muscles or feeling sick, or
a circular red rash
Tell them if you’ve been in forests or grassy areas.
It is also important to advice the patient on future measures to reduce the risk of tick bite and finding ticks early
Tick bite prevention
- walk on clearly defined paths to avoid brushing against vegetation where ticks may be present
- wear light coloured clothing so that ticks crawling on clothing can be spotted and brushed off
- use an insect repellent that can repel ticks and prevent them from climbing onto clothing or attaching to skin (always follow the manufacturer’s guidance)
- wear long trousers and long sleeved tops to reduce the direct exposure of ticks to your skin, making it more difficult for them to find a suitable area to attach
Recognising ticks and performing a tick check
In addition to carrying out the prevention measures outlined above, it is important to carry out a regular tick check after participating in outdoor activities (e.g. walking, running, gardening, camping, picnicking). A tick check is carried out by looking and feeling for ticks that may have attached to the skin. By performing a tick check, the chance of infection is reduced because feeding ticks are spotted and removed promptly.
To remove a tick safely:
- Use fine-tipped tweezers or a tick-removal tool if available – it may be worthwhile for patients at high risk of tick bite to purchase these.
- Grasp the tick as close to the skin as possible.
- Slowly pull upwards, taking care not to squeeze, twist or crush the tick.
- Dispose of it when you’ve removed it.
- Clean the bite with antiseptic or soap and water.
It is important to advise patients not to attempt to smother (such as with vaseline) or burn the tick to cause it “drop off” as this can cause regurgitation of the stomach contents which increases the risk of LD infection.
There is a voluntary tick surveillance scheme in the UK