BORRELIOSIS AND TICKS

FACTS AND MYTHS

Due to diverse and sometimes misleading information there is great uncertainty regarding the Lyme disease.

In the following we, the practice Dr. Frühwein & Partner would like to assist you to get some clarity about this disease. As infectious disease practice, we have decades of experience in diagnosis and treatment of Lyme disease.

PREVENT TICK BITES

IS THE BEST PROTECTION

  • If necessary, use anti-tick agents (such as DEET-based skin sprays) when you go out in nature
  • Look for ticks after an outdoor stay in the evening (especially the popliteal, pubic, navel, armpits, hairline). This is the best protection against a Borrelia infection: the shorter the suction time, the less likely a Borrelia transmission is!
  • Take a shower in the evening: ticks that are “on the lookout”- can be rinsed off in this way
  • If you remove a tick, do it with tweezers; grasp tightly over the skin and pull it out slowly and straight; but you can also pull out the tick with your fingernails (important: do not squeeze the tick body, do not unscrew, if necessary, shake carefully and turn back and forth to facilitate the withdrawal, no use of glue, oil, vinegar, alcohol, etc.)
  • Even if the lancet remains in the skin, there is no risk of infection, it will fall off with the forming scab later
  • As with all skin injuries, there is a risk of tetanus infection even with a tick bite; Check the vaccination record to see if the tetanus protection still exists (lasts for 10 years). If you are not sure, go to your family doctor
  • If the tick was undetected for more than 24 hours, observe the puncture site. If after a few days, rarely up to weeks, there is a circular redness around the puncture site, consult a doctor. He will then prescribe an antibiotic for you.
  • If you develop general malady or other nonspecific symptoms (fever, headache and body aches), consult a doctor and report the tick bite.

Lyme disease is a Borrelia-induced infection. Borrelia is a bacterial species, that are transmitted by tick bites (ticks sting, they do not bite). The disease is well treatable by antibiotics.

In Germany, about 5- 35% of all ticks (depending on the federal state) are infected with Borrelia. Since the borrelia are located in the intestine of the tick, it takes about 12-24 hours for the bacteria to be transmitted to humans.

By protecting yourself from ticks. A vaccine does not exist in Germany.

No. Even if Borrelia are detected in the tick, one is not automatically infected. A positive result is not a sufficient basis for a therapy.

So far no other insects are known as transmitters.

In more than 80% of those infected, after 1 to 2 weeks (rarely to 4 weeks) the so-called mollusc (erythema migrans) occurs, a magnifying reddish spot, that spreads locally around the site (diameter> 5 cm). This distinct, outward-migrating annular erythema is often paler in the center than at the edge.

Very rarely, the erythema migrans occurs at several body sites simultaneously. In 10% to 30% of cases, the wandering redness is accompanied by additional general symptoms such as malaise, temperature increase, fatigue, muscle or joint pain, similar to the symptoms of a “summer flu”.

Since a Borrelia infection can also occur in rare cases (in about 10% of those affected) even without the typical erythema, it is absolutely necessary to think of a Lyme disease, when the symptoms mentioned above, occur in the case of a previous tick bite . An antibiotic must be prescribed, to avoid an involvement of the heart, nervous system or joints.

No, when an erythema migrans occurs, it should definitely be treated with antibiotics. This skin condition is so typical, that even with a negative test result (missing antibodies in the blood) the therapy should begin, since the antibodies are often only much later verifiable.

If no erythema migrans has appeared, but the above-mentioned flu-like symptoms occur, the antibodies (IgM = early infection phase antibody, IgG = late infection phase antibody) are determined, as they may be a diagnostic tool.
If there are no physical dicomforts after a tick bite, no blood sample is recommended!

Because: 5 – 10% of the healthy population have a positive IgG (and / or IgM!), In some regions even 20% of adults.
Thus, a positive test result does not always indicate an active, “fresh” Lyme, but merely indicates that the immune system had contact with Borrelia at some point in life. After all, high antibody levels can be retained in the blood for many years after an earlier, possibly unnoticed infection.

In addition, the IgM antibodies are not necessarily specific for Borrelia. Non-specific means: there are detectable antibodies in the blood, which are directed according to laboratory expression against Borrelia, but de facto they show only an unspecific reaction of the immune system to another infection, which usually already has healed.

Other test methods, such as the lymphocyte transformation- test or antigen detection from the urine are not suitable for confirming the diagnosis of Lyme disease.

Lyme disease can in principle heal without any therapy, since the human immune system develops antibodies against it. Nevertheless, to avoid complications, antibiotic therapy is recommended after the occurrence of erythema migrans or flu-like complaints after a tick bite (see above).

Borrelia are sensitive to many well-tolerated antibiotics, which means that Lyme disease can be treated well. The therapy should last for a maximum of 21 days, usually 14 days are sufficient.

Unfortunately, patients with the suspected diagnosis of Lyme disease are often treated unnecessarily and without any scientific basis for months with high-dose regimens, which can be associated with severe side effects.

Since Lyme disease does not cause any specific complaints, it often has to be used as an “embarrassment diagnosis” for symptoms, that are also found in people who have never had contact with Borrelia. If positive blood levels are added, a therapy is justified, that does not provide any proven medical benefit.

It should be emphasized again: the Lyme disease can certainly be a serious illness, if it is not discovered and treated in the first few weeks.

Left untreated, Lyme disease can be a prolonged illness, involving the nervous system, joints, or heart. These different clinical pictures of the disease are divided into early and late stages.

Early manifestations (weeks to months after infection) are the wandering redness as well as nerve and heart involvement. Late manifestations (months to years after tick bites) are primarily inflammations and skin changes.

A Borrelia infection is treatable in all disease stages, in the early phase, the therapy is usually the most successful. A spontaneous healing is possible at any stage of the disease.

However, the existence of a so-called “chronic Lyme disease”, often called “post-Lyme syndrome”, is not scientifically proven. This diagnosis is occasionally made in people with nonspecific complaints, which have nothing to do with the actual Lyme disease (fatigue, chronic pain, etc.) and occur in the same frequency in the total population.

The speculations and fears about possible connections of a Borrelia infection with a large number of unspecific clinical pictures and complaints unfortunately often lead to overdiagnosis and overtreatment (see above).

PRINCIPALLY, BORRELIOSIS IS A DISEASE WITH GOOD FORECAST!

As with many medical problems, however, it is not always possible to rely exclusively on proven knowledge, when it comes to Lyme disease. Medicine is a science, that is in flux.

We try to look at each case individually. If you would like further information, this page is recommended by the Bavarian State Office for Health and Food Safety:

http://www.lgl.bayern.de/gesundheit/infektionsschutz/infektionskrankheiten_a_z/borreliose/index.htm

And if you are still unsure or have any questions: you are welcome to make an appointment in the practice Dr. Frühwein & Partners!

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