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Tick-Bourne Diseases

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August 6, 2020

The prevalence of diseases transmitted by tick bite have increased in recent years, within the UK. And it is now recognised that there are 3 main infections

  • Lyme Disease
  • Tick-Bourne Encephalitis
  • Babesia

Lyme Disease (Borrelia burgdorferi)

  • UK Prevalence: In 2019 alone there were >1600 lab confirmed casesin England and Wales, with a further 2000 without lab confirmation.
  • Vector: Deer Ticks
  • Geography:
    • UK – Most common in southern England and Scottish highlands (but in Yorkshire too)
    • World – More prevalent in parts of central, eastern and northern Europe (including Scandinavia) and parts of Asia, the US and Canada.
  • Seasonallity: Summer predominance (but can happen year round)

Clinical Presentation

Click image for more…

  • Often bite not noticed
  • Normal itchy bite rash
  • Erythema migrans (click HERE for more images)
  • fever and sweats
  • swollen glands
  • malaise
  • fatigue
  • neck pain or stiffness
  • migratory joint or muscle aches and pain
  • cognitive impairment, such as memory problems and difficulty concentrating (sometimes described as ‘brain fog’)
  • headache
  • paraesthesia.

Treating and testing

  • Erythema Migrans – Diagnose and treat Lyme disease without laboratory testing in people with erythema migrans.
  • No Erythema Migrans – If there is a clinical suspicion of Lyme disease in people without erythema migrans:
    • Offer an enzyme-linked immunosorbent assay (ELISA) test for Lyme disease
    • Consider starting treatment with antibiotics while waiting for the results if there is a high clinical suspicion.
  • Treatment – NICE treatment table
    • First line – Doxycycline 200mg OD 21 day
    • Central Nervous System Or Unstable Carditis – 2g Ceftriaxone IV (see nice for full regime)

Tick-Bourne Encephalitis

  • UK Prevalence: Two possible UK cases in 2019 & 2020
  • Vector: Deer Ticks
  • Geography: 
    • UK – Thetford and New forests Hampshire/Dorset (the south)
    • World – Forrested areas Central/eastern/northern Europe, Siberia, Russian far-East, China, Japan
  • Clinical:
    • 7 day incubation
      • 2/3 asymptomatic
    • Biphasic
      • Phase 1: 2-10days non-specific symptoms (fever, fatigue, headache, myalgia, nausea)
      • Asymptomatic Phase: Generally 7 day (1-33day)
      • Phase 2: Typical presentations are meningitis, meningoencephalitis, myelitis, paralysis, or radiculitis
    • Diagnosis – testing through RIPL (Rare and Important Pathogen Laboroatory)

Babesia

  • UK Prevalence: One patient July 2019 (uk transition) – historically 10 all imported
  • Vector: Cattle & Deer Ticks
  • Geography: 
    • UK – North Devon
    • World – Reports in Europe, USA, Japan
  • Clinical:
    • no history of a tick bite in this case
    • presented with fever, jaundice, haemolysis, thrombocytopenia
    • diagnosed based on classical morphological features of the Babesia parasite on a blood film. 

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