When a tick bites you … Interview with prof. Tomasz Wielkoszyński

This year, ticks are extremely active. Statistics show that even every second tick is a carrier of Borrelia spirochetes. And this means that after being bitten, it can “pass” on to us a disease that is not so easy to fight. What to do after a bite? What tests are worth doing? These questions are answered by prof. Tomasz Wielkoszyński – a doctor who has participated for over a decade in national and international research projects in the field of diagnostics of diseases transmitted by ticks, the founder of the Wielkoszyński Medical Center.

1. – Nature is not only gentle with ticks lately. The situation is similar with, for example, mosquitoes. The last winters were warm, there was almost no frost. Such an aura is conducive to the development of the tick population, says Prof. Wielkoszyński
2. It is estimated that even every second tick is a carrier of Borrelia spirochetes. In some areas of Poland, it occurs up to 60 percent. infected ticks – if we come across one, we can become infected with Lyme disease
3. Poles are afraid of Lyme disease for a reason. – If detected early, it gives a chance for a full recovery. However, in the vast majority of cases, Lyme disease develops insidiously and is detected when it has already caused irreversible havoc in the body. Such late Lyme disease becomes an uncomfortable companion for the rest of life, the presence of which is often associated with considerable expenses for treatment – explains the expert
4. What to do when a tick bites us? Is it worth sending a tick for examination? What are the treatment options for Lyme disease? The expert dispels all doubts

Natalia Mel: Summer is in full bloom, and with it the season for ticks has blossomed. This year, despite the dominant topic of the coronavirus in the media, there is a lot of talk about tick bites. Is the number of tick bites actually increasing?

Prof. Tomasz Wielkoszyński: Indeed, it can be said that ticks are extremely active this year. There is no official data on the number of tick bites in our population, as only patients infected with Lyme disease are required to report to the Sanitary Inspectorate.

However, I can refer to my own experiences. The growing tendency can be seen from the number of tests carried out in our Center, where people send ticks for testing for Borrelia carrier. Also, a few weeks after the bite, patients undergo Lyme tests. This year, the research is more popular than in previous years.

1. You can check if you have Lyme disease. Check the offers:

To what is the upward trend in the size of the tick population, which translates into more bites?

Many factors influence the size of the tick population. One of the leading ones is the temperature in winter. Simply put, it can be assumed that the lower the temperature, the more the tick population is thinned. On the other hand, the milder the winters, the weaker nature’s natural weapon against ticks.

Recently, nature is not only dealing with ticks gently. The situation is similar with, for example, mosquitoes. The last winters were warm, there was almost no frost. Such an aura is conducive to the development of the tick population.

You mentioned the tick research. This is still quite a controversial topic. There are different opinions on this subject in the media. Why are ticks tested?

My position on this issue is clear and based on the cases of thousands of patients who came to me for diagnostics. I will support this matter with facts.

The official estimates show that even every second tick carries Borrelia spirochetes. In some areas of Poland, it occurs up to 60 percent. infected ticks. Local tick tests conducted by the Wielkoszyński Medical Center in the summer of 2018. in Dąbrowa Górnicza and the surrounding area, more than 1/3 of the ticks were infected with Borrelia spirochetes.

An infected tick is one thing, but a bite by a tick carrying Lyme disease does not immediately mean that we are infected with Lyme disease. In such a situation, isn’t testing a tick an art for art’s sake? Or, as critics say, pulling money from bitten, fearful people?

I agree that not every infected tick will infect the person it feeds with Lyme disease. I would even say it’s a small percentage. Official estimates show that 4 percent. people bitten by infected ticks become infected with Lyme disease. So is 4 percent for this risk of infection should be tested? Everyone has to answer this question on their own.

My position on this issue is unequivocal. Firstly, based on the experiences of thousands of patients, I believe that this data is probably very understated. This may be related to the low reliability of standard Lyme disease tests that are used to test people bitten by ticks. Based on scientific data, the effectiveness of the ELISA test, which is usually used for initial diagnostics (i.e. the so-called screening test), has been estimated at about 30-40%.

Another barrier is the still low awareness of people about the advantages of testing ticks and therefore still rarely performed such tests. This makes it difficult to collect large-scale data that would be in favor of such a study. As well as the fact is that more and more often, when it turns out that the tick was a carrier of Lyme disease, patients decide to undergo prophylactic antibiotic therapy without risking developing an infection. Then, thanks to prophylaxis, they automatically fall out of the pool of 4 percent. infected people.

Then why are the ticks that have bitten us examined?

Ticks are tested to find out if the tick has been infected with Lyme disease or co-infections, other diseases transmitted by ticks. If it turns out that the tick was not a carrier of Lyme, the bitten person becomes sure that he has not “gifted” Lyme disease – a serious disease that, if not detected early, has serious consequences. The detectability of spirochetes in ticks is higher than in the case of human Lyme disease.

Testing a tick with the method of direct immuno-uorescence has a diagnostic sensitivity of about 85%, testing with the PCR technique – at the level of 90-95%. If the tick test has been carried out with a reliable test, there is a high probability that we will not get Lyme disease. However, there is always a margin of error and the risk of a false negative result in the tick. Therefore, to be sure, it is worth performing a Lyme disease test in a person bitten by a tick after six weeks.

Only we still have 4 percent here. the risk of falling ill if the tick was infected. So why invest in a study that does not give a clear answer about our safety?

Even if the risk was the underestimated 4%, the question is how serious the risk is, i.e. what are the potential consequences of falling ill with Lyme disease. And here I am referring again to the experience in my many years of work with patients suffering from Lyme disease.

The range of symptoms in such patients is wide and varied, and a large proportion of these symptoms literally ruin the quality of life and make it difficult or even impossible to function normally, excluding people from work. If we compare such serious consequences with the consequences of possible prophylactic antibiotic therapy, the balance is in favor of the latter.

Probably every patient who struggles with Lyme disease will answer the same. Because early detection of Lyme disease gives a chance for a complete cure. However, in the vast majority of cases, Lyme disease develops insidiously and is detected when it has already caused irreversible havoc in the body. Such late Lyme disease becomes an uncomfortable companion for life, the presence of which is often associated with considerable expenses for treatment.

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The late detection of Lyme disease is due to the still low awareness of doctors, who often do not associate the symptoms of Lyme disease with this disease and make different diagnoses. On the other hand, the low effectiveness of basic tests detecting Lyme disease causes patients with suspected Lyme disease to be sent back from the clinics with nothing, because the Lyme disease result is negative.

So what do you recommend when it turns out that the tick was a carrier of Lyme?

There are basically two ways to proceed.

The first is to wait before applying antibiotics, observe the bite site (an erythema may develop, which makes it certain that you are infected with Lyme disease), monitor the appearance of general symptoms and perform tests in a timely manner. Here we have a choice of several tests: PCR test (approx. 7-10 days after the bite), EliSpot test (approx. 4 weeks after the bite), Western Blot or Microblot Array (4-6 weeks after the bite). Please note that I do not recommend the ELISA test, which has a high risk of error.

The second route is the immediate prophylactic inclusion of antibiotics. Based on many years of experience with patients suffering from Lyme disease, I consider the second solution to be optimal. An antibiotic given at the time of infection, i.e. when the spirochetes are only locally in the skin, will do much less harm to the body than long-term treatment when the spirochetes have spread throughout the body. The sooner treatment is started, the greater the chance of avoiding Lyme disease. And it should be remembered that erythema occurs only in 30 percent. Lyme disease patients! Therefore, it is not an effective indicator of the onset of the disease in its early stages.

I am talking about antibiotic prophylaxis. What antibiotics are recommended in this situation?

There are two ways of proceeding after exposure to spirochetes in the world, i.e. after being bitten by an infected tick, which have supporters and opponents. These are methods called IDSA and ILADS. Ultimately, it is the patient who decides on the treatment method.

The IDSA recommendations, in line with the recommendations of the Polish Society of Epidemiologists and Doctors of Infectious Diseases and the state health care, include a single administration of 200 mg of doxycycline for people over 9 years of age.

The recommendations of the ILADS, the American scientific society in favor of the method of treatment, which I recommend based on the experience of patients, include 2-3 weeks of administration of one of the antibiotics: doxycycline (adults and children over 9 years of age), amoxycycline or cefuroxime axetil.

What else can you do to keep yourself safe after a tick bite?

Even if the tick test result is negative, it is worth being vigilant about symptoms such as flu-like conditions, joint symptoms, cognitive disorders, headaches, neurological symptoms, fatigue and palpitations up to three months after the bite. These could be signs of Lyme disease. This should be taken into account because there is no 100% market on the market. effective research, and this is what the situation of a false-negative result can happen to us. More inquiringly, people can perform tests to detect antibodies 6 weeks after the bite.

What if the tick has been removed and thrown away?

As in the answer to the previous question, the key here is to observe and perform one of the listed studies in a timely manner.

Let us return for a moment to the tick examination. What does such a study look like?

Borrelia spirochetes are found in the intestine and salivary glands of the tick. They are not in the limbs, but in the abdomen. Even if a headless tick is brought to the test, there is a chance that the test will detect spirochetes. The final decision on the diagnostic usefulness of the material is always made by the diagnostician receiving the material. A whole tick always increases the credibility of such an examination. We test the ticks in our Center using the direct immunofluorescence method (so-called DIF). After delivery to the laboratory, such a tick is homogenized, i.e. crushed in order to release the spirochetes present in its digestive tract and salivary glands. Then, their smear is prepared on a microscope slide, which, after fixation, is incubated with specific spirochetal antibodies labeled with fluorescein. If spirochetes are present in the preparation, we see them under the microscope as green glowing bacteria with threaded or spiral shape.

1. The main thing is to quickly remove the tick from the body. To do this, it makes sense to have a tick removal kit on hand.

Also check:

1. Mosquito, wasp, tick, snake – what to do when we get bitten or bitten?
2. A tick bit me. Should I get a Lyme test?
3. There is a slight infiltrate at the site of the tick bite? Don’t ignore him

Have a question about ticks or tick-borne diseases? Send them to the following address: [email protected]. You will find a daily updated list of answers HERE: Ticks and Lyme disease – frequently asked questions and answers