After a sunny afternoon in the park, the children are being bathed, when…oh my goodness!...you find a blood-sucking insect attached to little Suzie’s belly button! Now what?
First of all, if the tick can easily be flicked off the skin, it is not attached and feeding, and there is NO risk of transmission of disease. If the tick is firmly adherent, but for less than 36 hours, and is not engorged, the probability that it will cause Lyme disease is nil. An engorged tick looks like a balloon with little legs sticking out of it. A tick that has not had a chance to suck blood has a body size proportional to its leg size.
To remove a tick, firmly grasp the insect with tweezers or forceps as close to the skin as possible. Pull upwards steadily. The goal is to avoid squeezing the body. The head of the tick never remains in the human host, because it only inserts its tiny mouthparts. If any pieces are left in the skin, it is NOT necessary to pick them out. With time, they will be expelled spontaneously. Disinfect the area of the bite, preferably with a clear antiseptic like hydrogen peroxide or octanisept. Betadine or other iodine containing solutions may stain the skin, making recognition of a rash more difficult.
Although it is necessary to sustain a tick bite in order to contract Lyme disease, most recognized bites do not lead to Lyme. In fact, transmission of the organism that causes symptoms is as low as 3% in identified tick bites. An unrecognized tick is more likely to infect a human, because it is able to feed undisturbed for days. Over 60% of people with documented Lyme do not remember finding an attached tick. There is no point to testing the tick itself for Lyme disease, as the results will not affect therapy.
For a month after a tick bite, all that is needed is watchful waiting. The site of the bite should be checked daily for skin changes. Visit your doctor if an enlarging flat red rash appears. He or she can diagnose and treat Lyme disease based upon the physical examination of a rash. It is important to remember that treatment of early Lyme disease results in full resolution of all symptoms with a simple course of antibiotics in over 90% of patients. Laboratory evaluation of the patient with a typical Lyme disease rash is unnecessary and likely to yield false negative results.
The laboratory assessment of Lyme disease is quite complex and should only be undertaken by experienced, specialized pathologists. Blood need only be taken if there is an exposure to ticks, and symptoms consistent with disseminated or late Lyme disease. Lyme serology should not be drawn to explain puzzling, chronic complaints, like fatigue, irritability or musculoskeletal pain. It can take months for blood tests to become positive for Lyme, and the positive results may last long after the disease has been fully cured. The false positive and false negative rates are extremely high. For the aforementioned reasons, the use of home Lyme kits is discouraged.
In a nutshell, although Lyme disease is not uncommon in Hungary, it is usually simple to diagnose clinically. Treatment is also straightforward and consists of several weeks of antibiotic therapy. So little Suzie, with the tick bite in the anecdote above, is likely to do just fine!
