Forum for Nordic Dermato-Venereology Nr 3, 2018 | Page 17

Paul-Erik Uggeldahl – Ticks and human
and babesiosis, in borreliosis only the tick, Ixodes ricinus, is the
vector (of Borrelia burgdorferi), not mosquitos or horseflies (8).
Removing ticks
Having a tick embedded deep in the skin is disgusting, so we
try to remove them. Often our fingernails are sufficient for
this. Forceps are ideal, but usually these surgical instruments
are usually only available to doctors. Pharmacies in Finland
have suitable tweezers. If the tick does not come off whole,
but parts remain in the skin, it is not a problem; our body’s
rejection mechanisms will eliminate the rest. Disinfection of
the bite site is not necessary. The smallest of the blood sucking
stages, the larva, can be difficult to remove, even with forceps.
However, the larvae do not carry any microbes, with one
exception: babesiosis caused by B. divergens (1).
Diagnosis of tick-borne diseases
Diagnosis of tick-borne diseases is first and foremost based on
the patient’s symptoms. Symptoms of ehrlichiosis and babesi-
osis (9, 1) are not as specific as for borreliosis. The patient may
have borrelia-antibodies in his/her serum, but there must be
borreliotic symptoms also, before the diagnosis (Lyme) borreli-
osis can be made. Seropositivity merely is not a “case”.
Cases, humans with borreliotic symptoms, but being sero­
negative (no B.b. antibodies) do exist. Especially this is true
for erythema migrans, the most prevalent symptom of borrelia
and also Borrelial lymphocytoma. In erythema migrans not
even half of the patiens produce antibodies. in borrelial lym-
phocytoma more than half of the patients are seropositive.
So, what we see (and hear) is crucial, as in dermatology in
general. In Ref 7 is a description of a boy, 15 years old, who
come to my practice with an enlarged right mamilla. Seroneg-
ative, no skin symptoms (erythema), no ticks observed. With
docicyclin, this “miracle” antibioticum (9) a rapid response.
Two weeks treatment, 150 mg doxicyclin daily. Diagnosis:
Borrelial lymphocytoma (of the right mamilla).
The patients may not have seen any ticks on their skin, despite
having a tick-borne infection. On the other hand, a patient
may report many tick bites, but remain symptomless or have
symptoms that cannot be, for example, Lyme borreliosis.
A patient being investigated because of gastrointestinal
symptoms is not suffering from borreliosis, even though he
would have borrelia-antibodies in his serum, and perhaps
having observed ticks on his skin. Because the gastrointestinal
tract is not affected in borreliosis! Seropositivity as such is an
immunologic reminder of the infection; an infection now or
sometimes earlier.
Forum for Nord Derm Ven 2018, Vol. 23, No. 3
A rare possibility is that the patient with gastrointestinal symp-
toms has simultaneously some symptoms of Lyme borrreliosis
explaining the seropositivity. But an infection sometimes
earlier is more probable.
Role of the media
Medicine is a popular topic, and much is written in the media
about diseases in general. In Finland especially, tick-borne
encephalitis (TBE) and borreliosis (called Lyme disease in
the USA) are in focus. This has resulted in a groundless fear
of ticks and the diseases they may cause. It is unnecessary
for people go to health centres or emergency rooms to have
ticks removed.
About recommendations
Light-coloured clothing and rubber boots are recommended
for walking in tick-prone areas in summertime. This allows
ticks to be detected more easily. Especially children are rec-
ommended to wear rubber boots.
It is also recommended that people check their skin for ticks in
the evening. However, this may be of limited use in adults, as
the genitals and intergluteal skin are seldom checked. Even on
areas of skin that are easy to inspect, the most prevalent form
of tick, the nymph, can escape observation. A bite reaction
will reveal the presence of a tick, if such a reaction develops
during blood sucking. Small children, who are often naked in
the evening before going to bed, should be inspected. How-
ever, if a larva is detected on a small child it may be difficult
to remove as the child may not co-operate. The only microbe
this minuscule tick could harbour, is Babesia divergens; and this
is an extremely small possibility (1). Skin symptoms of bor-
reliosis may be detected by inspecting another person’s skin,
especially erythema migrans and multiple erythema migrans.
Iceland in this context
The issue of whether Ixodes ricinus can survive and complete its
lifecycle in Iceland is a topic of discussion. Ticks are certainly
found on migrating birds in Iceland, as in Finnish Lappland,
but that is a rather different matter.
In my review of babesiosis (1), I discuss the issue of when
and where ticks wait for their prey. Ecology, meteorology
and geography are important aspects, as written in detail in
a dissertation by the Swedish entomologist Hans Mejlon from
Uppsala (6).
The Finnish entomologist Camilla Öhman and co-workers
undertook a geographical and topographical study of the
R eview
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