BITES & TICKS
is a female who is about the size of a sesame seed (3mm) and is the same oval and fl at shape. After she has fed, she swells up to many times her original size (approx. 11mm). Male ticks are a bit smaller and are about 2.5 mm. Nymph ticks are even smaller pinhead or poppy seed size (1.5mm). Newly hatched ticks (larvae) are the smallest and can be smaller than a poppy seed (approx. 0.5mm) and in fact to the naked eye the larvae look like specks of soot.
There are 3 stages of the life-cycle: larva, nymph, and adult.
Q. What is the likelihood of developing lyme borreliosis (disease) from a tick bite?
A. Field studies of Scottish ticks have shown that 10% of ticks are infected with the borrelia bacteria. The distribution of infected ticks varies greatly between areas in Scotland and within geographically discreet areas. There are seasonal peaks of infected ticks in Spring and Autumn.
Q. What about the rash?
Q. What is the most important information to tell customers?
A. Look out for the rash for at least 7 days; take photographs on a phone before it disappears. Make an appointment with your GP or Out of Hours service if you think you have developed a rash after a tick bite.
Q. What will the GP do?
A. Erythema migrans is a clinical diagnosis and the British Association of Infection Guidelines advise against blood tests at this stage. The blood tests are unhelpful in diagnosing primary lyme borreliosis but may be helpful in diagnosing secondary lyme borreliosis. The balance of likelihood of lyme borreliosis is agreed with the patient and Doxycycline 100mg bd for 2 weeks should be curative.
Q. Who is at risk of lyme borreliosis?
A. People working outdoors in the forestry, estates and outdoor tourist industries are at particular risk from prolonged exposure. People fi shing on river banks or sitting on the ground at picnic sites may be at risk. People gardening in country areas where roe deer and ground nesting birds and animals are more prevelant may be at risk from kneeling on the ground and getting a tick bite in the groin or perineum.
Q. What simple measures can prevent tick bites?
A.Developing a rash around an area of a tick bite confi rms a clinical diagnosis of erythema migrans. The rash is often described as a ‘target bullseye’ with a 10p area of redness and a wider ring. However the two areas may have coalesced to make a large red patch. The rash may fade quickly and leave an indistinct water mark or mottled pattern or it may become established over the whole leg for several weeks. The ticks are attracted to behind the knees, groins and armpits. The public should be encouraged to inspect other people behind the knees after outdoor activity.
34 - SCOTTISH PHARMACIST
A. Stick to paths and avoid undergrowth, wear long trousers and tuck in socks. Be extra vigilant when wearing shorts or skirts! Inspect children after picnics and outdoor activity in country areas. City parks are normally regarded as low risk.
Q. Is this a new problem?
A. We think Lyme disease has been around for hundreds of years but there has been a defi nite increase over the past 5-10 years. There are many theories on why this might be so but no reliable method of predicting ‘Lyme disease hot spots’ as it seems to vary from year to year between locations and within locations.
Q. What about other diseases spread by ticks?
A. In Northern Europe tick borne encephalitis is a serious virus spread by ticks but it is not a problem in Scotland.
Q. Is it risky going into the countryside now?
A. There are far more health benefi ts from all of us going into and enjoying the countryside than any slight risk of tick bites. If we deal with the ticks confi dently and knowledgeably Lyme Disease will be a ‘non-problem’!
Q. Where can I get more information?
A.
http://www.nhs.uk/Conditions/ Lyme-disease/Pages/
Symptoms.aspx
http://www.lymediseaseaction.org.uk/ Lyme Borreliosis (LB)
Lyme Borreliosis (LB) is arguably the most common vector-borne human disease in the UK. Scotland has a particularly high incidence. Over the last ten years the number of cases reported in Scotland has increased more than ten-fold. The reasons for increasing incidence are not known, but may include ecological changes affecting the number of ticks or the proportion of ticks infected, and increasing recreational use of the countryside. Globally, the disease can be found in at least 80 countries, making it an issue of worldwide signifi cance.
If it is not diagnosed and treated promptly, LB can lead to serious chronic, debilitating disease. Borrelia burgdorferi, the causative organism of LB, is carried by ticks which become infected when they feed on species such as rodents and birds. People are
Code
Preferred Read Code 2015 onwards
#1JN1.00 Suspected Lyme disease (the patient or doctor may still use this term)
AA41.00 Erythema Chronicum Migrans 43T.
Lyme Borreliosis Test A871011 Lyme Borreliosis
A871100 Lyme Neuroborreliosis A871200 Lyme Carditis N010A11 Lyme Arthritis
A871300 Borrelial Lymphocytoma
at highest risk of contracting LB in woodland as well as grassland and moorland areas. Therefore outdoor workers, tourists and outdoor enthusiasts are particularly vulnerable.
Health organisations are tasked with reducing the incidence of Lyme disease and have limited effective tools at their disposal. Resident and visiting populations need an approach that will help them prevent getting Lyme disease and manage exposure to ticks better.
Organisations and companies that employ people exposed to infected ticks also need a better tool for preventing the disease from a health and safety and economic point of view. Hence, this project is designed to provide better tools to help individuals and organisations reduce the risk of LB.
Read Coding for Lyme Diease/ Lyme Borreliosis
The classifi cation of ‘Lyme Disease’ was reviewed by the British Infection Association in 2011 to refl ect new knowledge and clinical management in the UK. There is a scientifi c and clinical consensus to move away from ‘Lyme Disease’ to ‘Lyme Borelliosis’ to refl ect clinical management including positive serology with no history of disease and the persistence of symptoms after antibiotic treatment.
Rational:1 - There is a need to refl ect clinical uncertainty in coding.
2 - There is a need to improve coding to map prevalence of primary and secondary Lyme Borelliosis in the UK in the absence of routine blood testing for primary Lyme Borelliosis (Erythema Migrans).
‘Retired’ Read Codes still available
Lyme disease test Lyme disease
Arthritis in Lyme disease
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