Lyme borreliosis is currently the most common tick-borne infectious disease in Europe, including in Hungary. In recent years, increasing attention has been paid to the difficulties in diagnosing the infection, the issue of chronic or prolonged symptoms, and the role of co-infections; however, prevention remains one of the most important tools in reducing the spread of the infection. Prevention is of particular importance because early detection of Lyme disease is not always straightforward; tick bites often go unnoticed, and the initial symptoms are frequently non-specific.
Lyme disease is caused by bacteria belonging to the Borrelia burgdorferi sensu lato group, which in Europe are primarily transmitted by the Ixodes ricinus tick. The risk of infection is highest from spring to late autumn, but in milder winters, tick activity can persist practically all year round. There are still many misconceptions regarding the habitats of ticks: many people believe that they are found exclusively in dense forests or untouched natural areas, whereas they can also be present in large numbers in urban parks, gardens, dog parks, picnic areas and vegetation along waterways. The risk of infection therefore applies not only to hikers or foresters, but to virtually anyone who regularly spends time in vegetated areas or comes into contact with animals.
The basis of prevention is minimising contact with ticks. Although this is not entirely feasible, the risk of infection can be significantly reduced through conscious behaviour. The role of appropriate clothing is far more important than most patients realise. Long-sleeved tops, long trousers, closed shoes and light-coloured clothing can help prevent ticks from easily reaching the skin and make them easier to spot. Tucking trouser legs into socks may seem uncomfortable or an excessive precaution, yet it can provide effective physical protection in wooded or long-grassed environments.
The use of repellents (tick repellents) is also an important preventive measure. Products containing DEET, icaridin or permethrin can reduce the likelihood of ticks attaching themselves, particularly in high-risk areas. Permethrin can be particularly useful when applied to clothing, as it not only keeps ticks away but can also kill them. There are now items of clothing and outdoor accessories available that are impregnated with wash-resistant repellents. However, it is important to emphasise that repellents do not provide complete protection and are therefore not sufficient on their own.
One of the most important aspects of preventing Lyme disease is a thorough body check after outdoor activities. Clinical experience shows that a significant proportion of patients do not recall being bitten by a tick, which often gives a false sense of security. There is a biological explanation for this: tick saliva contains complex substances that have anti-inflammatory, anticoagulant and local anaesthetic effects. These substances allow the tick to feed on the host for a longer period without being noticed. For this reason, the bite is often completely painless and does not cause itching or immediate skin symptoms. Many patients only notice the tick days later – or fail to find it at all.
This phenomenon is particularly important in patient education, as a common misconception regarding Lyme disease persists to this day: “I would certainly have noticed the tick”. In reality, a significant proportion of infections develop following bites that remain hidden. According to various studies, between 25 and 45 per cent of Lyme disease patients recall a tick bite. Ticks tend to settle in areas that are difficult for the patient to see or check: in skin folds, on the scalp, behind the ears, in the armpits, around the navel, in the groin or behind the knees. In children, the scalp is particularly commonly affected. Checking the body therefore does not mean a routine quick check, but a conscious, thorough self-examination. If possible, a warm bath or shower immediately upon returning home can reduce the likelihood of a bite.
The method of tick removal is also an important issue. According to current recommendations, the tick should be removed as soon as possible using fine-tipped tweezers or a special tick removal tool. Methods such as the use of oil, alcohol, greasy cream or other substances should be avoided, as these can irritate the tick and, in theory, increase the risk of the infectious agent being released back into the bloodstream. Infection can also be facilitated if the tick is not grasped correctly; squeezing the abdomen injects the infected intestinal contents directly into the bloodstream or under the skin. You should always grasp the tick close to the skin, at the head and neck region; if necessary, it is better to remove it with a needle at the cost of a small ‘blood sacrifice’ than to grasp it with unsuitable tweezers and slip onto the abdomen. After removal, it is advisable to monitor the bite site; however, it is important to emphasise that only a third of Lyme disease cases are accompanied by the development of classic erythema migrans. The absence of skin symptoms therefore does not rule out infection. It may be worth disinfecting the bite site, as in many cases the tick has not yet reached the capillaries but may have deposited its infectious saliva or intestinal contents on the skin’s surface or into the upper layers of the skin. If a skin lesion develops at the bite site, it is worth marking it and taking a photograph: one of the characteristic, pathognomonic symptoms of Lyme disease is spreading redness.
Another issue dividing experts is how long after the bite one should remain at risk of infection. Everyone agrees that the likelihood of infection clearly increases as the duration of the bite increases. According to the leading expert, Willy Burgdorfer, there is no ‘safe window’ for Borrelia burgdorferi infection, because before the bite, the tick prepares the site with its saliva, so that at the moment of the bite, the ‘open wound’ is already on infected skin. Some researchers suggest a timeframe of more than one day. Whilst the facts support the first statement, and every bite must be taken seriously, we know that the tick feeds on blood, and accordingly reaches the capillaries within 4–6 hours. From this point onwards, the risk of infection increases significantly, as the chemical arsenal that delays the immune response to the tick’s proteins also inhibits the immune response to the bacteria it carries.
Pets also deserve special attention when it comes to prevention. Dogs and cats can easily bring ticks into the home environment, so regular checks on animals and appropriate tick protection can indirectly reduce the risk of human infection. Garden maintenance also plays an important role: regularly mowing the grass, thinning out dense undergrowth and reducing damp, shady areas can make the environment less favourable for ticks. It is worth preventing small and large mammals from passing through the garden; hedgehogs, for example, turn gardens into tick breeding grounds unnoticed at night.
Preventing Lyme disease is not solely an individual responsibility. Doctors play a crucial role in ensuring the public has a realistic understanding of the risks associated with ticks. Appropriate education can help reduce the number of cases detected too late, as well as dispel misconceptions about the infection. It is important to emphasise that prevention is not about causing panic, but about raising awareness. Ticks are a natural part of the ecosystem, so the aim is not to avoid nature, but to develop appropriate protection and vigilance.
Sources:
(C) Lyme Borreliosis Foundation
