Tick Centre

Significantly more people also visited a doctor due to tick bites or Lyme disease. By the end of June, around 21,300 visits to a doctor had been made for tick bites and 6,900 for acute cases of Lyme disease. After diagnosis, Lyme disease can be treated effectively with antibiotics. In cases of acute infection, the antibodies cannot be detected until 2-3 weeks after contact. There is no need to examine the tick. A serum tube is required for the analysis. CSF is examined only in clinically inconclusive and severe cases.

Figure above: TPE vaccination recommendation issued by the FOPH in 2020

Laboratory tests

TBE (tick-borne encephalitis)

• Successful vaccination, contact made: evidence of IgG antibodies
• Acute infection: evidence of IgM antibodies
• PCR = direct evidence of pathogen

Lyme disease

• Screening test (EIA)
• Further specific antigens in the IgG/IgM western blot test
• PCR

Suspected neuroborreliosis (CSF and serum required)

Typical pattern in basic diagnosis-specific Borrelia IgG and IgM antibodies
Other: Rickettsia, Babesia, tularaemia

Sensitisation
If you are bitten by a tick, alpha-gal is transferred from the tick’s saliva into your blood. As a result, the immune system forms antibodies against alpha-gal to neutralise it, including IgE antibodies. Sensitisation to alpha-gal can trigger an allergic reaction when a patient eats meat.

Alpha-gal is found in:

• The meat of mammals such as beef, pork, lamb and game, and offal such as kidney; the larger and fattier the piece of meat being consumed, the more likely it is for an allergic reaction to occur.
• Gelatine from mammals (for example in desserts, jelly sweets and medical infusions)

Clinical manifestation
Reactions generally occur 3-6 hours after consuming meat:

• Urticaria
• Gastrointestinal complaints (stomach ache, diarrhoea)
• Anaphylaxis

Laboratory tests

1. ImmunoCap Pork (f26), Beef (f27) and Mutton (f88)
   if positive
2. ImmunoCap alpha-gal (o215)

Diagnosis is confirmed by IgE against the meat of different mammals.
IgE against alpha-gal is higher than IgE against the meat of mammals.

Clinical manifestation

linical pictures 3 to 5 (21) days after infection can differ. Initial flu-like symptoms with fever are followed by ulcerative inflammation at the point of entry with swelling of regional lymph nodes, pneumonia, colitis and sepsis. A special form of the disease manifests as conjunctivitis with preauricular lymph node swelling. The outcome can be fatal in 5-15% of cases if left untreated. Early intervention with antibiotics such as ciprofloxacin or doxycycline, in combination with aminoglycosides (gentamicin, streptomycin, etc.) if required, reduces mortality to virtually zero.

Transmission

Highly contagious zoonotic diseases. They are transmitted through tick and insect bites, drinking contaminated water, eating insufficiently cooked meat of contaminated wild animals and inhaling contaminated water or hay dust. These diseases cannot be transmitted from one human to another.

Diagnosing Francisella tularensis

Serum antibody test: immunoassay for IgG and IgM
Detection of pathogens in the blood, lymph nodes, pus, ulcer swab, tick: culture, PCR