Thursday, 12 July 2012

Ticked off.

I've removed two ticks in the last couple of weeks. It's all part of the rich tapestry that GP provides. Having a conversation with a man whose bowel cancer is getting the better of him one moment, and just minutes later trying to rationalise the polypharmacy of a reluctantly ageing 92 year old, and then the 5 year old whose mother noticed a tick at the nape of her neck when brushing her hair for school this morning.

My patient's neck
The blood sucker proved very resistant to loose it's grip. However my wife (a practice nurse at the surgery) had a particularly effective pair of tweezers with an integral torch available and the beasty had to admit defeat. Here he (?she) is before the extraction.

Having removed it, I placed the tick on a white piece of paper for the little lass to see, and the tick promptly ran off! Only however to be flattened and consigned to the bin.

The big concern with ticks is the possibility of Lyme disease as a result of the transmission of the bacteria from an infected tick. According to the Health Protection Agency there were 972 cases of Lyme Borreliosis in England and Wales last year. It's an interesting infection which has three stages.

Erythema migrans-from wikipedia-
not my patient.
In stage one there is localised infection at the site of the bite. With an incubation period of from 3-32 days, a spreading red rash called erythema migrans gradually develops. Stage two follows with  variety of neurological and more vague symptoms of myalgia and fatigue. Stage three represents a persistent stage with joint symptoms predominating (in 60% of untreated cases in the US), and less commonly neurological problems.


Fortunately it is relatively easily treated with antibiotics if the treatment begins early enough. Although one textbook states,
If an attached engorged nymph is found a single 200mg dose of Doxycyline effectively prevents the disease. This measure is not routinely recommended.

I found this a little confusing. Since a very simple measure could effectively prevent an illness that can be very debilitating, why not 'routinely' give it?  So I contacted the HPA to ask the likelihood of the Lyme bacteria in being present in the ticks in the north Bucks area where I practice. I wasn't particularly helped by the reply I received.

'Lyme is found all over the UK and cannot be excluded on the basis of geography.  There are a few hot spots where it is particularly common such as Exmoor and the New Forest; as far as we are aware Bucks is not one of these.

However, there are reports of Lyme from every UK region'

So I've just decided to wait. If a spreading rash appears in the next month or so, I'll jump straight in with the antibiotics.

A typical conundrum for a GP in the midst of a busy day.
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