London - Six years ago, my son, James, then aged ten, developed Lyme disease. The bacterial infection is spread by ticks, but there was no obvious bite and no rash — the characteristic sign of the disease. He didn’t even feel particularly ill.
One night, he complained of swollen glands and said that his face “felt funny”, but I just sent him to bed with that old parental sop: “You’ll feel better after a good night’s sleep.”
However, come morning, something was clearly wrong. “My mouth’s gone weird, Mum,” he said. “I can’t smile.”
I took him straight to the doctor who, perplexed, diagnosed Bell’s palsy, which causes weakness or paralysis of the muscles in one side of the face. But she had never seen it in someone so young.
She immediately referred us to a consultant paediatrician at the hospital. Upon discovering we lived on Exmoor, the doctor asked whether James had been bitten by a tick.
We shook our heads. We knew all about ticks: Exmoor has a high deer population and ticks are common — our dogs were always picking them up, and I’ve been bitten myself — but James had no memory of being bitten.
Even so, the consultant tested him for the “highly unlikely” chance that he had the disease. This involved a blood test to check levels of antibodies.
He was as surprised as we were when, two days later, the test came back positive — James did have Lyme disease.
Treatment was a course of very strong antibiotics and, over a fortnight, the Bell’s palsy slowly cleared up. To all intents and purpose, James was cured.
According to the NHS, in Britain around 3 000 people a year are diagnosed with Lyme disease, though the charity Lyme Disease Action believes the true figure may be as high as 15 000. And the disease is on the rise.
Writing in the British Medical Journal last year, Roger Evans, of the Scottish Lyme disease testing laboratory, said that the number of positive tests is increasing year on year.
However, he believes only 20 percent of cases are referred for testing, meaning incidence may be “seriously under-reported”.
Many people are diagnosed at the rash stage — and many others are not diagnosed at all, says Stella Huyshe-Shires, chair of Lyme Disease Action.
In some cases, this may be because people don’t realise they’ve had a tick bite. Others may think their early symptoms are just an infection and, in other cases (where there is no rash present), the condition can be misdiagnosed by doctors.
Ticks are blood-sucking parasites, and around one in four carry the bacteria Borrelia, which causes Lyme disease. However, they are “tiny”, warns Stella Huyshe-Shires. “They are the size of a full stop on a page.
“And as they inject their host with an anaesthetic, the bite doesn’t cause irritation and so easily goes undetected.”
This can be a problem because the risk of infection increases the longer a tick is attached.
Ticks initially look like a pinhead-sized scab on the skin. If you look closely with a magnifying glass, you can see legs. As they feed, they get bigger and become more noticeable.
Symptoms generally appear between two and 30 days after a bite. Many people feel as if they have flu — with fatigue, headaches and muscle and joint pain.
A circular red “bull’s eye” rash is a clear signifier of the disease. However, the rash isn’t always this shape — and, like James, some people don’t get a rash at all, says Dr Matthew Dryden, a consultant in microbiology and infection at the Royal Hampshire County Hospital and a leading expert on the condition.
A stiff neck and disturbances in sight, hearing, co-ordination, digestion and sleep can also occur. It’s a broad range of symptoms and, without the telltale rash, it’s easy to see how so many cases go undiagnosed.
Around eight percent of patients will develop a facial palsy, like James did, although Dr Dryden says this is most common in children — “maybe because they get bitten on the head or scalp after rolling around in grass”.
Lyme disease is carried by ticks on mice, birds, voles, foxes, badgers and hedgehogs, as well as deer and sheep. It has historically been most prevalent in rural areas such as the Scottish Highlands, the New Forest, South Downs, the Lake District and Exmoor.
However, what many people, including some GPs, don’t realise is that it’s perfectly possible to catch it in a city park or even your own back garden.
“Ticks are found wherever there is longish grass, scrub or woodland and a wildlife population on which to feed,” says Stella Huyshe-Shires. “A suburban garden and the wilder fringes of urban parks both satisfy these requirements.”
It was summer when James caught the disease - the tick population peaks between April and October, and he had been spending a lot of time outdoors, playing cricket, lying on the grass and walking through the woods.
But why is Lyme disease on the increase? Is it simply because we’re becoming more aware of it?
Experts believe this is only part of the answer. The rise in outdoor leisure activities over the past two decades, as well as changes in agricultural practice - such as less sheep dipping, less deer control and an increase in bracken - may play a part.
“Warmer winters may also allow more ticks to survive, or Lyme disease may simply be spreading through the wildlife population,” adds Stella Huyshe-Shires.
The disease is not generally dangerous, as long as it’s treated early — ideally within eight weeks of being bitten.
Some people do fight it off and make a full recovery without treatment. Some even test positive for Lyme, but don’t have any symptoms. However, some go on to develop post-infectious Lyme disease, with symptoms similar to those of fibromyalgia or chronic fatigue syndrome.
If not treated promptly, it can also spread to affect the whole body, including the eyes, joints, heart and brain. According to Lyme Disease Action, it can even be life-threatening.
“Heart block, where the electrical pulses that control heart rate are disrupted, caused by the bacteria affecting the nerves, can be fatal if not diagnosed quickly,” says Stella Huyshe-Shires.
“There was also a case of suicide in the UK not long ago: a patient had a psychotic episode due to the disease affecting the brain.”
Dr Dryden is less convinced, but says there are “a handful of proven cases of Borrelia infection and damage to foetuses from the mother being infected”.
He adds that an unlucky few develop chronic symptoms despite being treated, whereas many others develop symptoms such as fatigue, muscle ache and headaches after a tick bite, yet all their tests are negative.
Tips
* Cover arms and legs when walking in areas of long grass and bracken, and try to stick to paths.
* Check for ticks regularly during the day and when you wash or shower after being outdoors. Check around children’s hairline.
* Remove ticks as soon as possible using a tick removal tool, a plastic device that hooks underneath the tick without squashing it - this would spread its body fluids. You can buy the tool from vets, pet shops or the charity Lyme Disease Action (lymediseaseaction.org.uk).
* Otherwise, wind a loop of cotton thread around the tick, close to your skin, and pull upwards before disinfecting with antiseptic cream. Avoid using tweezers: you risk squashing the tick and propelling its body fluid into you.
* Also avoid removing a tick with your fingers or burning or covering it with creams or chemicals.
* Check pets for ticks. They are commonly found around the head on dogs, but can be anywhere on cats. Brushing animals before they come inside can help dislodge ticks before they attach.
* Seek medical advice if symptoms appear.
Daily Mail