The Underrated Nuisance – by Ulrich Biele

As days become longer and temperature bearable, many of us feel the call of the open nature. After a long, cold winter finally a breath of fresh air!

It is too early for skeeter repellents so jump headlong into the pleasure! The garden yearns for a caring hand, too, so grab your scissors and rake, make the lawn mower ready and fresh to work!

As it is still chilly, firm shoes should give good protection against wet feet and cold and other harms. Sun happens to peek through anyway!

If it weren’t for a tiny little critter which has passed the winter in the foliage close to the ground and which just waits to jump at the next warm blooded creature to pass by and which is on nobody’s RADAR this early in the year: The tick.

These lil critters hide close to the ground and pass winter fairly well in our latitudes, and should winter not be excessively cold or long, now it is wake up time – and high time for a meal. How exactly they identify and find their victims is still subject to research, but body odor is an essential part of it. Unfortunately, most skeeter repellents do not work to a degree we would appreciate.

“Why should I care, I have been vaccinated!” – Good idea, if you happen to live in a region where tick-borne encephalitis (TBE) is prevailing or you intend to spend your vacations in such an area.

This is a serious disease which turns some people to a life term nursing case without chances for recovery.

Unfortunately, these viruses aren’t the only souvenir ticks leave behind when they visit you.

One which has much less public attention, but does no less harm, is Borrelia burgdorferi, bacteria which only 1975 have been identified as the cause of Lyme-Borreliosis. Lyme is a rural hamlet in the USA, where a physician found peculiar symptoms on patients who had but one thing in common: a tick bite.

It took long and intensive research to find the clue to the origin of this disease, as Borrelia are masters of deceit and deception.

The range of symptoms can vary from aching joints, fever, rheumatic ailments up to disturbed vision depression and psychoses. Not to forget neural damages, paralyses, numbness.

It does not exactly ease the patients’ ordeal that Borrelia are hard to diagnose by serological means either from blood or liquor. Simple blood test almost never work.

As a rule, patients fill questionnaire and telling by these results, special examinations lead to a diagnosis “Lyme borreliosis” when all other sources can be excluded.

That means nothing less that it is a very long way to the diagnosis.

Many a patient will be treated by his symptoms for rheumatic diseases, arthritis, AIDS, MS or for psychosomatic illness, which takes a long time and leads to nowhere. This is caused by Borreliosis being a complex disease which has not been completely understood on one hand, on the other hand, it still has no prominent place in the awareness of both physicians and patients.

One of the main reasons for Lyme-Borreliosis to escape so successfully from diagnostics is the main symptom, Erythema migrans, which does not occur at all in more of fifty per cent of all cases and the fact, that a tick bite which has no apparent consequences tends to be forgotten when the first symptoms have subsided. In three of four cases that is what happens. Borrelia are patient, and our body knows how to keep uninvited invaders at bay.

In most cases, that is.

Borrelia can hide within cells, preferrably in less perfused organs, such as joints, where cartilage offers a comfortable rest and cover. They have to leave their hideout but every 29 days in order to proliferate, but they can sleep for years as well, as long as the body’s immune system is working. A severe stress or disease can overstress the immune system and give the assault order for a large scale outbreak. Then, Borreliosis changes from latency to acute status and the patient has no idea why he feels exhausted, everything hurts, and he just can’t move the way he could a few weeks ago.

At first, he resorts to excuses, makeshift medicine and house recipes, then he consults a physician, who is clueless at first and who then refers the patient to specialized diagnostics in order to clear special suspicions.

Nobody here thinks of tick bites years in the past.

There are no serious figures available, but the suspicion is that one out of four people in Central Europe bears Borrelia in a latent state.

You will surly find ticks in woodland, but by far not only there. Urban parks, gardens, flower boxes, even Christmas trees can host ticks. And they know to appreciate when they will be broughtfrom a bitter cold forest into a cozy warm home where they find food in ample surfeit: us and our pets.

You can find these critters everywhere.

You can vaccine dogs for Borreliosis, bit neither for cats nor for human beings, there is a sufficient protection available.

Anyway, ticks host more that Borrelia: there are friend on board who join the party, and to date there have been about sixty of them identified. Few of them are known to research, of most we barely know the names. One reason is that tropical infections are far more focused on like Ebola or Zika. An other reason is that these hangers-on are divided in a variety of regional subspecies and their numbers vary by tick and region.

One of these companions is Babesia microti, dog owners’ dreaded Dog Malaria Bug. This is not even a real bacterium but a protozoon, which has much more in common with the cells of our own body. That makes it much harder to identify – and to kill. Of others, we know barely nothing except that they exist.

Erythema migrans,a red, inflammed ring around the tick bite, which grows outside and fades in the center, is strongly connected to an infection with Babesia. As this symptom has been understood as the main symptom of Borreliosis, a lack of this erythema was used to exclude Lyme disease. This turned out to be wrong.

From the other co-infections, we even know less.

All in all, diagnosis of Lyme disease is a difficult terrain, where there are many misleadings and ramifications. So it should be an easy thing to get rid of the buggers.

Unfortunately, this way is also far and winding. During the phase of Erythema migrans mostly Tetracyclins come to application, which cost little and are well-tolerable, but of little to no efficiency. Here, far more sophisticated means are required, as these beasts hide deep inside your cells and, once nested there, are out of reach for most antibiotics. Even many drugs which can penetrate the cell are helpless to the acid medium by which borrelia surround themselves.

The accompanying Babesia can at best be reached with anti-Malaria drugs, but „easy“ is no term applicable here as well.

We don’t know enough.

That is why it is time to study the life cycle of Borrelia burgdorferi and companions in an intensive mode, as here a lot of suffering and ailing exists, often unrecognized and, even in best intentions, falsely treated, tortures man and animal alike.

What can I do as a patient?

Important: pay attention to each and every tick bite. Remove ticks as fast and complete as possible, preserve the tick and turn it in for examination. Every pharmacist will sell you the sets.

Consult a physician in every case when there is an inflammation around the tick bite. It will itch for days anyway, but a palm-sized red ring which expands and then fades insides should cause all alarm bells to ring.

Important: remember tick bites in the past, even if they seem to have healed completely, when unclear ailing make you visit the doctor. He can’t guess what happened long ago and every minute, otherwise neglected detail can give essential help to find a correct diagnosis.

Important: reckon with ticks, even where you won’t think first of them. A clean and golf course trimmed lawn as well as a shrub in the woods or the Christmas tree from organic and sustainable culture can bear ticks.

Anywhere where wild birds, mice, dogs and cats find contact to the open there will be ticks. These beasts can hide for months in cover without food, waiting for some unwary, deliciously smelling warm blooded victim passes by. As they do neither snub stinking feet nor violet-perfumed, cleanly scrubbed peach skin, the degree of personal cleanliness is no criterion for assault or not. Some people are more prone to be assaulted than others, for no clear reason.

What can I do as a physician?

Whenever patients mention unclear symptoms, think of seemingly unimportant things such as tick bites in the past. More often than not the deductive mind of a detective is required to analyze the cause and find the clue towards a qualified diagnosis. That costs time and power, but when you can help the patient and save him from long term suffering up to complete invalidity and total loss of life quality, it was worth the effort.

Ulrich Biele

any requests to the author will be forwarded.

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