• 1: Laboratory.
• 2: Labor Immunabwehr.
• 3: Tick-Testing.
• 4: Laboratory transmittals.
• 5: Therapies.
• 6: Lyme Compact Treatment.
• 7: Accompanying therapies.
• 8: Dietary supplement.
• 9: Self help.
• 10: Prevention/vaccination .
• 11: Risk groups.

Tick Testing - to be absolutely sure!!!

- not only for us, but also for dogs!

3 days after the tick arrived in our laboratory you will receive a written report with the results of the tick testing and the invoice.

Note:  

• We only offer the combined analysis (4 tests).  A testing for Lyme disease only is not enough anymore according to our experience.  The risks of co-infections has increased extremely and this is important to decide on a prophylasis (medical prevention) in case of a positive result of the test.
• Unfortunately, health insurance companies do not cover the costs for this test.
• Ticks can be very small, but already infected.  A tick develops from an egg to a larva and then to a nymph (young tick).  The nymph is a hermaphrodite (male and female), which can either develop to a female or male adult tick.  Even small ticks can transmit bacteria.
• if the tick is tested positive for Borrelia and/or other co-infections, you can get advice from the Borreliose Centrum Augsburg.

Download the laboratory order form for tick testing here, including a short information leaflet.

Download a .pdf-file with pictures and explanations of tick bites here (in German).

Why the tick should be tested?

It is commonly known that ticks can transmit dangerous infectious diseases.  Usually, only TBE (Tick-borne-Encephalitis) is mentioned here; there is an effective vaccine for TBE and there are only about 300 infections per year in Germany.

The risks of Lyme disease and other co-infections that can also result from a tick bite are largely underestimated; there is no effective vaccine against these infections and in case of a tick bite it is recommended to start preventive measures (prophylaxis) very early.  This is usually done by a doctor who prescribes special antibiotics.

Germany, Switzerland and Austria, as well as many other European countries have regions that bear great risks of Borrelia-infected tick!  Between 10% to regionally over 50% of all nymphs and female adult ticks are infected with Borrelia.  Research studies have shown that ticks also transmit other pathogens besides Borrelia.

According to a research project done by the Health Department of Baden-Württemberg, Germany, the infection transmission rate of ticks, which contain Borrelia, is ca. 25%.  Therefore, it is recommended that a tick should first be tested for Borrelia when removed from the body.

New research studies have shown that the risk of co-infections increase dramatically.  A recent study (January 2009) of ticks in Brandenburg (county in the North-East of Germany) has shown that Rickettsia bacteria are not rare in ticks.  The Ixodes ricinus tick showed 13% Borrelia and 10% Rickettsia helvetica infections.  In case of the Dermacentor reticulates tick it was found that only 6% were infected by Borrelia, but 50% with Rickettsia.

Borrelia and possible transmission

It is important to recognise Borrelia infections early.  The earlier the disease is diagnosed, the better are the treatment measures (usually only antibiotics) and the shorter is the "suffering" for patients.

The main risk comes from the Ixodes tick (can transmit Borrlia bacteria during the bite), which can be found all over Europe.  However, other tick species, such as the Dermacentro tick, can also transmit diseases.

Patient support estimate that ca. 500,000 to 600,000 people are suffering from chronic Lyme disease in Germany.  Yearly another 50,000 to 60,000 new infections are added.

The cause of this infection are bacteria called Borrelia, which are transmitted to the blood during a tick bite.  If Lyme disease is not diagnosed early, the infection can cause chronic joint pain, or even damage the myocardal muscle.  There is no effective vaccine yet.  Therefore, it is very important to diagnose the illness as early as possible.

Nearly every third bite by an infected tick transmitts Borrelia bacteria!  At the same time other pathogens can be transmitted as well (e.g. Rickettsia, Babesia and Ehrlichia).

• The most important pathogens of Lyme disease are Borrelia burgdorferi, Borrelia garinii and Borrelia afzelii (3 Borrelia strains / spirochete bacteria) which are related to the syphilis pathogen Treponema pallidum.
• After the infection the pathogen spreads in almost all organs, including the synovial membrane.
• The illness can be described as a "chameleon" and makes high demands on diagnosis and therapy.

During the generalisation phase the body's immune system fights the pathogen.  Antibodies are build and the cellular immune response (white blood cells) reduce the amount of Borrelia.  The Borrelia usually only survive in places in the body where the immune system cannot fight them well, e.g. in the connective tissue.  In these places, they are also hard to reach by antibiotics.  This is where Borrelia bacteria survive in small numbers and are the cause for the reoccuring of symptoms in irregular intervals.  This can appear months to years after the begin of the infection.

If Borrelia are found in a tick a antibiotic prophylaxis can be carried out according to the Bulletin 2 of the State Health Department of Baden-Württembrg "Antibiotic Prophylaxis after a Tick Bite - yes or no?".  This should be carried out at the latest 10 days after the tick bite occured.  The Bulletin recommends the following antibiotic products:

Adults	Doxycycline Azithromycine Amoxicillin	2 to 3x 100 mg daily for 10 days 2x 250 to 500 mg daily for 3 days 3x 750 to 1.000 mg daily for 10 days
Children	Amoxicillin Azithromycine	3x 250 to 750 mg daily according to body weight for 10 days Dosage according to body weight for 3 days
Pregnant Women	Amoxicillin

Note:  if co-infections have been found as well, please contact your family doctor / general practitioner to ask which antibiotics should be taken as prophylaxis.

Advice from the Bulletin 2 "Antibiotic Prophylaxis after Tick Bites - yes or no?" of the State Health Department of Baden-Württemberg:

• In some cases the PCR analysis can be falsely incorrect.  If you still experience clinical symptoms even though the tick was tested negative for Borrelia, you are advised to consult a doctor.
• If you have symptoms of a Lyme disease infection even though you are taking prophylactic measures (e.g. Erythema migrans rash min. 5 days after the bite or flu-like symptoms), the prophylaxis should be extended to 20 days.
• It is recommended to do a serological test (blood testing) and clinical test 3 months after the prophylaxis.  If the patient is symptom-free and seronegative after 3 months no further measures have to be undertaken.  If the patient is seropositive, it should be decided wether further therapy is necessary depending on the clinical results.

Rickettsia

Rickettsia bacteria can be found in ticks, as well as flea, mites and lice, which all act as possible transmitters.  Rickettsia have been found to be widely distributed, e.g. in ticks in Germany and Switzerland.  These bacteria can cause various illnesses with different disease patterns in humans (Rickettsiosis), including spotted fever, Rickettsialpox, Brill-Zinsser disease, Mediterranean spotted fever and Rocky-Mountain spotted fever.

The clinical disease pattern includes fever, headaches, drowsiness, macular exanthema (little red spots).

The majority of all Rickettsia can be effectively destroyed with antibiotics of the Tetracycline-group.  

Babesia

Babesia are tick-borne bacteria that can cause Babesiosis in humans and animals.  The pathogens attack the red blood cells.  Due to the bursting of the erythrocytes the following typical symptoms can occur:  fever, anaemia and jaundice.  Another very frequent symptom is coffee-coloured (brown) to red-coloured urine.

The disease is known as dog malaria in dogs.  In humans it is only rarely diagnosed due to unremarkable disease patterns.  In case of patients with immune deficiencies the disease can have severe disease patterns.

Ehrlichia

Around 3,000 new infections are counted yearly in Germany.  Most of diagnosed diseases are harmless, only few are severe.  The number of chronic diseases are unknown so far.  

Ehrlichioses are newly detected infectious diseases.  They were first grouped with Rickettsioses but are now a named disease by themselves.  Ehrlichia bacteria can be transmitted to humans by ticks.  The symptoms are fever with flu-like appearances and headache.  In case of severe disease patters myalgia, liver and kidney disorders and meningitis can also occur.

Ehrlichioses can be treated with antibiotics.

 

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In case of a positive results, i.e. the tick was tested positive for Borrelia or one or more of the 3 co-infections, please contact your family doctor / GP who will know that

1. the risk of a transmission to humans (or dogs) is evidend and
2. what immediate measures should be taken.

A member of staff of the Borreliose Centrum Augsburg will also give you advice in case of any questions.

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Tick Removal: remove the tick as quickly as possible!

The risk of transmission of the infection depends on the duration of the tick bite, e.g. the pathogens of Lyme disease are usually only transmitted after several hours.

Using a tweezer or a special tick gripper the tick should be gasped a close a possible to the skin and carefully pulled away from the skin.  Any should be avoided as this might cause the tick to loose the head, which will then be stuck in the skin.  Usually nothing will happen if parts of the head will stay in the skin.

Important:  Do not cause any "stress" for the tick, i.e. removing the tick abruptly, squeezing it or using oil.  If the tick is under "stress" it usually empties out the contents of the intestines, which contain the pathogens.

Desinfect the area of the tick bite after removing the tick to avoid inflammations.  If parts of the tick are in the wound, inflammations or reactions can occur.  Please have the particles removed by a doctor.

How to minimise the risk of infection?

1. Try to avoid the habitat of ticks, i.e. areas known to have a high tick occurance - e.g. biotopes, high graslands, dense bush areas, etc.
2. Wear the right clothing:  protect your legs, pull the socks above your trousers.  Your body should be sealed to the heights of min. 60 cm to 150 cm.  
3. Insect sprays (e.g. "Zecken-Frey"):  ticks orientate themselves towards smell; therefore insect sprays might give protection for a while.  The spray should not only be applied to the skin but also to the clothes.
4. Body Scan:  After being outside, you should search/scan your body for ticks - particularly arm pits, hollow of the knees, throat and hairs on the head.  Children should be assisted by adults!  Ticks that are already attached to the skin should be removed immediately as explained before.  Caution:  Ticks can also be transmitted by pets or other animals.  Pets should also be searched for ticks accordingly.
5. Vaccination:  Only the vaccine for TBE (tick-borne encephalitis) is effective!

It is important to diagnose a Lyme disease infection early.  The earlier it is diagnosed, the easier is the treatment (antibiotics).

The following measures are recommended in the book „Krank nach Zeckenstich – Borreliose erkennen und wirksam behandeln“ by Dr. Petra Hopf-Seidel (ISBN 978-3-426-87392-2) after a tick-bite:

1. Determine whether the tick-bite was executed by a larvae, nymph or adult tick
2. If possible take a digital picture of the infected spot on the skin (for documentation purposes)
3. Careful removal of the tick (e.g. with a tick-loop)
4. Initiate a PCR-examination of the saturated tick to check for Borrelia. It should also be checked whether the tick had co-infections with the TBE-virus and/or Ehrlichia/Anaplasma.  The result of the examination should be available after three days.
5. In case of a positive PCR-result a physician should be consulted. In these cases Dr. Hopf-Seidel recommends the immediate treatment of antibiotics.
6. The patient should keep a diary to document possible physical changes as well as ailments and other symptoms.
7. The attending physician should initiate a Borrelia-LTT with blood samples 10 days after the tick-bite. If the LTT result is positive, the tick bite should be treated with antibiotics for at least 30 days.
8. At the same time it should be checked whether there is an activation of cytocine in the blood (TNF-alpha, INF gamma, IL 10) to detect a beginning defense reaction of the organism.
9. To be completely sure an additional serological test should be initiated 4-6 weeks after the tick-bite (antibodies titer and immunoblot).
10. Dr. Hopf-Seidel recommends a cerebrospinal fluid puncture in case of neurologic or psychological-cognitive disorders, as well as in case of disorders in the central nervous system even an MRI with contrast agent of skull, cervical spine and thorathic spine to detect inflammed Borrelia herds and irritations of the meninges early enough.

This is how you can recognise Lyme disease - according to the symptoms and ailments of the 3 stages in which the disease usually occurs (time measured after tick bite):

In contrast to an organic disease, the symptoms of Lyme disese occor in intervals with changing intensity and locality.  Many patients also have fever during these intervals.  Co-infections with other bacteria and viruses have increased in the past years and often cause complet disease patterns.  Often a tick bite is not recognised early enough or the doctor does not treat it sufficiently.  Due to this Lyme disease can become chronic and patients then experience a real "nightmare" due to the physical and mental ailments.  There are three main reasons why a Lyme disease infection is not recognised in the beginning and therefore an early treatment does not occur:

1. There is no "bull's eye rash" (Erythema chronicum migrans)!  Research studies have shown that only about 40% - 70% of patients show such a rash.
2. No tick bite was remembered or diagnosed.  Bites can also occur from very small ticks (larva or nymphs).  Sometimes the bites are also overseen because it did not cause any symptoms.  The scientific literature also explains that in some cases the illness can be transmitted by insects as well.
3. Only basic blood tests have been done.  These tests were either done too early (only ca. 6 weeks after the bite the antibodies test is positive), there was no antibody production in the body, or it was not tested on the cellular level (necessary are the Elispot®-LTT + CD3-/CD57+Cells tests)

However, co-infections should also be tested for, as they can cause severe and very complex disease patterns!

Therefore:  Have the tick tested in the first stay!  In case of negative results you should not have to worry.  In case of positive results you should consult a doctor immediately!

You can download the laboratory order for for tick testing (incl. a short info leaflet) here.