Prevention of Tick spread diseases

"An ounce of prevention is worth a pound of cure"

Benjamin Franklin

Prevention implies awarness

Solutions, imply problems, and problems imply causes. When causes of a problem are identified, an attempt at preventing these causes only seems commonsense. Causes can be prevented with the adequate attitude and habits. In certain cases, methods of prevention are unrealistic and difficultly achievable. In others, the origin and cause of the problem is not identified, making prevention particularly challenging. However, in the case of tick borne diseases, the name says it all; the most prominent cause obviously comes from… ticks. Ticks are the direct intermediacies between the germs and our bodies. They serve as temporary hosts, before releasing the germs into our body through their saliva. The germs then enter and invade our organism, rapidly reproducing and multiplying trough phagocytosis.

"Intellectuals solve problems, geniuses prevent them"

Albert Einstein

Know your enemy

To better understand how to efficiently prevent tick born diseases, it is important to consider the carrier bringing the germs to our bodies. Ticks are living animals, classified as Arachnida (sort of animal that also include spiders) and are relatively small in size, making it hard to locate them. Ticks like any living organism are on a perpetual strive to survive. In fact, they have managed to do so, for 90 million years by adapting to their surroundings, and relying on hosts for nutrition. Nutrition is key for these animals’ complex life cycle. It is during the nutrition phase that we become the target of millions of germs and pathogens.

Detecting their pray

The tick, mostly living in wooded areas, senses the carbon dioxide emitted by animals or humans. In a phase called questing, the tick places itself at the end of a branch, stretching its front legs for passing hosts. The legs have hooks that allow it to attach to skin or fabric. Ones on the skin, the tick seeks for an appropriate place to settle. The front of the tick is mainly composed of its gigantic mouth, consisting of hooks and a hypostome. The hooks in her mouth, tear apart flesh to allow the hypostome to penetrate and reach the blood flow. Slowly penetrating the flesh, the glands of the tick contain a highly specialized saliva, displaying anticoagulation, antiplatelet, vasodilatory, anti-inflammatory, and immunomodulatory activities”. These chemicals avoid the rejection of the tick by our immune system and to maintain the continuous blood flow to the tick. A tick relies on blood meals to evolve from Larva to Nymph, from Nymph to Adult, and then for the female adults to lay their eggs. In total, the tick is able to absorb over 100 times its initial body weight in blood.

Preventive procedures for tick borne diseases are relatively simple, mostly involving habits to take when exposed to high risks of tick bites. These habits considerably reduce the risks of tick bites, and help drastically prevent disease complexations in case of infections.

Taking action 

When exposing yourself to densely tick populated areas like forests; chances of being bitten become quite substantial. Ticks tend to passively wait on the end of leaves or branches, for an adequate host to pass by. By extending its long front limbs as far as possible, the tick reaches for clothing or the surface of the skin. It is therefore vital to protect any exposed surface of your body with clothing and avoiding gaps where ticks could pass through, to reach the skin. The preferred environment for ticks, is one that is warm and slightly humid, like underneath your armpits or where legs or arms bend. These areas rarely being inspected; the tick bite may remain unnoticed for several days or weeks, dramatically increasing the chances of important infections or complications. Cover any body part that might be attainable from the exterior, because ticks can easily pass under shorts and reach further areas of the body.

Protecting the integrity of the exposed limbs on your body, is essential for tick bite prevention. Clothes to wear:

  • -          Long pants

  • -          Long sleeved shirts

  • -          Socks

  • -          Closed shoes

  • -          Jackets

What not to wear:

  • -          Shorts

  • -          Short sleeved T-shirts

  • -          Open shoes

 

 

It is simply a matter of ensuring most of your body is covered, to stop the tick from reaching your skin. Preferably, you can tuck your pants inside your socks, and tuck your shirt inside your pants, to fully isolate your body.

Figure 15 - appropriate protective clothing

Figure 16 - The condensation of ticks in wooded areas, Lyme stats 2018

Insect repellents

Along with clothing protection, insect repellents are quite efficient for the prevention of tick bites. Most traditional strong insect repellents are efficient to keep ticks at a distance. It is preferable however, to ask confirmation of a doctor about their efficiency against ticks, as some repellents might not be as efficient as others.

Tick repellents have recently been available, and proven substantial efficiency against ticks. Some designed for humans and some for animals. Those designed for Dogs or other animals, are sometimes stronger than those for humans, and can result in increased efficiency. However, these might not be fully suitable on the long run, due to their strong concentration potentially being harmful for the skin.

In addition, some pharmacies now propose insect repellents, in the form of small ultrasound emitting devices, of waves at a specific frequency that disturbs the senses of the ticks, and prevents them from attaching to the skin.

Removing the tick

Steps to follow:

 

  1. Take a pair of tweezers or a specially designed tool

  2. With the tweezers come as close as possible to the mouth of the tick

  3. Make sure to be right above the surface of the skin

  4. Slightly pinch the tweezers to hold the tick steadily

  5. Pull straight up with the tweezers

  6. Put away the tick and disinfect the area of the tick bite

  7. Regularly observe the bite for several weeks to ensure no erythematic migrant appears.

  8. Check up on general health, possible symptoms that might indicate an infection

 

To avoid at all costs:

 

  • Twisting when pulling up

  • Burning the tick

  • Any sort of harm to the tick before removal

  • Separating the mouth of the tick and the body

  • Scratching the bite

  • Forgetting to check up on the wound

Figure 17 - How to properly remove a tick, Mayo Clinic

The current problematic

The scientific community has only recently payed attention to Lyme and other tick borne diseases. Their properties, and functioning are still not fully understood, which drastically impacts the possibilities of efficient treatments. Chronic Lyme disease, is very problematic and has still not officially been recognized in many countries. This, even though scientists have been able to gather experimental evidence of its existence.

The number of patients attained by the different forms of tick born diseases, have been exponentially growing in the past decade. The dramatic lack of diagnosis methods available for patients is extremely problematic and condemns them to live with their pains.

The great problem with these diseases, is their ability to mime symptoms of many others. Their symptoms can range from simple fatigue, to intense pains in practically all sections of the body. Our vascular system stretching over the integrity of our body, can carry the blood transmitted pathogens all around the body, and infect several different areas.

Attention to possible symptoms 

The first and primary symptom to identify after a tick bite, might be the erythematic migrant on the skin. It is characterized by a red sphere appearing around the location of the tick bite. In most cases a red patch will form on the skin, and sometimes, a white circular clearing will surround the redness. Their size can vary, but most do not reach a diameter bigger than 7 cm. Sometimes a second ring will appear, but the general looks of the erythematic migrants, will be a circular red patch with some kind of clearing around it.

The secondary symptoms will most likely appear a few weeks after the bite, but some rare cases can take years, to fully impact the body. The main symptoms will include:

  • Fever state, followed by physical and mental fatigue,

  • Headaches that do not pass even with pain killers,

  • Loss of memory,

  • Difficulties to concentrate,

  • Depressions (due to the neurotoxins in the body)

  • Night sweats

  • Red eyes

  • Sore trough

  • Sensitivity to noise

  • Pain on the right side of the abdomen

  • Muscular and articular pain (inflated articulations)

  • Frequent bruises (due to vascular system fragility)

  • Sensation of cold in feet and hands

Figure 18 - Symptoms of tick borne diseases

Articular problems will frequently come in the form of swollen knees. The inflammation will sometimes come and go, but the infection will always remain. Other articulations could also be attained and remain chronically infected. Muscular tensions and pain are very frequent and caused by inflammations. These muscular pains, just like the articular problems can come and go over time, but the infection will persist.

Clinical diagnosis 

One of the best and most accurate methods to detect the presence of any infection in our organism, is through blood tests. All diagnosis require more than one test to accurately determine if one is infected or not; a method refered to as two-tier testing. The first test will be performed to evaluate if the patient has potentially been infected. It does not give any certitude, but in most cases when scored positive on this test, the chances of being infected are quite substantial. When such test has high sensitivity, it means this test is quite accurate. The second test serves as a confrimation for the results of the first tests. It aims at ensuring only patients from which we have the absolute certitude that they are infected, are positively diagnoses. High specificity means this test is highly accurate.

Most elaborated tests like the ones for HIV/AIDS are extremely sensitive and specific. This allows them to have a diagnosis of practically 100% accuracy. The problem with Lyme disease is that the most frequently used primary test recommended by the CDC (ELISA) is very inaccurate. In fact, their two-tiered test system, misses roughly 54% of patients suffering from infection. (Stricker Minerva 2010). One of the explanations for this, might be that Lyme disease can only be tested indirectly. An indirect test means that instead of trying to detect the presence of pathogens, it analyses and measures the patient’s antibody response to the infection. In most cases of Lyme disease, the patient does not develop any antibody response that is significant enough to be detected, before 3 to 4 weeks post bite. Furthermore, if a patient has been infected for a longer duration, the first test is very low in sensitivity, failing to diagnose many patients.

In addition to this difficulty to detect if one has been infected by a germ, the diagnosis should tell if these germs may still be harmful, and if they are alive or not. This turns out particularly complex considering some germs undergo temporary hibernation states, where antibodies are not being produced. If blood is withdrawn in an inactive phase of these germs, the blood test will not reflect the presence of antibodies, and the test will fail.

The difference between a dead germ and an inactive germ, is very hard to distinguish. Some argue the type of antibody group can help to determine the activity state of the germ. They argue the IgM’s should theoretically reflect a current/active infection, whereas the presence of IgG’s tends to reflect a past infection. IgM’s are specific isotypes of antibodies (the largest antibody), which frequently appear right after infection and generally indicate an active infection. IgG’s are the secondary responses of our immune system to an infection. Like the IgM’s, they are a specific isotype of antibody which is much more abundant in our blood, and serves as a preventive antibody. Unfortunately, patients can produce igG's and IgM's in alternance, contradicting the idea that the type of antibody always determines the stage of infection. In fact, even if a patient has elevated IgG levels, this does not mean the infection has passed and vice versa. We therefore have to be very careful on how we draw conclusions on the state of the infection germ.

Figure 19 - Lyme disease statistics

Figure 20 - Reported cases of Lyme, Filaine 2019

Figure 21 - Funds provided for research, Filaine 2019

Figure 22 - funds per reported case, Filaine 2019

Western Blot test 

The Western blot analyses and compares the antigens in the patient’s blood with a template pattern. Thi is done by separating the antigens (a type of protein) into bands. If the bands correspond to the right place and the right number on the template, it is considered positive. To determine if a patient has Lyme disease, there must be a certain level of similitude between the results obtained, and the templates that were compared. The major problem with this test, is that it relies on templates. Because templates are only available for certain studied cases of Lyme disease, meaning the test could leave out cthe diagnosis of complications or the  possibility of dual infections.

Figure 23 - Western Blot vs ImmunoBlot

Other clinical tests

Luckily for future victims, laboratories are developing new and more accurate tests to identify and diagnose infections, as well as current tests being perfected for more reliable diagnosis. Some current tests and alternatives to the indirect tests previously mentioned are PCR, antigen detection and culture testing, aiming at the immediate detection of germs rather than the immune system’s responses. Complimentarily to the direct detection of these germs, certain characteristics of the blood are altered during infection, and could indicate the presence of active germs. The dysfunction of the following aspects are possible signs of infection:

 

  •           White blood cells

  •           Red blood cells

  •           Platelets

  •           ESR

  •           Liver function

  •           kidney function 

  •           thyroid function

  •           auto-immune factors 

  •           electrophoresis

  •           Pancreas

  •           Iron levels

  •           Abnormal cholesterol levels

Lyme ImmunoBlots test

Most elaborated tests like the ones for HIV/AIDS are extremely sensitive and specific. This allows them to have a diagnosis of practically 100% accuracy. The problem with Lyme disease is that the most frequently used primary test recommended by the CDC (ELISA) is very inaccurate. In fact, the two-tiered test system, misses roughly 54% of patients suffering from infection. (Stricker Minerva 2010). One of the explanations for this, might be that Lyme disease can only be tested indirectly. An indirect test means that instead of trying to detect the presence of pathogens, it analyses and measures the patient’s antibody response to the infection. In most cases of Lyme disease, the patient does not develop any antibody response significant enough to be detected, before 4 weeks post infection. Furthermore, if a patient was infected for a longer duration, the first test is very low in sensitivity, failing to detect many patients.

 

 

 

 

 

 

 

 

The Lyme ImmunoBlots test is very similar to the Western Blot test in its approach to detecting particular infections. However, as opposed to the Western blot, this test scans through a range of Lyme Borreliosis types. Instead of having to perform up to 16 different Western blot tests to diagnose the presence of a specific type of Borreliosis, this test generally only requires two. “the ImmunoBlot is comprised of specific recombinant antigens from several species of Borrelia burgdorferi.  The ImmunoBlot therefore detects multiple US and European species of Lyme Borrelia, making the P31 epitope confirmation test unnecessary.”

the ImmunoBlot test is therefore significantly more precise in its diagnostic, saves not onyl time but money, and can detect a variety of infection types.

Figure 24 - ELISA test failure rate , Lyme stats