Walking and playing in the woods is a pastime enjoyed by many who vacation in Germany or have relocated to the country. Yet many are unaware of the hidden dangers in the undergrowth.

They are tiny, blood-sucking parasites, related to the spider and they prefer to make their home in the shrubby areas of woodlands and forests. They may seem fairly harmless but actually are far more dangerous than most realize: their bite can cause serious infections such as Lyme disease or Tick Borne Encephalitis.

Over the past two decades, the incidence of Lyme disease (Lyme Borreliosis) and Tick Borne Encephalitis known in Germany as Frühsommer Meningoencephalitis has increased in several European countries, including Britain.

Every year more than 4000 cases are reported in Germany, mostly from the southern and eastern parts of the country and because there is no obligation to register the information with the health authorities, a large number of cases go unreported – an estimated 50,000 to100,000 annually.

"The risk of infection is greatest from April to October, when ticks are most active and because tick saliva contains an anaesthetic, a bite may go unnoticed," says H.R. Brodt, head of the Department of Infectious Diseases at Frankfurt University Hospital. "This means it is very important to check the body for attached ticks because evidence suggests that the transmission of the infection risk of starts around 12 hours after the bite."

Contrary to common belief, ticks don’t fly, jump, or drop from trees. Instead they inhabit shrubby undergrowth and meter-high vegetation where they use heat and carbon dioxide sensors to detect when an animal or human brushes past against the leaves. From there, they can easily transfer themselves onto clothing or skin.

More often than not, they feed on wild animals, especially deer, mice and voles, but they also feed on domestic animals such as sheep, goats, cattle, dogs and cats. Humans are accidental hosts.

The tick life cycle consists of four stages: egg, larva, nymph and adult. To progress from nymph to adult, ticks need a blood meal. Before feeding, the nymph is about the size of a poppy seed with a dark head and a translucent body. After filling up with blood, it becomes round in shape, turns dark grey and is about the size of a mustard seed. Adult ticks are the size of a sesame seed and after, feeding swell to the size of a sunflower seed and also turn a dark grey colour.

In humans, they cling on to the skin and wander around the body for several hours before finding a suitable place to insert their corkscrew-shaped mouthpiece and feed. Ticks can attach to any part of the human body but prefer to take their meals in the more hidden moist and hairy places such as the groin, armpits and scalp. The back of the knee, around the waist and buttocks are also favourite blood-sucking spots. They usually remain on the body for many days and transmit the infection as they feed.

"Symptoms of Lyme Borreliosis in the early stage often begin with a so called ‘erythema migrans’, a red blotch or widening ‘bulls-eye’ ring around the bite point, accompanied by flu-like feelings of headache, fever, stiff neck, muscle aches, fatigue and loss of appetite," explains Brodt. "Research shows that the majority of people who contract Lyme Borreliosis experience only these first-stage symptoms and never become seriously ill after treatment with antibiotics."

But some do.

"A minority will go on to the second stage of the disease, which begins two weeks to three months after the initial infection," he adds. "At this stage, people often suffer arthritic pain, cardiac and neurological complications such as irregular heart beats and cranial nerve paralysis. Disabling arthritis and neurological symptoms that resemble those of multiple sclerosis marks the third stage of Lyme disease, which generally begins within two years of the original infection. However, symptoms vary widely and some people also experience memory loss, mood swings, and an inability to concentrate."

Because Lyme Borreliosis often mimics other disorders, it is sometimes difficult to diagnose. Peter Larsen underwent knee surgery before his doctor confirmed Lyme disease. "I didn’t recall being bitten or having a rash," he recalls. "When my knee became very painful I thought I had arthritis or a meniscus problem. I had difficulty walking and eventually had knee surgery, but my joint was okay. Later a blood test revealed I had Lyme Borreliosis and needed intravenous antibiotics to halt the disease."

Generally Germans are cautious of tick bites and understand the difference between Lyme Borreliosis and Tick Borne Encephalitis, says Brodt. Lyme Borreliosis is a bacterial infection and can be treated with antibiotics. If the tick is removed quickly (within 12 hours after first contact), it is possible to prevent the infection developing. "Although infrequent, and rarely life threatening, if left untreated the disease can be serious." he adds.

Because it cannot be treated with antibiotics, Tick Borne Encephalitis poses a greater threat, warns Sarah Randolph, a professor in the Department of Zoology at the University of Oxford. This is a viral infection that can cause inflammation of the brain (encephalitis) or inflammation of the membranes covering the brain and spinal cord (meningitis). In about 1 per cent of people, it can be fatal.

Flu-like symptoms are typical in these infections and develop up to eight days after being bitten. A month later, a quarter of patients develop a second stage with high fever, inflammation of the brain and spinal cord and partial paralyses. A few patients may experience longer-term complications for example, balance and coordination problems, headaches and hearing defects as well as concentration difficulties. Liver cells and heart muscle can also be affected, says Randolph. How is Tick Borne Encephalitis treated?
Immunoglobulin injections are given as soon as possible after bite to try to prevent the virus multiplying. If you live in a geographical ‘hot spot’ vaccination is recommended. How is Lyme Borreliosis treated?

Antibiotics such as Amoxicillin or Doxycycline is given orally or intravenously. What to do if you find a tick on your body:

Do not force the tick to back out by prodding or squeezing. Using fine-point tweezers, grasp the tick firmly, as near to the mouth as possible, and pull straight out, then clean the area with disinfectant. Do not twist or rip the tick from your skin. Don’t panic. Not all tick bites are infectious. However, see your doctor if a rash develops, or symptoms occur. Is there a test?

A blood test will detect antibodies to the infection in your blood stream.

How to prevent tick bites:Anyone visiting forests, fields or pastures should wear light-coloured clothing so that the tick can be seen and removed. Wear long pants and a long-sleeved top. Tuck your pants into your socks and tuck your top into your pants. Children should wear a cap and avoid sitting or rolling around in long grass. Always do a thorough body search and shower after outdoors activities. Pets should wear a tick collar.Where are the tick ‘Hot Spots’?

Ticks that spread Lyme Borreliosis are common throughout Germany.

Tick Borne Encephalitis risk areas are mainly in the southern Germany, in the southwest from Aschaffenburg to Konstanz and in the southeast from Saaleholzland to Berchtesgardener Land. Cases have also been found in Thuringia and Marburg Biedenkopf.

-- Frances Geiger Pelles is a registered nurse and health consultant based in Frankfurt. She is the author of the book, "The Essential Balance."

Copyright Frances Geiger Pelles

May 2007

Subject: Germany, health, ticks, hiking, encephalitis, lyme disease