Lyme FAQ: Frequently asked questions about ticks and Lyme disease

Below is a selection of the most common questions about ticks and Lyme disease. The list will regularly be extended with new frequently asked questions. The answers are short and clear, and grouped into categories.

Category: Lyme Disease

What is Lyme disease?

Lyme disease is an infectious disease caused by the bacterium Borrelia burgdorferi (Bb).

How do you get Lyme disease?

You can get Lyme disease if you get bitten by a tick carrying the bacterium Borrelia. If the bacteria is transferred to you during the bite of an infected tick, then you can get Lyme disease. There is also evidence that a pregnant woman can transmit the bacterium Borrelia to the unborn child and the child can then get Lyme disease. Other infection routes are suspected by some people, such as sexual contact and blood-sucking insects (mosquitoes, flies, fleas), but there is no strong scientific evidence that supports this.

What is an erythema migrans?

In case of an infection with the Lyme bacteria Borrelia, a typical skin condition called erythema migrans (EM) can develop at the site of the tick bite, days or weeks after the bite of a tick. A typical erythema migrans looks annular (circular). A red rash developes that gradually expands and often pales centrally, so that a ring is created. Sometimes, multiple rings develop around one location on the skin. Sometimes multiple erythema migrans' develop at different locations on the body, even though one was bitten once; this indicates a disseminated infection. Note that there are also atypical erythema migrans with no apparent rings.

What are the symptoms of Lyme disease?

Early symptoms include a red ring / rash called erythema migrans (EM) at the site of the tick bite, flu-like symptoms such as headache, stiff neck, fever, muscle aches and fatigue. These symptoms may not occur. Later, various symptoms can occur. Lyme disease is a multi-system disease. It can cause neurological (nervous system / brains), dermatological (skin), rheumatologic (muscles and joints), cardiac (heart), opthalmologische (eyes) and psychiatric symptoms.

Category: ticks

What is a tick?

Ticks are classified as arthropods (Arthropoda), a biological Phylum (division) of invertebrate animals with jointed legs, a segmented body and an exoskeleton. Within this family ticks belong to the class of arachnids (Arachnida), a class that includes spiders and mites, but not insects (Insecta).

What does a tick look like?

A tick is only a few millimeters wide and runs slowly. At first glance, a tick looks like an insect, but ticks are not insects. There are some characteristic differences which helps to recognize ticks. A tick can be identified by the number of legs, the number of body parts and put the body on the head of the tick.

The three main differences between insects and ticks are:
• Insects have three body segments, but ticks have two.
• Adult insects have six legs, but adult ticks have eight.
• Insects have wings and antennae, but ticks don't have them.
Note: adult ticks have eight legs, but a tick larva has only six.

How big is a tick?

Ticks are not large. The size of a tick depends a.o. on the life stage of the tick. Especially in their first life stages, ticks are quite small. A tick larva (baby tick) is smaller than a millimeter, but gets three times bigger when it feeds. After a blood meal, the tick larva morphs to a tick nymph. A nymph is about 1 to 1.5 millimeters in size. After a blood meal, the nymph sheds its skin to an adult. Adult is the adult stage of the tick. Tick are then about 3 to 5 millimeters in size. Only the female tick can become as large as a 1 cm after she has fed.

How many legs does a tick have?

In the larval stage, ticks have 6 feet, and in ninf stadium and as an adult tick, ticks have 8 legs. This distinguishes ticks from insects, which have six legs, but they have as many legs as adult mites and spiders.

Where do ticks live?

Ticks are located in forests, dunes but also often in gardens. Ticks thrive in a moist environment and usually live in the vicinity of potential hosts. Ticks climb into grasses, shrubs and bushes and wait until a host comes along and just grab onto it. A tick usually remains less than one meter above the ground.

Does DEET repel ticks?

While DEET is very effective against mosquitos, it is questionable how well DEET works on ticks. It may work somewhat, but it's unsure if it's guaranteed whether it will keep ticks away and what percentage of DEET is needed to protect against ticks. However, according to the CDC, repellents containing 20% or more DEET can protect up to several hours. Supposedly, DEET does not kill ticks. (DEET = N, N-diethyl-m-toluamide).

Category: tick bites and tick removal

How to remove a tick?

Removing ticks can be done in a good and practical way with tweezers with thin ends. You remove the tick this way by grasping the head of the tick as close to the skin as possible and then with gradually increasing force you withdraw the tick from the skin. It is not necessary to rotate the tick.

How to get a tick head out of skin?

Often it is only the hypostome (the harpoon-like mouthpart that the tick inserts into the skin) that stays in the skin because it often breaks off during tick removal and is left in the skin. Try to remove it as you would remove a splinter, e.g. with a sterilized needle or tweezers. Making the skin wet may also help getting the mouth parts out of the skin.

If a larger part of the head section of the tick stays in the skin, then the salivary glands may still be there, possibly containing pathogens. In such a case there is still a potential risk of contamination. Therefore try to remove the tick head (with fine-tipped tweezers) and if it fails, consult a doctor.

What happens if a tick is not removed?

A tick that is alive will eventually let go by itself after a few days. That is when the tick has completed feeding with blood from the host (human, dog, cat, or other animal). However, one should not wait, but remove the tick as quickly as possible. The longer the tick is attached, the higher the risk of contracting tick-borne infections like the Lyme disease causing Borrelia burgdorferi.

What does a tick bite look like?

You can recognize a tick bite by a small red spot that looks like a mosquito bite, which is only an irritation of the skin by the bite. Some people also get allergic reactions around the bite site from mosquito bites or tick bites. Only when one gets infected with the Lyme bacteria, a ring-shaped rash called erythema migrans can develop. Confusingly this red ring is also often called tick bite.