Tick season is in full swing and with it comes an increased risk of two serious diseases – tick-borne encephalitis and Lyme disease. What are their typical symptoms?

I'll start with tick-borne encephalitis (TBE). It is an infectious viral disease that attacks the nervous system. It often has a two-stage course, but sometimes, the patient may only notice one stage and may even be asymptomatic altogether. The first stage usually lasts for three to five days and is associated with muscle and joint pain, fever, headache or lack of appetite. After a few days of improvement, the second stage occurs, with an inflammation of the brain and meninges, presenting with a high fever, neck stiffness, severe headache, vomiting, and light sensitivity. In severe cases, paralysis of the limbs or respiratory muscles can occur. Chronic headaches, sleep, concentration disorders, balance disorders, depression, tremors or paralysis of limb muscles may be long-lasting or permanent consequences.

What is the treatment? 

Treatment is only symptomatic, that is, we can only suppress the symptoms that occur and not the cause. Medication is given for vomiting, fever or pain and rest is important. In the case of paresis, or paralysis, we administer vitamin B and rehabilitation. Anti-edema treatment and corticosteroids are also beneficial. In the long term, it is recommended to avoid sun exposure, prolonged television viewing and increased mental stress.

A vaccine effectively protects against tick-borne encephalitis. What is the ideal time to get vaccinated and how much will it cost me?

 You can start vaccinating at any time of the year, as ticks are more or less year-round in our country due to the mild winters. However, you must take into account that antibodies will not be produced until about 14 days after the second dose. This is given between one and three months after the first dose. Since last year, the vaccine has been free of charge for insured persons of Czech health insurance companies over the age of fifty, otherwise, the price of one dose is around CZK 1,000. However, preventive vaccination is worthwhile - the treatment of possible tick-borne encephalitis is much more expensive. 

Does the vaccine have an age restriction? 

 On the other hand, it is suitable for people of all ages. Children as young as one can be vaccinated and there is no upper age limit.

Coming back to the first question, how do you know if you have Lyme disease?

Lyme disease is an infectious bacterial disease that is treated with antibiotics. It can occur in up to three stages. The first and most typical sign of infection, which greatly facilitates the possibility of a correct diagnosis, is a red spot with a white centre at the site of the tick bite. It is sometimes accompanied by fever, fatigue, malaise or vomiting. This red patch gradually expands in size.

However, in approximately 40 % of cases there are no symptoms whatsoever in the first stage of the infection, and the disease progresses unnoticed to the second, and more difficult-to-treat chronic symptoms. This stage occurs in approximately 2 to 12 weeks after the tick bite. It subsides after three months at the latest. It is characterised by muscle and joint pain and the development of swelling, especially of the knee joints. Peripheral nerve palsy is not an uncommon symptom; the most commonly affected nerve is the facial nerve. Transiently, inflammation of the cardiac musculature may also occur. In some cases, we also find Borrelial lymphocytoma, which is a tiny purple nodule on the skin, especially on the nipple, auricle, lobe or testicles.

The last stage comes on several months to years after infection. Symptoms include inflammatory involvement of the skin and its subsequent atrophy, i.e. loss of quality, especially in the lower limbs, inflammation of the joints and inflammatory diseases of the brain and spinal cord, heart or eye.

Ticks also carry other diseases that can complicate the treatment of Lyme disease. There is no vaccine for Lyme disease as of yet. Is there any hope in this regard?

A vaccine has been developed for dogs. The human vaccine is currently in the testing phase. It can therefore be assumed that it will also be available within a few years.

The Czech Republic ranks among the countries with the highest number of tick-borne encephalitis cases in the EU. Why is that the case?

 The Czech Republic is indeed the country with the highest incidence of tick-borne encephalitis. Several hundred cases of tick-borne encephalitis are reported every year and the number is increasing. This is due to the geographical location, the abundance of deciduous forests and green areas, and the fact that people like to spend spring, summer and autumn in their cottages, in nature, foraging for mushrooms... Infected ticks are found in all regions of the country and are active from 5 °C, preferring damp places.

About 80 % of cases are transmitted by tick bites, and 20% of cases of viral encephalitis can be caused by ingestion of raw goat, cow or sheep milk.

Summer and family holidays are slowly approaching. What should you generally look out for when travelling to avoid unnecessary health complications?

 You must always check how risky an area you are going to. In economically developed countries there are no major problems with medical care and buying medication, but in less developed countries the risk is higher. I highly recommend taking out insurance if you are involved in any adrenaline sports. It’s also advisable to pack a first aid kit with basic medical equipment with you. 

What do I need to think about when going on holiday to an exotic destination?

 It is important to consider all the risks. Don't forget about insurance. Also, find out through your GP if any special vaccinations are required and if so, get them in advance so there is adequate time for them to be effective.

Again, bring along a first aid kit with basic medication such as antipyretics for fevers, painkillers and antidiarrheals, including one broad-spectrum antibiotic. And, of course, disinfectants, and plasters for minor injuries. Travellers on long-term medication should remember to take plenty of these. If they take them on board the plane, it's a good idea to ask your doctor for a certificate in English confirming their regular use, just in case.

Anyone who has ever had deep vein inflammation or a pulmonary embolism and is planning a flight longer than six hours should consult their GP who will most likely prescribe blood thinning medication.

As a general practitioner, you often care for three generations of a family. What is key for you in caring for your patients?

 Really knowing their medical history, knowing their genetic predisposition, and their susceptibility to certain types of diseases that can be effectively prevented by adjusting their lifestyle is key. It also means mutual trust and respect, which means that my patients are more involved in their healthcare and are more likely to listen to advice and recommendations.

MUDr. Miluše Vostradovská, Chief physician at Walter clinic