Can a tick bite paralyse your face?

August 1, 2017

Lyme disease due to tick bites may mimic Bell’s palsy.

Last week France launched a tick alert app to track a rising number of ticks which cause over 30,000 cases of Lyme disease in the country per year. Experts warned that growing number of disease-carrying ticks are moving north to the UK. The disease is increasingly common in England, due to warmer and wetter conditions linked to climate change, and is often misdiagnosed as Bell’s palsy. Not everyone who has Lyme disease will experience facial paralysis, but healthcare providers treating a patient with facial paralysis should have a high index of suspicion for Lyme disease following travel in high risk areas, particularly in the summer months. They should also not discount Lyme disease just because the patient hasn’t recently visited a high risk area. It’s not just dogs and owners on woodland walks that are at risk, urban foxes and domestic cats can also spread the disease.

How do you get Lyme disease?

When a tick bites an animal carrying bacteria that cause Lyme disease (Borrelia burgdorferi) the tick can become infected. If the tick then bites a human, the bacteria causing Lyme disease may also be transferred. Scientists are also discovering new species of tick-borne bacteria that causes Lyme disease.

In April 2017 an article in the The Telegraph reported warnings from scientists that Britain’s 1.5 million deer population is contributing to the increase in Lyme disease; numbers of deer have doubled since 1999. The NHS say the number of reported cases of Lyme disease is estimated to be around 3,000 each year, compared to just 250 reported cases at the turn of the century. A recent study stated that Lyme disease hospital diagnosis increased by 42% per year from 2011 to 2015 in England.

Lyme disease is not just carried by deer though; sheep, hedgehogs, foxes, dogs, cats, mice, other small mammals and even birds can carry ticks. It’s believed only a small proportion of ticks carry the bacteria that cause Lyme disease, so being bitten doesn’t automatically mean you will be infected. Some ticks can be found wherever animals travel, other types mainly live in the homes of the hosts. There are high risk areas in the UK, particularly moors, highlands, forests and other places of natural beauty such as the Lake District. However, it’s important not to discount Lyme disease just because you haven’t been in a high risk area, because ticks can also be found in urban areas with overgrown gardens or lots of parkland. Anyone can get Lyme disease if an infected tick has bitten them.

Early symptoms (approx. 3 – 30 days after being bitten) may include an expanding pink or red rash surrounding the bite area, it’s usually greater than five centimetres in diameter and may be circular, oval or irregular shaped. It’s often referred to as a bull’s-eye rash. In up to 30% of cases the rash may be so pale that it is missed altogether. The person may also develop flu-like symptoms, joint pain or tiredness during these early stages.

It is when the early signs are missed and the patient is left untreated that debilitating symptoms take hold, sometimes several months or years later, hence early diagnosis is critical. The longer the disease is in the patient’s system, the more difficult it is to diagnose and treat. Left untreated the disease can cause muscle pain, joint pain, swelling and neurological symptoms such as facial paralysis. It may also trigger chronic fatigue syndrome or fibromyalgia. Blood tests which look for antibodies to the bacteria that cause Lyme disease can sometimes come back negative despite active infection, when antibodies have not developed sufficiently. More research and awareness of the symptoms is needed.

Janet was bitten on a muggy evening after arriving in Seattle, USA, on a business trip. She was not in a high-risk area.

I remember waking up after a 16-hour sleep with a very large angry bite just above my right knee, which was unusual for me and I remember telling my mum about it when I called home. I hadn’t been anywhere particularly to get the bite, and this was the key thing that started all my problems with getting a diagnosis and the treatment I needed.

Janet had to tape her eye closed

Returning home to Northern Ireland after her trip, Janet was fatigued, running a fever and suffering with excruciating pain in her head, hands, knees and legs. She thought she’d been overdoing it working long hours. It was six weeks later when Janet’s face gave the second clue to what should by now have been quickly identified as Lyme disease due to her recent history of a bite. The local Accident & Emergency (A&E) department diagnosed Janet with Bell’s palsy and gave her the routine treatment for this condition, steroids. No follow-up care or tests were offered. Days later Janet’s right arm became so weak she could not lift a knife, another A&E admission and this time she was diagnosed with a Stroke. Several tests later and the diagnosis was changed back to Bell’s palsy plus a virus. At seven weeks post bite a healthcare professional finally decided to test Janet for Lyme disease. Thirteen weeks post bite Janet was by now having to use a walking stick and struggling to retain information in her memory, she returned to the hospital for a follow-up appointment. The consultant told her that she had tested positive for Lyme disease but he didn’t believe she had it because the test was ‘flaky’ and she wasn’t in one of the locations where you could get a tick bite.

He decided to give me a month’s course of Doxycycline anyway as a precaution, which is the recommended treatment for Lyme disease. By the third week I was starting to improve quite dramatically. After the fourth week I was doing really well and my face started to come back. But by then I had finished my antibiotics and I went straight back to square one. All my symptoms returned and my facial palsy was back.

Antibiotics via IV

Janet referred herself to Infectious Diseases in Northern Ireland but again experts decided she couldn’t have Lyme disease despite a positive blood test, because she hadn’t been in an area where you could be infected. As a precaution Janet was given intravenous antibiotics for a month and the symptoms eased, Janet’s face was almost fully recovered. But a few weeks later all the symptoms came back as well as the facial paralysis. By this time discharged by Infectious Diseases because they still wouldn’t recognise that the cause was Lyme disease, Janet was incorrectly diagnosed with sarcoidosis and a heart defect. It was Janet’s GP, a generalist and not a specialist, who eventually took the lead in her care and started her on Doxycycline again because he believed she did have Lyme disease. Janet also did her own research and consulted a Lyme specialist in Seattle privately.

The doctor in the USA said Lyme disease can be caught on the breeze, he said “I am treating people from downtown Seattle who have never ever been in a field in their life before.” My fight from day one is that I wasn’t in an area where doctors believed I could have got this disease from.

Paying for her own private consultations with the doctor in the USA, Janet took antibiotics for around seven months and is finally back to walking around 4 miles a day. She had to fight for over two years for treatment for Lyme disease but considers herself one of the lucky ones because her GP listened to her and she was able to see a specialist privately. A lasting reminder of Lyme disease is the facial palsy. Janet’s face had made a full recovery when she was first given treatment for Lyme disease, which she finds frustrating, because if the follow-up care had been consistent, she might not be living with a permanent reminder of the battle she has fought.