Ticks

TBE; Early Summer Meningoencephalitis; tick bite; Borrelia burgdorferi; 

Due to their lifestyle, ticks frequently transmit pathogens between their hosts without being infected themselves. They carry more types of pathogens than any other group of parasitic animals. The threat to humans stems from the transmission of pathogens that cause:

• borreliosis
• Early summer meningoencephalitis (ESME)
• Rickettsial diseases
• Tularemia (Dermacentor species)
• Babesiosis (Ixodes species; malaria-like disease)
• Human granulocytic anaplasmosis (human granulocytic ehrlichiosis)
• Neoehrlichiosis (very rare; 10 cases known in Europe)

A tick bite is an event that should be taken seriously. The most important vectors in Central Europe are species of the genus Ixodes, with the most common native species being the so-called “common wood tick” (Ixodes ricinus), as well as the genera Rhipicephalus, Dermacentor, Haemaphysalis, Amblyomma, and, from the family of soft ticks, the genera Argas and Ornithodorus.

Ticks (Ixodidae) are a superfamily within the mites (Acari) with leathery skin, belonging to the class of arachnids. Ticks are among the largest species of mites. Most species are ectoparasites (they do not penetrate the host’s body). Their hosts include birds, reptiles, and mammals. There are approximately 650 species of ticks worldwide (see also pigeon tick). 

Ixodidae lay eggs in various sheltered locations, such as the undersides of blades of grass. Six-legged larvae hatch from these eggs. After a few days, these larvae seek out an intermediate host (a rodent), attach themselves to it, and feed on blood for two to three days. After feeding, they detach themselves and, after a few months at the end of their development, molt into the first eight-legged nymph, which is about 1.5 to 2 millimeters in size. This nymph, in turn, seeks out another intermediate host (a cat). They then enter a dormant stage until the following spring. Only after this dormant period do they seek out another host. This is followed by another molt into the second nymph (leather tick) or into an adult (hard tick). The adult tick then infests the final host (humans, cattle). This is followed by the mating of the female. Shortly thereafter, she lays up to 3,000 eggs. The male ticks die after mating, while the females die only after laying their eggs.

The tick uses its paired mouthparts (called chelicerae) to pierce the skin and inserts the hypostome (biting apparatus) into the wound. This is symmetrically lined with barbs. However, they use it only to pierce the skin superficially and then “lick up” the blood that seeps out. The process is colloquially referred to as a “tick bite,” but the correct term is “tick sting.”  The technical term for this type of blood-feeding is telmophagia (pool feeding). 

Infection of ticks with Borrelia burgdorferi rarely occurs transovarially. Rather, the larvae become infected while feeding on the blood of infected mice. The mice themselves constitute the largest natural reservoir.  

In terms of TBE transmission, Northeastern and Eastern Europe are among the regions with the highest risk of TBE transmission. High-risk areas include Bavaria and Baden-Württemberg (accounting for about 80% of TBE reports), parts of Hesse, Rhineland-Palatinate, and Thuringia, regions in Austria and Switzerland, Northeast and Eastern Europe, as well as Asia. 

Cases (Germany): In 2025, 693 confirmed TBE cases were recorded. In addition, there were 100 suspected cases.  

Milder temperatures extend the active season for ticks and facilitate the spread of TBE northward.   

The highest risk of TBE in Europe, with several hundred cases annually, is found in the Baltic States, Slovenia, and the Czech Republic. Vaccination is recommended for travelers to endemic areas (according to the Center for Travel Medicine, CRM).

Checking for ticks is no substitute for vaccination: After all, half of those affected don’t even remember being bitten by a tick!  

1. A tick that has attached itself should be removed as soon as possible after it is discovered.
2. It is best to grasp the tick as close to the skin as possible using fine tweezers or tick removal forceps (do not grasp the tick’s body, as this can squeeze pathogens into the wound) and slowly pull it out of the skin. Thoroughly remove any remaining parts of the tick (usually the so-called hypostome). Then thoroughly disinfect the bite site. The use of oil or nail polish for removal is not recommended, as it is not certain that these methods do not accelerate the entry of pathogens. On the contrary, it is likely that aggressive agents cause the tick to release secretions—and thus potential pathogens—more rapidly.
3. For smaller ticks: It is often difficult to grasp small ticks securely with tick tweezers. In such cases, professional removal with a scalpel is recommended. The blunt side of the blade is placed against the patient’s skin, and the tick is pried out.

4. If a remnant of the mouthparts (often misinterpreted as the “head”) remains in the skin, it can be removed with a sterile needle or curette. With regard to the transmission of Borrelia, the presence of the “mouthparts” in the skin poses no risk.

5. In general, ticks can also be removed via punch biopsy under local anesthesia. This procedure is recommended if the affected person has already attempted to remove the tick by other means. There is no risk of crushing the tick or leaving tick fragments in the skin.

6. It is recommended to carefully check the body—and, in the case of children, especially the head—for any additional ticks.
7.   Lyme disease is completely curable in its early stages with antibiotic therapy administered according to guidelines. This prevents late-stage manifestations.
8. Testing the tick for Borrelia is not advisable, since a positive result does not confirm whether the Borrelia bacteria were actually transmitted to the skin or, if transmitted, whether they would lead to disease. A negative result does not rule out transmission.
9. Only a small percentage of people infected with Borrelia actually develop the disease! For this reason, preventive oral antibiotic therapy is not recommended.

Wear sturdy shoes.

Wear light-colored clothing so you can spot ticks more easily.

Hike on trails instead of off-trail.

Tuck your socks over the tops of your pants.

Check children in particular after walks or hikes in the great outdoors.

Apply insect repellent to the lower legs, wrists, and neck, e.g., Zanzarin Organic Lotion or Nexa Lotte Skin Protection Milk (the effect lasts up to 6 hours).

Garlic: Studies have shown that taking garlic capsules can reduce the tick bite rate in endemic areas by about 30%. Alternatively: Use garlic spray.

Leather ticks often live close to their hosts and prefer rather dry dark shelters. Particularly well suited conditions are provided by forest edges and clearings with tall grasses, wet meadows and brook margins with similar vegetation, and also deciduous or mixed forest with grassy or herbaceous undergrowth. They normally carry out their activities from March to October. Their life span is between two and five years. Ticks can survive a full wash of clothing, so a tick bite can occur long after a walk in the forest.

In the next few years, tropical tick species of the genus Hyalomma could also spread to Central Europe. These tick species can carry the bacterium Rickettsia aschlimanni, the causative agent of spotted tick fever. Individual specimens have been found in Germany.

Ixodes inopinatus from the Mediterranean region has now spread as far as Denmark.

Rhipicephalus sanguineus, the "brown dog tick", originally native to Africa, has also been discovered on Hunades in Central Europe.

1. Carroll J (2007) Tough: Ticks survive the full wash cycle. Close to the skin 6: 318 (see also http://www.ars.usda.gov/is/pr/2007/071005.htm)
2. Laursen K et al (2003) Tick-borne encephalitis: a retrospective study of clinical cases in Bornholm, Denmark. Scand J Infect Dis 35: 354-357
3. Lesnicar G et al (2003) Pediatric tick-borne encephalitis in 371 cases from an endemic region in Slovenia, 1959 to 2000 Pediatric Infect Dis J 22: 612-617
4. Oehme R et al (2002) Foci of tick-borne diseases in southwest Germany. Int J Med Microbiol 291(Suppl 33): 22-29
5. Perkins SE et al (2003) Empirical evidence for key hosts in persistence of a tick-borne disease. Int J Parasitol 33: 909-917
6. Spitalska E et al (2003) Tick-borne microorganisms in southwestern Slovakia. Ann NY Acad Sci 990: 196-200
7. Stjernberg L et al (2000) Garlic as insect repellant. J Am Med Assoc 284: 831
8. Thuile T et al (2015) Cutaneous and systemic Lyme disease. Act Dermatol 41: 234-241