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tick bite

Epidemiology: 1) probability of acquiring a tick-borne infection from a tick bite even in endemic areas is low 2) most persons bitten by a tick are unaware of having been bitten Clinical manifestations: 1) normal reaction following any sting or bite a) immediate local pain with swelling b) subsides within 1-2 hours c) pruritus that may persist for days 2) local wheal & itching may occur 3) associated symptoms of tick bite fever, tick paralysis, Rocky Mountain spotted fever of Lyme disease may be present 4) symptoms of tick borne infections (up to 8 weeks) a) rash b) fever c) arthralgias d) headache e) stiff neck f) photophobia g) facial droop * image of tick attached to tympanic membrane [5[ Laboratory: 1) leukocytosis & hyperglycemia typical of stress reaction 2) generally laboratory tests not useful Differential diagnosis: 1) spider bite 2) vasculitis Management: 1) tick removal a) firm traction with foreceps at the site of attachment b) rupture of the tick body may permit escape of fluids containing pathogenic viruses, rickettsiae, borreliae, or the agent of tularemia 2) prophylactic antibiotics for asymptomatic tick bites is NOT indicated 3) tick-borne infections respond to antibiotic therapy started with the onset of symptoms 4) patients should be counseled to observe for symptoms of tick-borne infections for up to 8 weeks

Related

tick tick borne infection tick fever tick-related allergy

General

animal bite superficial injury/trauma

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1172-74
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 18. American College of Physicians, Philadelphia 1998, 2018
  3. Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 935
  4. Ogden NH, Lindsay LR, Schofield SW. Methods to Prevent Tick Bites and Lyme Disease. Clin Lab Med. 2015 Dec;35(4):883-99. Review. PMID: 26593263
  5. Kasle D, Waldman E. Tick Attached to the Tympanic Membrane. N Engl J Med 2019; 380:1761 PMID: 31042828 https://www.nejm.org/doi/full/10.1056/NEJMicm1812049