tick bite

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Epidemiology

probability of acquiring a tick-borne infection from a tick bite even in endemic areas is low
most persons bitten by a tick are unaware of having been bitten

normal reaction following any sting or bite
- immediate local pain with swelling
- subsides within 1-2 hours
- pruritus that may persist for days
local wheal & itching may occur
associated symptoms of tick bite fever, tick paralysis, Rocky Mountain spotted fever of Lyme disease may be present
symptoms of tick borne infections (up to 8 weeks)
- rash
- fever
- arthralgias
- headache
- stiff neck
- photophobia
- facial droop

* image of tick attached to tympanic membrane [5[

tick removal
- firm traction with foreceps at the site of attachment
- rupture of the tick body may permit escape of fluids containing pathogenic viruses, rickettsiae, borreliae, or the agent of tularemia
prophylactic antibiotics for asymptomatic tick bites is NOT indicated
tick-borne infections respond to antibiotic therapy started with the onset of symptoms
patients should be counseled to observe for symptoms of tick-borne infections for up to 8 weeks

↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1172-74
↑ Medical Knowledge Self Assessment Program (MKSAP) 11, 18. American College of Physicians, Philadelphia 1998, 2018
↑ Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 935
↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/26593263
↑ Kasle D, Waldman E. Tick Attached to the Tympanic Membrane. N Engl J Med 2019; 380:1761 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31042828 https://www.nejm.org/doi/full/10.1056/NEJMicm1812049