September 23, 2018
Robert R. Cawley, D.O.
Dover, NH 03802
By Lukas Kolm, MD, MPH, FACEP, Seacoast Emergency Physicians and Chair of Wentworth-Douglass Hospital Emergency Medicine
Symptoms of tick-related illnesses can be highly variable, from an atypical rash, joint swelling, headache, fever, neurologic changes with facial numbness or drooping, inability to walk or simply overall malaise with flu like symptoms. If you suspect a tick bite or tick borne illness may be causing your symptoms, see your doctor or visit an urgent care center right away.
Always consider potential for tick exposure when you experience new or unexplained symptoms or changes in your health. Tick-related illnesses can be grand masqueraders of several other underlying medical conditions. This clinical variability, along with unawareness of prior tick exposure, often translates to confusion as to whether to treat immediately or wait for test results.
There are several different tests for tick transmitted illnesses such as Lyme disease, human granulocytic diseases, (ehrlichiosis, babesiosis, anaplasmosis), rocky mountain spotted fever, or tularemia, to list several but not all tick-borne infections. The tests can be falsely positive or negative depending on possible underlying chronic medical conditions or simply the timing of the test in relationship to tick exposure, specifically, how long the tick was attached to the skin. The decision to treat empirically - before or without test results - is most often supported by either timing of known tick exposure, greater than 48 hours, or presenting signs and symptoms.
Treatment for tick-related illnesses can be a one-time prophylactic dose of an antibiotic based on the known duration of exposure. While awaiting test results, a week or longer course of antibiotics can be initiated, where the course of treatment can be extended as needed, reducing risk of prolonged treatment when not required.
Starting treatment while awaiting test results can be appropriate without recklessly overprescribing antibiotics. In those who present with concerning symptoms or known exposure, and therefore high preclinical suspicion of a tick-borne illness, starting treatment along with close follow may be prudent. The risk of exposure has spread through the seasons and includes domestic pets and a variety of wildlife species.
Ticks are embedded on animals throughout the fall and winter months continuing right into the spring and summer. When walking, hiking or doing yard work, or allowing pets to rest or sleep on furniture, can lead to more ticks finding their way onto our bodies or to developing symptoms, with or without awareness of a tick bite.
Embedded or attached ticks are best removed using tweezers or similar tools. Pull the tick straight back from the point of attachment closest to the skin, don’t twist it. If not successful in removing all tick parts, such as the head or pincers, it is not necessary to dig them out. Applying toxic substances or solvents, such gasoline, or lighter fluid or attempting to burn the tick while embedded, is not a good idea and can cause injury. Consult a health care provider or visit an urgent care center for concerns regarding appropriate tick removal, evaluation of retained tick parts or risk of infection.
Don’t let your guard down - tick checks are a must, year-round.
Ref: Toyin Fapohunda-Adekola,M.D., MBA , Urgent Care Diagnosis and Management of Tick-Borne Diseases. JUCM January 2016 V. 10, Num. 4: 8-15