{
 "topic": "Tick-Borne Illness",
 "slug": "tick-borne-illness",
 "category_id": 15139,
 "summary": "The major tick-transmitted infections and tick paralysis in children, including relapsing fever, spotted fever rickettsioses, and the prevention measures that matter most.",
 "written_by": "claude-sonnet",
 "references": [
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 ],
 "short": [
  {
   "title": "In short",
   "content": "- Nearly 100 tick species can transmit bacterial, viral, and protozoal disease to humans; the most important tick-borne illnesses in the United States are Lyme disease, spotted fever rickettsioses (e.g., Rocky Mountain spotted fever), ehrlichiosis, babesiosis, anaplasmosis, tularemia, endemic (tick-borne) relapsing fever, and Colorado tick fever.\n- Children are exposed to ticks via household pets or contact with grasses and brush.\n- Tick-borne relapsing fever has an incubation of about 7 days (range 2-9); it presents with sudden high fever, lethargy, headache, photophobia, nausea, vomiting, myalgia, and arthralgia, with later abdominal pain, cough, mild respiratory distress, and bleeding manifestations (epistaxis, hemoptysis, hematuria, hematemesis); a diffuse erythematous macular or petechial rash over the trunk and shoulders can appear near the end of the primary febrile episode and lasts up to 2 days. Soft-bodied Ornithodoros ticks transmit Borrelia hermsii and other spirochetes that cause this illness.\n- Relapsing fever can also cause lymphadenopathy, pneumonia, splenomegaly, hepatomegaly with tenderness (jaundice in half of affected children), and CNS findings \u2014 lethargy, stupor, meningismus, convulsions, peripheral neuritis, focal deficits, and cranial nerve paralysis \u2014 which can be the principal feature of late relapses.\n- Rickettsial illness complications and death result from severe vasculitis, especially in the brain, heart, and lungs, with a mortality rate of 5-7% and persistent neurologic deficits in 10-15% of children who recover; delay in therapy is an important determinant of both sequelae and mortality.\n- Tick attachment of 6 hours or longer is associated with pathogen transmission, making frequent tick checks and prompt removal an important preventive measure.\n- Tick paralysis is a rare but potentially fatal, and more common in children than adults, ascending flaccid paralysis caused by a neurotoxin in tick saliva; it begins with an ataxic gait, can progress to bulbar involvement (ptosis, facial weakness) and respiratory failure, is often misdiagnosed as Guillain-Barr\u00e9 syndrome or botulism, and resolves rapidly with tick removal.\n- In the US, the Rocky Mountain wood tick (Dermacentor andersoni, northwest) and the American dog tick (Dermacentor variabilis, southeast) are common causes of tick paralysis; examination shows flaccid, ascending, generalized weakness with hyporeflexia.\n- Treatment of tick-borne illness is largely supportive; avoid analgesics that modify platelet function given the bleeding risk from vasculitis. Postexposure doxycycline prophylaxis after a tick bite is not routinely indicated because of low infection risk and unproven effectiveness. Ehrlichiosis and anaplasmosis are notifiable diseases requiring health department reporting.\n- Prevention centers on avoiding tick habitats (dense vegetation, brush), using repellents and protective clothing, and limiting the duration ticks remain attached to skin."
  }
 ],
 "long": [
  {
   "title": "Definition",
   "content": "Tick-borne illness refers to the group of bacterial, viral, and protozoal infections transmitted to humans by tick bites. Nearly 100 tick species are capable of such transmission. In the United States, the most important tick-borne illnesses are Lyme disease, spotted fever rickettsioses (including Rocky Mountain spotted fever), ehrlichiosis, babesiosis, anaplasmosis, tularemia, endemic (tick-borne) relapsing fever, and Colorado tick fever."
  },
  {
   "title": "Etiology",
   "content": "Children are exposed to ticks through household pets or contact with grasses and brush. Different tick species and genera transmit different pathogens: soft-bodied ticks of the Ornithodoros genus transmit Borrelia hermsii and other spirochetes causing tick-borne relapsing fever, while hard-bodied ticks such as Dermacentor variabilis and A. americanum transmit other tick-borne pathogens. Tick paralysis, a distinct entity, results not from an infectious pathogen but from a neurotoxin in tick saliva; in the United States it is most often caused by the Rocky Mountain wood tick (Dermacentor andersoni) in the northwest and the American dog tick (Dermacentor variabilis) in the southeast, while the Ixodes holocyclus tick in Australia is thought to interfere with acetylcholine release at the neuromuscular junction."
  },
  {
   "title": "Clinical features",
   "content": "Tick-borne relapsing fever has an incubation period of about 7 days (range 2-9) and presents with sudden onset of high fever, lethargy, headache, photophobia, nausea, vomiting, myalgia, and arthralgia. Later features can include abdominal pain, productive cough, mild respiratory distress, and bleeding manifestations such as epistaxis, hemoptysis, hematuria, and hematemesis. Near the end of the primary febrile episode, a diffuse erythematous, macular, or petechial rash lasting up to 2 days may appear over the trunk and shoulders. Additional findings include lymphadenopathy, pneumonia, splenomegaly, and hepatic tenderness with hepatomegaly, with jaundice in about half of affected children. Central nervous system manifestations \u2014 lethargy, stupor, meningismus, convulsions, peripheral neuritis, focal neurologic deficits, and cranial nerve paralysis \u2014 can occur and may be the principal feature of late relapses. Tick-borne rickettsial illnesses more broadly can present with fever, severe headache, abdominal tenderness, rash, chills, myalgias, arthralgias, anorexia, nonproductive cough, and dizziness, typically with an incubation period under 14 days. Tick paralysis presents differently: an ataxic gait followed by ascending, generalized flaccid weakness, often with paresthesias, that progresses and can involve bulbar function (ptosis, facial weakness) with hyporeflexia on examination, and can lead to respiratory failure if unrecognized."
  },
  {
   "title": "Diagnostics",
   "content": "Diagnosis of tick-borne rickettsial disease relies on clinical recognition supported by exposure history (residence in or travel to an endemic area, tick bite or attachment) and serology or other pathogen-specific testing. Tick paralysis is a clinical diagnosis based on the pattern of ascending flaccid weakness with a history of tick exposure, and is confirmed retrospectively by rapid improvement after tick removal; because of its resemblance to other causes of acute ascending paralysis, it is frequently misdiagnosed as Guillain-Barr\u00e9 syndrome or botulism until a tick is found and removed."
  },
  {
   "title": "Complications",
   "content": "Severe rickettsial vasculitis, particularly involving the brain, heart, and lungs, is responsible for the most serious complications and deaths, with a mortality rate of 5-7% and persistent neurologic deficits in 10-15% of children who recover; delay in initiating therapy is an important determinant of both sequelae and mortality. In relapsing fever, CNS involvement can be the dominant feature of late disease relapses. In tick paralysis, unrecognized progression to bulbar and respiratory muscle involvement can cause respiratory failure, though the paralysis resolves rapidly once the tick is removed."
  },
  {
   "title": "Treatment",
   "content": "Treatment of tick-borne illness is largely supportive; analgesics that modify platelet function should be avoided given the bleeding risk associated with the underlying vasculitis of some of these illnesses. Tick paralysis is treated simply by careful search for and removal of the tick, after which weakness resolves rapidly. Postexposure prophylactic doxycycline after a tick bite is not routinely indicated because the risk of infection is low and effectiveness is unproven."
  },
  {
   "title": "Prevention",
   "content": "Limiting exposure to ticks and tick bites is the primary means of prevention: avoiding known endemic and densely vegetated areas, reducing tick habitats, and using repellents and protective clothing. Because tick attachment lasting 6 hours or longer is associated with pathogen transmission, frequent tick checks with prompt removal are an important preventive measure. In areas with endemic infection, the risk of transmission through blood transfusion or organ transplantation should also be considered. Ehrlichiosis and anaplasmosis are notifiable diseases in the United States and should be reported to the local or state health department."
  }
 ],
 "clinical": [
  {
   "title": "Recognizing tick paralysis versus a rickettsial illness",
   "content": "In a child with progressive ataxia evolving into ascending, generalized flaccid weakness \u2014 with possible paresthesias, hyporeflexia, and bulbar signs such as ptosis or facial weakness \u2014 search the scalp and skin folds carefully for an attached tick before assuming Guillain-Barr\u00e9 syndrome or botulism, since tick paralysis is more common in children than adults and resolves rapidly once the tick is removed; delay risks progression to respiratory failure. In a febrile child with a tick-exposure history, headache, myalgia/arthralgia, rash, or abdominal tenderness, consider a rickettsial or relapsing-fever illness: relapsing fever classically produces sudden high fever with headache, photophobia, nausea, myalgia, and arthralgia, later joined by abdominal pain, cough, bleeding manifestations, and a brief trunk/shoulder rash near the end of the febrile episode, with jaundice in about half of affected children and CNS findings possible in late relapses. Because vasculitic complications (brain, heart, lung) and death are linked to delayed therapy, treat presumptively based on clinical suspicion rather than waiting for confirmatory testing."
  },
  {
   "title": "Management and prevention counseling",
   "content": "Treatment for tick-borne rickettsial illness is supportive, avoiding analgesics that impair platelet function because of the bleeding risk from vasculitis. Do not offer routine doxycycline prophylaxis after an isolated tick bite, since the risk of infection is low and effectiveness unproven; instead counsel on prevention \u2014 avoiding densely vegetated or brushy areas, using repellents and protective clothing, and checking for and promptly removing attached ticks, since attachment for 6 hours or more is associated with transmission. Report confirmed ehrlichiosis or anaplasmosis to the local or state health department, as these are notifiable diseases."
  }
 ]
}