What if a tick is not fully removed?

From the Guidelines

If a tick is not fully removed, you should try to extract the remaining parts with clean, fine-tipped tweezers, grasping the tick as close to the skin as possible and pulling upward with steady, even pressure, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. When dealing with a partially removed tick, it is essential to prioritize prompt and complete removal to minimize the risk of disease transmission. The longer a tick remains attached, the higher the risk of transmitting pathogens, many of which require 24-48 hours of feeding to be transmitted. Some key considerations for tick removal include:

• Using clean, fine-tipped tweezers to grasp the tick close to the skin and pulling upward with steady, even pressure 1
• Avoiding the use of folk remedies, such as gasoline, kerosene, petroleum jelly, fingernail polish, or lit matches, which can cause more harm than good 1
• Cleaning the bite area with rubbing alcohol, an iodine scrub, or soap and water to reduce the risk of infection 1
• Monitoring the bite area for signs of infection or rash over the next few weeks and seeking medical attention promptly if symptoms such as fever, rash, severe headache, muscle or joint pain, or facial paralysis develop 1 It is also important to note that if mouthparts remain embedded in the skin after removal attempts, it is best to leave them alone and let the skin heal, rather than attempting to remove them forcibly.

From the Research

Incomplete Tick Removal

If a tick is not fully removed, there is a risk of infection transmission, including Lyme disease. The following points highlight the potential consequences and treatment options:

• Incomplete removal of a tick can lead to the transmission of Lyme disease, as the tick must feed for at least 36 hours for transmission of the causative bacterium, Borrelia burgdorferi, to occur 2.
• The disease can progress through three stages: early localized infection, early disseminated infection, and late disseminated infection, each with specific clinical features 2.
• Treatment options for Lyme disease include doxycycline or amoxicillin, with cefuroxime axetil or erythromycin as alternatives, and intravenous ceftriaxone or penicillin G for late or severe disease 2, 3, 4.
• A network meta-analysis found that oral amoxicillin, oral azithromycin, injectable ceftriaxone, and injectable cefotaxime were effective for treating Lyme disease, while cefuroxime and penicillin were safe for treatment 5.
• Antibiotic prophylaxis, such as single-dose doxycycline, may be effective in preventing Lyme disease after a tick bite, with a pooled risk ratio of 0.38 (95% CI: 0.22-0.66) 6.

Prevention and Treatment

To prevent Lyme disease, it is essential to:

• Remove ticks promptly and correctly to minimize the risk of infection transmission.
• Use antibiotic prophylaxis, such as single-dose doxycycline, in areas where Lyme disease is endemic.
• Seek medical attention if symptoms of Lyme disease occur, such as erythema migrans, fever, or neurologic manifestations.
• Follow treatment guidelines, including the use of oral or intravenous antibiotics, depending on the stage and severity of the disease 2, 3, 4.