From the Guidelines
Immediate removal of the tick is essential to prevent the transmission of tick-borne illnesses.
Management of Tick Bite
- The risk of contracting a tick-borne illness is increased if the tick is attached for >24 to 48 hours 1.
- Antibiotic prophylaxis may be recommended for Lyme disease when a tick bite occurs in a highly endemic region and tick attachment is estimated to have been ≥36 hours 1.
- In New Mexico, where Rocky Mountain Spotted Fever is endemic, prophylactic antibiotic administration is not recommended for tick bites, but doxycycline is recommended at the first sign of fever or rash 1.
- The Infectious Diseases Society of America (IDSA) recommends prophylactic antibiotic therapy only for adults and children within 72 hours of removal of an identified high-risk tick bite 1.
- A tick bite is considered high-risk only if it meets the following criteria:
- The tick bite was from an identified Ixodes spp. vector species.
- It occurred in a highly endemic area.
- The tick was attached for ≥36 hours 1.
- If a tick bite cannot be classified with a high level of certainty as a high-risk bite, a wait-and-watch approach is recommended 1.
From the Research
Management of Tick Bites in Children
The management of a child with a recent tick bite in New Mexico involves several key considerations:
- A high index of suspicion for tick-borne infections is necessary, as these illnesses can present with nonspecific findings 2
- Prompt treatment with doxycycline is recommended, even in young children, when rickettsial infections are suspected 3, 2
- The choice of antibiotic therapy depends on the specific tick-borne infection suspected, with doxycycline being the treatment of choice for Rocky Mountain spotted fever, human monocytic ehrlichiosis, and human granulocytic ehrlichiosis 3
- Other tick-borne infections, such as Lyme disease, may require different antibiotic therapies, such as amoxicillin or penicillin 3
Prevention and Diagnosis
Prevention of tick-borne diseases depends on the avoidance of tick bites, and a high index of suspicion is necessary to recognize the clinical features of these illnesses 4
- Characteristic clinical features, such as erythema migrans in Lyme disease, or spotted rash in a spotted fever group disease, may serve as important diagnostic clues 4
- Patients at risk for tick bites may be coinfected with two or more tick-borne pathogens, making diagnosis and treatment more complex 4
- Awareness of the diseases that can be transmitted by ticks in specific locations is key to detection and selection of appropriate treatment 5
Special Considerations
Children are at an increased risk of tick bites due to their exposure to tick-infested areas during the summer, and pediatric emergency physicians should be aware of the risks associated with tick bites 6
- Tick bites can present with unusual symptoms, such as penile edema, and a high index of suspicion is warranted to accurately diagnose and initiate treatment 6