TICK BITE & FIRST AID

1. TICK BITE & FIRST AID
There are manydifferenttypesof ticks,some of whichare capable of transmittinginfections.The riskof
developingtheseinfectionsdependsuponthe geographiclocation,seasonof the year, type of tick,and,for
Lyme disease,howlongthe tickwasattachedto the skin
While manypeople are concernedafterbeingbittenbyatick,the riskof acquiringa tick-borne infectionisquite
low,evenif the tickhas beenattached,fed,andisactuallycarryinganinfectiousagent.Tickstransmitinfection
onlyaftertheyhave attachedand thentakena bloodmeal fromtheirnew host.A tick thathas not attached
(andtherefore hasnotyetbecome engorgedfromitsbloodmeal) hasnotpassedanyinfection.Since the deer
tickthat transmitsLyme disease mustfeedfor>36 hours before transmissionof the spirochete,the riskof
acquiringLyme disease fromanobservedtickbite,forexample,isonly1.2to 1.4 percent,eveninanarea
where the disease is common.
The organismthat causesLyme disease,Borreliaburgdorferi,liesdormantinthe inneraspectof the tick's
midgut.The organismbecomesactive onlyafterexposuretothe warmbloodmeal enteringthe tick'sgut.Once
active,the organismentersthe tick'ssalivaryglands.Asthe tickfeeds,itmustgetridof excesswaterthrough
the salivaryglands.Thus,the tickwill literallysalivateorganismsintothe wound,therebypassingthe infection
to the host.
If a personisbittenbya deertick(the type of tick that carriesLyme disease),ahealthcare providerwill likely
advise one of twoapproaches:
●Observe andtreatif signsor symptomsof infectiondevelop
●Treat witha preventiveantibioticimmediately
There isno benefitof bloodtestingforLyme disease atthe time of the tickbite;evenpeoplewhobecome
infectedwillnothave apositive bloodtestuntilapproximatelytwotosix weeksafterthe infectiondevelops
(post-tickbite).
Before seekingmedical attention,the affectedpersonorhouseholdmembershouldcarefullyremove the tick
and make note of its appearance.Onlythe Ixodesspeciesof tick,alsoknownasthe deertick,causesLyme
disease.
HOW TO REMOVE A TICK
The properway to remove atick isto use a setof fine tweezersandgripthe tickas close to the skinas is
possible.Donotuse a smolderingmatchorcigarette,nail polish,petroleumjelly(eg,Vaseline),liquidsoap,or
kerosene because theymayirritate the tickandcause it to behave like asyringe,injectingbodilyfluids intothe
wound.
The propertechnique fortickremoval includesthe following:
●Use fine tweezerstograspthe tick as close tothe skinsurface aspossible.
●Pull backwardsgentlybutfirmly,usinganeven,steadypressure.Donotjerkor twist.
●Do not squeeze,crush,orpuncture the bodyof the tick,since itsbodilyfluidsmaycontaininfection-causing
organisms.
●Afterremovingthe tick,washthe skinandhandsthoroughlywithsoapandwater.
●If any mouthparts of the tickremaininthe skin,these shouldbe leftalone;theywillbe expelledontheirown.
Attemptstoremove these partsmayresultinsignificantskintrauma.

2. AFTER THE TICKIS REMOVED
Tick characteristics — It ishelpful if the personcanprovide informationaboutthe size of the tick, whetherit
was actuallyattachedtothe skin,if itwasengorged(thatis,full of blood),andhow longitwasattached.
●The size and colorof the tickhelpto determinewhatkindof tickitwas;
●Ticksthat are brownand approximatelythe size of apoppyseedorpencil pointare deerticks.These can
transmitBorreliaburgdorferi (thebacteriumthatcausesLyme disease) andanumberof othertick-borne
infections,includingbabesiosisandanaplasmosis.
●Ticksthat are brownwitha white collarandabout the size of a pencil eraserare more likelytobe dogticks
(Dermacentorspecies).Theseticksdonotcarry Lyme disease,butcanrarelycarry anothertick-borne infection
calledRockyMountainspottedfeverthatcan be seriousorevenfatal.
●A brownto blacktickwitha white splotchonitsbackis likelyafemale Amblyommaamericanum(Lone Star
tick;namedafterthe white splotch).Thisspeciesof tickhasbeenreportedtospreadan illnesscalledSTARI
(southerntick-associatedrashillness).STARIcausesarash that issimilartothe erythemamigransrash,but
withoutthe otherfeaturesof Lyme disease.Althoughthisrashisthoughttobe causedbyan infection,acause
for the infectionhasnotyetbeenidentified.Thistype of tickcan alsocarry and transmitanotherinfection
calledhumanmonocyticehrlichiosis.
●A tickthat was notattached,was easyto remove orjustwalkingonthe skin,andwas still flatandtinyandnot
full of bloodwhenitwasremovedcouldnothave transmittedLyme disease or anyotherinfectionsince ithad
not yettakena bloodmeal.
●Onlyticksthat are attached andhave finishedfeedingorare near the endof theirmeal can transmitLyme
disease.Afterarrivingonthe skin,the tickthatspreadsLyme disease usuallytakes 24hoursbefore feeding
begins.
●Evenif a tick isattached,it musthave takena bloodmeal to transmitLyme disease.Atleast36 to48 hoursof
feedingisrequiredforatick to have fedandthentransmitthe bacteriumthatcauses Lyme disease.Afterthi s
amountof time,the tickwill be engorged(full of blood).Anengorgedtickhasa globularshape andislarger
than an unengorgedone.
●It isnot clearhowlong a tickneedstobe attachedto transmitbacteriaotherthanBorreliaburgdorferi.
Needfortreatment — The clinicianwill reviewthe descriptionof the tick,alongwithanyphysical symptoms,to
decide uponacourse of action. Recommendspreventive treatmentwithantibioticsonlyinpeople whomeet
ALL of the followingcriteria:
●Attachedtickidentifiedasan adultor nymphal I.scapularis(deer) tick
●Tick isestimatedtohave beenattachedfor≥36 hours(baseduponhow engorgedthe tickappearsor the
amountof time since outdoorexposure)
●The antibioticcanbe givenwithin72hoursof tickremoval
●The local rate of tickinfectionwithB.burgdorferi is≥20percent
●The personcan take doxycycline (eg,the personisnotpregnantorbreastfeedingora child<8 yearsof age)
If the personmeetsALLof the above criteria,the recommendeddose of doxycycline isasingle dose of 200 mg
for adultsand4 mg/kg,up to a maximumdose of 200 mg,in children≥8 years.
If the personcannottake doxycycline,notrecommendedpreventivetreatmentwithanalternate antibioticfor
several reasons:there are nodata to supporta shortcourse of anotherantibiotic,alongercourse of antibiotics

3. may have side effects,antibiotictreatmentishighlyeffectiveif Lyme disease weretodevelop,andthe riskof
developingaseriouscomplicationof Lyme disease afterarecognizedbite isextremelylow.
MONITORINGFOR LYME DISEASE
Many people have incorrectinformationaboutLyme disease.Forexample,some people are concernedthat
Lyme disease isuntreatableif antibioticsare notgivenearly(thisis untrue;evenlaterfeaturesof Lyme disease
can be effectivelytreatedwithappropriateantibiotics).Manylocal Lyme disease networksandnational
organizationsdisseminate unproveninformationandshouldnotbe the sole source of educationaboutLyme
disease.Reputable sourcesare listedbelow.
Signsof Lyme disease — Whetherornot a clinicianisconsultedafteratickbite,the personwhowasbitten(or
the parents,if a childwas bitten) shouldobservethe areaof the bite forexpandingredness,which would
suggesterythemamigrans(EM),the characteristicrashof Lyme disease .
The EM rashis usuallyasalmoncoloralthough,rarely,itcan be an intense red,sometimesresemblingaskin
infection.The colormaybe almostuniform.The lesiontypicallyexpandsoverafew daysor weeksandcan
reach over20 cm (8 inches) indiameter.Asthe rashexpands,itcanbecome clear(skin-colored) inthe center.
The centerof the rash can thenappeara lightercolorthanitsedgesor the rash can developintoaseriesof
concentricringsgivingita "bull'seye"appearance.The rashusuallycausesnosymptoms,althoughburningor
itchinghasbeenreported.
In people withearlylocalizedLyme disease,EMoccurs withinone monthof the tick bite,typicallywithinaweek
of the tickbite,althoughonlyone-thirdof people recall the tickbite thatgave themLyme disease.Components
of ticksalivacan cause a short-lived(24to48 hours) rashthat shouldnotbe confusedwithEM. Thisreaction
usuallydoesnotexpandtoa size largerthana dime.
Approximately80percentof people withLyme disease developEM;10 to 20 percentof people have multiple
lesions.If EMor othersignsor symptomssuggestive of Lyme disease develop,the personshouldsee a
healthcare providerforproperdiagnosisandtreatment