Last night a patient came into the Urgent Care with a tick on his belly. He recently returned from a trip to New York State and he was concerned about the possibility of developing Lyme disease. When I looked at the tick, I noticed that it was small and almost translucent. It was attached to his skin but its head was still clearly visible and had not burrowed below the surface of the skin on his abdomen.
Tick bites are common this time of year. They occur on humans as well as animals such as dogs. Many different types of ticks in the United States, only some of which are capable of transmitting infections. The risk of developing an infection such as Lyme disease after being bitten depends upon the geographic location, season of the year, type of tick and how long the tick was attached to the skin.
The risk of acquiring an infection from a tick is actually quite low. In the case of my patient, the tick hadn’t even taken a blood meal – ie. it was not engorged with blood. His risk of developing Lyme disease from that tick was absolutely 0%. Ticks transmit infection only after they have attached and become engorged with blood. Deer ticks that transmit Lyme disease must feed for more than 36 hours before transmission of the organism called Borrelia burgdorferi.
If you come in to see me after you’re bitten by a deer tick (the type that carries Lyme disease), I would generally advise one of two approaches:
1) Observe the area and treat with antibiotics only if signs of infection develop
2) Treat with antibiotics immediately as a preventative measure
The individual patient’s history, the type of tick and how long it was attached and the patient’s wishes will help determine which approach to take.
How to Remove a Tick: Some patients come in to see me after they’ve already tried removing a tick and have been unsuccessful or partially successful. I commonly see patients who come in after they’ve removed only part of the tick and the head and are concerned because the tick head is still buried below the skin. Here is the technique that I use to remove a tick:
1) Do not attempt to use a match, cigarette, nail polish, Vaseline, liquid soap or kerosene because it may just irritate the tick and cause it to inject the harmful organism into the wound
2) Use fine tipped tweezers to grasp the tick as close to the skin as possible
3) Pull back gently but firmly using even, steady pressure without jerking or twisting the tick
4) After removing the tick, wash the skin and hands with warm soapy water
5) If any part of the tick is still in the skin, they generally come out on their own. I don’t recommend attempting to remove little pieces of the tick at home as this can cause skin trauma and scarring.
6) Go see your medical provider if you are concerned about not being able to remove the tick.
Treatment: The Infectious Diseases Society of America recommends treatment with antibiotics preventatively only in people who meet ALL the criteria below:
1) The attached tick was identified as an adult or nymph deer tick
2) The tick was attached for more than 36 hours based on how engorged the tick appears and the amount of time since outdoor exposure
3) Antibiotic treatment can begin within 72 hours of tick removal
4) The area where the tick bite occurred was in an area where the organism B. burgdorferi infection rate is greater than 20% – generally in parts of New England, parts of the mid-Atlantic states and parts of Minnesota and Wisconsin.
5) The patient can take doxycycline – i.e. the patient is not pregnant or breastfeeding a young child or allergic to this antibiotic.
If all the criteria above are met, the treatment is a single dose of doxycycline 200mg for adults and 4mg/kg up to a maximum of 200mg for children older than 8 years of age.
Symptoms of Lyme disease: What the area where the tick bite occurred and observe for expanding redness. The rash that is associated with Lyme disease is called erythema migrams (EM). This rash is a salmon color usually and typically expands over a few days or weeks and can reach up to 8 inches in diameter. The center of the rash tends to become skin colored (clear) as the rash grows in size. This gives the rash a sort of “bull’s eye” appearance. The rash generally doesn’t cause any symptoms.
Other associated symptoms of Lyme disease could include:
1) A few days to a month after the bite: fatigue, malaise, lethargy, mild headache, mild neck stiffness, aches, joint pain and enlarged lymph nodes.
2) Weeks to months after the bite: Inflammation of the heart, heart rhythm problems, meningitis, encephalitis, severe joint pain, multiple areas of rash, eye pain/vision problems, liver disease, kidney disease.
This document is for informational purposes only, and should not be considered medical advice for any individual patient. If you have questions please contact your medical provider.
I hope that you have found this information useful. Wishing you the best of health,
Scott Rennie, DO