Tick-Borne Illnesses: Identification and Management in the Emergency Department

Points and Pearls Excerpt

• Common presentations of tick-borne illnesses include fever, myalgia, rash, fatigue, headache, vomiting, and diarrhea.
• Consider tick paralysis in patients who present with ataxia and ascending paralysis; facial nerve paralysis and ophthalmoplegia may also be present.
• A vital component of the physical examination is a thorough head-to-toe examination for the presence of a tick, particularly in the hair, axilla, and groin, where attached ticks can be easily missed.
• If a tick is found, remove it using tweezers or fine-tip forceps by grasping the head of the tick near where it enters the skin and pulling the tick straight out with gentle, even pressure.

Most Important References

• Buckingham SC. Tick-borne infections in children: epidemiology, clinical manifestations, and optimal management strategies. Paediatr Drugs. 2005;7(3):163- 176. (Review article) https://link.springer.com/article/10.2165/00148581-200507030-00003
• Cohn KA, Thompson AD, Shah SS, et al. Validation of a clinical prediction rule to distinguish Lyme meningitis from aseptic meningitis. Pediatrics. 2012;129(1):e46-e53. (Validation of a clinical prediction rule; 423 patients) DOI: http://dx.doi.org/10.1542/peds.2011-1215
• Wormser GP, Dattwyler RJ, Shapiro ED, et al. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006;43(9):1089-1134. (Clinical practice guidelines for tick-borne illnesses based on evidence and expert consensus from the Infectious Diseases Society of America) DOI: http://dx.doi.org/10.1086/508667
• American Academy of Pediatrics. Lyme disease. In: Kim-berlin DW, Brady MT, Jackson MA, et al, eds. Red Book: 2018 Report of the Committee on Infectious Diseases. 31st ed. Itasca: American Academy of Pediatrics; 2018:515-523. (Professional society recommendations) https://redbook. solutions.aap.org/chapter.aspx?sectionid=189640125&book id=2205
• Warshafsky S, Lee DH, Francois LK, et al. Efficacy of antibiotic prophylaxis for the prevention of Lyme disease: an updatd systematic review and meta-analysis. J Antimicrob Chemother. 2010;65(6):1137-1144. (Systematic review; 4 placebo-controlled clinical trials) DOI: http://dx.doi.org/10.1093/jac/dkq097