• Knowledgebase: Information on Specific Illnesses

    Here you will find discussions of specific illnesses and their management.

    35. Ticks, Lyme Disease, and Rocky Mountain Spotted Fever - Top

    I have received several questions concerning ticks and so I will devote this month's column to how ticks may affect your child's health this summer.

    Fortunately most ticks do not carry disease and most tick bites result in no reaction or only a local reaction to the bite. In rare cases, ticks do carry germ that can result in Rocky Mountain Spotted Fever or Lyme disease. Even more rare are ticks carrying a toxin that can cause tick paralysis.

    Rocky Mountain Spotted Fever, despite its name, is rare in the West and North Carolina is the second most common state for cases of Rocky Mountain Spotted Fever. Tick attachment of at least 4 hours in necessary for this disease to occur. From time of tick attachment to the onset of disease is from two to ten days. It generally begin with high fever and severe headache and also the association of severe muscle aches. Two to mix days after the onset of fever, that persists, is a faint red rash generally beginning on arms and legs, (especially palms and soles). This rash then changes to purple dots on palms and soles and can quickly change to small bruises. If not treated early it can be fatal (more mo in adults than children). The treatment is with one of two antibiotics (chloramphenicol or tetracycline). Unfortunately both of these antibiotics carry significant side effects in children and should not be started unless there is certainty or high probability of Rocky Mountain Spotted Fever.

    Lyme Disease is carried by a small deer tick common in New England, the Northern Atlantic Coast and the Western Great Lakes areas. The disease we named after the town of Lyme, Connecticut after the persistence of some mothers of affected children in that area. There are a few reported cases every year in North Carolina and the numbers seem to be increasing slightly. The disease begins with a circular reddened rash forming around the tick bite 3 - 30 days after the initial bite. This circular red rash enlarges sometimes up to 8 - 10 inches. Up to 4 weeks after the rash, the patient may develop arthritis of one or a few joints. They may also then develop flu-like symptoms t headache, fatigue, muscle aches, fever). Twenty (20%) percent of cases will develop neurologic symptoms like Bell's palsy (facial paralysis) or meningitis. The diagnosis can be very difficult due to the inconsistency of symptoms from patient to patient and no easily diagnostic test. Treatment is possible with antibiotics (either penicillin or tetracycline).

    Tick paralysis is a rare complication to tick bites. The tick actually injects a toxin in the patient that causes paralysis that starts in the leg" and progressively moves upward. The ascending paralysis begins one to two days after the tick attaches. The disease stops and the patient recovers soon after the tick is removed which in different from Rocky Mountain Spotted Fever or Lyme Disease.

    Lastly, I would like to discuss the proper removal of attached ticks. Old methods were to apply petroleum jelly or heat to get the tick to aback out.. This is generally not effective and not recommended. Presently, we suggest that the head of the tick should be grasped with tweezers and gently removed intact or use a needle to remove the head with the top layer of skin to which it is attached. After removal of tick, they should be destroyed without getting blood on anyone and you should wash your hands well. If you are uncertain about removal or any other problems with ticks, please contact your doctor. - Updated: August 28, 2001

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    • James L Horwitz, MD

    David C. Thomas, MD

    Barbara Lindberg, PNP