Ticks

Through its bite, a Tick can transmit a variety of organisms (e.g., bacteria, virus) to humans that cause a wide array of infectious diseases in children.

The most common diseases caused by tick bites include Rocky Mountain spotted fever (RMSF) and Lyme disease.

  • Ticks are often found in tall grass, where they will rest themselves at the tip of a blade so as to attach themselves to a passing animal or human.
  • It is a common misconception that the tick can jump from the plant onto an animal or human.
  • Physical contact is the only method of transportation for ticks.
  • Ticks contain a structure in their mouth area that allows them to anchor themselves firmly in place while sucking blood.
  • They will generally drop off of an animal when full, but this may take several days.
  • Many patients do not recall a tick bite in cases where a tick-borne disease is present.
  • Fortunately, the likelihood of disease transmission from the bite of an infected tick is very small but increases the longer the tick is attached.
  •  In general, the deer tick that causes Lyme disease is unlikely to transmit the organism that causes the disease if attached less than a day but highly likely if attached more than 3 days.

Rocky Mountain Spotted Fever (RMSF)

What is the cause of RMSF and who is at risk?


  • RMSF is caused by a species of bacteria that is spread to humans by hard ticks (Ixodidae).
  • The American dog tick, is perhaps the most well-known of the North American hard ticks and is the tick responsible for RMSF in the eastern and central US states (see photo called American dog tick).
  • The Rocky Mountain wood tick is responsible for RMSF in the west (see photo called Rocky Mountain wood tick).
  • Individuals with frequent exposure to dogs and who reside near wooded areas or areas with high grass may also be at increased risk of infection.
  • Previous studies had indicated that the highest incidence of RMSF occurred in children under the age of 10 years, but recent evidence points to the 40-64 year old age group as having the highest incidence.
  • Over 90% of patients with RMSF are infected during April through September.

Where can a child be exposed to the tick that passes the bacteria that causes RMSF?

Not just the Rocky Mountain states.

  • RMSF has been reported from every U.S. state except Hawaii, Vermont, Maine, and Alaska.
  • Over 1/2 of reported cases of RMSF are from only 5 states: North Carolina, South Carolina, Tennessee, Oklahoma, and Arkansas.

How long after a tick bite can a child become ill with RMSF?

  • Patients infected with the bacteria that causes RMSF start to become ill approximately 5-10 days after a tick bite.

What are the signs and symptoms of Rocky Mountain spotted fever?

The early clinical presentation of Rocky Mountain spotted fever is nonspecific and may resemble a variety of other infectious and non-infectious diseases.

Initial symptoms may include:

Later signs and symptoms include:

  • The rash first appears 2-4 days after the onset of fever and is often not present or may be very subtle when the patient is initially seen by a physician.
  • The rash may occur sooner in children and eventually develops in 90% of childhood cases.
  • Most often it begins as small, flat, pink, non-itchy spots on the wrists, forearms, and ankles.
  • These spots turn pale when pressure is applied (blanches) and eventually become raised on the skin.
  • The characteristic red, spotted (petechial) rash of Rocky Mountain spotted fever is usually not seen until the sixth day or later after onset of symptoms (see photo called Petechiae).
  • The petechial rash occurs in only 1/2 of patients with Rocky Mountain spotted fever.
  • The rash involves the palms or soles in as many as 50% to 80% of patients.

What is the treatment for RMSF?

  • The disease can be difficult to diagnose in the early stages, and without prompt and appropriate treatment it can be fatal.
  • Effective antibiotic therapy, usually a tetracycline such as doxycycline, has dramatically reduced the number of deaths caused by Rocky Mountain spotted fever.
  • Appropriate antibiotic treatment is initiated immediately when there is a suspicion of Rocky Mountain spotted fever.
  • If the patient is treated within the first 4-5 days of the disease, fever generally subsides within 24-72 hours after treatment with an appropriate antibiotic.

Lyme disease

What is the cause of Lyme disease?

  • The deer (or black-legged) tick is common to the Northeast and upper Midwest and is known for spreading Lyme disease (see photo called Deer tick).
  • These ticks get the bacteria that cause Lyme disease from mice and then pass it along to humans.
  • These ticks are smaller than the dog ticks that cause Rocky Mountain Spotted Fever and harder to detect.

Where can a child be exposed to the tick that causes Lyme disease?

  • Nearly 90% of all Lyme disease cases have been reported in the Northeastern and upper midwestern areas of the US.

How long after a tick bite can a person become ill with Lyme disease?

  • The period of time from infection to the onset of symptoms is usually within 1 week but can be as long as a month.
  • In some cases, there are no symptoms at all.

What are the signs and symptoms of Lyme disease?

Lyme disease has many signs and symptoms, but skin signs, arthritis and/or various neurological symptoms are often present.

Acute (early) symptoms that may occur:

- usually appears 1 – 2 weeks after the disease is transmitted
and may last 3 – 5 weeks

- the rash may also have a bulls-eye shape to it around the site
of the bite

- two or more areas of the rash may occur later in the disease


Some of the Chronic (late) symptoms
 if left untreated:

  • meningitis
  • neuropathy – numbness, tingling
  • muscle and joint aches (arthritis)
  • fatigue
  • tachycardia (too-rapid heartbeat)
  • irregular heart rythm

What is the treatment for Lyme disease?

  • Early diagnosis and treatment relieves your symptoms and protects you against Lyme disease appearing at a later and often more serious stage.
  • Doctors will treat Lyme disease with antibiotics including doxycycline, penicillins, or erythromycin.

Prevention tips

  • Limiting exposure to ticks is the most effective way to reduce the likelihood of Rocky Mountain Spotted Fever or Lyme disease.

Avoidance

Avoid walking in tall grass or thick ground cover.

In the woods or wilderness, try to stay on cleared trails

What to wear

Wear light-colored clothing outdoors to help spot ticks.

Wear long sleeves and long pants tucked into your socks or boots.

Use a hat for added protection.

Don’t wear sandals or other open-toed shoes.

Use repellents

If you can get it, spray a repellent containing permethrin on your clothes (not the skin)

Also, protect your pets by using flea and tick sprays and collars.

Talk to your veterinarian about getting your pets vaccinated against Lyme disease.

Be careful when using repellents that contain DEET in kids

Important note:

1.  DEET is absorbed through the skin.

2.  In high concentrations, DEET can have harmful side effects

3.  The American Academy of Pediatrics recommends that repellents with no more than 6 to 10% DEET be applied to children over the age of two.

Self-inspection

After being outdoors, check your child’s body and hair for ticks.  You can use a fine-tooth comb to find ticks in hair.

Check the pets too.

Tick removal

It may take several hours of attachment before organisms are transmitted from the tick to an animal or person; therefore regular checks and timely tick removal can help prevent disease.

Pulling a tick out forcefully may squeeze contents of the tick back into the bite and often leaves the mouthpiece behind, which may result in infection.

  • To remove a tick, grasp it with a pair of tweezers at the head, as close to the skin as possible
  • Gently pull straight up with a slow, steady force. Try not to break or crush the tick.
  • Wash the bite site with soapy water.
  • See photo called Tick removal