injuries poisoning
Tick Bites
Treatment of Tick Bites
Tick removal with blunt, curved forceps Sometimes prophylacticdoxycycline Tick removalshould occur as soon as possible to reduce the cutaneous immune response and the likelihood of disease transmission. If the patient presents with the tick still attached, the best method of extracting the tick and all of its mouth parts from the skin is by using a blunt forceps with medium-sized, curved tips. The forceps should be placed parallel to the skin to grasp the tick’s mouth parts firmly as close to the skin as possible. Care should be taken to avoid puncturing the patient’s skin and the tick’s body. The forceps should be pulled slowly and steadily, directly away from the skin without twisting. Curved-tip forceps are best because the outer curve can be laid against the skin while the handle remains far enough from the skin to grasp easily. Tick mouth parts that remain in the skin and are readily visible should be removed carefully. However, if the presence of mouth parts is questionable, attempts at surgical removal may cause more tissue trauma than would occur if the parts are left in the skin; leaving mouth parts in the skin does not affect disease transmission and, at most, prolongs irritation. Other methods of tick removal, such as burning it with a match (which can damage the patient’s tissues) or covering it with petroleum jelly (which is ineffective), are not recommended. After tick removal, an antiseptic should be applied. If local swelling and discoloration are present, an oral antihistamine may be helpful. Although rarely practical, the tick may be saved for laboratory analysis to check for etiologic agents of tick-borne disease in the geographic area where the patient acquired the tick. Pajaroello ticklesions should be cleaned, soaked in 1:20 Burow’s solution, and debrided when necessary. Corticosteroids are helpful in severe cases. Infections are common during the ulcer stage but rarely require more than local antiseptic measures. A single dose ofdoxycycline(200 mg for adults and 4 mg/kg to a maximum of 200 mg for children≥8 years) should be considered when all of the following criteria are met: The tick is an adult or nymphalIxodes scapularis. The tick is estimated to have been attached for≥36 hours based on degree of engorgement or certainty about time of exposure. Prophylaxis can be started within 72 hours after the tick was removed. The local rate of infection of ticks withBorrelia burgdorferiis≥20%. Doxycyclineis not contraindicated. However, theBorreliaspirochete has a longer than average reproductive cycle and is susceptible to antibiotics only during the reproductive phase. Therefore, some experts recommend a longer course ofdoxycycline(100 mg orally 2 times a day for up to 4 weeks) to ensure eradication. Prior to considering this longer course, consultation with an infectious disease specialist is recommended. 