Prevention and treatment information for tick borne illnesses

For  children in this area who love to play outdoors during the summer, tick bites are almost a foregone conclusion. That's why it is extremely important for parents to know how to properly remove ticks as well as identify the signs for certain tick-borne illnesses such as Rocky Mountain Spotted Fever and Ehrlichiosis. We talked to Dr. Sandy Arnold, infectious disease specialist at Le Bonheur Children's Hospital, about what parents need to look for after pulling a tick off of a child. 

First off, what are ticks and why are they so potentially harmful?

Ticks are arachnids that live in wooded areas and fields and can drop or crawl on you from the vegetation.Ticks can also be brought in to your home on a pet. 

Ticks feed on blood and can transmit diseases to whomever they bite.The diseases ticks carry depend on where you live. Ticks attach to animals (including humans) and will feed for several days. Before they fill with blood they can be difficult to see. A tick that is filled with blood has been attached for a while. Transmission of tick borne diseases usually takes place after the tick has been attached for a while. Finding a tick right away by performing tick checks after coming in from outside can prevent the tick from transmitting disease.

What should I do if I am bitten by a tick?

It is very important not to use any home remedies to remove a tick. Things like nail polish, petroleum jelly, heat or flames are not effective.

Use tweezers to grasp the part of the tick that is closest to the skin. Apply steady upward pressure to pull the tick's mouthparts from your skin. If you pull too hard, the mouth parts may break off. If this happens, you need to use the tweezers to pull out the remaining parts of the tick if possible.

Once the tick is removed, clean your hands and the area well with soap and water or rubbing alcohol. The saliva from the tick can be irritating and cause some redness and discomfort at the site. However, this does not necessarily mean the site is infected. Some diseases transmitted by ticks will result in a lesion or rash at the site of the tick bite but many do not. If your child develops a skin abnormality in the area from which you removed the tick, consult your child's pediatrician.

What illnesses can I get from a tick in this region?

There are several important tick borne illnesses that are relatively common in the Mid-South. Lyme disease is not transmitted in this region. While the tick that carries disease, (Black Legged tick) is found in this region, its feeding habits make it highly unlikely to transmit Lyme disease in this part of the country. This may, however, change with time.

1. Southern Tick Associated Rash Illness (STARI): It is thought that cases of Lyme-like illness with the classic "bull's-eye" rash at the site of the tick bite that occurs in this region is cause by Southern Tick Associated Rash Illness (STARI). The rash is very similar to that seen with Lyme disease and these can be easily confused. This rash may be accompanied by fatigue, headache, fever and muscle pains. The cause of STARI is unknown. As it appears very similar to Lyme Disease, most physicians will treat this infection with antibiotics. Many people believe they have Lyme disease when they have unexplained medical symptoms such as chronic fatigue, joint pains or headaches. There is no connection between these symptoms and Lyme disease and giving long term antibiotics for these symptoms does not help and can cause harm. There are guidelines that recommend whom to test for Lyme disease and the type of tests and interpretation of these test.

2. Rocky Mountain Spotted Fever (RMSF): Caused by Rickettsia rickettsii, RMSF is an infection transmitted by the dog tick. Symptoms can begin 2 to 14 days after a tick bite and include fever, rash (which appears 2-5 days after onset of illness), headache, nausea, vomiting, abdominal pain, muscle pain, red eyes, confusion and neck pain.

3. Ehrlichiosis: Erlichiosis is transmitted by the Lone Star tick in this region. The symptoms of Ehrlichiosis usually develop within 1-2 weeks after being bitten by an infected tick. There are many symptoms associated with Ehrlichiosis. These are similar to symptoms of Rocky Mountain Spotted Fever. Patients with Ehrlichiosis have fever, chills, headache, malaise, muscle pain, nausea, vomiting, diarrhea, red eyes, confusion and rash (not at the site of the tick bite). While the rash is different from that of RMSF, these two diseases can be difficult to distinguish.

These diseases can be difficult for physicians to diagnose because the symptoms overlap with many common, self-resolving, viral illnesses. It is important to note that not all patients have all symptoms and some people have very mild or no symptoms. Unfortunately, there is no test that your doctor can do to easily diagnose these infections when they first begin so treatment must be started based on suspicion. The infection may be confirmed by doing a blood test 10-14 days after the diagnosis but this will not influence the decision to treat. If your child has an illness with fever that persists for more than 2-3 days, especially during the summer, and is associated with a rash, you should take your child to be assessed, even if you have already seen a doctor for this condition. Treatment should never be withheld pending the results of a blood test. Severe Ehrlichiosis or RMSF infection can be fatal if not treated appropriately. Prompt treatment is associated with rapid resolution of symptoms. The appropriate treatment for Ehrlichiosis and RMSF is doxycycline for children of all ages even though this antibiotic is not used to treat other infections in children under 8 years of age. This is the drug recommended by both the Centers for Disease Control and the American Academy of Pediatrics. No other drug should be used to treat these infections. There is no evidence that short courses of doxycycline will cause staining of the teeth.

4. Tularemia: Tularemia is a disease that can be transmitted by both the Lone Star tick and the Dog Tick. This disease is much less common than the others. While tick borne Tularemia can present in many ways, it may be associated with an ulcerated lesion at the site of the tick bite with or without a swollen lymph node nearby. This is often associated with fever. If this occurs, you should see your child's doctor.

5. Tick Paralysis: Tick paralysis has been described all over the U.S. although it is not most common in our region. There are many different ticks associated with this condition which results from a toxin in the tick saliva. It results in ascending paralysis which resolves within 24 hours of tick removal. Careful examination for ticks should be done in anyone with rapidly progressive muscle weakness.

How can I prevent my child from being exposed to these illnesses?

The best prevention for tick infections is the prevention of tick bites. The Centers for Disease Control and Prevention recommends the following to prevent tick attachment:

• Avoid areas with high grass and leaf litter and walk in the center of trails when hiking.
• Use repellent that contains 20 percent or more DEET, picaridin, or IR3535 on exposed skin for protection that lasts several hours.
• Use products that contain permethrin to treat clothing and gear, such as boots, pants, socks and tents or look for clothing pre-treated with permethrin.
• Treat dogs for ticks. Dogs are very susceptible to tick bites and to some tickborne diseases. They may also bring ticks into your home. Tick collars, sprays, shampoos, or monthly “top spot” medications help protect against ticks.
• Bathe or shower as soon as possible after coming indoors to wash off and more easily find crawling ticks before they bite you.
• Conduct a full-body tick check using a hand-held or full-length mirror to view all parts of your body upon returning from tick-infested areas. Parents should help children check thoroughly for ticks. Remove any ticks right away.
• Tumble dry clothes in a dryer on high heat for 10 minutes to kill ticks on dry clothing after you come indoors. If the clothes are damp, additional time may be needed.

Please consult the CDC website for more information.