Makindo Medical Notes

Note: Tick paralysis predominantly affects children, presenting as ascending paralysis. Timely removal of the engorged tick typically results in a dramatic recovery.

Overview

• Geographic prevalence: Predominantly observed in the United States and Australia.
• High-risk group: Children with recent outdoor activities in tick-prone areas are most affected.
• Animals affected: Domestic animals and livestock, such as dogs and cattle, are also susceptible.
• Common tick species:
  • In the United States: Dermacentor andersoni and Dermacentor variabilis
  • In Australia: Ixodes holocyclus

Pathophysiology

• The tick's salivary glands secrete a neurotoxin during feeding, disrupting acetylcholine release at the neuromuscular junction.
• Neurotoxin effects peak between the fifth and seventh day of tick attachment, leading to paralysis.

Clinical Features

• Progressive paralysis: Symptoms emerge within 2-7 days of attachment, starting with weakness and progressing to ascending flaccid paralysis.
• Associated symptoms:
  • Paresthesia (tingling), restlessness, irritability, fatigue, and muscle pain (myalgias).
  • Cranial nerve involvement: Facial nerve palsy, bulbar palsy, and ophthalmoplegia.
  • Advanced stages: Respiratory failure and hyporeflexia (reduced reflexes).
• Tick bite location: Commonly found on the scalp, nape of the neck, or hidden areas of the body, necessitating a thorough examination.

Differential Diagnosis

• Guillain-Barré Syndrome (GBS): Similar presentation with ascending paralysis, but GBS is immune-mediated and develops more gradually.

Investigations

• Clinical assessment: A thorough physical examination to locate and identify the tick.
• Electromyography (EMG): May show reduced compound muscle action potential amplitude, distinguishing tick paralysis from other neuromuscular disorders.

Management

• Immediate tick removal: Use fine-tipped tweezers to grasp the tick close to the skin’s surface and pull upward with steady pressure. Avoid crushing the tick.
• Monitoring and supportive care:
  • Observe for signs of respiratory distress; mechanical ventilation may be necessary in severe cases.
  • Provide hydration and supportive therapies as needed.
• Prevention:
  • Wear protective clothing such as long-sleeved shirts and pants in tick-prone areas.
  • Use insect repellents containing DEET or permethrin.
  • Conduct thorough body checks after outdoor activities, paying attention to hidden areas.

Key Takeaways

• Tick paralysis is a rare, reversible cause of acute flaccid paralysis.
• Early detection and removal of the tick are critical to prevent severe complications.
• Preventive measures are essential, especially in regions with high tick activity.