π·οΈ Note: Tick paralysis most often affects children, presenting as an acute ascending flaccid paralysis. Removal of the engorged tick usually results in rapid and dramatic recovery within 24β48 hours.
π Overview
- Geographic prevalence: Mainly seen in the United States and Australia.
- High-risk group: Children with recent outdoor activities in tick-prone areas.
- Animals affected: Dogs, cats, and cattle are also vulnerable (important in veterinary practice).
- Tick species:
- πΊπΈ Dermacentor andersoni & Dermacentor variabilis
- π¦πΊ Ixodes holocyclus
𧬠Pathophysiology
- Tick saliva contains a neurotoxin that blocks acetylcholine release at the neuromuscular junction.
- Toxin effects peak after 5β7 days of attachment β progressive paralysis.
- Distinct from GBS: not immune-mediated, and symptoms reverse quickly once the tick is removed.
π©Ί Clinical Features
- Progressive paralysis: Onset 2β7 days post-attachment β ascending flaccid paralysis.
- Associated symptoms:
- π Paresthesias, irritability, fatigue, myalgias.
- π§ Cranial nerve involvement: facial palsy, bulbar palsy, ophthalmoplegia.
- β οΈ Severe: respiratory failure, hyporeflexia/areflexia.
- Tick bite location: Often hidden (scalp, nape, skin folds). Thorough examination is essential.
π§Ύ Differential Diagnosis
- Guillain-BarrΓ© Syndrome (GBS): Both cause ascending paralysis, but GBS develops over daysβweeks, is immune-mediated, and requires immunotherapy, whereas tick paralysis reverses after tick removal.
π§ͺ Investigations
- Clinical assessment: Careful skin and scalp inspection to identify tick.
- Electromyography (EMG): May show reduced CMAP amplitude but improves after tick removal.
- Lab tests generally unremarkable β diagnosis is clinical + confirmed by tick detection.
βοΈ Management
- Immediate tick removal: Use fine-tipped tweezers, grasp close to skin, pull steadily upward. β Do not crush or burn the tick.
- Monitoring and supportive care:
- Watch closely for respiratory compromise; ventilation if needed.
- Hydration, analgesia, reassurance for child and family.
- Prevention:
- π Wear long sleeves/pants in tick-prone areas.
- π¦ Use repellents (DEET or permethrin-treated clothing).
- π Full-body tick checks after outdoor activities.
π Key Takeaways
- π·οΈ Tick paralysis = rare, reversible cause of acute flaccid paralysis.
- β±οΈ Early tick detection and removal β rapid recovery, often within 24 hours.
- β Always consider in children with acute paralysis + outdoor exposure, to avoid misdiagnosis as GBS.