Tick bites

Assessment

History

If the patient has a history of allergic reactions to tick bites, the tick should only be removed where resuscitation facilities are readily available.

Determine domestic travel and activity (e.g. bushwalking).

In patients who present with symptoms suspicious for an Australian tick-borne disease, knowledge of where the patient has travelled in Australia will assist with differential diagnosis.

• Mosquito-borne diseases may present in the acute phase similarly, those at risk of tick bites are also likely to be at risk of mosquito bites. Bites can appear similar (if tick is not seen), particularly if the wound is inflamed and scratched.
• Keep an open mind when patients speak of symptoms associated with tick bites. The patient may have other underlying medical issues brought to light at the time of the tick bite, therefore a considered investigation of the whole clinical history is indicated.

Causes and clinical presentation

Suspect Australian tick-borne diseases (or Australian vector-borne diseases) and seek expert advice in patients who:

• have not travelled overseas and
• who have or may have recently or in the past been bitten by a tick, or
• who engage in activities such as bushwalking and
• present with relevant acute or chronic symptoms.

A local allergic reaction to ticks is not uncommon and may take the form of urticaria or induration (due to tick saliva), scrub itch (due to infestations of nymphs) or rash.

Tick bites in Australia can lead to a variety of illnesses in patients. These include infection, allergies (e.g. mammalian meat allergy), paralysis, autoimmune disease, post-infection fatigue and Australian multisystem disorder.

Examination

A-G clinical assessment, specifically presence of tick bite, rash or enlarged lymph nodes.

Do not remove tick – see Management.

Assess patients for additional ticks, particularly scalp, skin folds (including joints) and patient clothing.

Management

Treatment – confirmed tick

• Cover the tick with an ether-containing spray or permethrin cream.
• Do not attempt to remove the tick with tweezers as the head can pull off and remain embedded.
• Wait approximately 10 minutes for the tick to die, then carefully brush off.

Treatment – suspected tick

Tick bite diagnoses are challenging as clinical features can be similar to many other diseases (infectious and non-infectious).

Refer to primary care provider and or consult with appropriate experts in vector-borne diseases, including specialist microbiologists with diagnostic experience and infectious disease physicians for treatment of diagnosed vector-borne diseases.

Background

Tick bites have the potential to cause an anaphylactic reaction. Treatment of anaphylaxis is a clinical priority.

Diagnosis of tick-borne disease known to exist in Australia is challenging.

The focus of this clinical tool is acute tick bites.

For more comprehensive information about Australian and international tick bites refer to Australian Government Department of Health and Aged Care: Debilitating symptom complexes attributed to ticks (DSCATT) clinical pathway

Patient information

Tick bites
Source: Healthdirect

Insect bites and stings
Source: Healthdirect