Joanna Rulf, DO
So, you've been enjoying some outdoor time as is your god-given right during Vacationland's gorgeous summer. You've applied your sunscreen, your insect repellent, and now you've found a tick on yourself, or on your child. What to do?
1. Remove it. You can use fine-tipped tweezers, grasping as close to the skin as possible and pulling upward with a steady, even pressure. Afterward, clean the area with soap and water, or rubbing alcohol. Don't crush the tick with your fingers, rather flush it down the toilet or drop it in alcohol to kill it. Removal techniques that are not recommended include applying petroleum jelly, nail polish, isopropyl alcohol, or a hot match. Unlike the use of tweezers, these techniques can increase the likelihood of tick mouth-parts being left in the skin.
Question: what happens if the mouth parts get stuck in my skin? Should I go digging? Should I come have you dig?
No. Let the area heal, and the mouth parts will eventually extrude themselves. Digging for them does not decrease your chance of contracting Lyme, but definitely will increase your chances of getting a skin infection and/or unsightly scar.
2. Identify it. Deer or Blacklegged ticks (Ixodes scapularis) are the ticks that typically carry Lyme and other tick-borne illnesses. Other common ticks we may find on ourselves are the much-larger dog ticks. It is useful to be able to distinguish between them (see figure below - the smaller/top one is the deer tick. The bottom/larger one is a dog tick).
Question: Should I keep the tick and have it tested for Lyme?
Probably not necessary as the tests done through online advertising are not necessarily trustworthy. A negative test could be false, and/or a tick testing positive for Lyme doesn't mean that you have contracted Lyme from that tick.
3. Do I need antibiotics to prevent Lyme disease?
Antibiotic prophylaxis is indicated for nonpregnant adults and children who meet all of the following criteria:
Attached tick is identified as an adult or nymphal I. scapularis tick (deer/blacklegged tick)
Tick is estimated to have been attached for ≥36 hours based on degree of engorgement or time of exposure
Prophylaxis is begun within 72 hours of tick removal.
The bite occurs in a highly endemic area. (ie, Maine. Other endemic areas can be found on the Centers for Disease Control and Prevention (CDC) website.)
Doxycycline is not contraindicated
Antibiotic regimen for Lyme prophylaxis consists of one dose of Doxycycline.
4. How common is Erythema migrans (the red expanding rash or the classic "bull's-eye rash) in people with Lyme disease?
"Classic" Lyme disease rash
This occurs in about 70-80% of cases nationally.
In Maine, the rash is reported in about 50% of cases. This is likely lower than the actual number since not all rashes are reported.
This usually appears 3-30 days after a tick bite.
Early on, the rash of Lyme disease may appear only as a flat red circle (usually two inches or more across) without the "bull's-eye" appearance.
The rash usually expands and then goes away. Its disappearance does not necessarily mean the infection is gone.
Call your doctor to start treatment if you have an erythema migrans rash.
5. What is early localized Lyme disease?
This develops days to weeks after becoming infected.
You may have:
Erythema migrans (the red expanding rash or the classic "bull's-eye" rash).
Flu-like symptoms, with or without the rash. These symptoms include lack of energy, headache, fever, chills, and muscle and joint pain.
When treated with antibiotics, early Lyme disease usually resolves.
6. What is disseminated Lyme disease?
This is when the bacteria that causes Lyme disease spreads throughout your body.
This can occur within days to months after the tick bite.
Symptoms include:
Multiple erythema migrans rashes.
Nervous system involvement (cranial nerve palsies, meningitis, radiculitis, peripheral nerve involvement, encephalopathy).
Heart involvement (carditis, heart block).
Connective tissue involvement (aching muscles, joints, or peri-joint areas, and frank arthritis).
Eye involvement (inflammation of every part of the eye has been reported.).
Disseminated Lyme disease is often accompanied by "flu-like" symptoms and extreme fatigue. Joint and muscle problems are often migratory and other symptoms may come and go.
8. What diseases can the ticks found in Maine carry?
The deer or black-legged tick (Ixodes scapularis) is the primary vector of Lyme disease, anaplasmosis, babesiosis, and Borrelia miyamotoi (a relapsing fever illness). Deer ticks are also a vector for Powassan virus, a potentially deadly form of encephalitis.
American dog ticks (Dermacentor variabilis) can transmit Rocky Mountain spotted fever and tularemia. Ticks in Maine are not known to carry Rocky Mountain spotted fever or tularemia.
The woodchuck tick (Ixodes cookei) can transmit Powassan virus.
The lone star tick (Amblyomma americanum) can transmit Ehrlichia chaffeensis and Ehrlichia ewingii (which cause human ehrlichiosis), tularemia, and STARI. The lone star ticks are moving north and are not fully established in Maine.
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