Tick paralysis can occur worldwide and is associated with over 40 different species of tick. Tick paralysis occurs when an egg-laden female tick produces a neurotoxin and transmits it to its host during feeding. Unlike other tick born diseases suck as Lyme disease, ehrlichiosis, and babesiosis which are caused by a parasitic infection after a tick bite and result in systemic symptoms which persist long after the tick has been removed, tick paralysis is the result of a neurotoxin produced by the salivary glands of the tick and will only occur while the tick is present. Symptoms will typically rapidly improve once the tick is removed. In rare cases, the paralysis can cause respiratory failure and, in up to 12% of untreated cases, death before anyone is aware of the presence of a tick.
Treatment involves simply removing the feeding tick and all the mouthparts, as they contain the salivary glands which may continue to infect the patient even after the body of the tick has been removed. Symptoms will typically rapidly improve once the tick is removed. In rare cases, the paralysis can cause respiratory failure and, in up to 12% of untreated cases, death before anyone is aware of the presence of a tick.
Symptoms of fatigue, irritability, ataxia, muscle weakness, leg paresthesias, and generalized myalgias generally begin two to seven days after a tick becomes attached. These tick are often found on the scalp and hidden in the hair. Paralysis rapidly ascends from the lower extremities to the trunk and then to the upper extremities, followed by tongue and facial paralysis similar to Guillain–Barré syndrome. Deep tendon reflexes may be weak or absent. The most severe complications may include convulsions, respiratory failure and, in up to 12% of untreated cases, death. Tick paralysis most often occurs in children less than 10 yrs of age. Fortunately, human cases are rare.
There are no specific blood tests for tick paralysis, and conventional blood and spinal fluid studies are almost always normal. Thus, correct diagnosis is contingent upon physician awareness. Any case involving sudden-onset ataxia and ascending paralysis, especially in a patient who lives in a tick-endemic area and who fits the demographic profile described above, should be considered suspicious for tick paralysis. Such patients should be searched immediately for ticks, particularly in body areas where the tick might not be immediately apparent, such as the scalp, hairline, ear canals or pubic region.
This is a recent video posted to Facebook after a young child had rapidly developed ataxia and lower extremity weakness. She was found to have a tick in her hair and was diagnosed in the emergency department with tick paralysis and fortunately had a rapid and full recovery.
This video was posted with permission from this child’s mother Amanda Lewis.
Want to read more….?
- Tick Paralysis: Medscape
- Edlow JA, McGillicuddy DC: Tick paralysis. Inf Dis Clin North Am. 2008, 22, 397-414
- Gordon BM, Giza CC: Tick paralysis presenting in an urban environment. Pediatr Neurol. 2004, 30, 122-4
- Gentile DA, Lang JE. Tick-borne diseases. In: Auerbach PS, ed. Wilderness Medicine. 4th Ed. St. Louis: Mosby, Inc; 2001:769-806
- Doan-Wiggins L. Tick-borne diseases. Emerg Med Clin North Am 1991;9:303-325