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Tick bite

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of tick bite are prepared by our editorial team based on guidelines from the Infectious Diseases Society of America (IDSA/ACR/AAN 2021), the Wilderness Medical Society (WMS 2021), and the American Academy of Family Physicians (AAFP 2012). ...
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Screening and diagnosis

Clinical presentation: as per AAN/ACR/IDSA 2021 guidelines, make a clinical diagnosis of Lyme disease in patients having ≥ 1 skin lesions compatible with erythema migrans and potential tick exposure in an endemic area.
B
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Diagnostic investigations

Tick testing
As per AAN/ACR/IDSA 2021 guidelines:
Send the removed tick for species identification.
B
Do not test the removed Ixodes tick for Borrelia burgdorferi.
D

More topics in this section

  • Evaluation for Lyme disease (serology)

  • Evaluation for Lyme disease (ECG)

  • Evaluation for Lyme disease (asymptomatic patients)

Medical management

Setting of care: as per WMS 2021 guidelines, evacuate patients developing systemic or high-risk symptoms (fever, generalized rash, arthralgias, cranial nerve palsy, dyspnea, or syncope) related to a suspected tick-borne illness to a higher level of medical care.
B

More topics in this section

  • Management of erythema migrans

  • Management of Lyme disease

Nonpharmacologic interventions

Removal of attached ticks
As per AAN/ACR/IDSA 2021 guidelines:
Remove promptly the attached tick by mechanical means using a clean fine-tipped tweezer (or a comparable device) inserted between the tick body and the skin.
B
Do not burn the attached tick (with a match or other heat device) or apply noxious chemicals or petroleum products to coax its detachment.
D

Preventative measures

Tick avoidance
As per AAN/ACR/IDSA 2021 guidelines:
Advise using personal protective measures in individuals at risk of exposure to reduce the risk of tick exposure and infection with tick-borne pathogens.
B
Advise using N, N-Diethyl-meta-toluamide, picaridin, ethyl‐3-(N-n‐butyl‐N- acetyl) aminopropionate (IR3535), oil of lemon eucalyptus, p‐methane‐3, 8-diol, 2‐undecanone, or permethrin for the prevention of tick bites.
B

More topics in this section

  • Immunization

  • Post-exposure prophylaxis

Quality improvement

Educational programs: as per WMS 2021 guidelines, implement and encourage educational programs to change behavior and lower rates of tick-borne illnesses.
B