Tick bite

Tick bites are usually painless and often noticed only once the tick becomes engorged (2+ days). Local reactions and infection are common (take days to appear); a prolonged local reaction lasting weeks is common unless the whole tick, including the head, is removed.

Complications

• Tick paralysis — an ascending paralysis appearing over days: leg weakness and unsteady gait first, then upper limbs, trunk, neck, and bulbar/ facial muscles (ptosis, ophthalmoplegia, dysarthria, stridor), ultimately respiratory muscle paralysis.
• Anaphylaxis — rare, but can occur early. (Repeated bites can also cause mammalian-meat allergy / alpha-gal syndrome.)
• Tick-borne infection — see below.

Australian tick-borne infections to consider

• Queensland tick typhus (Rickettsia australis) and other Australian spotted-fever rickettsioses — fever, an eschar at the bite site, and a maculopapular rash; treat with doxycycline. A genuine endemic Australian disease (unlike classic Lyme disease, which is not locally acquired).
• Q fever can follow a tick bite (page in respiratory).

Management

• Remove the tick intact — fine-pointed forceps or a proprietary tick-removal device placed as close to the skin as possible so it comes out whole (embedded mouthparts cause prolonged reactions). (For a paralysis tick in an allergic/sensitised patient, freezing with an ether-containing spray rather than gripping is often advised.)
• Tick paralysis — mild-to-moderate needs only observation with serial neurological exams for ~48 h (paralysis may progress after removal). Severe envenoming needs advanced life support (intubation/ventilation). Tick antitoxin/antivenom is no longer available in Australia (withdrawn ~2018).