Although summer is waning, ticks are still abundant in many parts of the country.  I frequently receive questions from persons who are worried about what to do following a tick removal.  Questions range from how to safely remove them to whether or not to take antibiotics to make sure they don't get Lyme disease or Rocky Mountain Spotted fever. 

Yesterday, I received a question from a client who had noticed a small tick on his arm and "burned" it off with a match.  The next day, he had a round, red area around the bite and wondered whether this indicated presence of a tick-borne illness and whether he should begin to take antibiotics.

This is how I responded to this question: 

Even if a tick is attached, it must have taken a blood meal in order to transmit Lyme disease. At least 36 to 48 hours of feeding is required for a tick to have fed and then transmit the organism that causes Lyme disease. After this amount of time, the tick will be engorged (full of blood). An engorged tick has a globular shape and is larger than an unengorged one. So it doesn't sound at all likely that this occurred in your case.

The attached page has examples of the tiny ticks that transmit Lyme disease. The Infectious Disease Society of America recommends preventive treatment with antibiotics only in patients who meet all of the following circumstances:

1. Attached tick identified as an adult or nymphal I. scapularis (deer) tick
2. Tick is estimated to have been attached for 36 hours (by degree of engorgement or time of exposure)
3. Prophylaxis should begin within 72 hours of tick removal
4. Rate of infection of ticks with B. burgdorferi is about 20 percent (these rates of infection have been shown to occur in parts of New England, parts of the mid-Atlantic States, parts of Minnesota and Wisconsin)
5. Doxycycline is not contraindicated (ie, the patient is not pregnant or lactating or a child <8 years of age)

I would say that you don't meet the recommendations for antibiotic prophylaxis, so all we should do is monitor for possible Lyme disease, as noted below.

Many people have incorrect information about Lyme disease. For example, individuals may be concerned that Lyme disease is untreatable if antibiotics are not given early (this is untrue; even later features of Lyme disease can be effectively treated with appropriate antibiotics).

The person who was bitten should observe the area of the bite for expanding redness (you have some of this but this can also occur just from the inflammation of the tick bite), which would suggest erythema migrans (EM), the characteristic rash of Lyme disease.

The rash is usually a salmon color although, rarely, it can be an intense red, occasionally resembling cellulitis (infection of the skin). The color may be almost uniform. The lesion typically expands over a few days and is usually asymptomatic, although burning or itching has been reported. As the rash expands, it can clear in the center. The center of the rash can then appear a lighter color than its edges or the rash can develop into a series of concentric rings giving it a ''bull's eye'' appearance.

In people with early localized Lyme disease, EM occurs within one month of the tick bite, typically within a week of the tick bite, although only one-third of people recall the tick bite that gave them Lyme disease. Components of tick saliva can cause a short-lived (24 to 48 hours--this sounds like what you have) rash that should not be confused with EM. This reaction usually does not expand to a size larger than a dime.

Up to 90 percent of patients with Lyme disease will develop EM; 10 percent of these may have multiple lesions. If EM or signs or symptoms suggestive of Lyme disease develop, the person should see a healthcare provider for proper diagnosis and treatment.

I hope this information helps you figure out what to do. Please let me know if you have other questions about this.

One of the most common issues I encounter following a tick bite is people who experience this one-to-two day small red inflammatory area around a tick bite that is the result of regurgitation of tick saliva and subsequent inflammation from it.  People see this and often "freak out", thinking that they, for sure, have Lyme disease.  This reaction typically doesn't occur, though, if the tick is removed properly, which involves use of tweezers, grasping the tick near the head and tugging steadily and firmly until it releases from the skin. Then, swab the area with alcohol. 

Have you had a close encounter of the tick kind?  Let me hear from you...

Labels: antibiotic, disease, infection, people