PARALISIS PRODUCIDA POR LA PICADURA DE GARRAPATAS.
Paralysis produced by Tick bites./
EDITORIAL ESPAÑOL
=================
Hola amigos de la red hoy DERMAGIC EXPRESS te trae otro tema bien interesante y caliente, una vez más sobre las GARRAPATAS y las enfermedades que son capaces de transmitir al humano, se trata de la PARALISIS POR GARRAPATAS, producida por la picadura de unas GARRAPATAS, las cuales transmiten una NEUROTOXINA la cual produce PARALISIS en ciertas partes de tu organismo incluso pudiendo causar la muerte en un 10 a 12% de los casos.
La PARALISIS POR MORDEDURA DE GARRAPATAS, es considerada hoy día un ENVENENAMIENTO NEUROTOXICO la cual es similar al polio, afecta tanto niños como adultos (mayormente a niños) especialmente en regiones consideradas HIPERENDEMICAS como el Oeste de los Estados Unidos y las regiones del Este de Australia.
Históricamente los Australianos Hamilton Hume y William Hove describieron las primeras mordeduras de GARRAPATAS A HUMANOS en 1.824, pero fue Bancroft en 1.884 el primero en reportar dos casos (2) de toxicosis por GARRAPATAS A HUMANOS describiendo 2 casos con debilidad y visión Borrosa. La primera muerte fu reportada por Cleland en 1,912.
Desde esa época la enfermedad ha sido reportada en casi todo el mundo.
Esta enfermedad es considerada una rara condición, pero muy bien estudiada por nuestros científicos, y comienza por la transmisión de una NEUROTOXINA que está en las glándulas salivales de las garrapatas HEMBRAS que al alimentarse de sangre pasan al torrente sanguíneo ocasionando los síntomas los cuales están caracterizados por UNA PARALISIS FLACIDA de los músculos ASCENDENTE que comienza 2 a 7 días después de la picadura, en los miembros inferiores, y luego sube al troco, brazos, cabeza y puede ocurrir la muerte por fallo respiratorio. Otros síntomas incluyen, obnubilación, disminución de los reflejos tendinosos, oftalmoplegia y parálisis bulbar.
LA PARALISIS POR GARRAPATAS (TP) puede ser diagnosticada erróneamente, y confundir a la ciencia médica con entidades como: ATAXIA AGUDA, MIELITIS TRANSVERSA, ABSCESO EPIDURAL, BOTULISMO Y SINDROME DE GULLAIN BARRE (GBS), siendo este ultimo el que se presta más a confusión.
Los agentes causales de esta condición están totalmente identificados: En los Estados Unidos de Norteamérica el vector es la GARRAPATA DERMACENTOR ANDERSONI, la cual también es transmisora de LA ENFERMEDAD FIEBRE MOTEADA DE LAS MONTAÑAS ROCOSAS. Otro agente causal de esta enfermedad es la GARRAPATA DERMACENTOR VARIABILIS, considerado el segundo vector más frecuente en la transmisión DE LA FIEBRE MOTEADA DE LAS MONTAÑAS ROCOSAS.
Pero esto no queda aquí, Aproximadamente 69 especies de garrapatas de todo el mundo son capaces de inducir LA PARALISIS POR MORDEDURA DE GARRAPATA. En otros países como el sureste de AUSTRALIA, esta enfermedad (TP) también es endémica y los agentes causales son otras GARAPATAS entre las que destacan principalmente la GARAPATA del genero IXODES, IXODES HOLOCYCLUS, e IXODES CORNUATUS, también DERMACENTOR ANDESONI y VARIABILIS.
En SUDAFRICA el vector más importante es LA GARRAPATA IXODES RUBICUNDUS, en ETIOPIA, las GARRAPATAS RHIPICEPHALUS EVERTSI EVERTIS y ARGAS WALKERAE y la GARRAPATA ARGAS RADIATUS en la región Neartica de América del Norte.
La enfermedad considerada de extensión mundial "SUPUESTAMENTE" no ha sido descrita en el HEMISFERIO SUR, pero en él año 1.994 fueron descritos dos (2) caso en ARGENTINA en la provincia de Jujuy. También fue descrito un caso (1) en la costa del pacifico MEXICANA producido por la GARRAPATA AMBLYOMA MACULATUM. También ha sido reportada en LA COLUMBIA BRITANICA, tercera provincia más poblada de CANADA, 57 casos entre 1.993 Y 2.016 siendo el vector mas común la GARRAPATA DERMACENTOR ANDERSONI, los caso fueron hallados tanto en humanos como animales.
La PARALISIS POR GARRAPATAS también ha sido descrita en animales como: gatos perros, ganado caballos, ovejas, y pájaros, siendo la GARRAPATA IXODES HOLOCYCLUS la mas involucrada. De hecho hoy día esta enfermedad en Australia es considerada un problema veterinario por la gran cantidad de animales infectados, y el huesped principal de esta garrapata en AUSTRALIA es el mamifero marsupial "BANDICOOT DE NARIZ LARGA"
A diferencia de otras enfermedades como LA ENFERMEDAD DE LYME, POWASSAN y HEARTLAND donde LA GARRAPATA involucrada TRANSMITE una bacteria (LYME) o virus (POWASSAN y HEARTLAND) que infecta el organismo, en el caso de la PARALISIS POR GARRAPATA (TP) es una NEUROTOXINA que solo permanece en el organismo MIENTRAS LA GARRAPATA ESTA ADHERIDA A LA PIEL ALIMENTANDOSE CON SANGRE, al despegarla los síntomas paulatinamente desaparecen recuperándose el paciente, aun así la LETALIDAD es del 10 -12%. De modo que...
Te describo hoy otra enfermedad TRANSMITIDAD POR GARRAPATAS, y te dejo la misma reflexión de mis otras revisiones, la mejor manera de EVITARLAS NO ES SOLO luchar por los derechos humanos a recibir tratamiento adecuado COMO EL CASO DE LA ENFERMEDAD DE LYME, los cuales han sido violentados en muchos países, especialmente en US, también hay que luchar contra los VECTORES y HUESPEDES.
Saludos a Todos
Dr. José Lapenta.
=================
Hola amigos de la red hoy DERMAGIC EXPRESS te trae otro tema bien interesante y caliente, una vez más sobre las GARRAPATAS y las enfermedades que son capaces de transmitir al humano, se trata de la PARALISIS POR GARRAPATAS, producida por la picadura de unas GARRAPATAS, las cuales transmiten una NEUROTOXINA la cual produce PARALISIS en ciertas partes de tu organismo incluso pudiendo causar la muerte en un 10 a 12% de los casos.
La PARALISIS POR MORDEDURA DE GARRAPATAS, es considerada hoy día un ENVENENAMIENTO NEUROTOXICO la cual es similar al polio, afecta tanto niños como adultos (mayormente a niños) especialmente en regiones consideradas HIPERENDEMICAS como el Oeste de los Estados Unidos y las regiones del Este de Australia.
Históricamente los Australianos Hamilton Hume y William Hove describieron las primeras mordeduras de GARRAPATAS A HUMANOS en 1.824, pero fue Bancroft en 1.884 el primero en reportar dos casos (2) de toxicosis por GARRAPATAS A HUMANOS describiendo 2 casos con debilidad y visión Borrosa. La primera muerte fu reportada por Cleland en 1,912.
Desde esa época la enfermedad ha sido reportada en casi todo el mundo.
Esta enfermedad es considerada una rara condición, pero muy bien estudiada por nuestros científicos, y comienza por la transmisión de una NEUROTOXINA que está en las glándulas salivales de las garrapatas HEMBRAS que al alimentarse de sangre pasan al torrente sanguíneo ocasionando los síntomas los cuales están caracterizados por UNA PARALISIS FLACIDA de los músculos ASCENDENTE que comienza 2 a 7 días después de la picadura, en los miembros inferiores, y luego sube al troco, brazos, cabeza y puede ocurrir la muerte por fallo respiratorio. Otros síntomas incluyen, obnubilación, disminución de los reflejos tendinosos, oftalmoplegia y parálisis bulbar.
LA PARALISIS POR GARRAPATAS (TP) puede ser diagnosticada erróneamente, y confundir a la ciencia médica con entidades como: ATAXIA AGUDA, MIELITIS TRANSVERSA, ABSCESO EPIDURAL, BOTULISMO Y SINDROME DE GULLAIN BARRE (GBS), siendo este ultimo el que se presta más a confusión.
Los agentes causales de esta condición están totalmente identificados: En los Estados Unidos de Norteamérica el vector es la GARRAPATA DERMACENTOR ANDERSONI, la cual también es transmisora de LA ENFERMEDAD FIEBRE MOTEADA DE LAS MONTAÑAS ROCOSAS. Otro agente causal de esta enfermedad es la GARRAPATA DERMACENTOR VARIABILIS, considerado el segundo vector más frecuente en la transmisión DE LA FIEBRE MOTEADA DE LAS MONTAÑAS ROCOSAS.
Pero esto no queda aquí, Aproximadamente 69 especies de garrapatas de todo el mundo son capaces de inducir LA PARALISIS POR MORDEDURA DE GARRAPATA. En otros países como el sureste de AUSTRALIA, esta enfermedad (TP) también es endémica y los agentes causales son otras GARAPATAS entre las que destacan principalmente la GARAPATA del genero IXODES, IXODES HOLOCYCLUS, e IXODES CORNUATUS, también DERMACENTOR ANDESONI y VARIABILIS.
En SUDAFRICA el vector más importante es LA GARRAPATA IXODES RUBICUNDUS, en ETIOPIA, las GARRAPATAS RHIPICEPHALUS EVERTSI EVERTIS y ARGAS WALKERAE y la GARRAPATA ARGAS RADIATUS en la región Neartica de América del Norte.
La enfermedad considerada de extensión mundial "SUPUESTAMENTE" no ha sido descrita en el HEMISFERIO SUR, pero en él año 1.994 fueron descritos dos (2) caso en ARGENTINA en la provincia de Jujuy. También fue descrito un caso (1) en la costa del pacifico MEXICANA producido por la GARRAPATA AMBLYOMA MACULATUM. También ha sido reportada en LA COLUMBIA BRITANICA, tercera provincia más poblada de CANADA, 57 casos entre 1.993 Y 2.016 siendo el vector mas común la GARRAPATA DERMACENTOR ANDERSONI, los caso fueron hallados tanto en humanos como animales.
La PARALISIS POR GARRAPATAS también ha sido descrita en animales como: gatos perros, ganado caballos, ovejas, y pájaros, siendo la GARRAPATA IXODES HOLOCYCLUS la mas involucrada. De hecho hoy día esta enfermedad en Australia es considerada un problema veterinario por la gran cantidad de animales infectados, y el huesped principal de esta garrapata en AUSTRALIA es el mamifero marsupial "BANDICOOT DE NARIZ LARGA"
A diferencia de otras enfermedades como LA ENFERMEDAD DE LYME, POWASSAN y HEARTLAND donde LA GARRAPATA involucrada TRANSMITE una bacteria (LYME) o virus (POWASSAN y HEARTLAND) que infecta el organismo, en el caso de la PARALISIS POR GARRAPATA (TP) es una NEUROTOXINA que solo permanece en el organismo MIENTRAS LA GARRAPATA ESTA ADHERIDA A LA PIEL ALIMENTANDOSE CON SANGRE, al despegarla los síntomas paulatinamente desaparecen recuperándose el paciente, aun así la LETALIDAD es del 10 -12%. De modo que...
Te describo hoy otra enfermedad TRANSMITIDAD POR GARRAPATAS, y te dejo la misma reflexión de mis otras revisiones, la mejor manera de EVITARLAS NO ES SOLO luchar por los derechos humanos a recibir tratamiento adecuado COMO EL CASO DE LA ENFERMEDAD DE LYME, los cuales han sido violentados en muchos países, especialmente en US, también hay que luchar contra los VECTORES y HUESPEDES.
Saludos a Todos
Dr. José Lapenta.
EDITORIAL ENGLISH
=================
Hello friends of the network today DERMAGIC EXPRESS brings you another interesting and hot topic, once again about the TICKS and the diseases that are capable of transmitting to the human being, it is the TICK PARALYSIS (TP), produced by the bite of some TICKS,which transmit a NEUROTOXIN which produces PARALYSIS in some parts of your body, even causing death in 10 to 12% of cases.
The TICK PARALYSIS, is now considered a ENVENOMING NEUROTOXIC which is similar to polio, affects both children and adults (majoritychildren) especially in regions considered HYPERENDEMIC as the West of the United States and the regions of Eastern Australia.Historically, the Australians Hamilton Hume and William Hovedescribed the first bites of TICKS TO HUMANS in 1.824, but it wasBancroft in 1.884 the first to report two cases (2) of toxicosis by
TICKS TO HUMANS describing 2 cases with weakness and blurred vision.The first death was reported by Cleland in 1,912.
Since that time the disease has been reported almost everywhere inthe world.
This disease is considered a rare condition, but very well studied by our scientists, and begins with the transmission of a NEUROTOXIN that is in the salivary glands of the FEMALE ticks that when feed
with blood enter to the bloodstream causing the symptoms which are characterized by A ASCENDING FLACCID PARALYSIS of the muscles that begins 2 to 7 days after the bite, in the lower limbs, and then goes up to the trunk, arms, head and death can occur due to respiratory
failure. Other symptoms include numbness, decreased tendon reflexes, ophthalmoplegia, and bulbar palsy.
THE TICK PARALYSIS (TP) can be misdiagnosed, and confuse medical science with entities such as: ACUTE ATAXIA, TRANSVERSE MYELITIS, EPIDURAL ABSCESS, BOTULISM AND GULLAIN BARRE SYNDROME (GBS), the latter being the one that lends itself most to confusion.
DERMACENTOR VARIABILIS, considered the second most frequent vector in the transmission of THE ROCKY MOUNTAINS SPOTTED FEVER.
But this does not stop here; Approximately 69 species of TICKS from all over the world are able to induce PARALYSIS BY BITTING. In other countries, such as the southeast of AUSTRALIA, this disease (TP) is also endemic and the causative agents are other TICKS, among which the TICK of the IXODES genus, IXODES HOLOCYCLUS, and IXODES CORNUATUS, also DERMACENTOR ANDESONI and VARIABILIS stand out.
In South Africa the most important vector is the TICK IXODES RUBICUNDUS, in ETHIOPIA, the TICKS RHIPICEPHALUS EVERTSI EVERTIS and ARGAS WALKERAE and TICK ARGAS RADIATUS in the Neartic region of North America.
The disease considered as a global extension "SUPPOSEDLY" has not been described in the HEMISPHERE SUR, but in the year 1.994, two (2) cases were described in ARGENTINA in the province of Jujuy. A case (1) was also described on the Pacific coast of MEXICO, produced by
the TICK AMBLYOMA MACULATUM. It has also been reported in THE BRITISH COLUMBIA, the third most populated province of CANADA, 57 cases between 1.993 and 2.016 being the most common vector the TICK DERMACENTOR ANDERSONI, the cases were found in both humans and animals.
Unlike other diseases such as LYME, POWASSAN and HEARTLAND DISEASE, where the TICK involved TRANSMITS a bacterium (LYME) or virus (POWASSAN and HEARTLAND) that infects the organism, in the case of TICK PARALYSIS (TP) it is a NEUROTOXIN that only remains in the organism WHILE THE TICK IS ADHERED TO THE SKIN FEEDING WITH BLOOD, when
taking it off the symptoms gradually disappear recovering the patient, even though the LETHALITY is of 10 -12%. So that...
I describe another disease TRANSMITTED BY TICKS, and I leave you the same reflection of my other reviews, the best way to AVOID THEM, is not only to fight for human rights to receive adequate treatment LIKE THE CASE OF LYME DISEASE, which have been Violated in many countries, especially in the US, we also have to fight against VECTORS and HOSTS.
Greetings to all
Dr. José Lapenta
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BIBLIOGRAPHICAL REFERENCES / REFERENCIAS BIBLIOGRAFICAS
=========================================================================
1.) A Retrospective Cohort Study of Tick
Paralysis in British Columbia.
2.) A Comparative Meta-Analysis of Tick Paralysis in the United States and
Australia.
3.) A 60-year meta-analysis of tick paralysis in the United States: a predictable, preventable, and often misdiagnosed poisoning.
4.) Tick paralysis.
5.) Tick paralysis cases in Argentina.
6.) Neurotoxin-induced paralysis: a case of tick paralysis in a 2-year-old child.
7.) Tick paralysis presenting in an urban environment.
8.) Tick paralysis: 33 human cases in Washington State, 1946-1996.
9.) Cluster of tick paralysis cases--Colorado, 2006.
10.) The association between landscape and climate and reported tick paralysis cases in dogs and cats in Australia.
11.) Delineation of an endemic tick paralysis zone in southeastern
Australia.
12.) A list of the 70 species of Australian ticks; diagnostic guides to and species accounts of Ixodes holocyclus (paralysis tick), Ixodes cornuatus (southern paralysis tick) and Rhipicephalus australis (Australian cattle tick); and consideration of the place of Australia in the evolution of ticks with comments on four controversial ideas.
13.) Tick paralysis caused by Amblyomma maculatum on the Mexican Pacific Coast.
14.) Tick Paralysis — Washington, 1995
15.) Rare Cause of Facial Palsy: Case Report of Tick Paralysis by Ixodes Holocyclus Imported by a
Patient Travelling into Singapore from Australia.
16.) A Comparative Meta-Analysis of Tick Paralysis in the United States and Australia.
17.) Tick paralysis in Australia caused by Ixodes holocyclus Neumann
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1.) A Retrospective Cohort Study of Tick Paralysis in British Columbia.
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Vector Borne Zoonotic Dis. 2017 Oct 30. doi: 10.1089/vbz.2017.2168. [Epub ahead of print]
Morshed M1,2, Li L1,2, Lee MK1, Fernando K1, Lo T1, Wong Q1.
Author information
1 Zoonotic Diseases and Emerging Pathogens Section, BC Centre of Disease Control Public Health Laboratory , Vancouver, Canada .
2
2 Department of Pathology and Laboratory Medicine, University of British Columbia , Vancouver, Canada .
Abstract
BACKGROUND:
Tick paralysis is a frequently overlooked severe disease characterized by bilateral ascending flaccid paralysis caused by a neurotoxin produced by feeding ticks. We aimed to characterize suspected tick paralysis cases documented at the BC Centre for Disease Control (BCCDC) in British Columbia (BC) from 1993 to 2016 and reviewed prevention, diagnosis, and treatment considerations.
METHODS:
Demographic, geographic, and clinical data from test requisition forms for ticks submitted to the BCCDC Public Health Laboratory (PHL) from patients across BC between 1993 and 2016 for suspected human and animal tick paralysis were reviewed. Descriptive statistics were generated to characterize tick paralysis cases in BC, including tick species implicated, seasonality of disease, and
regional differences.
RESULTS:
From 1993 to 2016, there were 56 cases of suspected tick paralysis with at least one tick specimen submitted for testing at the BCCDC PHL. Humans and animals were involved in 43% and 57% of cases, respectively. The majority of cases involved a Dermacentor andersoni tick (48 cases or 86%) and occurred between the months of April and June (49 cases or 88%). Among known locations of
tick acquisition, the Interior region of BC was disproportionately affected, with 25 cases (69%) of tick bites occurring in that area.
CONCLUSIONS:
Tick paralysis is a rare condition in BC. The region of highest risk is the Interior, particularly during the spring and summer months. Increasing awareness of tick paralysis among healthcare workers and the general public is paramount to preventing morbidity and mortality from this rare disease.
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2.) A Comparative Meta-Analysis of Tick Paralysis in the United States and Australia.
=========================================================================
Clin Toxicol (Phila). 2015 Nov;53(9):874-83. doi: 10.3109/15563650.2015.1085999. Epub 2015 Sep 11.
2.) A Comparative Meta-Analysis of Tick Paralysis in the United States and
Australia.
3.) A 60-year meta-analysis of tick paralysis in the United States: a predictable, preventable, and often misdiagnosed poisoning.
4.) Tick paralysis.
5.) Tick paralysis cases in Argentina.
6.) Neurotoxin-induced paralysis: a case of tick paralysis in a 2-year-old child.
7.) Tick paralysis presenting in an urban environment.
8.) Tick paralysis: 33 human cases in Washington State, 1946-1996.
9.) Cluster of tick paralysis cases--Colorado, 2006.
10.) The association between landscape and climate and reported tick paralysis cases in dogs and cats in Australia.
11.) Delineation of an endemic tick paralysis zone in southeastern
Australia.
12.) A list of the 70 species of Australian ticks; diagnostic guides to and species accounts of Ixodes holocyclus (paralysis tick), Ixodes cornuatus (southern paralysis tick) and Rhipicephalus australis (Australian cattle tick); and consideration of the place of Australia in the evolution of ticks with comments on four controversial ideas.
13.) Tick paralysis caused by Amblyomma maculatum on the Mexican Pacific Coast.
14.) Tick Paralysis — Washington, 1995
15.) Rare Cause of Facial Palsy: Case Report of Tick Paralysis by Ixodes Holocyclus Imported by a
Patient Travelling into Singapore from Australia.
16.) A Comparative Meta-Analysis of Tick Paralysis in the United States and Australia.
17.) Tick paralysis in Australia caused by Ixodes holocyclus Neumann
=================================================================
1.) A Retrospective Cohort Study of Tick Paralysis in British Columbia.
=================================================================
Vector Borne Zoonotic Dis. 2017 Oct 30. doi: 10.1089/vbz.2017.2168. [Epub ahead of print]
Morshed M1,2, Li L1,2, Lee MK1, Fernando K1, Lo T1, Wong Q1.
Author information
1 Zoonotic Diseases and Emerging Pathogens Section, BC Centre of Disease Control Public Health Laboratory , Vancouver, Canada .
2
2 Department of Pathology and Laboratory Medicine, University of British Columbia , Vancouver, Canada .
Abstract
BACKGROUND:
Tick paralysis is a frequently overlooked severe disease characterized by bilateral ascending flaccid paralysis caused by a neurotoxin produced by feeding ticks. We aimed to characterize suspected tick paralysis cases documented at the BC Centre for Disease Control (BCCDC) in British Columbia (BC) from 1993 to 2016 and reviewed prevention, diagnosis, and treatment considerations.
METHODS:
Demographic, geographic, and clinical data from test requisition forms for ticks submitted to the BCCDC Public Health Laboratory (PHL) from patients across BC between 1993 and 2016 for suspected human and animal tick paralysis were reviewed. Descriptive statistics were generated to characterize tick paralysis cases in BC, including tick species implicated, seasonality of disease, and
regional differences.
RESULTS:
From 1993 to 2016, there were 56 cases of suspected tick paralysis with at least one tick specimen submitted for testing at the BCCDC PHL. Humans and animals were involved in 43% and 57% of cases, respectively. The majority of cases involved a Dermacentor andersoni tick (48 cases or 86%) and occurred between the months of April and June (49 cases or 88%). Among known locations of
tick acquisition, the Interior region of BC was disproportionately affected, with 25 cases (69%) of tick bites occurring in that area.
CONCLUSIONS:
Tick paralysis is a rare condition in BC. The region of highest risk is the Interior, particularly during the spring and summer months. Increasing awareness of tick paralysis among healthcare workers and the general public is paramount to preventing morbidity and mortality from this rare disease.
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2.) A Comparative Meta-Analysis of Tick Paralysis in the United States and Australia.
=========================================================================
Clin Toxicol (Phila). 2015 Nov;53(9):874-83. doi: 10.3109/15563650.2015.1085999. Epub 2015 Sep 11.
Diaz JH1.
Author information
1 a Louisiana State University Health Sciences Center, School of Public Health , 2020 Gravier Street, New Orleans, Louisiana 70112 United States.
Abstract
CONTEXT:
Tick paralysis is a neurotoxic envenoming that mimics polio and primarily afflicts children, especiallyin hyperendemic regions of the Western United States of America (US) and Eastern Australia.
OBJECTIVE:
To compare the epidemiology, clinical and electrodiagnostic manifestations, and outcomes of tick paralysis in the US versus Australia.
METHODS:
A comparative meta-analysis of the scientific literature was conducted using Internet search engines to identify confirmed cases of tick paralysis in the US and Australia. Continuous variables including age, time to tick removal, and duration of paralysis were analyzed for statistically significant differences by unpaired t-tests; and categorical variables including gender, regional distribution, tick vector, tick attachment site, and misdiagnosis were compared for statistically significant differences by chi-square or Fisher exact tests.
RESULTS:
DISCUSSION:
Tick paralysis was a potentially lethal envenoming that occurred in children and adults in a seasonally and regionally predictable fashion. Tick paralysis was increasingly misdiagnosed as GBS during more recent reporting periods in the US. Such misdiagnoses often directed unnecessary therapies including central venous plasmapheresis with intravenous immunoglobulin G that delayed correct diagnosis and tick removal.
CONCLUSION:
Tick paralysis should be added to and quickly excluded from the differential diagnoses of acute ataxia with ascending flaccid paralysis, especially in children living in tick paralysis-endemic regions worldwide.
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3.) A 60-year meta-analysis of tick paralysis in the United States: a predictable, preventable, and often misdiagnosed poisoning.
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J Med Toxicol. 2010 Mar;6(1):15-21. doi: 10.1007/s13181-010-0028-3.
Diaz JH1.
Author information
1 LSU School of Public Health, New Orleans, LA, USA. jdiaz@lsuhsc.edu
Abstract
Tick paralysis (TP) is a neurotoxic poisoning primarily afflicting young girls in endemic regions. Recent case series of TP have described increasing misdiagnoses of TP as the Guillain-Barré syndrome (GBS). A meta-analysis of the scientific literature was conducted using Internet search engines to assess the evolving epidemiology of TP. Fifty well-documented cases of TP were analyzed over the period 1946-2006. Cases were stratified by demographics, clinical manifestations, and outcomes. Misdiagnoses were subjected to Yates-corrected chi-square analyses to detect statistically significant differences in proportions of misdiagnoses between earlier and later reporting periods. TP occurred seasonally and sporadically in individuals and in clusters of children and adults of both sexes in urban and rural locations. The case fatality rate (CFR) for TP was 6.0% over 60 years. The proportion of misdiagnoses of TP as GBS was significantly greater (chi(2) = 7.850, P = 0.005) in more recently collected series of TP cases, 1992-2006, than the proportion of misdiagnoses in earlier series,
1946-1996. TP was a potentially lethal poisoning that occurred in children and adults in a seasonally and regionally predictable fashion. TP was increasingly misdiagnosed as GBS during more recent reporting periods. Such misdiagnoses often directed unnecessary therapies such as central venous plasmapheresis with intravenous immunoglobulin G, delayed correct diagnosis, and tick removal, and
could have increased CFRs. TP should be added to and quickly excluded from the differential diagnoses of acute ataxia and ascending flaccid paralysis, especially in children living in TP-endemic regions of the USA.
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4.) Tick paralysis.
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Infect Dis Clin North Am. 2008 Sep;22(3):397-413, vii. doi: 10.1016/j.idc.2008.03.005.
Edlow JA1, McGillicuddy DC.
Author information
1 Beth Israel Deaconess Medical Center, West Clinical Center 2, One
Deaconess Road, West Campus - CC 2, Boston, MA 02215, USA. jedlow@bidmc.harvard.edu
Abstract
The one tick-borne disease that rarely comes under the auspices of the infectious disease specialist is not caused by an infectious agent, but is tick paralysis. This condition is caused by tick bite and typically presents as a flaccid ascending paralysis. This article discusses this entity partly because of completeness, but also because tick paralysis, or tick toxicosis as it is sometimes called, is worth the infectious disease consultant's consideration. The differential diagnosis includes entities that are infectious or caused by toxins of infectious agents, such as epidural abscess, some causes of transverse
myelitis, and botulism. Lastly, in an era of antibiotic toxicity, multidrug-resistant bacteria, antigen-switching viruses, and complex antibiotic regimens, the cure for tick paralysis-removing the tick-is as simple as it is gratifying.
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5.) Tick paralysis cases in Argentina.
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Rev Soc Bras Med Trop. 2012 Jul-Aug;45(4):533-4.
Remondegui C1.
Author information
1 Servicio de Infectología y Medicina Tropical, Hospital San Roque, Ministerio de Salud de la Provincia de Jujuy, Jujuy, Argentina. remondegui@arnet.com.ar
Abstract
Tick paralysis (TP) occurs worldwide and is caused by a neurotoxin secreted by engorged female ticks that affects the peripheral and central nervous system. The clinical manifestations range from mild or nonspecific symptoms to manifestations similar to Guillain-Barré syndrome, bulbar involvement, and death in 10% of the patients. The diagnosis of TP is clinical. To our knowledge, there are no formal reports of TP in humans in South America, although clusters of TP among hunting dogs in Argentina have been identified recently. In this paper, clinical features of two cases of TP occurring during
1994 in Jujuy Province, Argentina, are described.
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6.) Neurotoxin-induced paralysis: a case of tick paralysis in a 2-year-old child.
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Pediatr Neurol. 2014 Jun;50(6):605-7. doi: 10.1016/j.pediatrneurol.2014.01.041. Epub 2014 Jan 24.
Taraschenko OD1, Powers KM2.
Author information
1 Department of Neurology, Albany Medical College, Albany, New York. Electronic address: tarasco@mail.amc.edu.
2 Department of Neurology, Albany Medical College, Albany, New York.
Abstract
BACKGROUND:
Tick paralysis is an arthropod-transmitted disease causing potentially lethal progressive ascending weakness. The presenting symptoms of tick paralysis overlap those of acute inflammatory diseases of the peripheral nervous system and spinal cord; thus, the condition is often misdiagnosed, leading to
unnecessary treatments and prolonged hospitalization.
PATIENT:
A 2-year-old girl residing in northern New York and having no history of travel to areas endemic to ticks presented with rapidly progressing ascending paralysis, hyporeflexia, and intact sensory examination. Investigation included blood and serum toxicology screens, cerebrospinal fluid analysis, and brain imaging. With all tests negative, the child's condition was initially mistaken for botulism; however, an engorged tick was later found attached to the head skin. Following tick removal, the patient's weakness promptly improved with no additional interventions.
CONCLUSION:
Our patient illustrates the importance of thorough skin examination in all cases of acute progressive weakness and the necessity to include tick paralysis in the differential diagnosis of paralysis, even in nonendemic areas.
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7.) Tick paralysis presenting in an urban environment.
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Pediatr Neurol. 2004 Feb;30(2):122-4.
Gordon BM1, Giza CC.
Author information
1 Department of Pediatrics, David Geffen School of Medicine, UCLA, Los
Angeles, California 90095, USA.
Abstract
We report the case of a 17-month-old female with tick paralysis presenting to an urban Los Angeles emergency department. The tick was later identified as the North American wood tick, Dermacentor andersoni, and was likely obtained while the family was vacationing on a dude ranch in Montana. We discuss the epidemiology of tick paralysis, a differential diagnosis for health care providers, and methods of detection and removal. Given the increasing popularity of outdoor activities and ease of travel, tick paralysis should be considered in cases of acute or subacute weakness, even in an urban setting.
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8.) Tick paralysis: 33 human cases in Washington State, 1946-1996.
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Clin Infect Dis. 1999 Dec;29(6):1435-9.
Dworkin MS1, Shoemaker PC, Anderson DE.
Author information
1 Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. mdd3@cdc.gov.
Abstract
Tick paralysis is a preventable cause of illness and death that, when diagnosed promptly, requires simple, low-cost intervention (tick removal). We reviewed information on cases of tick paralysis that were reported to the Washington State Department of Health (Seattle) during 1946-1996. Thirty-three cases of tick paralysis were identified, including 2 in children who died. Most of the patients were female (76%), and most cases (82%) occurred in children aged <8 years. Nearly all cases with information on site of probable exposure indicated exposure east of the Cascade Mountains. Onset of illness occurred from March 14 to June 22. Of the 28 patients for whom information regarding hospitalization was available, 54% were hospitalized. Dermacentor andersoni was consistently identified when information on the tick species was reported. This large series of cases of tick paralysis demonstrates the predictable epidemiology of this disease. Improving health care provider awareness of tick paralysis could help limit morbidity and mortality due to this disease.
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9.) Cluster of tick paralysis cases--Colorado, 2006.
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MMWR Morb Mortal Wkly Rep. 2006 Sep 1;55(34):933-5.
Centers for Disease Control and Prevention (CDC).
Abstract
Tick paralysis is a rare disease characterized by acute, ascending, flaccid paralysis that is often confused with other acute neurologic disorders or diseases (e.g., Guillain-Barré syndrome or botulism). Tick paralysis is thought to be caused by a toxin in tick saliva; the paralysis usually resolves
within 24 hours after tick removal. During May 26-31, 2006, the Colorado Department of Public Health and Environment received reports of four recent cases of tick paralysis. The four patients lived (or had visited someone) within 20 miles of each other in the mountains of north central Colorado. This report
summarizes the four cases and emphasizes the need to increase awareness of tick paralysis among health-care providers and persons in tick-infested areas.
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10.) The association between landscape and climate and reported tick paralysis cases in dogs and cats in Australia.
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Vet Parasitol. 2014 Aug 29;204(3-4):339-45. doi: 10.1016/j.vetpar.2014.05.018. Epub 2014 May 17.
Brazier I1, Kelman M2, Ward MP3.
Author information
1 The University of Sydney, Faculty of Veterinary Science, Camden 2570, NSW,
Australia.
2 Virbac Australia, Milperra 1891, NSW, Australia.
3 The University of Sydney, Faculty of Veterinary Science, Camden 2570, NSW,
Australia. Electronic address: michael.ward@sydney.edu.au.
Abstract
The aim of this study was to describe the association between landscape and climate factors and the occurrence of tick paralysis cases in dogs and cats reported by veterinarians in Australia. Data were collated based on postcode of residence of the animal and the corresponding landscape (land cover and elevation) and climate (precipitation, temperature) information was derived. During the study period (October 2010-December 2012), a total of 5560 cases (4235 [76%] canine and 1325 [24%] feline cases) were reported from 341 postcodes, mostly along the eastern seaboard of Australia and from the states of New South Wales and Queensland. Significantly more cases were reported from postcodes which
contained areas of broadleaved, evergreen tree coverage (P=0.0019); broadleaved, deciduous open tree coverage (P=0.0416); and water bodies (P=0.0394). Significantly fewer tick paralysis cases were reported from postcodes which contained areas of sparse herbaceous or sparse shrub coverage (P=0.0297) and areas that were cultivated and managed (P=0.0005). No significant (P=0.6998) correlation between number of tick paralysis cases reported per postcode and elevation was found. Strong positive correlations were found between number of cases reported per postcode and the annual minimum (rSP=0.9552, P<0.0001) and maximum (rSP=0.9075; P=0.0001) precipitation. Correlations between reported tick paralysis cases and temperature variables were much weaker than for
precipitation, rSP<0.23. For maximum temperature, the strongest correlation between cases was found in winter (rSP=0.1877; P=0.0005) and for minimum temperature in autumn (rSP=0.2289: P<0.0001). Study findings suggest that tick paralysis cases are more likely to occur and be reported in certain eco climatic zones, such as those with higher rainfall and containing tree cover and areas of water. Veterinarians and pet owners in these zones should be particularly alert for tick paralysis cases to maximize the benefits of early treatment, and to be vigilant to use chemical prophylaxis to reduce the risk of tick parasitism.
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11.) Delineation of an endemic tick paralysis zone in southeastern Australia.
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Vet Parasitol. 2017 Nov 30;247:42-48. doi: 10.1016/j.vetpar.2017.09.005.
Epub 2017 Sep 6.
Whitfield Z1, Kelman M2, Ward MP3.
Author information
1 Sydney School of Veterinary Science, The University of Sydney, Camden NSW,
Australia.
2 Kelman Scientific, Peregian Beach QLD, Australia.
3 Sydney School of Veterinary Science, The University of Sydney, Camden NSW,
Australia. Electronic address: michael.ward@sydney.edu.au.
Abstract
Tick paralysis has a major impact on pet dog and cat populations in southeastern Australia. It results from envenomation by Ixodes holocyclus and Ixodes cornuatus ticks, the role of Ixodes cornuatus in the epidemiology of this disease in Australia being unclear. The aim of this study was to describe the
geographical distribution of tick paralysis cases in southeastern Australia using data from a national disease surveillance system and to compare characteristics of "endemic" cases with those reported outside this endemic zone ("sporadic" cases). Data were collated and a proportional symbol map of all
cases by postcode was created. A 15-case isopleth was developed based on descriptive spatial statistics (directional ellipses) and then kernel smoothing to distinguish endemic from sporadic cases. During the study period (January 2010-December 2015) 12,421 cases were reported, and 10,839 of these reported by clinics located in 434 postcodes were included in the study. Endemic cases were predominantly reported from postcodes in coastal southeastern Australia, from southern Queensland to eastern Victoria. Of those cases meeting selection criteria, within the endemic zone 10,767 cases were reported from 351 (88%) postcodes and outside this zone 72 cases were reported from 48 (12%) postcodes.
Of these latter 48 postcodes, 18 were in Victoria (26 cases), 16 in New South Wales (28 cases), 7 in Tasmania (9 cases), 5 in South Australia (7 cases) and 2 in Queensland (2 cases). Seasonal distribution in reporting was found: 62% of endemic and 52% of sporadic cases were reported in spring. The number of both endemic and sporadic cases reported peaked in October and November, but importantly a secondary peak in reporting of sporadic cases in April was found. In non-endemic areas, summer was the lowest risk season whilst in endemic areas, autumn was the lowest risk season. Two clusters of sporadic cases were identified, one in South Australia (P=0.022) during the period 22 May to 2 June 2012 and another in New South Wales (P=0.059) during the period 9 October to 29 November 2012. Endemic and sporadic cases did not differ with respect to neuter status (P=0.188), sex (P=0.205), case outcome (P=0.367) or method of diagnosis (P=0.413). However, sporadic cases were 4.2-times more likely to be dogs than cats (P<0.001). The endemic tick paralysis zone described is consistent with previous anecdotal reports. Sporadic cases reported outside this zone might be due to a history of pet travel to endemic areas, small foci of I. holocyclus outside of the endemic zone, or in the case of southern areas, tick paralysis caused by I. cornuatus.
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12.) A list of the 70 species of Australian ticks; diagnostic guides to and species accounts of Ixodes holocyclus (paralysis tick), Ixodes cornuatus (southern paralysis tick) and Rhipicephalus australis (Australian cattle tick); and consideration of the place of Australia in the evolution of ticks with
comments on four controversial ideas.
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Barker SC1, Walker AR2, Campelo D3.
Author information
1 Department of Parasitology, School of Chemistry and Molecular Biosciences,
The University of Queensland, Brisbane, Qld 4072, Australia. Electronic address:
s.barker@uq.edu.au.
2 Royal (Dick) School of Veterinary Studies, University of Edinburgh, EH25
9RG Scotland, United Kingdom.
3 Department of Parasitology, School of Chemistry and Molecular Biosciences,
The University of Queensland, Brisbane, Qld 4072, Australia.
Abstract
Seventy species of ticks are known from Australia: 14 soft ticks (familyArgasidae) and 56 hard ticks (family Ixodidae). Sixteen of the 70 ticks in Australia may feed on humans and domestic animals (Barker and Walker 2014). The other 54 species of ticks in Australia feed only on wild mammals, reptiles and birds. At least 12 of the species of ticks in Australian also occur in Papua New Guinea. We use an image-matching system much like the image-matching systems of field guides to birds and flowers to identify Ixodes holocyclus (paralysis tick), Ixodes cornuatus (southern paralysis tick) and Rhipicephalus (Boophilus) australis (Australian cattle tick). Our species accounts have reviews of the literature on I. holocyclus (paralysis tick) from the first paper on the biology of an Australian tick by Bancroft (1884), on paralysis of dogs by I. holocyclus, to papers published recently, and of I. cornuatus (southern paralysis tick) and Rhipicephalus (Boophilus) australis (Australian cattle tick). We comment on four controversial questions in the evolutionary biology of ticks: (i) were labyrinthodont amphibians in Australia in the Devonian the first hosts of soft, hard and nuttalliellid ticks?; (ii) are the nuttalliellid ticks the sister-group to the hard ticks or the soft ticks?; (iii) is Nuttalliella namaqua the missing link between the soft and hard ticks?; and (iv) the evidence for a lineage of large bodied parasitiform mites (ticks plus the holothyrid mites plus theopiliocarid mites).
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13.) Tick paralysis caused by Amblyomma maculatum on the Mexican Pacific Coast.
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Vector Borne Zoonotic Dis. 2011 Jul;11(7):945-6. doi: 10.1089/vbz.2010.0154. Epub 2011 Mar 11.
Espinoza-Gomez F1, Newton-Sanchez O, Flores-Cazares G, De la Cruz-Ruiz M, Melnikov V, Austria-Tejeda J, Rojas-Larios F.
Author information
1 Communicable Disease Group, Faculty of Medicine, University of Colima,
Colima, Mexico.
Abstract
Tick paralysis is a rare entity in which it is necessary to identify the cause and remove the arthropod to have a rapid remission of symptoms. In the absence of an early diagnosis, the outcome can be fatal, as toxins are released from the tick's saliva as it feeds. To the best of the authors' knowledge, this
is the first clinical report of the disease in Mexico and Latin America. A 22-year-old man from a rural area, who was in contact with cattle, developed ascending flaccid paralysis secondary to Amblyomma maculatum tick toxin. He presented flaccid paraplegia and arreflexia that progressed until causing
dyspnea. The clinical symptoms subsided 48 h after the ticks spontaneously detached. The ticks were discovered by nursing personnel while the patient was being transferred to a regional hospital with the diagnosis of Guillain-Barré syndrome. The patient was asymptomatic on discharge from hospital and showed no further motor deterioration at a 1-month follow-up.
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14.) Tick Paralysis — Washington, 1995
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Tick Paralysis — Continued Tick paralysis (tick toxicosis)—one of the eight most common tickborne diseases in the United States (1 )—is an acute, ascending, flaccid motor paralysis
that can be confused with Guillain-Barré syndrome, botulism, and myasthenia gravis. This report summarizes the results of the investigation of a case of tick paralysis in Washington. On April 10, 1995, a 2-year-old girl who resided in Asotin County, Washington, was taken to the emergency department of a regional hospital because of a 2-day history of unsteady gait, difficulty standing, and reluctance to walk. Other that a recent history of cough, she had been healthy and had not been injured. On physical
examination, she was afebrile, alert, and active but could stand only briefly before requiring assistance. Cranial nerve function was intact. However, she exhibited marked extremity and mild truncal ataxia, and deep tendon reflexes were absent. She was admitted with a tentative diagnosis of either Guillain-Barré syndrome or postinfectious polyradiculopathy. Within several hours of hospitalization, she had onset of drooling and tachypnea. A nurse incidentally detected an engorged tick on the girl’s hairline by an ear and removed the tick. Within 7 hours after tick removal, tachypnea subsided and reflexes were present but diminished. The patient recovered fully and was discharged on April 11. The tick species was not identified.
Reported by: E Haas, D Anderson, R Neu, Asotin County Health Dept, Clarkston, Washington.
N Berkheiser, MD, Saint Joseph Regional Medical Center, Lewiston, Idaho. J Grendon, DVM,
P Shoemaker, J Kobayashi, MD, P Stehr-Green, DrPH, State Epidemiologist,
Washington State
Dept of Health. Div of Field Epidemiology, Epidemiology Program Office. CDC.
Editorial Note: Tick paralysis occurs worldwide and is caused by the introduction of a neurotoxin elaborated into humans during attachment of and feeding by the female on several tick species. In North America, tick paralysis occurs most commonly in the Rocky Mountain and northwestern regions of the United States and in western Canada. Most cases have been reported among girls aged <10 years during
April–June, when nymphs and mature wood ticks are most prevalent (2 ). Although tick paralysis is a reportable disease in Washington, surveillance is passive, and only 10 cases were reported during 1987–1995. In the United States, this disease is associated with Dermacentor andersoni (Rocky Mountain wood tick), D. variabilis (American dog tick), Amblyomma americanum
(Lone Star tick), A. maculatum, Ixodes scapularis (black-legged tick), and I. pacificus April 26, 1996 / Vol. 45 / No. 16
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES / Public Health Service 325 Tick Paralysis — Washington, 1995 326 Update: Influenza Activity — United States and Worldwide, 1995–96 Season, and Composition of the 1996–97 Influenza Vaccine 330 Multidrug-Resistant Tuberculosis Outbreak on an HIV Ward — Madrid, Spain, 1991–1995 333 Adult Blood Lead Epidemiology and Surveillance — United States. Fourth Quarter, 1995 335 Notice to Readers (western black-legged tick) (3,4 ). Onset of symptoms usually occurs after a tick has fed for several days. The pathogenesis of tick paralysis has not been fully elucidated, and pathologic and clinical effects vary depending on the tick species (4). However, motor neurons probably are affected by the toxin, which diminishes release of acetylcholine (5 ). In addition, experimental studies indicate that the toxin may produce a substantial decrease in maximal motor-nerve conduction velocities while simultaneously increasing the stimulating current potential necessary to elicit a response (5 ). If unrecognized, tick paralysis can progress to respiratory failure and may be fatal in approximately 10% of cases (6 ). Prompt removal of the feeding tick usually is followed by complete recovery. Ticks can be attached to the scalp or neck and concealed y hair and can be removed using forceps or tweezers to grasp the tick as closely as possible to the point of attachment (7 ). Removal requires the application of even pressure to avoid breaking off the body and leaving the mouth parts imbedded in the host. Gloves should be worn if a tick must be removed by hand; hands should be promptly washed with soap and hot water after removal of a tick. The risk for tick paralysis may be greatest for children in rural areas, especially in the Northwest, during the spring and may be reduced by the use of repellants on ski and permethrin-containing acaricides on clothing. Paralysis can be prevented by carefu examination of potentially exposed persons for ticks and prompt removal of ticks. Health-care providers should consider tick paralysis in persons who reside or have recently visited tick-endemic areas during the spring or early summer and who present with symmetrical paralysis.
References
1. Spach DH, Liles WC, Campbell GL, Quick RE, Anderson DE, Fritsche TR.
Tick-borne diseases in the United States. N Engl J Med 1993;329:936–47.
2. CDC. Tick paralysis—Wisconsin. MMWR 1981;30:217–8.
3. CDC. Tick paralysis—Georgia. MMWR 1977;26:311.
4. Gothe R, Kunze K, Hoogstraal H. The mechanisms of pathogenicity in the tick paralysis. J Med Entomol 1979;16:357–69.
5. Kocan AA. Tick paralysis. J Am Vet Med Assoc 1988;192:1498–500.
6. Schmitt N, Bowmer EJ, Gregson JD. Tick paralysis in British Columbia. Can Med Assoc J 1969;100:417–21.
7. Needham GR. Evaluation of five popular methods for tick removal. Pediatrics 1985;75:9
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15.) Rare Cause of Facial Palsy: Case Report of Tick Paralysis by Ixodes Holocyclus Imported by a Patient Travelling into Singapore from Australia.
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J Emerg Med. 2016 Nov;51(5):e109-e114. doi: 10.1016/j.jemermed.2016.02.031. Epub 2016 Sep 9.
Pek CH1, Cheong CS2, Yap YL1, Doggett S3, Lim TC1, Ong WC1, Lim J1.
Author information
1 Division of Plastic, Reconstructive and Aesthetic Surgery, Department of
Surgery, National University Health System, Singapore.
2 Department of Otolaryngology - Head and Neck Surgery, National University
Health System, Singapore.
3 Department of Medical Entomology, Pathology West, Westmead Hospital,
Westmead, NSW, Australia.
Abstract
BACKGROUND:
Ticks are blood-sucking arachnids that feed on all classes of vertebrates, including humans. Ixodes holocyclus, also known as the Australian Paralysis Tick, is capable of causing a myriad of clinical issues in humans and companion animals, including the transmission of infectious agents, toxin-mediated
paralysis, allergic and inflammatory reactions, and mammalian meat allergies in humans. The Australian Paralysis Tick is endemic to Australia, and only two other exported cases have been reported in the literature.
CASE REPORT:
We report the third exported case of tick paralysis caused by I. holocyclus, which was imported on a patient into Singapore. We also discuss the clinical course of the patient, the salient points of management, and the proper removal of this tick species. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: With increasing air travel, emergency physicians need to be aware of and to identify imported cases of tick paralysis to institute proper management and advice to the patient. We also describe the tick identification features and proper method of removal of this tick species.
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16.) A Comparative Meta-Analysis of Tick Paralysis in the United States and Australia.
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Clin Toxicol (Phila). 2015 Nov;53(9):874-83. doi: 10.3109/15563650.2015.1085999. Epub 2015 Sep 11
Diaz JH1.
Author information
1 a Louisiana State University Health Sciences Center, School of Public Health , 2020 Gravier Street, New Orleans, Louisiana 70112 United States.
Abstract
CONTEXT:
Tick paralysis is a neurotoxic envenoming that mimics polio and primarily afflicts children, especially in hyperendemic regions of the Western United States of America (US) and Eastern Australia.
OBJECTIVE:
To compare the epidemiology, clinical and electrodiagnostic manifestations, and outcomes of tick paralysis in the US versus Australia.
METHODS:
A comparative meta-analysis of the scientific literature was conducted using Internet search engines to identify confirmed cases of tick paralysis in the US and Australia. Continuous variables including age, time to tick removal, and duration of paralysis were analyzed for statistically significant differences by unpaired t-tests; and categorical variables including gender, regional distribution, tick vector, tick attachment site, and misdiagnosis were compared for statistically significant differences by chi-square or Fisher exact tests.
RESULTS:
Tick paralysis following ixodid tick bites occurred seasonally and sporadically in individuals and in more clusters of children than in adults of both sexes in urban and rural locations in North America and Australia. The case fatality rate for tick paralysis was low, and the proportion of misdiagnoses of
tick paralysis as Guillain-Barré syndrome (GBS) was greater in the US than in Australia. Although electrodiagnostic manifestations were similar, the neurotoxidromes differed significantly with prolonged weakness and even residual neuromuscular paralysis following tick removal in Australian cases compared with US cases.
DISCUSSION:
Tick paralysis was a potentially lethal envenoming that occurred in children and adults in a seasonally and regionally predictable fashion. Tick paralysis was increasingly misdiagnosed as GBS during more recent reporting periods in the US. Such misdiagnoses often directed unnecessary therapies including central venous plasmapheresis with intravenous immunoglobulin G that delayed correct diagnosis and tick removal.
CONCLUSION:
Tick paralysis should be added to and quickly excluded from the differential diagnoses of acute ataxia with ascending flaccid paralysis, especially in children living in tick paralysis-endemic regions worldwide.
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17.) Tick paralysis in Australia caused by Ixodes holocyclus Neumann
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Ann Trop Med Parasitol. 2011 Mar;105(2):95-106. doi: 10.1179/136485911X12899838413628
S Hall-Mendelin,* S B Craig,†‡ R A Hall,* P O’Donoghue,* R B Atwell,§ S M Tulsiani,† and G C Graham
Author information
1 School of Chemistry and Molecular Biosciences, University of Queensland,
St Lucia, Australia. sonja.hallmendelin@uqconnect.edu.au
Abstract
Ticks are obligate haematophagous ectoparasites of various animals, including humans, and are abundant in temperate and tropical zones around the world. They are the most important vectors for the pathogens causing disease in livestock and second only to mosquitoes as vectors of pathogens causing human disease. Ticks are formidable arachnids, capable of not only transmitting the pathogens involved in some infectious diseases but also of inducing allergies and causing toxicoses and paralysis, with possible fatal outcomes for the host. This review focuses on tick paralysis, the role of the Australian paralysis tick Ixodes holocyclus, and the role of toxin molecules from this species in causing paralysis in the host.
Many forms of tick toxicosis affect humans and other animals (Gothe and Neitz, 1991; Mans et al., 2004). According to Gothe (1984), a tick toxicosis is defined as a ‘generalized, experimentally standardizable, reproducible disease syndrome induced by one or a few potent ticks, even on first infestation of a physiological susceptible vertebrate species without participation of an immunopathological reaction during or following the tick feeding’. Such toxicoses are mostly caused by ixodid or hard ticks (Stone and Wright, 1981) and, in their most severe form, result in paralysis of the infested host. About 69 species of ticks from around the world are capable of inducing paralysis
(Gothe and Neitz, 1991), the most important being Ixodes holocyclus in Australia, Dermacentor andersoni, De. variabilis and Argas (Persicargas) radiatus in North America, Ix. rubicundus in South Africa, Rhipicephalus evertsi evertsi and Ar. (Pers.) walkerae in Ethiopia, and Ar. (Pers.) radiatus in the
Nearctic region of North America (Stone, 1986). Some important paralysing ticks and their distributions are summarized in Table 1. In Australia, Ix. holocyclus can cause paralysis in humans, dogs, cats, sheep, cattle, goats, pigs and horses but predominantly infests dogs, cats and humans (Stone, 1986). It appears to be the most potently toxic tick species, with a single tick capable of killing a large dog (Stone and Wright, 1981) or sheep (Sloan, 1968). Although the Tasmanian paralysis tick Ix. cornuatus has been reported to cause bulbar paresis and respiratory failure in humans (Tibballs and Cooper, 1986) and dogs
(Beveridge et al., 2004), its habitat is more restricted than that of Ix. holocyclus and very few cases of paralysis have been associated with this tick. In Australia, tick paralysis has mainly been seen as a problem in veterinary medicine, affecting approximately 10,000 companion animals/year (Stone and
Aylward, 1987). Occasionally, however, the climatic conditions become particularly favorable to tick survival, tick densities reach very high levels, and the number of humans being bitten by Ix. holocyclus increases. Although rarely severe, tick paralysis caused by Ix. holocyclus can be fatal.
Author information
1 a Louisiana State University Health Sciences Center, School of Public Health , 2020 Gravier Street, New Orleans, Louisiana 70112 United States.
Abstract
CONTEXT:
Tick paralysis is a neurotoxic envenoming that mimics polio and primarily afflicts children, especiallyin hyperendemic regions of the Western United States of America (US) and Eastern Australia.
OBJECTIVE:
To compare the epidemiology, clinical and electrodiagnostic manifestations, and outcomes of tick paralysis in the US versus Australia.
METHODS:
A comparative meta-analysis of the scientific literature was conducted using Internet search engines to identify confirmed cases of tick paralysis in the US and Australia. Continuous variables including age, time to tick removal, and duration of paralysis were analyzed for statistically significant differences by unpaired t-tests; and categorical variables including gender, regional distribution, tick vector, tick attachment site, and misdiagnosis were compared for statistically significant differences by chi-square or Fisher exact tests.
RESULTS:
Tick paralysis following ixodid tick bites
occurred seasonally and sporadically in individuals and in more clusters of
children than in adults of both sexes in urban and rural locations in North
America and Australia. The case fatality rate for tick paralysis was low, and the
proportion of misdiagnoses of
tick paralysis as Guillain-Barré syndrome (GBS) was
greater in the US than in Australia. Although electrodiagnostic
manifestations were similar, the neurotoxidromes differed significantly with
prolonged weakness and even residual neuromuscular paralysis following tick removal in
Australian cases compared with US cases.
DISCUSSION:
Tick paralysis was a potentially lethal envenoming that occurred in children and adults in a seasonally and regionally predictable fashion. Tick paralysis was increasingly misdiagnosed as GBS during more recent reporting periods in the US. Such misdiagnoses often directed unnecessary therapies including central venous plasmapheresis with intravenous immunoglobulin G that delayed correct diagnosis and tick removal.
CONCLUSION:
Tick paralysis should be added to and quickly excluded from the differential diagnoses of acute ataxia with ascending flaccid paralysis, especially in children living in tick paralysis-endemic regions worldwide.
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3.) A 60-year meta-analysis of tick paralysis in the United States: a predictable, preventable, and often misdiagnosed poisoning.
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J Med Toxicol. 2010 Mar;6(1):15-21. doi: 10.1007/s13181-010-0028-3.
Diaz JH1.
Author information
1 LSU School of Public Health, New Orleans, LA, USA. jdiaz@lsuhsc.edu
Abstract
Tick paralysis (TP) is a neurotoxic poisoning primarily afflicting young girls in endemic regions. Recent case series of TP have described increasing misdiagnoses of TP as the Guillain-Barré syndrome (GBS). A meta-analysis of the scientific literature was conducted using Internet search engines to assess the evolving epidemiology of TP. Fifty well-documented cases of TP were analyzed over the period 1946-2006. Cases were stratified by demographics, clinical manifestations, and outcomes. Misdiagnoses were subjected to Yates-corrected chi-square analyses to detect statistically significant differences in proportions of misdiagnoses between earlier and later reporting periods. TP occurred seasonally and sporadically in individuals and in clusters of children and adults of both sexes in urban and rural locations. The case fatality rate (CFR) for TP was 6.0% over 60 years. The proportion of misdiagnoses of TP as GBS was significantly greater (chi(2) = 7.850, P = 0.005) in more recently collected series of TP cases, 1992-2006, than the proportion of misdiagnoses in earlier series,
1946-1996. TP was a potentially lethal poisoning that occurred in children and adults in a seasonally and regionally predictable fashion. TP was increasingly misdiagnosed as GBS during more recent reporting periods. Such misdiagnoses often directed unnecessary therapies such as central venous plasmapheresis with intravenous immunoglobulin G, delayed correct diagnosis, and tick removal, and
could have increased CFRs. TP should be added to and quickly excluded from the differential diagnoses of acute ataxia and ascending flaccid paralysis, especially in children living in TP-endemic regions of the USA.
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4.) Tick paralysis.
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Infect Dis Clin North Am. 2008 Sep;22(3):397-413, vii. doi: 10.1016/j.idc.2008.03.005.
Edlow JA1, McGillicuddy DC.
Author information
1 Beth Israel Deaconess Medical Center, West Clinical Center 2, One
Deaconess Road, West Campus - CC 2, Boston, MA 02215, USA. jedlow@bidmc.harvard.edu
Abstract
The one tick-borne disease that rarely comes under the auspices of the infectious disease specialist is not caused by an infectious agent, but is tick paralysis. This condition is caused by tick bite and typically presents as a flaccid ascending paralysis. This article discusses this entity partly because of completeness, but also because tick paralysis, or tick toxicosis as it is sometimes called, is worth the infectious disease consultant's consideration. The differential diagnosis includes entities that are infectious or caused by toxins of infectious agents, such as epidural abscess, some causes of transverse
myelitis, and botulism. Lastly, in an era of antibiotic toxicity, multidrug-resistant bacteria, antigen-switching viruses, and complex antibiotic regimens, the cure for tick paralysis-removing the tick-is as simple as it is gratifying.
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5.) Tick paralysis cases in Argentina.
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Rev Soc Bras Med Trop. 2012 Jul-Aug;45(4):533-4.
Remondegui C1.
Author information
1 Servicio de Infectología y Medicina Tropical, Hospital San Roque, Ministerio de Salud de la Provincia de Jujuy, Jujuy, Argentina. remondegui@arnet.com.ar
Abstract
Tick paralysis (TP) occurs worldwide and is caused by a neurotoxin secreted by engorged female ticks that affects the peripheral and central nervous system. The clinical manifestations range from mild or nonspecific symptoms to manifestations similar to Guillain-Barré syndrome, bulbar involvement, and death in 10% of the patients. The diagnosis of TP is clinical. To our knowledge, there are no formal reports of TP in humans in South America, although clusters of TP among hunting dogs in Argentina have been identified recently. In this paper, clinical features of two cases of TP occurring during
1994 in Jujuy Province, Argentina, are described.
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6.) Neurotoxin-induced paralysis: a case of tick paralysis in a 2-year-old child.
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Pediatr Neurol. 2014 Jun;50(6):605-7. doi: 10.1016/j.pediatrneurol.2014.01.041. Epub 2014 Jan 24.
Taraschenko OD1, Powers KM2.
Author information
1 Department of Neurology, Albany Medical College, Albany, New York. Electronic address: tarasco@mail.amc.edu.
2 Department of Neurology, Albany Medical College, Albany, New York.
Abstract
BACKGROUND:
Tick paralysis is an arthropod-transmitted disease causing potentially lethal progressive ascending weakness. The presenting symptoms of tick paralysis overlap those of acute inflammatory diseases of the peripheral nervous system and spinal cord; thus, the condition is often misdiagnosed, leading to
unnecessary treatments and prolonged hospitalization.
PATIENT:
A 2-year-old girl residing in northern New York and having no history of travel to areas endemic to ticks presented with rapidly progressing ascending paralysis, hyporeflexia, and intact sensory examination. Investigation included blood and serum toxicology screens, cerebrospinal fluid analysis, and brain imaging. With all tests negative, the child's condition was initially mistaken for botulism; however, an engorged tick was later found attached to the head skin. Following tick removal, the patient's weakness promptly improved with no additional interventions.
CONCLUSION:
Our patient illustrates the importance of thorough skin examination in all cases of acute progressive weakness and the necessity to include tick paralysis in the differential diagnosis of paralysis, even in nonendemic areas.
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7.) Tick paralysis presenting in an urban environment.
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Pediatr Neurol. 2004 Feb;30(2):122-4.
Gordon BM1, Giza CC.
Author information
1 Department of Pediatrics, David Geffen School of Medicine, UCLA, Los
Angeles, California 90095, USA.
Abstract
We report the case of a 17-month-old female with tick paralysis presenting to an urban Los Angeles emergency department. The tick was later identified as the North American wood tick, Dermacentor andersoni, and was likely obtained while the family was vacationing on a dude ranch in Montana. We discuss the epidemiology of tick paralysis, a differential diagnosis for health care providers, and methods of detection and removal. Given the increasing popularity of outdoor activities and ease of travel, tick paralysis should be considered in cases of acute or subacute weakness, even in an urban setting.
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8.) Tick paralysis: 33 human cases in Washington State, 1946-1996.
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Clin Infect Dis. 1999 Dec;29(6):1435-9.
Dworkin MS1, Shoemaker PC, Anderson DE.
Author information
1 Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. mdd3@cdc.gov.
Abstract
Tick paralysis is a preventable cause of illness and death that, when diagnosed promptly, requires simple, low-cost intervention (tick removal). We reviewed information on cases of tick paralysis that were reported to the Washington State Department of Health (Seattle) during 1946-1996. Thirty-three cases of tick paralysis were identified, including 2 in children who died. Most of the patients were female (76%), and most cases (82%) occurred in children aged <8 years. Nearly all cases with information on site of probable exposure indicated exposure east of the Cascade Mountains. Onset of illness occurred from March 14 to June 22. Of the 28 patients for whom information regarding hospitalization was available, 54% were hospitalized. Dermacentor andersoni was consistently identified when information on the tick species was reported. This large series of cases of tick paralysis demonstrates the predictable epidemiology of this disease. Improving health care provider awareness of tick paralysis could help limit morbidity and mortality due to this disease.
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9.) Cluster of tick paralysis cases--Colorado, 2006.
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MMWR Morb Mortal Wkly Rep. 2006 Sep 1;55(34):933-5.
Centers for Disease Control and Prevention (CDC).
Abstract
Tick paralysis is a rare disease characterized by acute, ascending, flaccid paralysis that is often confused with other acute neurologic disorders or diseases (e.g., Guillain-Barré syndrome or botulism). Tick paralysis is thought to be caused by a toxin in tick saliva; the paralysis usually resolves
within 24 hours after tick removal. During May 26-31, 2006, the Colorado Department of Public Health and Environment received reports of four recent cases of tick paralysis. The four patients lived (or had visited someone) within 20 miles of each other in the mountains of north central Colorado. This report
summarizes the four cases and emphasizes the need to increase awareness of tick paralysis among health-care providers and persons in tick-infested areas.
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10.) The association between landscape and climate and reported tick paralysis cases in dogs and cats in Australia.
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Vet Parasitol. 2014 Aug 29;204(3-4):339-45. doi: 10.1016/j.vetpar.2014.05.018. Epub 2014 May 17.
Brazier I1, Kelman M2, Ward MP3.
Author information
1 The University of Sydney, Faculty of Veterinary Science, Camden 2570, NSW,
Australia.
2 Virbac Australia, Milperra 1891, NSW, Australia.
3 The University of Sydney, Faculty of Veterinary Science, Camden 2570, NSW,
Australia. Electronic address: michael.ward@sydney.edu.au.
Abstract
The aim of this study was to describe the association between landscape and climate factors and the occurrence of tick paralysis cases in dogs and cats reported by veterinarians in Australia. Data were collated based on postcode of residence of the animal and the corresponding landscape (land cover and elevation) and climate (precipitation, temperature) information was derived. During the study period (October 2010-December 2012), a total of 5560 cases (4235 [76%] canine and 1325 [24%] feline cases) were reported from 341 postcodes, mostly along the eastern seaboard of Australia and from the states of New South Wales and Queensland. Significantly more cases were reported from postcodes which
contained areas of broadleaved, evergreen tree coverage (P=0.0019); broadleaved, deciduous open tree coverage (P=0.0416); and water bodies (P=0.0394). Significantly fewer tick paralysis cases were reported from postcodes which contained areas of sparse herbaceous or sparse shrub coverage (P=0.0297) and areas that were cultivated and managed (P=0.0005). No significant (P=0.6998) correlation between number of tick paralysis cases reported per postcode and elevation was found. Strong positive correlations were found between number of cases reported per postcode and the annual minimum (rSP=0.9552, P<0.0001) and maximum (rSP=0.9075; P=0.0001) precipitation. Correlations between reported tick paralysis cases and temperature variables were much weaker than for
precipitation, rSP<0.23. For maximum temperature, the strongest correlation between cases was found in winter (rSP=0.1877; P=0.0005) and for minimum temperature in autumn (rSP=0.2289: P<0.0001). Study findings suggest that tick paralysis cases are more likely to occur and be reported in certain eco climatic zones, such as those with higher rainfall and containing tree cover and areas of water. Veterinarians and pet owners in these zones should be particularly alert for tick paralysis cases to maximize the benefits of early treatment, and to be vigilant to use chemical prophylaxis to reduce the risk of tick parasitism.
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11.) Delineation of an endemic tick paralysis zone in southeastern Australia.
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Vet Parasitol. 2017 Nov 30;247:42-48. doi: 10.1016/j.vetpar.2017.09.005.
Epub 2017 Sep 6.
Whitfield Z1, Kelman M2, Ward MP3.
Author information
1 Sydney School of Veterinary Science, The University of Sydney, Camden NSW,
Australia.
2 Kelman Scientific, Peregian Beach QLD, Australia.
3 Sydney School of Veterinary Science, The University of Sydney, Camden NSW,
Australia. Electronic address: michael.ward@sydney.edu.au.
Abstract
Tick paralysis has a major impact on pet dog and cat populations in southeastern Australia. It results from envenomation by Ixodes holocyclus and Ixodes cornuatus ticks, the role of Ixodes cornuatus in the epidemiology of this disease in Australia being unclear. The aim of this study was to describe the
geographical distribution of tick paralysis cases in southeastern Australia using data from a national disease surveillance system and to compare characteristics of "endemic" cases with those reported outside this endemic zone ("sporadic" cases). Data were collated and a proportional symbol map of all
cases by postcode was created. A 15-case isopleth was developed based on descriptive spatial statistics (directional ellipses) and then kernel smoothing to distinguish endemic from sporadic cases. During the study period (January 2010-December 2015) 12,421 cases were reported, and 10,839 of these reported by clinics located in 434 postcodes were included in the study. Endemic cases were predominantly reported from postcodes in coastal southeastern Australia, from southern Queensland to eastern Victoria. Of those cases meeting selection criteria, within the endemic zone 10,767 cases were reported from 351 (88%) postcodes and outside this zone 72 cases were reported from 48 (12%) postcodes.
Of these latter 48 postcodes, 18 were in Victoria (26 cases), 16 in New South Wales (28 cases), 7 in Tasmania (9 cases), 5 in South Australia (7 cases) and 2 in Queensland (2 cases). Seasonal distribution in reporting was found: 62% of endemic and 52% of sporadic cases were reported in spring. The number of both endemic and sporadic cases reported peaked in October and November, but importantly a secondary peak in reporting of sporadic cases in April was found. In non-endemic areas, summer was the lowest risk season whilst in endemic areas, autumn was the lowest risk season. Two clusters of sporadic cases were identified, one in South Australia (P=0.022) during the period 22 May to 2 June 2012 and another in New South Wales (P=0.059) during the period 9 October to 29 November 2012. Endemic and sporadic cases did not differ with respect to neuter status (P=0.188), sex (P=0.205), case outcome (P=0.367) or method of diagnosis (P=0.413). However, sporadic cases were 4.2-times more likely to be dogs than cats (P<0.001). The endemic tick paralysis zone described is consistent with previous anecdotal reports. Sporadic cases reported outside this zone might be due to a history of pet travel to endemic areas, small foci of I. holocyclus outside of the endemic zone, or in the case of southern areas, tick paralysis caused by I. cornuatus.
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12.) A list of the 70 species of Australian ticks; diagnostic guides to and species accounts of Ixodes holocyclus (paralysis tick), Ixodes cornuatus (southern paralysis tick) and Rhipicephalus australis (Australian cattle tick); and consideration of the place of Australia in the evolution of ticks with
comments on four controversial ideas.
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Barker SC1, Walker AR2, Campelo D3.
Author information
1 Department of Parasitology, School of Chemistry and Molecular Biosciences,
The University of Queensland, Brisbane, Qld 4072, Australia. Electronic address:
s.barker@uq.edu.au.
2 Royal (Dick) School of Veterinary Studies, University of Edinburgh, EH25
9RG Scotland, United Kingdom.
3 Department of Parasitology, School of Chemistry and Molecular Biosciences,
The University of Queensland, Brisbane, Qld 4072, Australia.
Abstract
Seventy species of ticks are known from Australia: 14 soft ticks (familyArgasidae) and 56 hard ticks (family Ixodidae). Sixteen of the 70 ticks in Australia may feed on humans and domestic animals (Barker and Walker 2014). The other 54 species of ticks in Australia feed only on wild mammals, reptiles and birds. At least 12 of the species of ticks in Australian also occur in Papua New Guinea. We use an image-matching system much like the image-matching systems of field guides to birds and flowers to identify Ixodes holocyclus (paralysis tick), Ixodes cornuatus (southern paralysis tick) and Rhipicephalus (Boophilus) australis (Australian cattle tick). Our species accounts have reviews of the literature on I. holocyclus (paralysis tick) from the first paper on the biology of an Australian tick by Bancroft (1884), on paralysis of dogs by I. holocyclus, to papers published recently, and of I. cornuatus (southern paralysis tick) and Rhipicephalus (Boophilus) australis (Australian cattle tick). We comment on four controversial questions in the evolutionary biology of ticks: (i) were labyrinthodont amphibians in Australia in the Devonian the first hosts of soft, hard and nuttalliellid ticks?; (ii) are the nuttalliellid ticks the sister-group to the hard ticks or the soft ticks?; (iii) is Nuttalliella namaqua the missing link between the soft and hard ticks?; and (iv) the evidence for a lineage of large bodied parasitiform mites (ticks plus the holothyrid mites plus theopiliocarid mites).
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13.) Tick paralysis caused by Amblyomma maculatum on the Mexican Pacific Coast.
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Vector Borne Zoonotic Dis. 2011 Jul;11(7):945-6. doi: 10.1089/vbz.2010.0154. Epub 2011 Mar 11.
Espinoza-Gomez F1, Newton-Sanchez O, Flores-Cazares G, De la Cruz-Ruiz M, Melnikov V, Austria-Tejeda J, Rojas-Larios F.
Author information
1 Communicable Disease Group, Faculty of Medicine, University of Colima,
Colima, Mexico.
Abstract
Tick paralysis is a rare entity in which it is necessary to identify the cause and remove the arthropod to have a rapid remission of symptoms. In the absence of an early diagnosis, the outcome can be fatal, as toxins are released from the tick's saliva as it feeds. To the best of the authors' knowledge, this
is the first clinical report of the disease in Mexico and Latin America. A 22-year-old man from a rural area, who was in contact with cattle, developed ascending flaccid paralysis secondary to Amblyomma maculatum tick toxin. He presented flaccid paraplegia and arreflexia that progressed until causing
dyspnea. The clinical symptoms subsided 48 h after the ticks spontaneously detached. The ticks were discovered by nursing personnel while the patient was being transferred to a regional hospital with the diagnosis of Guillain-Barré syndrome. The patient was asymptomatic on discharge from hospital and showed no further motor deterioration at a 1-month follow-up.
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14.) Tick Paralysis — Washington, 1995
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Tick Paralysis — Continued Tick paralysis (tick toxicosis)—one of the eight most common tickborne diseases in the United States (1 )—is an acute, ascending, flaccid motor paralysis
that can be confused with Guillain-Barré syndrome, botulism, and myasthenia gravis. This report summarizes the results of the investigation of a case of tick paralysis in Washington. On April 10, 1995, a 2-year-old girl who resided in Asotin County, Washington, was taken to the emergency department of a regional hospital because of a 2-day history of unsteady gait, difficulty standing, and reluctance to walk. Other that a recent history of cough, she had been healthy and had not been injured. On physical
examination, she was afebrile, alert, and active but could stand only briefly before requiring assistance. Cranial nerve function was intact. However, she exhibited marked extremity and mild truncal ataxia, and deep tendon reflexes were absent. She was admitted with a tentative diagnosis of either Guillain-Barré syndrome or postinfectious polyradiculopathy. Within several hours of hospitalization, she had onset of drooling and tachypnea. A nurse incidentally detected an engorged tick on the girl’s hairline by an ear and removed the tick. Within 7 hours after tick removal, tachypnea subsided and reflexes were present but diminished. The patient recovered fully and was discharged on April 11. The tick species was not identified.
Reported by: E Haas, D Anderson, R Neu, Asotin County Health Dept, Clarkston, Washington.
N Berkheiser, MD, Saint Joseph Regional Medical Center, Lewiston, Idaho. J Grendon, DVM,
P Shoemaker, J Kobayashi, MD, P Stehr-Green, DrPH, State Epidemiologist,
Washington State
Dept of Health. Div of Field Epidemiology, Epidemiology Program Office. CDC.
Editorial Note: Tick paralysis occurs worldwide and is caused by the introduction of a neurotoxin elaborated into humans during attachment of and feeding by the female on several tick species. In North America, tick paralysis occurs most commonly in the Rocky Mountain and northwestern regions of the United States and in western Canada. Most cases have been reported among girls aged <10 years during
April–June, when nymphs and mature wood ticks are most prevalent (2 ). Although tick paralysis is a reportable disease in Washington, surveillance is passive, and only 10 cases were reported during 1987–1995. In the United States, this disease is associated with Dermacentor andersoni (Rocky Mountain wood tick), D. variabilis (American dog tick), Amblyomma americanum
(Lone Star tick), A. maculatum, Ixodes scapularis (black-legged tick), and I. pacificus April 26, 1996 / Vol. 45 / No. 16
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES / Public Health Service 325 Tick Paralysis — Washington, 1995 326 Update: Influenza Activity — United States and Worldwide, 1995–96 Season, and Composition of the 1996–97 Influenza Vaccine 330 Multidrug-Resistant Tuberculosis Outbreak on an HIV Ward — Madrid, Spain, 1991–1995 333 Adult Blood Lead Epidemiology and Surveillance — United States. Fourth Quarter, 1995 335 Notice to Readers (western black-legged tick) (3,4 ). Onset of symptoms usually occurs after a tick has fed for several days. The pathogenesis of tick paralysis has not been fully elucidated, and pathologic and clinical effects vary depending on the tick species (4). However, motor neurons probably are affected by the toxin, which diminishes release of acetylcholine (5 ). In addition, experimental studies indicate that the toxin may produce a substantial decrease in maximal motor-nerve conduction velocities while simultaneously increasing the stimulating current potential necessary to elicit a response (5 ). If unrecognized, tick paralysis can progress to respiratory failure and may be fatal in approximately 10% of cases (6 ). Prompt removal of the feeding tick usually is followed by complete recovery. Ticks can be attached to the scalp or neck and concealed y hair and can be removed using forceps or tweezers to grasp the tick as closely as possible to the point of attachment (7 ). Removal requires the application of even pressure to avoid breaking off the body and leaving the mouth parts imbedded in the host. Gloves should be worn if a tick must be removed by hand; hands should be promptly washed with soap and hot water after removal of a tick. The risk for tick paralysis may be greatest for children in rural areas, especially in the Northwest, during the spring and may be reduced by the use of repellants on ski and permethrin-containing acaricides on clothing. Paralysis can be prevented by carefu examination of potentially exposed persons for ticks and prompt removal of ticks. Health-care providers should consider tick paralysis in persons who reside or have recently visited tick-endemic areas during the spring or early summer and who present with symmetrical paralysis.
References
1. Spach DH, Liles WC, Campbell GL, Quick RE, Anderson DE, Fritsche TR.
Tick-borne diseases in the United States. N Engl J Med 1993;329:936–47.
2. CDC. Tick paralysis—Wisconsin. MMWR 1981;30:217–8.
3. CDC. Tick paralysis—Georgia. MMWR 1977;26:311.
4. Gothe R, Kunze K, Hoogstraal H. The mechanisms of pathogenicity in the tick paralysis. J Med Entomol 1979;16:357–69.
5. Kocan AA. Tick paralysis. J Am Vet Med Assoc 1988;192:1498–500.
6. Schmitt N, Bowmer EJ, Gregson JD. Tick paralysis in British Columbia. Can Med Assoc J 1969;100:417–21.
7. Needham GR. Evaluation of five popular methods for tick removal. Pediatrics 1985;75:9
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15.) Rare Cause of Facial Palsy: Case Report of Tick Paralysis by Ixodes Holocyclus Imported by a Patient Travelling into Singapore from Australia.
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J Emerg Med. 2016 Nov;51(5):e109-e114. doi: 10.1016/j.jemermed.2016.02.031. Epub 2016 Sep 9.
Pek CH1, Cheong CS2, Yap YL1, Doggett S3, Lim TC1, Ong WC1, Lim J1.
Author information
1 Division of Plastic, Reconstructive and Aesthetic Surgery, Department of
Surgery, National University Health System, Singapore.
2 Department of Otolaryngology - Head and Neck Surgery, National University
Health System, Singapore.
3 Department of Medical Entomology, Pathology West, Westmead Hospital,
Westmead, NSW, Australia.
Abstract
BACKGROUND:
Ticks are blood-sucking arachnids that feed on all classes of vertebrates, including humans. Ixodes holocyclus, also known as the Australian Paralysis Tick, is capable of causing a myriad of clinical issues in humans and companion animals, including the transmission of infectious agents, toxin-mediated
paralysis, allergic and inflammatory reactions, and mammalian meat allergies in humans. The Australian Paralysis Tick is endemic to Australia, and only two other exported cases have been reported in the literature.
CASE REPORT:
We report the third exported case of tick paralysis caused by I. holocyclus, which was imported on a patient into Singapore. We also discuss the clinical course of the patient, the salient points of management, and the proper removal of this tick species. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: With increasing air travel, emergency physicians need to be aware of and to identify imported cases of tick paralysis to institute proper management and advice to the patient. We also describe the tick identification features and proper method of removal of this tick species.
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16.) A Comparative Meta-Analysis of Tick Paralysis in the United States and Australia.
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Clin Toxicol (Phila). 2015 Nov;53(9):874-83. doi: 10.3109/15563650.2015.1085999. Epub 2015 Sep 11
Diaz JH1.
Author information
1 a Louisiana State University Health Sciences Center, School of Public Health , 2020 Gravier Street, New Orleans, Louisiana 70112 United States.
Abstract
CONTEXT:
Tick paralysis is a neurotoxic envenoming that mimics polio and primarily afflicts children, especially in hyperendemic regions of the Western United States of America (US) and Eastern Australia.
OBJECTIVE:
To compare the epidemiology, clinical and electrodiagnostic manifestations, and outcomes of tick paralysis in the US versus Australia.
METHODS:
A comparative meta-analysis of the scientific literature was conducted using Internet search engines to identify confirmed cases of tick paralysis in the US and Australia. Continuous variables including age, time to tick removal, and duration of paralysis were analyzed for statistically significant differences by unpaired t-tests; and categorical variables including gender, regional distribution, tick vector, tick attachment site, and misdiagnosis were compared for statistically significant differences by chi-square or Fisher exact tests.
RESULTS:
Tick paralysis following ixodid tick bites occurred seasonally and sporadically in individuals and in more clusters of children than in adults of both sexes in urban and rural locations in North America and Australia. The case fatality rate for tick paralysis was low, and the proportion of misdiagnoses of
tick paralysis as Guillain-Barré syndrome (GBS) was greater in the US than in Australia. Although electrodiagnostic manifestations were similar, the neurotoxidromes differed significantly with prolonged weakness and even residual neuromuscular paralysis following tick removal in Australian cases compared with US cases.
DISCUSSION:
Tick paralysis was a potentially lethal envenoming that occurred in children and adults in a seasonally and regionally predictable fashion. Tick paralysis was increasingly misdiagnosed as GBS during more recent reporting periods in the US. Such misdiagnoses often directed unnecessary therapies including central venous plasmapheresis with intravenous immunoglobulin G that delayed correct diagnosis and tick removal.
CONCLUSION:
Tick paralysis should be added to and quickly excluded from the differential diagnoses of acute ataxia with ascending flaccid paralysis, especially in children living in tick paralysis-endemic regions worldwide.
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17.) Tick paralysis in Australia caused by Ixodes holocyclus Neumann
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Ann Trop Med Parasitol. 2011 Mar;105(2):95-106. doi: 10.1179/136485911X12899838413628
S Hall-Mendelin,* S B Craig,†‡ R A Hall,* P O’Donoghue,* R B Atwell,§ S M Tulsiani,† and G C Graham
Author information
1 School of Chemistry and Molecular Biosciences, University of Queensland,
St Lucia, Australia. sonja.hallmendelin@uqconnect.edu.au
Abstract
Ticks are obligate haematophagous ectoparasites of various animals, including humans, and are abundant in temperate and tropical zones around the world. They are the most important vectors for the pathogens causing disease in livestock and second only to mosquitoes as vectors of pathogens causing human disease. Ticks are formidable arachnids, capable of not only transmitting the pathogens involved in some infectious diseases but also of inducing allergies and causing toxicoses and paralysis, with possible fatal outcomes for the host. This review focuses on tick paralysis, the role of the Australian paralysis tick Ixodes holocyclus, and the role of toxin molecules from this species in causing paralysis in the host.
Many forms of tick toxicosis affect humans and other animals (Gothe and Neitz, 1991; Mans et al., 2004). According to Gothe (1984), a tick toxicosis is defined as a ‘generalized, experimentally standardizable, reproducible disease syndrome induced by one or a few potent ticks, even on first infestation of a physiological susceptible vertebrate species without participation of an immunopathological reaction during or following the tick feeding’. Such toxicoses are mostly caused by ixodid or hard ticks (Stone and Wright, 1981) and, in their most severe form, result in paralysis of the infested host. About 69 species of ticks from around the world are capable of inducing paralysis
(Gothe and Neitz, 1991), the most important being Ixodes holocyclus in Australia, Dermacentor andersoni, De. variabilis and Argas (Persicargas) radiatus in North America, Ix. rubicundus in South Africa, Rhipicephalus evertsi evertsi and Ar. (Pers.) walkerae in Ethiopia, and Ar. (Pers.) radiatus in the
Nearctic region of North America (Stone, 1986). Some important paralysing ticks and their distributions are summarized in Table 1. In Australia, Ix. holocyclus can cause paralysis in humans, dogs, cats, sheep, cattle, goats, pigs and horses but predominantly infests dogs, cats and humans (Stone, 1986). It appears to be the most potently toxic tick species, with a single tick capable of killing a large dog (Stone and Wright, 1981) or sheep (Sloan, 1968). Although the Tasmanian paralysis tick Ix. cornuatus has been reported to cause bulbar paresis and respiratory failure in humans (Tibballs and Cooper, 1986) and dogs
(Beveridge et al., 2004), its habitat is more restricted than that of Ix. holocyclus and very few cases of paralysis have been associated with this tick. In Australia, tick paralysis has mainly been seen as a problem in veterinary medicine, affecting approximately 10,000 companion animals/year (Stone and
Aylward, 1987). Occasionally, however, the climatic conditions become particularly favorable to tick survival, tick densities reach very high levels, and the number of humans being bitten by Ix. holocyclus increases. Although rarely severe, tick paralysis caused by Ix. holocyclus can be fatal.
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