Tick Paralysis

• Present in Eastern, Southern and Western states and the Rocky Mountain Region

• Neurotoxin produced by engorged female D.variabilis or D. andersoni ticks

• incidence higher in children

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Tick paralysis.

1. Prevalence of this disease is highest in Eastern, Southern and Western states and the Rocky Mountain region.
2. The etiology is a neurotoxin produced by engorged female D. variabilis or D. andersoni ticks
3. The incidence is higher in children, occurring most often in girls with long hair
a. The patient is afebrile but presents with ataxia, leg weakness and gait instability.
b. Progressive ascending symmetric paralysis resembles that seen in Guillain-Barr6 syndrome.
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c. Patients with advanced cases of the illness present with

areflexia, dysphagia, respiratory compromise and obtundation.
d. Untreated cases can result in death.
5. Diagnosis. a. A diligent search of the patient's scalp, fossa axillaris or perineum reveals an engorged tick. b. Laboratory testing reveals a normal white blood cell count. Cerebrospinal fluid and neuroirnaging studies are also normal in patients with tick paralysis. c. In any child with ascending paralysis and areflexia, it is essential to also consider Guillain-Barr6 syndrome or acute cervical spinal cord compression if a tick cannot be found.
6. Treatment. a. Tweezer removal of the embedded female tick eliminates neurotoxin production and results in dramatic recovery of neurologic function, usually within hours to a few days. b. If respiratory function and vital capacity are severely compromised, intubation and ventilation may be required until the tick is removed and the neurotoxin is eliminated.

7. Prognosis. Recovery is rapid and complete after tick removal.