Posted 6/24/2024 10:51 AM (GMT -5)
this was a timely post from Invisible Internationals Newsletter - and since we are in the middle of the Tick season in the northern hemisphere - i thought it worth posting - and perhaps even making it a sticky ( if i can figure out how to do that)
i will post the text of the article in its entirety below:
--------------------------------------------------------------------------------------------------------------------------------------------------------
What to Do When You’ve Been Bitten by a Tick: Advice from Dr. Elizabeth Maloney
Ticks are out across the country and given that there are roughly 500,000 new cases of Lyme disease each year in the U.S., many people will have the misfortune of being bitten by one. If you find an embedded tick, don’t panic. Dr. Elizabeth Maloney, Education Co-Director for Invisible International, a Minnesota family medicine physician, who has published on the management of blacklegged (deer) tick bites, discusses what people and clinicians should and shouldn’t do when a bite occurs.
Question: Which ticks bite people?
Dr. Maloney: There are dozens of tick species in the United States that can bite humans but most human bites are from one of these three species: the blacklegged (deer) tick, the American dog tick and the lone star tick. These ticks generally transmit different bacteria, viruses and parasites.
Question: Which tick transmits Lyme disease and what should I do if I find one biting me?
Dr. Maloney: In the US and Canada, only the blacklegged ticks, Ixodes scapularis and Ixodes pacificus, transmit Lyme disease. Not all blacklegged ticks are infected and infection rates are highly variable from one locale to another. If you find a blacklegged tick follow these steps:
1. Remain calm
2. Grasp the tick with tweezers as close to your skin as possible. Ideally, this will be on the tick’s head but if it can’t be, that’s ok.
3. Pull straight up with steady pressure until the tick is out.
4. Save the tick in a plastic bag; a clinician will need to identify the tick species so you can know what diseases you may have been exposed to.
5. Wash the bite area with soap and water.
6. Call your primary care clinician as soon as the tick is out; if it’s after hours, call the next morning and report you’ve been bitten by a deer tick. ONLY report an attachment time if you are 100% certain of this. If you don’t know, say that. If it looks like the tick has blood in it, you may report that, too
Question: I heard there are antibiotics for treating Lyme disease when you have it but are there any that prevent the infection?
Dr. Maloney: Yes; taking doxycycline at the time of a bite may prevent you from getting Lyme disease but there are important details to consider because not every bite benefits from prophylaxis.
Question: What are they?
Dr. Maloney: Not every encounter with a blacklegged tick is worrisome. Ticks that are simply crawling on your clothing or skin won’t give you Lyme disease. Newly embedded ticks (easy to remove and still flat) could potentially transmit the disease but that risk is quite low.
The goal of antibiotic prophylaxis is to quickly kill any on the Lyme bacteria (Borrelia burgdorferi) that the tick may have injected into you before they have time to make you ill so antibiotic prophylaxis needs to begin as soon as possible. Although the prevailing recommendation is to start prophylaxis within 72 hours of removing a tick, a study in mice demonstrated that prophylaxis wasn’t useful after 48 hours. (1)
Question: What if It’s been less than 72 hours and the tick is no longer flat (partially engorged); will doxycycline be useful and how much do I need? It seems that most clinicians give a single 200mg dose of doxycycline; is that enough?
Dr. Maloney: Under those circumstances, doxycycline could prevent Lyme disease but the prevailing practice of using single dose doxycycline isn’t a very effective one. This approach is based on a single study that had many flaws. (2) (Management of Ixodes Bites) A closer analysis of the data suggests that a single 200mg dose of doxycycline is only 50% effective; you should want better odds than that. Studies in humans using 10 days of antibiotics didn’t prove treatment helped because few patients got sick, even in the placebo groups. Studies in mice found long-acting doxycycline, present at low levels for 19 days, was 100% effective.3 This was true even when the mice had Lyme and anaplasmosis. This group of evidence demonstrates that the ideal duration for antibiotic prophylaxis of Lyme disease in humans is currently unknown but it isn't a single dose doxycycline.
Question: Does antibiotic prophylaxis with doxycycline work for other blacklegged tick-transmitted infections?
Dr. Maloney: The short answer is that we don’t know. Deer ticks transmit other bacteria, viruses and Babesia parasites. Antibiotics for Lyme disease prophylaxis won’t prevent viral or Babesial infections but did prevent anaplasmosis in the previously described mouse study. (3)
Question: Should we be sending ticks for testing, and if so, what resource should we use?
Dr. Maloney: Yes, sending ticks for testing can be a valuable step in managing potential tick-borne diseases. Knowing whether a tick carries pathogens can help guide early treatment decisions. For reliable tick testing, I recommend using the resources provided by the University of Rhode Island's TickEncounter Resource Center. They offer comprehensive tick testing services, and you can find more information on how to submit a tick for testing on their website: University of Rhode Island TickEncounter Testing. However, do not delay antibiotic prophylaxis while awaiting tick results, as timely intervention is crucial to preventing Lyme disease.
The Invisible Education Initiative, funded by the Montecalvo Foundation, provides accredited Continuing Medical Education (CME) courses focused on vector-borne and environmental illnesses within a One Health framework. Outreach to medical professionals through the dissemination of these educational materials is supported by the Lovell Healthcare Foundation. Together, these generous foundations and our annual fund donors help Invisible equip clinicians with the most updated evidence and knowledge for improved patient care.
References:
1. Piesman J, Hojgaard A. Protective value of prophylactic antibiotic treatment of tick bite for Lyme disease prevention: an animal model. Ticks Tick Borne Dis. 2012;3(3):193-196. doi:10.1016/j.ttbdis.2012.01.001
2. Maloney EL. The management of Ixodes scapularis bites in the upper Midwest. WMJ. 2011;110(2):78-85.
3. Zeidner N, Massung R, Dolan M, et al. A sustained-release formulation of doxycycline hyclate (Atridox) prevents simultaneous infection of Anaplasma phagocytophilum and Borrelia burgdorferi transmitted by tick bite. J Med Microbio.2008;57:463-468.