Tick Bites, HealthLink BC

Tick Bites

British Columbia Specific Information

Ticks are tiny bugs which feed on blood. For information on ticks, removing ticks, and how to avoid being bitten, see HealthLinkBC File #01 Tick Bites and Disease. You may also be interested in the HealthLinkBC File #96 Insect Repellent and DEET.

While most tick bites do not result in diseases, some can. Some of the diseases passed on by ticks include relapsing fever, tularemia, Rocky Mountain Spotted Fever (RMSF), Q Fever and anaplasmosis. The most well-known is Lyme disease. For more information on Lyme Disease, visit BC Centre for Disease Control — Lyme Disease (Borrelia burgdorferi infection).

Top of the page Check Your Symptoms

Topic Overview

Ticks are small spider-like animals (arachnids) that bite to fasten themselves onto the skin and feed on blood. Ticks live in the fur and feathers of many birds and animals. Tick bites occur most often during early spring to late summer and in areas where there are many wild animals and birds.

Most ticks don’t carry diseases, and most tick bites don’t cause serious health problems. But it is important to remove a tick as soon as you find it. Removing the tick’s body helps you avoid diseases the tick may pass on during feeding. Removing the tick’s head helps prevent an infection in the skin where it bit you. See Home Treatment for the best way to remove a tick .

Usually, removing the tick, washing the site of the bite, and watching for signs of illness are all that is needed. When you have a tick bite, it is important to determine whether you need a tetanus shot to prevent tetanus (lockjaw) .

Some people may have an allergic reaction to a tick bite. This reaction may be mild, with a few annoying symptoms. In rare cases, a severe allergic reaction ( anaphylaxis ) may occur.

Many of the diseases ticks carry cause flu-like symptoms, such as fever, headache, nausea, vomiting, and muscle aches. Symptoms may begin from 1 day to 6 weeks after the tick bite. Sometimes a rash or sore appears along with the flu-like symptoms. Common tick-borne diseases include:

Tick paralysis is a rare problem that may occur after a tick bite. In some parts of the world, tick bites may cause other tick-borne diseases, such as South African tick-bite fever .

Check your symptoms to decide if and when you should see a doctor.

Check Your Symptoms

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

  • Your age. Babies and older adults tend to get sicker quicker.
  • Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
  • Medicines you take. Certain medicines and natural health products can cause symptoms or make them worse.
  • Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
  • Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

  • Try home treatment to relieve the symptoms.
  • Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

Symptoms of a severe allergic reaction can start within minutes of eating or being exposed to an allergen. While symptoms usually occur within 2 hours, in rare cases the time frame can vary up to several hours after exposure. Do not ignore early symptoms. When a reaction begins, it is important to respond right away.

Symptoms of a severe allergic reaction can vary from person to person. The same person can have different symptoms each time they have a severe allergic reaction. Symptoms can include any of the following:

    • Skin: hives, swelling (face, lips, tongue), itching, warmth, redness
    • Respiratory (breathing): coughing, wheezing, shortness of breath, chest pain or tightness, throat tightness, hoarse voice, nasal congestion or hay fever-like symptoms (runny, itchy nose and watery eyes, sneezing), trouble swallowing
    • Gastrointestinal (stomach): nausea, pain or cramps, vomiting, diarrhea
    • Cardiovascular (heart): paler than normal skin colour/blue colour, weak pulse, passing out, dizziness or lightheadedness, shock
    • Other: anxiety, sense of doom (the feeling that something bad is about to happen), headache, uterine cramps, metallic taste

A severe reaction can take place without hives, so make sure to look out for all of the signs of an allergic reaction.

Adapted from: Anaphylaxis in Schools and Other Settings, Copyright 2005-2009 Canadian Society of Allergy and Clinical Immunology

Symptoms of infection may include:

  • Increased pain, swelling, warmth, or redness in or around the area.
  • Red streaks leading from the area.
  • Pus draining from the area.
  • A fever.

You may need a tetanus shot depending on how dirty the wound is and how long it has been since your last shot.

    • For a deep or dirty wound that has things like dirt, saliva, or feces in it, you may need a shot if:
      • You haven’t had a tetanus shot in the past 5 years.
      • You don’t know when your last shot was.
      • You have not received 3 doses of the tetanus vaccine series.
    • For a clean wound, you may need a shot if:
      • You have not had a tetanus shot in the past 10 years.
      • You don’t know when your last shot was.
      • You have not received 3 doses of the tetanus vaccine series.

Certain health conditions and medicines weaken the immune system’s ability to fight off infection and illness. Some examples in adults are:

  • Diseases such as diabetes, cancer, heart disease, and HIV/AIDS.
  • Long-term alcohol and drug problems.
  • Steroid medicines, which may be used to treat a variety of conditions.
  • Chemotherapy and radiation therapy for cancer.
  • Other medicines used to treat autoimmune disease.
  • Medicines taken after organ transplant.
  • Not having a spleen.

Tick paralysis is a rare reaction to the venom that some ticks release when they bite. Symptoms usually start 4 to 7 days after a tick attaches to your body and may include:

  • Tingling, numbness, or loss of feeling or movement that starts in your hands or feet.
  • Trouble swallowing or talking.
  • Double vision.
  • Loss of movement in your face.

Removing the tick stops the release of the venom and reverses the problem.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

  • Call your doctor now to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don’t have one, seek care in the next hour.
  • You do not need to call an ambulance unless:
    • You cannot travel safely either by driving yourself or by having someone else drive you.
    • You are in an area where heavy traffic or other problems may slow you down.

Make an Appointment

Based on your answers, the problem may not improve without medical care.

  • Make an appointment to see your doctor in the next 1 to 2 weeks.
  • If appropriate, try home treatment while you are waiting for the appointment.
  • If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

  • Call your doctor today to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don’t have one, seek care today.
  • If it is evening, watch the symptoms and seek care in the morning.
  • If the symptoms get worse, seek care sooner.

Home Treatment

Most ticks don’t carry diseases, and most tick bites don’t cause serious health problems. The sooner ticks are removed, the less likely they are to spread disease.

Some ticks are so small that it is hard to see them. This makes it hard to tell whether you have removed the tick’s head. If you do not see any obvious parts of the tick’s head in the bite site, assume you have removed the entire tick, but watch for signs of a skin infection .

    • Use fine-tipped tweezers to remove a tick. If you don’t have tweezers, put on gloves or cover your hands with tissue paper, then use your fingers. Do not handle the tick with bare hands.
    • Do not try to smother a tick that is attached to your skin with petroleum jelly, nail polish, gasoline, or rubbing alcohol. This may increase your risk of infection.
    • Do not try to burn the tick while it is attached to your skin.
    • Put the tick in a dry jar or ziplock bag and save it in the freezer for later identification if necessary.
    • Wash the area of the tick bite with soap and a lot of warm, clean water.
    • Apply a thin layer of antiseptic cream, lightly to the wound. It will keep the bite from sticking to the bandage.
    • After you remove the tick, wash your hands really well with soap and water.

When you return home from areas where ticks might live, carefully examine your skin and scalp for ticks. Check your clothing, outdoor gear, and pets, too. Remove any ticks you find. Then put your clothing in a clothes dryer on high heat for 1 hour to kill any ticks that might remain.

Home treatment to help relieve pain and itching

  • Apply an ice pack to your bite for 15 to 20 minutes once an hour for the first 6 hours. When you are not using ice, keep a cool, wet cloth on the bite for up to 6 hours.
  • Try a non-prescription medicine for the relief of itching, redness, and swelling. Be sure to follow the non-prescription medicine precautions.
    • An antihistamine medicine, such as a non-drowsy one like loratadine (Claritin) or one that might make you sleepy like diphenhydramine (Benadryl), may help relieve itching, redness, and swelling. Don’t give antihistamines to your child unless you’ve checked with the doctor first.
    • A spray of local anesthetic containing benzocaine, such as Solarcaine, may help relieve pain. If your skin reacts to the spray, stop using it.
    • Calamine lotion applied to the skin may help relieve itching.
  • After the first 6 hours, if there is no swelling, try putting a warm face cloth on the bite for comfort.
Medicine you can buy without a prescription

Try a non-prescription medicine to help treat your fever or pain:

  • Acetaminophen, such as Tylenol
  • Non-steroidal anti-inflammatory drugs (NSAIDs):
    • Ibuprofen, such as Advil or Motrin
    • Naproxen, such as Aleve
  • Aspirin (also a non-steroidal anti-inflammatory drug), such as Entrophen

Talk to your child’s doctor before switching back and forth between doses of acetaminophen and ibuprofen. When you switch between two medicines, there is a chance your child will get too much medicine.

Be sure to follow these safety tips when you use a non-prescription medicine:

  • Carefully read and follow all directions on the medicine bottle and box.
  • Do not take more than the recommended dose.
  • Do not take a medicine if you have had an allergic reaction to it in the past.
  • If you have been told to avoid a medicine, call your doctor before you take it.
  • If you are or could be pregnant, do not take any medicine other than acetaminophen unless your doctor has told you to.
  • Do not give aspirin to anyone younger than 18 unless your doctor tells you to.

Symptoms to watch for during home treatment

Call your doctor if any of the following occur during home treatment:

  • Flu-like symptoms develop.
  • A rash or sore develops.
  • Symptoms of a skin infection develop.
  • Symptoms become more severe or more frequent.

Prevention

To prevent tick bites:

  • Apply an insect repellent safely. Use insect repellents according to the directions on the label, particularly when applying repellent to children.
    • Use a lower-concentration repellent on children.
    • Do not put repellent on small children’s hands, since they often put their hands in their mouths.
    • Wash the insect repellent off with soap and water after returning indoors.
  • Use products that contain 0.5% permethrin on your clothing and outdoor gear, such as your tent. You can also buy clothing already treated with permethrin. Permethrin is not available as an insect repellent in Canada, but travel health clinics may be able to advise you on how to buy permethrin or permethrin-treated gear.
  • Cover as much of your skin as possible when working or playing in grassy or wooded areas. Wear a hat, a long-sleeved shirt, and long pants with the legs tucked into your socks. Keep in mind that it is easier to spot ticks on light-coloured clothes. If you think you may have a tick on your clothing, put your clothing in a clothes dryer for 10 to 15 minutes to kill the tick.
  • Wear gloves when you handle animals or work in the woods.
  • Take steps to control ticks on your property if you live in an area where Lyme disease is prevalent. Clearing leaves, brush, tall grasses, woodpiles, and stone fences from around your house and the edges of your yard or garden may help reduce the tick population and the rodent population that the ticks depend on. Remove plants that attract deer, and use barriers to keep deer—and the deer ticks they may carry—out of your yard. Treating yards with chemicals that kill ticks (ascaricides) is sometimes effective but exposes you and your pets to chemicals that may not be safe. You may choose to treat your lawn for ticks with nonchemical or environmentally safe methods instead. Call your local landscaping nursery or local health unit for more information.
  • Stay away from tick-infested areas.

For information on how to specifically prevent Lyme disease, see the topic Lyme Disease.

Preparing For Your Appointment

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

  • When were you bitten? How many times were you bitten? If you saved the tick, bring it with you to your doctor’s appointment. If not, be prepared to describe the tick.
  • What are your main symptoms?
  • When did your symptoms begin? How have your symptoms developed, progressed, or changed since the bite?
  • What home treatment have you tried? Did it help?
  • When was your last tetanus shot?
  • Have you travelled in the wilderness or in another country recently?
  • Do you have any health risks?

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LymeSci

Lonnie Marcum

LYME SCI: Help! I’ve gotten a tick bite. Now what?

Tick season is in full-swing. How do I know that? I wake up practically every day to another text or email from a friend or relative telling me they had a tick bite.

Last week, I got a desperate call from a relative whose son had found a tick embedded in his skin after a camping trip. Both my cousin and her son are well aware of my daughter’s missed diagnosis and years’ long battle with Lyme and co-infections. Needless to say, they were in a panic. More about this later…

Of course the best thing is to prevent tick bites in the first place, but life happens and that’s probably why you’re reading this.

Here’s my advice if you have a tick bite:

Step 1 – Take a picture of the tick that bit you

Take a picture while the tick is still attached. This will show details of the tick that can help you identify it later. It will also show how deeply embedded the tick is, how engorged it is, and if a rash has already formed prior to you removing the tick and cleaning the area.

Step 2 – Remove the tick

Proper and prompt removal of the tick is critical. Read this section very carefully before getting started. If you do not feel comfortable removing the tick, see your physician or go to the nearest urgent care. (Although I’ve heard horror stories of MDs improperly removing ticks…)

  • DO NOT squeeze, twist or squash the tick. Don’t burn it with a match or cover it with Vaseline or nail polish. Squeezing or agitating the tick may force it to expel more pathogens into your body.
  • Use fine-point tweezers or a special tick-removing tool. Grasp the ticks mouth parts or get as close to the skin as possible.
  • DO NOT pull back sharply; this may tear the mouthparts from the body of the tick and leave them embedded in the skin.
  • Pull the tick straight out with steady, slow, even pressure as pictured above. Be patient. The tick has long mouthparts. Pull steadily without twisting until you can ease the tick head straight out of the skin. It may take several seconds to a few minutes for the tick to unhook its mouth.
  • Wash the bite area and your hands with soap and water. Disinfect the site with rubbing alcohol, then apply a triple antibiotic ointment or antiseptic.

Step 3 – Identify the tick you were bitten by

It’s important to identify the tick because different kinds of ticks can carry different bacteria, viruses, protozoa and parasites. (Lyme disease isn’t the only thing you need to worry about with ticks bites.)

There are two families of ticks found in the United States: Ixodidae (hard ticks) and Argasidae (soft ticks). Of the 700 species of hard ticks and 200 species of soft ticks found throughout the world, only a few are known to bite and transmit disease to humans. Knowing the type of tick will help you be aware of what possible symptoms to watch for.

Here’s how to identify a tick after a tick bite:

  • After removing the tick, place it on a white piece of paper or clear tape, then take a picture of the front and back of the tick. DO NOT let it crawl away.
  • Place the tick in a small plastic bag with a green leaf, damp cotton ball or moist piece of tissue. DO NOT place it in alcohol. Label the bag with your name, date, site of bite and how long the tick was attached.
  • Use one of the following links to identify the tick. (If you can’t identify the tick, don’t worry, the testing lab will do it for you. Step 5 below)
    • TickEncounter.org (you can submit a picture of the tick and they will identify for free)
    • or you can download the TickTracker app on your smart phone.
    [Optional: log your information in the app if you’d like advance knowledge of ticks in your area.]

    Step 4 – See your primary care doctor

    Before you get to the doctor, I highly recommend doing a little research about what tick-borne diseases are known to be in your area’s ticks.

    There are a lot of misconceptions surrounding Lyme and tick-borne diseases. These are the main points I think you need to know before heading to the doctor:

    The following are the most common misunderstood facts about tick bites:

    1. Ticks can transmit several pathogens (especially viruses) in as little as 15 minutes. While it is true that the longer a tick is attached, the more likely it is able to transfer Lyme, no one really knows how long a tick needs to be attached to transmit infection. A minimum attachment time has NEVER been established. It is dangerous to assume there is zero risk of contracting a disease if the tick has been attached less than 24 hours.
    2. Not everyone with Lyme gets a rash. Studies have shown that only 40-60% of Lyme patients will get an erythema migrans rash, and only 20-30% of those will present as the telltale bullseye rash. Several other tick-borne diseases may cause a rash. See here for Rocky Mountain spotted fever, and other common rickettsial rashes.
    3. A Single dose of Doxycycline is only effective at reducing the tick bite rash. It does not adequately treat any of the known pathogens. In fact, a single dose of doxy may only prevent the rash from surfacing, masking a crucial sign of illness. (Dr. Daniel Cameron does a great job of explaining the science here.)
    4. There is no point in testing for Lyme if you’ve just been bitten by a tick. First, Lyme disease is a clinical diagnosis based on signs and symptoms and history of possible exposure to infected blacklegged ticks. Second, the test for Lyme is prone to false-negatives, especially in the first 4-6 weeks, before the body has had a chance to produce the antibodies that are detected by the standard test. Each tick-borne disease requires a different test, and some of them are more accurate than others. Testing the tick can help you know what you’ve been exposed to. More about Lyme disease testing here:

    If your Lyme disease test is negative, that doesn’t mean you are out of danger. It depends on your exposure and your symptoms.

    Step 5 – Start Tick Bite Treatment

    Rather than give medical advice about recommended treatment, I’m going to quote the International Lyme and Associated Diseases Society (ILADS – how to handle a tick bite):

    “ILADS recommends that prophylaxis (preventive treatment) be discussed with all who have had a blacklegged tick bite. An appropriate course of antibiotics has been shown to prevent the onset of infection.

    When the decision is made to use antibiotic prophylaxis, ILADS recommends 20 days of doxycycline (provided there are no contraindications). The decision to treat a blacklegged tick bite with antibiotics often depends on where in the country the bite occurred, whether there was evidence that the tick had begun feeding, and the age of the person who was bitten. Based on the available evidence, and provided that it is safe to do so, ILADS recommends a 20-day course of doxycycline.

    Patients should also know that although doxycycline can prevent cases of Lyme disease, ticks in some areas carry multiple pathogens, some of which, including Babesia, Powassan virus, and Bartonella, are not responsive to doxycycline. This means a person could contract a tick-borne illness despite receiving antibiotic prophylaxis for their known bite.

    ILADS recommends against single-dose doxycycline. Some doctors prescribe a single 200 mg dose of doxycycline for a known bite. However, as discussed in detail in the guidelines, this practice is based on a flawed study that has never been replicated.

    Read more in the ILADS treatment guidelines.

    Step 6 – Mail The Tick For Testing

    Knowing what diseases the tick is carrying (if anything) will either give you peace of mind or provide valuable clues as to what symptoms to watch for and which disease(s) to treat. One thing we know for sure, early treatment for any tick-borne disease is the key to full recovery. Delaying treatment by as little as 3-4 weeks can increase your odds of having long-term damage.

    Many states offer free tick testing, although they may only test for one or two pathogens. You can call your local public health department and see what they offer.

    I recommend sending the tick in for testing to determine if the tick is carrying any pathogens that can lead to tick-borne illness. If you can not find free testing, I recommend one of following laboratories:

    • IGeneX (tests individually for up to 8 pathogens, $75 each)
    • Tick Report (test for up to 23 pathogens, $50 – $200)
    • Ticknology (test for up to 11 pathogens, $25 – $45)

    Step 7 – Start Tracking Symptoms From Your Tick Bite

    Immediately start tracking any symptoms that are out of the ordinary. On a calendar or diary, write down any flu-like symptoms, headache, fever, ringing in the ears, weird numbness or tingling, facial palsy, nausea, migrating pain, joint swelling, night sweats. Seriously, write down anything that is not normal for you. Symptoms of tick-borne diseases can begin anywhere from 1-3 days to 4-6 weeks after the bite. (More about tick bite symptoms to watch for)

    Observe the bite site over the next three weeks for any signs of a rash. Take pictures of any visible changes anywhere on your body (not just the bite site). Place a quarter or tape measure next to any rash for size reference.

    Let your doctor know immediately of any signs of illness. (Check your symptoms for Lyme.)

    Step 8 – Await The Results Of Your Tick Test

    Most of these results are coming back within a week. During that time, monitor your symptoms and notify your doctor if anything gets worse. If you are on doxycycline, you may actually avoid getting sick.

    Once the results come back you will need to discuss what to do. If the tick is positive, you will want to stay on treatment. Many ILADS practitioners will prescribe 4-6 weeks for early Lyme. Other pathogens, like Anaplasma or Ehrlichia, will be treated for a different duration. Babesia is treated with an entirely different medication.

    If the tick test is negative, that doesn’t mean you are out of danger. It depends on your exposure and your symptoms. One thing to consider is how long you were exposed to the ticks and whether there could have been another bite that you did not see. Even though one tick is negative, another tick could have been positive. This is something you will really need to discuss with your medical provider.

    What happened to my relative?

    To finish the story about my cousin’s son. I basically told them everything I have spelled out above. Just as I predicted, when they got to the doctor, he said, “If the tick hasn’t been attached for over 24 hours you’ve got nothing to worry about.” STRIKE ONE

    They showed him the photograph of the embedded tick and the red circular rash that had started to form. The doctor said, “Well, because you’ve got a rash, I’m going to give you a single dose of doxycycline and that should cover it.” STRIKE TWO

    They explained what they had learned and the doctor was actually very interested. They established a rapport. In the end, they left with a 20-day supply of doxycycline and their doctor wanting them to come back with the full tick report and any information they had to share. He was interested in learning more. A HOME RUN!

    www.lymedisease.org

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