- Tick paralysis
Name = Tick paralysis
DiseasesDB = 31779
ICD10 = ICD10|T|63|4|t|51
ICD9 = ICD9|989.5
MedlinePlus = 001359
MeshID = D013985
Tick paralysis is the only
tick-borne diseasethat is not caused by an infectious organism. The illness is caused by a neurotoxinproduced in the tick's salivary gland. After prolonged attachment, the engorged tick transmits the toxin to its host. The incidence of tick paralysis is unknown.
igns and symptoms
Tick paralysis results from inoculation of a toxin from tick salivary glands during a blood meal. The toxin causes
symptoms within 2-7 days, beginning with weakness in both legs that progresses to paralysis. The paralysis ascends to trunk, arms, and head within hours and may lead to respiratory failure and death. The disease can present as acute ataxiawithout muscle weakness.
Patients may report minor sensory symptoms but constitutional signs are usually absent. Deep tendon reflexes are usually hypoactive or absent and
ophthalmoplegiaand bulbar palsycan occur.
Electromyographic (EMG) studies usually show a variable reduction in the amplitude of compound muscle
action potentials but no abnormalities of repetitive nerve stimulation studies. These appear to result from a failure of acetylcholine release at the motor nerve terminal level. There may be subtle abnormalities of motor nerveconduction velocity and sensory action potentials.
Tick paralysis is believed to be due to toxins found in the tick's saliva that enter the bloodstream while the tick is feeding. The two ticks most commonly associated with North American tick paralysis are the Rocky Mountain wood tick ("
Dermacentor andersoni") and the American dog tick (" Dermacentor variabilis"); however, 43 tick species have been implicated in human disease around the world. [cite journal | author=Gothe R, Kunze K, Hoogstraal H | title=The mechanisms of pathogenicity in the tick paralyses | journal=J Med Entomol | year=1979 | volume=16 | pages=357–69 ] Most North American cases of tick paralysis occur from April to June, when adult Dermacentor ticks emerge from hibernation and actively seek hosts. [cite journal | author=Dworkin MS, Shoemaker PC, Anderson D | title=Tick paralysis: 33 human cases in Washington state, 1946–1996 | journal=Clin Infect Dis | year=1999 | volume=29 | pages=1435–9 | doi=10.1086/313502 ] . In Australia, tick paralysis is caused by the tick " Ixodes holocyclus". Up to 1989 20 fatal cases have been reported in Australia. [cite journal
author = Masina S, Broady K. W.
title = Tick paralysis: development of a vaccine
journal = International Journal for Parasitology
volume = 29
issue = 4
pages = 535–541
year = 1999
doi = 10.1016/S0020-7519(99)00006-5]
Tick paralysis has killed thousands of animals, mainly cows and sheep, in other parts of the world. Although tick paralysis is of concern in domestic animals and livestock in the United States as well, human cases are rare and usually occur in children under the age of 10.
Tick paralysis occurs when an engorged and gravid (egg-laden) female tick produces a
neurotoxinin its salivary glands and transmits it to its host during feeding. Experiments have indicated that the greatest amount of toxin is produced between the fifth and seventh day of attachment (often initiating or increasing the severity of symptoms), although the timing may vary depending on the species of tick.
Lyme disease, ehrlichiosis, and babesiosis, which are caused by the systemic proliferation and expansion of parasites in their hosts long after the offending tick is gone, tick paralysis is chemically induced by the tick and therefore usually only continues in its presence. Once the tick is removed, symptoms usually diminish rapidly. However, in some cases, profound paralysis can develop and even become fatal before anyone becomes aware of a tick's presence.
Diagnosis is based on symptoms and upon finding an embedded tick, usually on the scalp.
In the absence of a tick, the differential diagnosis includes
Guillain-Barre syndromeand botulism.
Removal of the embedded tick usually results in resolution of symptoms within several hours to days. If the tick is not removed, the toxin can be fatal, with reported mortality rates of 10–12 percent, [cite journal | author=Schmitt N, Bowmer EJ, Gregson JD | title=Tick paralysis in British Columbia | journal=Can Med Assoc J | year=1969 | volume=100 | pages=417–21 ] usually due to respiratory paralysis. The tick is best removed by grasping the tick as close to the skin as possible and applying firm steady pressure. [cite journal | author=Needham GR | title=Evaluation of five popular methods for tick removal | journal=Pediatrics | year=1985 | volume=75 | pages=997–1002 ]
vaccineis currently available for any tick-borne disease, except for Tick-borne encephalitis. Individuals should therefore take precautions when entering tick-infested areas, particularly in the spring and summer months. Preventive measures include avoiding trails that are overgrown with bushy vegetation, wearing light-colored clothes that allow one to see the ticks more easily, and wearing long pants and closed-toe shoes. Tick repellents containing DEET(N,N, diethyl-m-toluamide) are only marginally effective and can be applied to skin or clothing. Rarely, severe reactions can occur in some people who use DEET-containing products. Young children may be especially vulnerable to these adverse effects. Permethrin, which can only be applied to clothing, is much more effective in preventing tick bites. Permethrin is not a repellent but rather an insecticide; it causes ticks to curl up and fall off of the protected clothing.
Although several attempts have been made to isolate and identify the
neurotoxinsince the first isolation in 1966 the exact structure of the toxin is still unknown. [cite journal
author = Doube B. M.
title = Cattle and Paralysis Tick Ixodes-Holocyclus
journal = Australian Veterinary Journal
volume = 51
issue = 11
pages = 511–515
year = 1975
doi = 10.1111/j.1751-0813.1975.tb06901.x] The 40-80 kDa
proteinfraction contains the toxin. [cite journal
author = B. F. Stone, K. C. Binnington, M. Gauci, J. H. Aylward
title = Tick/host interactions forIxodes holocyclus: Role, effects, biosynthesis and nature of its toxic and allergenic oral secretions
journal = Experimental and Applied Acarology
volume = 7
issue = 1
pages = 59–69
year = 1989
doi = 10.1007/BF01200453]
Polyneuropathy in dogs and catsfor tick paralysis in dogs
* [http://www.avma.org/reference/zoonosis/znticpar.asp Overview at avma.org]
* [http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5534a1.htm Description of four cases in Colorado]
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