Lyme disease. That is usually what comes to mind when people find a tick on their child or if they simply think about tick-borne diseases.
It is important to know that there are many diseases that can be caused by many different types of ticks though, from anaplasmosis to tularemia. And since these ticks and the diseases they transmit are fairly regional, it is easy to be unfamiliar with them if you don't live in their specific habitats. That can especially be a problem if, for example, you are from Hawaii, where tick-borne diseases aren't a big issue, and you travel for a camping trip to Oklahoma and your child is bitten by a tick. Will you or your doctor know what to do if your child develops symptoms of Rocky Mountain spotted fever?
Symptoms of Tick-Borne Diseases
Although some of the symptoms of tick-borne diseases are specific to the tick that bit your child, some other symptoms are common to all of them, including:
Unlike many insect bites and stings, tick bites are usually painless. That often leads to a delay in actually figuring out that a tick has bitten your child, which makes it important to do frequent tick checks if they are doing something that will expose them to ticks.
Do a full body check for ticks, looking under their arms, in and around their ears and hair, inside their belly button, around their waist, between their legs, and around the back of their knees.
Lyme disease is the most common tick-borne disease, but only if you live in the Northeast and Upper Midwestern parts of the United States, including Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota, New Jersey, New Hampshire, New York, Pennsylvania, Virginia, and Wisconsin.
That doesn't mean that you don't have to be concerned about tick-borne diseases if your child is bitten by a tick in another part of the country, it just isn't likely that your child will develop Lyme disease.
If your child is bit in an area where Lyme disease is common, in addition to the symptoms listed above, your child will likely develop a classic skin rash - erythema migrans (EM) and swollen glands (lymphadenopathy). These Lyme disease symptoms usually start about 3 to 30 days after the tick bite, with the erythema migrans rash appearing as a red ring-like area that gradually expands. The rash, which is absent in about 20% of people with Lyme disease, begins at the site of the original tick bite and often takes on the appearance of a "bull's eye."
Over the next few days or weeks, a child with Lyme disease may develop other EM lesions, a Bell's palsy (facial paralysis), symptoms of meningitis (severe headache and neck stiffness), arthritis, and heart problems.
Untreated, many people with Lyme disease will develop arthritis and chronic neurological symptoms.
Fortunately, Lyme disease can usually be treated with commonly prescribed antibiotics, including amoxicillin (Amoxil), doxycycline, or cefuroxime (Ceftin), which are given for 14 to 21 days. If your child's symptoms linger after treatment, then he may have post-treatment Lyme Disease Syndrome, which may reflect an auto-immune response to the original infection.
Children with ehrlichiosis develop symptoms about 1-2 weeks after getting bitten by a lone star tick in the southeastern and south-central United States, especially Oklahoma, Missouri, Arkansas.
Although the symptoms of ehrlichiosis are similar to other tick-borne diseases, ehrlichiosis can be fatal and unfortunately, hard to diagnose.
Doxycycline is the treatment of choice for all children, even for those under age 8-years.
Rocky Mountain Spotted Fever
Unlike many other tick-borne diseases, Rocky Mountain spotted fever (RMSF) can be transmitted by multiple ticks in the United States, including the American dog tick, the Rocky Mountain wood tick, and the brown dog tick.
Also unlike other tick-borne diseases, although most cases of RMSF are in just five states - North Carolina, Oklahoma, Arkansas, Tennessee, and Missouri - cases have been reported from most states, except Vermont, Maine, Alaska, and Hawaii.
As in Lyme disease, the characteristic skin rash can be a clue that a child has Rocky Mountain spotted fever. After having a fever for 2 to 4 days and other symptoms of a tick-borne disease, many children with RMSF develop a rash on their ankles, wrists and forearms. These small, pink spots spread to the the rest of the child's body over the next few days, including their palms and soles, but usually spares their face. The spots can eventually become more red and purple (petechiae).
Although many other infections can cause a fever and a rash, which can delay the diagnosis of RMSF, they don't usually have this same characteristic of starting peripherally (on a child's wrists and ankles). For example, like RMSF, the measles rash usually appears after 2 to 4 days of fever, but it starts on a child's face and head and then spreads down to his trunk, arms, and legs.
Like ehrlichiosis, doxycycline is the first-line treatment for RMSF in children of all ages.
Other Tick-Borne Diseases
Many people are surprised at how many different diseases can be transmitted by ticks, including:
- Anaplasmosis - transmitted by the black-legged tick (northeast and upper midwestern United States) and the western black-legged tick (Northern California). May not cause a rash.
- Babesiosis - transmitted by the black-legged tick (northeast and upper midwestern United States). Can cause severe hemolytic anemia.
- Colorado Tick Fever - a viral infection that is transmitted by the Rocky Mountain wood tick (western United States, especially Colorado, Utah, Montana, and Wyoming). Can cause meningoencephalitis.
- Powassan disease - a viral infection that is transmitted by the black-legged tick (northeastern United States and the Great Lakes region). Can cause biphasic illness, with children appearing to get better and then the symptoms reappearing again.
- Rickettsia parkeri Rickettsiosis - transmitted by the Gulf Coast tick in the eastern and southern United States.
- STARI (Southern Tick-Associated Rash Illness) - "transmitted" by the lone star tick (central Texas and Oklahoma eastward to the the whole Atlantic coast). Children have an expanding "bull's eye" lesion at the tick bite, like Lyme disease, but the cause is unknown.
- Tickborne relapsing fever (TBRF) - spread by multiple soft ticks in the western United States which live in rodent infested cabins and can cause relapsing fever - 3 day episodes of fever, in between 7 days stretches in which a child might be fever free, over 3 to 4 weeks.
- Tularemia - transmitted by dog ticks, wood ticks, and lone star ticks or by handling a sick animal, including wild rabbits, muskrats, prairie dogs, and domestic cats. Can cause an ulcer at the site of infection.
- 364D Rickettsiosis - transmitted by the Pacific Coast tick in Northern California dn along the Pacific Coast.
What You Need To Know About Tick-Borne Diseases
You can reduce your child's risk of getting a tick-borne disease by avoiding ticks in first place, including limiting his exposure to grassy and wooden areas, wearing protective clothing, using insect repellent, treating your dogs for ticks, taking a shower within two hours of possibly being exposed to ticks, and doing frequent tick checks.
In addition to avoiding ticks, it is important to know that:
- Tick bites that lead to tick-borne diseases are often not noticed because they are usually painless and are often caused by nymphs, the immature, smaller forms of a tick. So while you might be thinking about a large, adult tick when you are asked about a recent tick bite, a nymph is tiny (about 2mm long) and might even be missed.
- Testing, including antibody tests, can be done to confirm a diagnosis of most tick-borne diseases, but keep in mind that testing can be negative early on. You also shouldn't wait for results before starting treatment in a child with a suspected tick-borne disease. Testing is usually done with either indirect immunofluorescence antibody (IFA) assay or enzyme immunoassay (EIA) tests.
- You should remove a tick with fine-tipped tweezers, grasping the tick close to the skin's surface and pulling it upward with steady pressure.
- It is usually not recommended that you have a tick that has bitten your child tested for tick-borne diseases.
- Experts don't usually recommend that people be treated for tick-borne diseases after a tick bite unless they show symptoms.
- Although most tick-borne diseases can be treated with antibiotics, you might find it hard to find one of the antibiotics that is commonly recommended and often prescribed. Doxycycline has been in short supply for most of 2013, but should still be used Rocky Mountain spotted fever, ehrlichiosis, and anaplasmosis.
Most importantly, if your child is bitten by a tick and gets sick within a week or two, be sure to see your pediatrician and mention the tick bite.
American Academy of Pediatrics. Red Book: 2012 Report of the Committee on Infectious Diseases. Pickering LK, ed. 29th ed. 2012.
CDC. Diagnosis and Management of Tickborne Rickettsial Diseases: Rocky Mountain Spotted Fever, Ehrlichiosis and Anaplasmosis - United States. March 31, 2006 / 55(RR04);1-27.
CDC. Nationwide Shortage of Doxycycline: Resources for Providers and Recommendations for Patient Care. June 12, 2013.
CDC. Tickborne Diseases of the United States: A Reference Manual for Health Care Providers. First Edition, 2013.
Long: Principles and Practice of Pediatric Infectious Diseases , 4th ed.