Wednesday, May 27th, 2009

| CWK Producer

“Do you know how to skip?” Dr. Carden Johnston, an emergency room pediatrician, asks 6-year-old Chelsea Ludorf, who answers, “Yes.”

Chelsea can skip today, but in the emergency room the night before, she could barely walk.  In fact, she had to hold her mother’s hand to prevent herself from falling.

“Chelsea came in wobbly legged, and that could be anything.  It could be really serious … could be Guillaume-Barre, polio, could be a brain tumor; but it also could be the poison from a tick,” Dr. Johnston says.

Chelsea says that before arriving at the hospital, when she woke up that morning, “I got out of bed, and I took a couple of steps and then I fell down.”

“She eventually crawled to her sister’s room and said ‘I can’t walk, I can’t walk,’” Chelsea’s mother adds.

At her pediatrician’s office and then later at the emergency room, doctors searched through Chelsea’s thick hair but found nothing unusual.  But after a second examination, Dr. Johnston found a tick.

Its formal name is Dermacentor variabilis, a dog tick.  It can have a neurotoxin in its saliva that causes paralysis.  If doctors had not discovered the tick, it eventually would have fallen off, “…but the paralysis does go up; it goes up from the ankles, to the knees, to the hips, to the arms and then up to the diaphragm and then they quit breathing, so yes, it can be too late … this can be a fatal disease, “ Dr. Johnston says.

“Very few [ticks] carry this poison.  Nonetheless, it’s important enough that when your child is playing in the woods or outside or goes camping, check your child for ticks every day,” he adds.

Once the tick is removed, Chelsea’s recovery is fast and, in a day or two, will be complete. 

Tips for Parents

According to the Centers for Disease Control and Prevention (CDC), tick paralysis (tick toxicosis) is one of the eight most common tick-borne diseases in the United States.  It occurs when a female tick produces a neurotoxin in its salivary glands and then transmits the poison when it bites a victim.  The disease is caused by more than 40 species of ticks worldwide.  In the United States, it is most commonly associated with Dermacentor andersoni (Rocky Mountain wood tick) and Dermacentor variabilis (American dog tick). 

The CDC reports that North American cases of tick paralysis occur most commonly in the Rocky Mountain and northwestern regions of the United States.  Most cases occur among girls aged less than 10 years from April to June, when nymphs and mature wood ticks are most prevalent.  Although tick paralysis is of concern in domestic animals and livestock, the National Library of Medicine (NLM) says that human cases are rare and usually occur in children under the age of 10.

What are the symptoms of tick paralysis?  The American Lyme Disease Foundation (ALDF) says that symptoms generally begin from five to seven days after a tick becomes attached (usually on the scalp) and may include the following:

• Fatigue
• Headache
• Vomiting
• Numbness of the legs
• Muscle pains
• Paralysis that rapidly develops from the lower to the upper extremities
• Tongue and facial paralysis (if the tick is not removed)

In severe cases, symptoms may progress to respiratory failure and death in up to 12% of untreated cases.  Death in young children with tick paralysis can occur in one to two days; therefore, it is crucial to seek immediate medical care if you observe these symptoms in your tick-bitten child.

The ALDF says that diagnosis of tick paralysis diagnosis is based on your child’s symptoms and his or her rapid improvement once the engorged tick is removed.  Unlike Lyme disease, which is affected by the expansion of parasites in the host long after the tick is removed, tick paralysis is chemically induced by the tick and can therefore continue only in its presence.  Once the tick is removed, symptoms usually diminish rapidly. 

If you find a tick attached to your child, the CDC recommends the following steps for removing the tick:

• Use forceps or tweezers to grasp the tick as closely as possible to the point of attachment.
• Apply even pressure to avoid breaking off the tick’s body and leaving the mouth parts imbedded in your child’s skin.
• Always wear gloves if the tick must be removed by hand, and promptly wash your hands with soap and hot water after removal.

The Lyme Disease Foundation (LDF) says that ticks like to rest on low-lying brush and “catch a ride” on a passing animal or person.  The LDF offers the following advice in order to reduce your child’s chances of getting a tick bite and developing tick paralysis:

• Avoid tick-infested areas when possible.  The areas that hold a high risk of tick infestation are wooded areas, low-growing grassland and the seashore.  Also, avoid taking shortcuts through heavily wooded areas.
• Ensure that your child uses caution upon entering tick-infected areas.  Teach your child to stay in the center of paths and avoid sitting directly on the ground. 
• Dress your child properly.  Have your child wear light-colored clothing, which allows you to more easily see ticks on clothing and gives you the opportunity to remove them before they can attach to your child’s skin.
• Use EPA-approved tick repellents on your child.  During the summer months, it can be inconvenient to wear pants and long-sleeved clothing, so using DEET repellents can help protect your child from ticks.  Make sure your child washes off the repellents when he or she returns inside.  It is important for children to always have an adult apply the repellent for them.
• Conduct frequent tick checks of your child.  This step includes a visual inspection of your child’s clothing and exposed skin, followed by a naked, full-body examination in a private location.  Be sure to check your child’s scalp, behind and in the ears and behind any joints.
• Remember to check your pets, too!  This step should be taken not only for your pets’ safety but also for your family’s.  Pets can bring ticks in from outside and put you and your family at risk for infection.

References

• American Lyme Disease Foundation
• Centers for Disease Control and Prevention
• Lyme Disease Foundation
• National Library of Medicine

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