A Case of Tick-Borne Paralysis in a Traveling Patient

Abstract

Background. Tick paralysis is a neurotoxic tick-borne illness that causes ascending paralysis and may lead to respiratory failure. Patients often undergo extensive testing and prolonged hospitalization before the proper diagnosis is reached. Case Presentation. An 88-year-old man with dementia and dyslipidemia presented with new onset gait instability and was admitted for suspected cerebellar stroke. Exam was significant for the inability to perform tandem gait. Investigations included comprehensive metabolic panel, complete blood count, and noncontrast CT scan; none of them found any evidence of acute pathology. Two days into admission, a tick with surrounding erythema was found on the patient’s left lateral chest during bathing. Dramatic improvement in truncal ataxia was noted following tick extraction. Discussion. Clinical suspicion of tick paralysis is often low due to the rarity of the condition. Although it is imperative to rule out acute cerebral or cerebellar pathology, a thorough skin examination should be performed on admission in any patient with new onset ataxia and ascending paralysis. This can lead to early diagnosis, conservation of resources, and the avoidance of subjecting patients to invasive testing.

Allergic Reactions and Immunity in Response to Tick Salivary Biogenic Substances and Red Meat Consumption in the Zebrafish Model

“…Arthropod ectoparasites are a growing burden worldwide (Stutzer et al, 2018). Local allergic reactions to the bite of arthropod ectoparasites such as mosquitoes, ticks, fleas, mites, and lice are common, but in some cases large local and anaphylactic reactions are possible (Lee et al, 2016;Mihara, 2017;Stringer et al, 2017;Haddad et al, 2018;Ha et al, 2019).…”

“…Tick saliva contains multiple biomolecules such as proteins and lipids that facilitate feeding while counteracting host defense responses, properties that also lead to possible application of these molecules in therapeutic interventions (Chmelar et al, 2019). However, tick bites themselves can induce a spectrum of inflammatory reactions in response to toxic and anticoagulant biogenic substances present in tick saliva and/or mouthpart penetration such as coagulative necrosis producing firm papules, tick paralysis, intense pruritus, tick bite alopecia, cutaneous lymphoid hyperplasia, and cell histiocytosis (Mihara, 2017;Stringer et al, 2017;Haddad et al, 2018;Ha et al, 2019). Additionally, tick bites can induce in humans high levels of immunoglobulin E (IgE) antibodies against the carbohydrate Galα1-3Galβ1-(3)4GlcNAc-R (α-Gal) present in glycoproteins and glycolipids from tick saliva that mediate delayed anaphylaxis to red meat consumption, and immediate anaphylaxis to tick bites, xenotransplantation, and certain drugs such as cetuximab (Mateos-Hernández et al, 2017;Hilger et al, 2019).…”

Tick Paralysis: A Thorough Examination May Prevent Unnecessary Harm

“…Extra care should be taken to apply a gentle motion to pull the tick up without squeezing or twisting its body to ensure that the toxin-containing mouthparts remain intact. It takes about 24-48 hours for a complete recovery after the successful removal of Dermacentor ticks, although weakness and paralysis can occasionally worsen during this time period [ 12 , 13 ]. Thus, patients with paralysis or weakness due to I. holocyclus ticks should be observed carefully following tick removal [ 7 ].…”

Neuroimaging in Tick Paralysis: Looking Outside the Box

“…Because the removal of the tick is the main treatment for TP, MRI identification and localization, especially with 3D reconstruction, may play a critical role in these patients, as the tick can be removed before the progressive paralysis causes respiratory failure or even death in rare cases. As TP is frequently misdiagnosed as GBS and other acute ascending motor neuropathies, early tick identification may also prevent further unnecessary diagnostic tests or treatments [ 1 , 2 , 7 , 8 ].…”