Increasing Risk for Tick-Borne Disease: What Should Clinicians Know?

Telford, Sam R.; Stewart, Philip E.; Bloom, Marshall E.

doi:10.1001/jamainternmed.2024.1754

JAMA Intern Med

2024

DOI: 10.1001/jamainternmed.2024.1754

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Increasing Risk for Tick-Borne Disease: What Should Clinicians Know?

Sam R. Telford,

Philip E. Stewart,

Marshall E. Bloom

Abstract: This clinical insights article examines reasons behind the increase in tick-borne diseases and what clinicians should know about diagnosis and mitigation.

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2024

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Tick Paralysis—A Rare but Important Tick-Borne Disease

Edlow

2024

JAMA Intern Med

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To the Editor In a recent Clinical Insights article in JAMA Internal Medicine, Telford et al 1 proficiently addressed tick-borne diseases; however, one additional condition remains worthy of mention. 1 Tick paralysis is a rare, toxin-mediated disorder that results after a bite from numerous tick species, including Dermacentor andersoni (the wood tick) in the northwestern US, and D variabilis (the dog tick) in the eastern US. 2 Rarely, Ixodes scapularis (the black-legged tick), the vector of Lyme disease, is the offending tick. 3 When tick paralysis occurs, it is often in pediatric patients, particularly girls with long hair. 2,4 However, the disease affects patients of all ages and is found worldwide. 2,4 The mechanism of paralysis is mediated by a toxin released by the tick that blocks acetylcholine release at the presynaptic nerve terminal of the neuromuscular junction. 5 Patients present with an ascending flaccid paralysis that evolves over 12 to 24 hours. 2,4 Muscles innervated by the lower cranial nerves may become involved. Some prodromal paresthesias, myalgias, fatigue, and restlessness may also occur. Fever is absent, and the patient's mental status is normal unless hypoxia and hypercarbia occur.Without treatment or implementation of mechanical ventilation, death can occur from respiratory failure due to diaphragmatic paralysis. 2,4 Tick paralysis has been confused with Guillain-Barré syndrome, cerebellar ataxia, and other causes of acute weakness, at times leading to unnecessary tests such as lumbar puncture or advanced brain imaging. 2,4 The treatment is one of the simplest in all of medicine: tick removal, which results in improvements in muscle function, often within hours.

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Current and emerging approaches for eliminating Borrelia burgdorferi and alleviating persistent Lyme disease symptoms

Zafar,

Azuama,

Parveen

2024

Front. Microbiol.

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Lyme disease is the most prevalent tick-borne infection caused by Borrelia burgdorferi bacteria in North America. Other Borrelia species are predominately the cause of this disease in Eurasia with some distinct and various overlapping manifestations. Consequently, caution must be exercised when comparing the disease and its manifestations and treatment regimens in North America and Europe. Diagnosis of the early Lyme disease remains difficult using the currently FDA approved serological tests in the absence of a reported tick bite or of erythema migrans in many individuals, non-specific initial symptoms, and the absence of detectable anti-Borrelia antibodies in the prepatent period of infection. Furthermore, it is difficult to distinguish persistence of infection and disease versus reinfection in the endemic regions of Lyme disease by serological assays. If early infection remains untreated, spirochetes can disseminate and could affect various organs in the body with a variety of disease manifestations including arthralgias and musculoskeletal pain, neurologic symptoms and anomalies, and acrodermatitis chronicum atrophicans (ACA) in Europe. Although most patients recover after antibiotic treatment, an estimated ∼10–20% patients in the United States show persistence of symptoms known as post-treatment Lyme disease syndrome (PTLDS). The causes and biomarkers of PTLDS are not well-defined; however, several contributing factors with inconsistent degree of supporting evidence have been suggested. These include antigenic debris, dysregulation of immunological response, bacterial persisters, or combination of these features. This review highlights currently employed treatment approaches describing different antimicrobials used, and vaccine candidates tried to prevent B. burgdorferi infection.

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Increasing Risk for Tick-Borne Disease: What Should Clinicians Know?

Abstract: This clinical insights article examines reasons behind the increase in tick-borne diseases and what clinicians should know about diagnosis and mitigation.

Cited by 3 publications

References 11 publications

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Tick Paralysis—A Rare but Important Tick-Borne Disease

Current and emerging approaches for eliminating Borrelia burgdorferi and alleviating persistent Lyme disease symptoms

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