Rare Cause of Facial Palsy: Case Report of Tick Paralysis by Ixodes Holocyclus Imported by a Patient Travelling into Singapore from Australia

Pek, Chong Han; Cheong, Crystal Shuk Jin; Yap, Yan Lin; Doggett, Stephen L.; Lim, Thiam Chye; Ong, Wei Chen; Lim, Jane Mingjie

doi:10.1016/j.jemermed.2016.02.031

Cited by 11 publications

(8 citation statements)

References 17 publications

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“…Two patients in Turkey were adults and underwent removal of tick including mouth parts upon detection with a help of cup forceps apparently they recovered after 2 weeks [ 23 , 25 ]. A case of right sided partial palsy was reported from an Australian traveler in Singapore who had a Ixodes holocyclus bite in right temporal scalp area [ 26 ]. In above reports, the authors reiterated the toxin theory to explain facial nerve palsy.…”

Section: Discussionmentioning

confidence: 99%

Intra-aural tick bite causing unilateral facial nerve palsy in 29 cases over 16 years in Kandy, Sri Lanka: is rickettsial aetiology possible?

et al. 2018

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BackgroundOver the last two decades intra-aural tick infestation (otoacariasis) has been a common occurrence in the hilly central region in Sri Lanka. Very occasional detection of isolated unilateral facial nerve palsy associated with otoacariasis attributed to toxin damage of the nerve prompted us to study the clinico-epidemiology and aetio-pathology of the problem.MethodsAll cases having isolated unilateral facial nerve palsy associated with otoacariasis presented to, Ear Nose and Throat clinic at General Hospital Kandy, Sri Lanka from 2001 to 2016 were included in the study. The facial palsies were assessed with nerve conduction studies and, harvested ticks were identified.ResultsThere were 29 patients with mean age of 46 years (range 22–76 years) with male to female ratio of 1:1.9. First 12 patients without specific treatment took 1–55 months for recovery and 4 had axonal degeneration. Last 5 patients were treated with doxycycline and recovered in 4 weeks. They had strong sero-conversion of immunofluorescence antibodies against spotted fever rickettsioses and the tick harvested from the last patient was PCR positive for rickettsial DNA. Identified ticks belonged to Dermacentor, Amblyomma, Rhipicephalus and Hyalomma species.ConclusionsOn contrary to popular toxin theory, we were able to demonstrate treatable rickettsial aetio-pathology as the cause of otoacariasis associated lower motor facial palsy in Sri Lanka.

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Section: Discussionmentioning

confidence: 99%

Intra-aural tick bite causing unilateral facial nerve palsy in 29 cases over 16 years in Kandy, Sri Lanka: is rickettsial aetiology possible?

et al. 2018

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“…Excision of the tick is curative, with paralysis often resolving within days to weeks. 3,5 Delayed resolution should prompt clinical review and further imaging as appropriate. Emergency physicians should also be aware of the recognised risk of anaphylaxis, which can occur following the removal of ticks.…”

Section: Isolated Facial Nerve Palsy Following Ixodes Holocyclus Tick Envenomationmentioning

confidence: 99%

“…To ensure progress is accurately recorded, specific scoring tools like the Bush-Francis Catatonia Rating Scale rather than GCS are often used. 5 While a comprehensive initial work-up for organic pathology is clearly indicated in an acute altered level of consciousness (ALOC) state, early use of LCT may help reduce time to diagnosis and thus a number of costly and potentially harmful investigations. No studies have yet evaluated cost effectiveness of LCT; however in this case, we suggest a number of costly investigations that may have been avoidable by early implementation of LCT.…”

mentioning

confidence: 99%

Isolated facial nerve palsy following Ixodes holocyclus tick envenomation

Kobuch

Matar

Fung

2021

Emerg Medicine Australasia

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“…The ticks were finally discovered and removed from her lower leg. Two years later, a paralysis tick was attached to a woman's right temporal region of scalp following a trip to Sydney (Pek et al, 2016). She presented to a Singapore Emergency Department (ED) with facial swelling, facial pain and a painful, swollen skin tag over her right temporal region, that proved to be a female adult I. holocyclus tick.…”

Section: Other Tick-borne Diseasesmentioning

confidence: 99%

“…She presented to a Singapore Emergency Department (ED) with facial swelling, facial pain and a painful, swollen skin tag over her right temporal region, that proved to be a female adult I. holocyclus tick. She developed motor and sensory changes with weakness in the distribution of the temporal branch of the facial nerve with dysesthesiae over scalp in the sensory distribution of that nerve (Pek et al, 2016).…”

Section: Other Tick-borne Diseasesmentioning

confidence: 99%

Human Tick-Borne Diseases in Australia

Dehhaghi

Panahi

Holmes

et al. 2019

Front. Cell. Infect. Microbiol.

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There are 17 human-biting ticks known in Australia. The bites of Ixodes holocyclus, Ornithodoros capensis, and Ornithodoros gurneyi can cause paralysis, inflammation, and severe local and systemic reactions in humans, respectively. Six ticks, including Amblyomma triguttatum, Bothriocroton hydrosauri, Haemaphysalis novaeguineae, Ixodes cornuatus, Ixodes holocyclus, and Ixodes tasmani may transmit Coxiella burnetii, Rickettsia australis, Rickettsia honei, or Rickettsia honei subsp. marmionii. These bacterial pathogens cause Q fever, Queensland tick typhus (QTT), Flinders Island spotted fever (FISF), and Australian spotted fever (ASF). It is also believed that babesiosis can be transmitted by ticks to humans in Australia. In addition, Argas robertsi, Haemaphysalis bancrofti, Haemaphysalis longicornis, Ixodes hirsti, Rhipicephalus australis, and Rhipicephalus sanguineus ticks may play active roles in transmission of other pathogens that already exist or could potentially be introduced into Australia. These pathogens include Anaplasma spp., Bartonella spp., Burkholderia spp., Francisella spp., Dera Ghazi Khan virus (DGKV), tick-borne encephalitis virus (TBEV), Lake Clarendon virus (LCV), Saumarez Reef virus (SREV), Upolu virus (UPOV), or Vinegar Hill virus (VINHV). It is important to regularly update clinicians' knowledge about tick-borne infections because these bacteria and arboviruses are pathogens of humans that may cause fatal illness. An increase in the incidence of tick-borne infections of human may be observed in the future due to changes in demography, climate change, and increase in travel and shipments and even migratory patterns of birds or other animals. Moreover, the geographical conditions of Australia are favorable for many exotic ticks, which may become endemic to Australia given an opportunity. There are some human pathogens, such as Rickettsia conorii and Rickettsia rickettsii that are not currently present in Australia, but can be transmitted by some human-biting ticks found in Australia, such as Rhipicephalus sanguineus, if they enter and establish in this country. Despite these threats, our knowledge of Australian ticks and tick-borne diseases is in its infancy.

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Rare Cause of Facial Palsy: Case Report of Tick Paralysis by Ixodes Holocyclus Imported by a Patient Travelling into Singapore from Australia

Cited by 11 publications

References 17 publications

Intra-aural tick bite causing unilateral facial nerve palsy in 29 cases over 16 years in Kandy, Sri Lanka: is rickettsial aetiology possible?

Intra-aural tick bite causing unilateral facial nerve palsy in 29 cases over 16 years in Kandy, Sri Lanka: is rickettsial aetiology possible?

Isolated facial nerve palsy following Ixodes holocyclus tick envenomation

Human Tick-Borne Diseases in Australia

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