Tick paralysis.
Tick paralysis is a toxin-mediated cause of acute flaccid paralysis. Most practitioners will go through their entire career without ever encountering a case. An important veterinary disease, tick paralysis is rare in humans. Although it has certain geographical proclivities, it exists worldwide. Although it tends to occur in young girls, it can occur in any age group. Due to its rarity, doctors often forget to consider tick paralysis in the differential diagnosis of the weak patient. Therefore it is perhaps not surprising that the literature is full of cases in which a mother stroking her child's head or an alert nurse bathing her patient made the diagnosis serendipitously.Physicians should consider tick paralysis in any patient with an acute flaccid paralysis. As a general rule, aimed more towards patient safety than the likelihood of making a correct diagnosis, never definitively diagnose Guillain-Barré syndrome without first searching the entire body for a tick. The treatment of tick paralysis is among the simplest and most gratifying in all of medicine. Tick removal results in rapid improvement of all symptoms. Some patients may require mechanical ventilation and support in an intensive care unit as the toxin clears. Since tick paralysis is toxin-mediated and not caused by an infectious agent, antimicrobials are not indicated. Finally, prevention of tick paralysis, as with most tick-borne diseases, involves changing behavior to avoid tick exposure and performing frequent tick checks to remove them if they have already attached.
Edlow
Jonathan A
JA
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, 02115, USA, jedlow@bidmc.harvard.edu.