Rare Cause of Facial Palsy: Case Report of Tick Paralysis by Ixodes Holocyclus Imported by a Patient Travelling into Singapore from Australia.
BACKGROUND
Ticks are blood-sucking arachnids that feed on all classes of vertebrates, including humans. Ixodes holocyclus, also known as the Australian Paralysis Tick, is capable of causing a myriad of clinical issues in humans and companion animals, including the transmission of infectious agents, toxin-mediated paralysis, allergic and inflammatory reactions, and mammalian meat allergies in humans. The Australian Paralysis Tick is endemic to Australia, and only two other exported cases have been reported in the literature.


METHODS
We report the third exported case of tick paralysis caused by I. holocyclus, which was imported on a patient into Singapore. We also discuss the clinical course of the patient, the salient points of management, and the proper removal of this tick species. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: With increasing air travel, emergency physicians need to be aware of and to identify imported cases of tick paralysis to institute proper management and advice to the patient. We also describe the tick identification features and proper method of removal of this tick species.
Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore.
Chong Han
CH
Pek
Department of Otolaryngology - Head and Neck Surgery, National University Health System, Singapore.
Crystal Shuk Jin
CS
Cheong
Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore.
Yan Lin
YL
Yap
Department of Medical Entomology, Pathology West, Westmead Hospital, Westmead, NSW, Australia.
Stephen
S
Doggett
Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore.
Thiam Chye
TC
Lim
Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore.
Wei Chen
WC
Ong
Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore.
Jane
J
Lim
D000658:Amoxicillin / Q000494:pharmacology / Q000627:therapeutic use; D000818:Animals; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D001315:Australia; D019818:Clavulanic Acid / Q000494:pharmacology / Q000627:therapeutic use; D003023:Cloxacillin / Q000494:pharmacology / Q000627:therapeutic use; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005158:Facial Paralysis / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D018884:Ixodes / Q000472:pathogenicity*; D008875:Middle Aged; D012846:Singapore; D013985:Tick Paralysis / Q000150:complications* / Q000209:etiology / Q000503:physiopathology; D014195:Travel
D000900:Anti-Bacterial Agents; D019818:Clavulanic Acid; D000658:Amoxicillin; D003023:Cloxacillin
Australian paralysis tick; Ixodes holocyclus; facial paralysis; tick paralysis