Tick paralysis

From IDWiki

Background

  • Non-infectious disease caused by saliva injected during tick bite

Epidemiology

Pathophysiology

Clinical Manifestations

  • Ascending neuromuscular paralysis with preserved sensation
  • Can cause ataxia
  • Often misdiagnosed as Guillain-Barré syndrome until an engorged tick is found, often hidden in hair

Differential Diagnosis

Feature Tick Paralysis Guillain-Barré syndrome Cervical Spine Lesion Poliomyelitis
Onset acute and rapid, within 24 to 28 hours slower, over days to weeks abrupt or gradual days to weeks
Ataxia present absent absent absent
DTRs hypo- or areflexia hypo- or areflexia variable hypo- to areflexia
Plantar reflex downgoing downgoing upgoing downgoing
Sensation unaffected mildly affected affected unaffected
Meningismus no rarely no yes
Fever no rarely no yes
CSF protein normal high normal or high high
CSF WBCs normal normal elevated
CSF differential normal <10 mononuclear cells variable lymphocytosis
Time to recovery rapid ≤24 hours after tick removal weeks to months variable months to years
Permanent sequelae none possible possible possible

Management

  • Removal of tick with forceps; recovery typically within 24 hours