By: Dr. Brian Gannon
As summer begins, we see vision of children playing out in the grass, walks in the park, and family camping trips. All these fun summer activities also share a common visitor: ticks. Parents worry, understandably, about infections their children may get from ticks. How do we prevent tick bites and recognize the signs of a more serious problem?
Why worry about ticks?
There are about a dozen infections that ticks may carry to humans, but the majority of these illnesses in the USA are from Lyme disease and Rocky Mountain Spotted Fever, or RMSF. Both infections are treatable if caught early, but also preventable by taking a few simple steps. People hear lots of stories about Lyme disease, but almost all cases occur in the Northeast US, Minnesota, and Wisconsin. It rarely occurs in Kentucky. In order to get Lyme disease, the tick must stay attached for 48 hours, and the typical rash will occur within 30 days. The rash looks like a bull’s-eye, with a pink center surrounded by a white ring then an outer pink ring. If the doctor strongly suspects Lyme, he will often treat the patient even without any test results to prove the infection. This accounts for the many people who believe they had Lyme disease, even when the testing turns up negative. It is true that undiagnosed Lyme disease may progress to serious complications, especially arthritis, but this is very rare in our part of the country without a history of travel to the northeast. Almost all cases happen between May and September, so going north for Christmas is not an issue!
So what is a spotted fever?
RMSF is so named because it was first described in Idaho, but most cases occur in Tennessee, Arkansas, North Carolina, and Missouri, with fewer than 10 cases in Kentucky every year, mostly in the summer. Children between ages 5-9 are the most likely to become infected by ticks, probably because of their outdoor activities in summer. The tick must be attached for at least 6 hours to spread the infection, and the fever will start within a week of the bite. The main symptoms are the high fever with sudden onset, bad headache, and the typical rash, although there are also “spotless” fevers. The rash, when present, starts as flat pink dots that start on hands and feet and spread toward the center of the body, then turns into dark purple dots, which do not turn white when touched. Once again, we test for this, but we usually treat based on symptoms and presence of tick bite, without waiting for test results.
What can I do to keep my kids safe?
Ticks love wooded areas and shaded, moist areas. If you cannot avoid a tick-infested area, at least use bug spray containing DEET (like Off or Cutter) and wear a light-colored shirt and pants that cover the ankles. Most importantly, check the whole family once you come inside to see if any ticks are on the skin. The tick should be removed carefully with tweezers, taking care to get the entire head out. Do not use alcohol, Vaseline, or any other method to “smother” the tick, because these increase the chances the tick will inject infected material into the person. The skin should be cleaned after removal, however, and this would be the time to use that rubbing alcohol. It is helpful to keep the tick, if possible, because examining the tick will help if the child does get a fever later.
Are there any other dangers from tick bites?
The most common reaction is just a local irritant rash, possibly from a mild allergy to the tick’s bite, even if the tick is not infected. This may trigger an itchy, red bump at the bite location, but no symptoms in the rest of the body. If the bump is scratched, it may get infected locally, causing a crusted scabby lesion on a red base, also called impetigo. This type of infected scab will often respond to topical antibiotic ointments, like Neosporin or Bactroban.
The take-home message for the summer is to have fun outside, but with some simple precautions. Don’t worry too much about infections, because they are not very likely. But check for ticks after you return indoors!