Case report: Vigilance around ticks and children

Now that Spring is here—and with it, the increased chance of tick bites—we are contemplating the various, somewhat complex, guidelines regarding tick exposure. Patients are inordinately apprehensive and “spooked out” if they have discovered a tick attached to their skin. A bite by a black-legged tick, previously occurring mainly in the area close to the lake in southwest Ontario (but now extending father north and east) is said to be the most possible source of the agent causing Lyme disease. The presence of a “bullseye” rash is perhaps almost definitive of infection, but need not be present. It depends heavily on duration of attachment of the tick, and if the tick is actually carrying the disease. Read: Case report: Is it ringworm? We assume that if a tick is definitely known to have been present for less than 24 hours, infection is unlikely to have been transmitted, the patient can be reassured and no treatment is required. History and timing are critical. That brings me to a visit to our walk-in clinic yesterday, the last patient of the day (fortunately, since it ended up being time-consuming). He was a healthy, fair-skinned boy age five, accompanied by his mother who confessed to being panicked. Preparing to wash her son’s hair, she was alarmed to see a tick imbedded in his scalp (see picture). Her immediate reaction was to come to our clinic minutes later. Now the situation became a bit muddy. The source of the tick—visibly black-legged and somewhat engorged—was unknown. The boy had not been away from Hamilton, although had played outside extensively in recent days. He acknowledged that he had noticed a “lump” on his head “for a while,” but since it was painless, had not mentioned it. Read: Case report: A cellphone in the car is bad for the hand In the office, when the mother questioned the boy (using a time-honoured technique about “how many sleeps?”), the boy settled on two or three. Obviously well past the time of possible infection. I explained the factors involved, prescribed Amoxicillin for 10 days, and suggested the mother could go home and remove the tick at her leisure. This is where the visit lengthened. She was devastated at the thought of her performing the procedure, especially unless a doctor was present. The patient was not keen on the idea either. I caved in, provided forceps, and with a soothing sucker provided by mother, she removed the tick painlessly with me present, and quickly flushed it down the toilet. That ended the possibility of submitting the tick for analysis. It was a lengthy and emotional consultation, with everyone happy at the end. I was reminded of the importance of vigilance for ticks—especially on children—and the critical nature of timelines. Dr. Robert Dickson is a family physician in Hamilton. This report is based on a real case from Dr. Dickson’s files.

Case report: Vigilance around ticks and children

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