Skill Checkup: Tick Removal

Richard H. Sinert, DO

Disclosures

September 23, 2019

Ticks can carry and transmit a remarkable array of pathogens, including bacteria, spirochetes, rickettsiae, protozoa, viruses, nematodes, and toxins. A single tick bite can transmit multiple pathogens, a phenomenon that has led to atypical presentations of some classic tick-borne diseases.

Tick-borne diseases are on the rise in the United States, although the reasons are unclear. In North America, the following diseases are caused by tick bites:

In Europe, the list is similar, but other diseases should be considered as well, including boutonneuse fever (caused by a less virulent spotted fever rickettsial organism, Rickettsia conorii) and tick-borne encephalitis.

Indication

Removal is indicated when a tick is attached to the skin. No contraindications for removal are recognized.

Procedure

For simple, uncomplicated tick removal, anesthesia is generally unnecessary. The patient should be in a comfortable position that allows the clinician easy access to the tick. The room should be well lit. The use of fine-tipped forceps and gloves is important because handling ticks with bare fingers may result in infection through breaks in the skin.

Grasp the tick as close to the skin surface as possible (eg, grasp the mouthparts), and pull upward with steady, even traction (see the image below).

Figure 1.

  • Do not twist or jerk the tick, because this may cause the mouthparts to break off and remain in the skin. Do not be unduly alarmed, however, if the mouthparts remain in the skin; they are not infectious.

  • Do not squeeze, crush, or puncture the body of the tick, because its fluids (ie, saliva, hemolymph, and gut contents) may contain infectious organisms.

  • Do not apply a hot match to the tick or try to smother it with petroleum jelly, gasoline, nail polish, or other noxious substances. Doing so only prolongs exposure time and may cause the tick to eject infectious organisms into the body.

Once the tick is removed, wash the bite area with soap and water or with an antiseptic to destroy any contaminating microorganisms. The person who removed the tick should wash his or her hands as well.

Persons who have undergone tick removal should monitor for signs and symptoms of tick-borne diseases for 30 days;these signs and symptoms include a skin lesion at the site of the tick bite (which may suggest Lyme disease; see the image below) or a temperature higher than 100.4° F (38° C), which may suggest human granulocytic ehrlichiosis or babesiosis.

Figure 2.

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