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Published on: February 4, 2018
Tick Paralysis Case Series: An 11-Year Institutional Case Series
Kristen Pontiff1, Christopher Woodward, Pamela McMahon2
1From the Our Lady of the Lake Children's Hospital.
Insights
Pediatric tick paralysis cases in Louisiana are likely underestimated. Prompt diagnosis and tick removal ensure full recovery, while delays incur unnecessary medical costs and procedures.
Area of Science:
- Pediatric Neurology
- Toxicology
- Emergency Medicine
Background:
- Tick paralysis is a rare neurological condition caused by toxins in tick saliva.
- Prompt diagnosis and removal are crucial for patient recovery.
Purpose of the Study:
- To identify and describe pediatric tick paralysis cases in southern Louisiana.
- To analyze diagnostic delays and their impact on patient outcomes.
Main Methods:
- Retrospective chart review of patients aged 0-18 years.
- Data collection included patient demographics, symptoms, diagnosis, and treatment.
- Study period: July 2005 to June 2016.
Main Results:
- Nine pediatric cases (ages 2-10) presented with neurological deficits.
- Five cases were diagnosed rapidly; four experienced diagnostic delays.
- Delayed diagnosis led to extensive, unnecessary medical workups.
Conclusions:
- Tick paralysis incidence in southern Louisiana may be higher than previously thought.
- Prompt diagnosis and tick removal are vital for efficient patient management.
- Delayed diagnosis increases medical costs and patient burden.
Objectives:
The aims of the study were to identify and to describe cases of pediatric tick paralysis presenting to an emergency department in southern Louisiana during an 11-year period.
Methods:
We conducted a retrospective chart review of patients aged 0 to 18 years with a diagnostic code of toxic effect of venom, tick-borne viral encephalitis, Guillain-Barré syndrome, acute infective polyneuritis, or abnormality of gait from July 2005 to June 2016. Data were collected on visit month, patient age, race and sex, tick's attachment site, location of tick removal, symptoms and length of symptoms, initial diagnosis, time to appropriate diagnosis, and hospital length of stay.
Results:
Nine patients aged 2 to 10 years presented with lower limb weakness and varying degrees of upper extremity ataxia or paralysis, areflexia, dysarthria, diplopia, or petechia. Five cases were accurately and rapidly diagnosed; 4 cases involved a delay in accurate diagnosis. Treatment of the misdiagnosed cases ranged from septic workup to neurologic workup, including magnetic resonance imaging. The tick was discovered by the patients' relative in 4 cases, by a primary care or emergency care physician at another facility in 3 cases, and by 1 of our emergency care physicians in 2 patients.
Conclusions:
The incidence of tick paralysis in southern Louisiana is unknown. However, our case series indicates that it is likely higher than expected. Although most cases in our facility were quickly diagnosed and treated through tick removal, delayed diagnosis results in unnecessary tests, procedures, and medical costs. All of our cases fully recovered after tick removal.
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