A 14-year-old boy is brought to the office by his camp counselor due to a tick bite. He arrived at summer camp in Vermont earlier today and spent the afternoon outdoors. About an hour ago, the patient noticed a tick attached to his right thigh. He has no fever or pain at the site and has no chronic medical conditions. Vital signs are normal. Physical examination shows a small, brown tick attached to the right medial thigh with an area of erythema 3 mm in diameter. The remainder of the examination is unremarkable. Which of the following is the best next step in management of this patient?

Question

A 14-year-old boy is brought to the office by his camp counselor due to a tick bite.  He arrived at summer camp in Vermont earlier today and spent the afternoon outdoors.  About an hour ago, the patient noticed a tick attached to his right thigh.  He has no fever or pain at the site and has no chronic medical conditions.  Vital signs are normal.  Physical examination shows a small, brown tick attached to the right medial thigh with an area of erythema 3 mm in diameter.  The remainder of the examination is unremarkable.  Which of the following is the best next step in management of this patient?

Quizplus · Accepted Answer

11ec25c8_d6bf_2306_bc81_113e334fbb3c_MD0003_00 Ixodes scapularis (deer tick) is endemic to the northeastern United States and serves as a vector for several zoonotic infections, including Lyme disease, anaplasmosis, and babesiosis. northeastern United States Transmission of disease occurs when organisms pass from the tick salivary glands into the bite wound. Anaplasmosis and babesiosis are typically transmitted soon after attachment; Borrelia burgdorferi, which causes Lyme disease, resides in the gut of the tick and requires 48-72 hours of feeding before salivary gland migration. The first step in tick management is removal with small forceps as close to the skin surface as possible. The body of the tick should not be squeezed or crushed because this can expel secretions into the wound and increase the risk of transmission (Choice C). Surrounding erythema during tick attachment (as seen in this patient) is typically due to local skin irritation from the tick saliva, not infection. removal with small forceps Antimicrobial prophylaxis is not effective against anaplasmosis and babesiosis but is recommended to prevent Lyme disease if specific criteria are met (see table). If the deer tick is attached ≥36 hours, a prophylactic single dose of doxycycline is indicated within 3 days of tick removal if local infection rates are high. This patient has had a tick attached for <36 hours and therefore does not require antimicrobial prophylaxis. (Choice A) Ticks should be removed as soon as possible to decrease risk of transmission. In addition, Lyme serology cannot diagnose infection at the time of the tick bite because antibodies develop at least 1-4 weeks after transmission. (Choices B and D) Petroleum jelly is not an effective measure for tick removal, and the tick should not be punctured due to increased risk of infectious disease exposure. In addition, although doxycycline or amoxicillin for 21 days is the treatment for erythema migrans (EM), the earliest sign of Lyme disease, EM develops days after the tick bite and classically expands into a bull's-eye appearance. In contrast, this patient's skin findings are due to local irritation. erythema migrans (EM) Educational objective: Ticks should be removed with a small forceps as soon as possible to reduce the risk of a tickborne illness. If the tick is attached for <36 hours, antimicrobial prophylaxis (eg, single-dose doxycycline) for Lyme disease is not required. References: Effective methods for tick removal: a systematic review. (http://www.ncbi.nlm.nih.gov/pubmed/28464468) Diagnosis, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: a review. (http://www.ncbi.nlm.nih.gov/pubmed/27115378)

A 14-Year-Old Boy Is Brought to the Office by His