Deer Tick

Aka: Deer Tick, Black Legged Tick, Ixodes Scapularis, Ixodes pacificus, Antibiotic Prophylaxis After Known Deer Tick Bite

1. See Also
   1. Vector Borne Disease
   2. Lyme Disease
   3. Babesiosis
   4. Human Granulocytic Anaplasmosis (HGA)
2. Pathophysiology
   1. Deer Tick (Ixodes Scapularis) Image derived from CDC
      1. 
   2. Deer Ticks have four stage life cycle over 2 years
      1. Egg
      2. Larva
      3. Nymph (most common form to transmit disease)
      4. Adult
   3. Transmission of disease
      1. Transmission unlikely before attached for 1-2 days
      2. Engorged nymph most likely to transmit disease
3. Pathophysiology: Diseases transmitted by the Deer Tick
   1. Lyme Disease (Borrelia Burgdorferi)
   2. Human Babesiosis (Babesia Microti)
   3. Human Granulocytic Anaplasmosis (HGA)
      1. Previously known as: Human Granulocytic Ehrlichiosis
      2. Organism name
         1. New: Anaplasma phagocytophila
         2. Prior: Ehrilichia phagocytophila
4. Differential Diagnosis
   1. American Dog Tick (Dermacentor variabilis)
      1. Twice the size of Deer Ticks
      2. Not associated with Lyme Disease
      3. Associated with Babesiosis
5. Management: Deer Tick Bite
   1. See Deer Tick Bite (includes antibiotic prophylaxis)
   2. Prompt Tick Removal
      1. Infection transmission 1% at under 24 hours
      2. Infection transmission 20% at over 72 hours
   3. Observe for Tick Borne Illness for 30 days after bite
      1. Erythema Migrans (Lyme Disease)
      2. If fever occurs, consider additional conditions
         1. Babesiosis
         2. HGA (previously known as Ehrlichiosis)
   4. Antibiotic Prophylaxis After Known Deer Tick Bite
      1. Routine prophylaxis not recommended
      2. Following known deer Tick Bite in endemic area
         1. Early Lyme DiseaseIncidence: 1.2%
      3. Antibiotics after deer Tick Bite in endemic area
         1. Doxycycline
            1. Dose within 72 hours of Tick Bite
               1. Adults: 200 mg orally for one dose
               2. Child >8 years: 4 mg/kg (max: 200 mg) orally for one dose
            2. Efficacy in preventing Lyme Disease: 87%
            3. References
               1. Nadelman (2001) N Engl J Med 345:133-4 [PubMed]
         2. No other antibiotic is indicated in prophylaxis
            1. Prior study showed some efficacy with Amoxicillin
               1. Shapiro (1992) N Engl J Med 327:1769 [PubMed]
6. Prevention
   1. See Prevention of Vector-borne Infection
7. Resources
   1. CDC Lyme Disease
      1. http://www.cdc.gov/ncidod/dvbid/lyme/index.htm
   2. Iowa State Deer Tick Home Page
      1. http://www.ent.iastate.edu/imagegallery/ticks/