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  • The best ways to prevent tick-borne diseases are to avoid tick exposure and ensure prompt tick removal if bites do occur. Children that are going to be in rural, wooded areas in endemic regions should wear long-sleeved shirts buttoned at the cuff and long pants tucked into their socks. Clothing may be sprayed with 0.5% permethrin and diethyltoluamide (DEET) can also be used at concentrations of 20% to 30%.
  • Attached ticks should be removed as soon as possible to lessen the risk of infection. Viscous lidocaine may be applied to kill the tick and anesthetize the site, followed by gentle, continuous traction with a pair of fine forceps to the tick's head, ensuring that the tick is not crushed.
  • Borrelia burgdorferi, the most common cause of Lyme disease in the United States, is a gram-negative organism that is transmitted by ticks of the Ixodes ricinus complex.
  • The most common manifestation of early-localized Lyme disease is erythema migrans, the “bull's eye” rash, which usually begins within 7 to 10 days of tick infection.
  • Antibiotics recommended for children with erythema migrans are
    • amoxicillin (50 mg/kg/d in three divided doses, maximum of 500 mg/dose)
    • cefuroxime axetil (30 mg/kg/d in two divided doses, maximum of 500 mg/dose)
    • doxycycline (4 mg/kg/d in two divided doses, maximum of 100 mg/dose)
      • –if the child is ≥ 8 years old
  • Rocky Mountain spotted fever (RMSF) is the most common tick-borne rickettsial disease in the United States and is one of the most virulent human infections identified.
  • The American dog tick (Dermacentor variabilis) is the primary vector of R. rickettsii in most of the United States, while the Rocky Mountain wood tick (D. andersoni) is a major culprit in the mountain states and Canada.
  • Symptoms of RMSF usually appear approximately 7 days after tick exposure, although a history of tick bite is only elicited in 50% to 60% of patients. The initial phase of RMSF infection is characterized by sudden onset of fever, malaise, and severe headache, with accompanying nonspecific symptoms such as myalgias, nausea and vomiting, abdominal pain, anorexia, and photophobia.
  • The rash of RMSF usually begins as blanching, erythematous macules on the wrists and ankles, and spreads centripetally to the arms, legs, and trunks within hours. The palms and soles are also involved.
  • Because RMSF has a 20% mortality rate if untreated and up to a 5% rate if treated, and rapid confirmatory diagnosis is not easily achieved, antibiotic therapy should be started when the disease is suspected. Doxycycline is the drug of choice for treating RMSF regardless of the child's age.


Ticks are capable of transmitting numerous diseases to children including bacterial, viral, and parasitic pathogens. Many of the tick-borne diseases have higher incidences in children than in the general population, thus clinicians who treat the pediatric population must be especially aware of them. As most patients do not recall a tick bite, tick-borne illnesses should be included in the differential diagnosis of nonspecific febrile illnesses, ...

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