P TICK BORNE ILLNESS

Risk Management Pitfalls for Management of Pediatric Patients With Tick-Borne Illnesses

1. “There was no history of a tick bite, so I don’t have to worry about tick-borne illnesses.”

Tick bites are often painless and may be in locations that are not easily visible. Patients may not give a history of a tick bite; therefore, a careful history to elicit risk factors for tick exposure is necessary, particularly in endemic areas. In studies of tick-borne illnesses, a history of a tick bite was not reported in 30% to 40% of confirmed cases.1,2,26,97,98

4. “I had a strong suspicion that my patient had a tick-borne illness, but I wanted to be sure, so I waited for the confirmatory tests to result before starting her on an antimicrobial.”

For most tick-borne illnesses, confirmatory testing may take days or weeks to result. In patients with a consistent history, examination, and preliminary laboratory findings, empiric treatment may be started while test results are pending. In particular, delayed treatment with doxycycline is associated with a higher mortality rate for RMSF.143 Untreated, RMSF has a case fatality rate of 10% to 25%.144

10. “I’m not in a high-risk area, so I don’t need to consider tick-borne illnesses in my differential.”

While there are areas that are highly endemic for certain diseases, tick-borne illnesses have been reported in all of the contiguous 48 states.154 A thorough travel history is critical to identifying possible tick exposures, as cases acquired during travel to endemic areas may be easily missed.155 Patients may also be exposed during international travel.156,157 Excluding a specific disease based solely on geographic location may delay diagnosis and increase the risk of developing complications.