What are the guideline sources, guidelines and references for Tick bite ?
Guideline sources The following summarized guidelines for the evaluation and management of tick bite are prepared by our editorial team based on guidelines from the Wilderness Medical Society (WMS 2021), the Infectious Diseases Society of America (IDSA/ACR/AAN 2021), and the American Association of Family Physicians (AAFP 2012). 2 3 4 Calculator Suspicious Index Lyme Carditis Guidelines 1. Screening and diagnosis Clinical presentation: As per IDSA 2021 guidelines, make a clinical diagnosis of Lyme disease in patients having 1 skin lesions compatible with erythema migrans and potential tick exposure in an endemic area. https://web.pathway.md/diseases/recw93JaGLngp3rmf 1/5 6/24/23, 4:06 PM Tick bite Pathway B As per AAFP 2012 guidelines, make a diagnosis of Lyme disease in patients with erythema migrans rash following a tick bite in the absence of laboratory confirmation. B 2. Diagnostic investigations Tick testing: Send the removed tick for species identification. B Do not test the removed Ixodes tick for Borrelia burgdorferi. D Evaluation for Lyme disease, serology: As per ACR/AAN/IDSA 2021 guidelines, consider obtaining antibody testing rather than currently available direct detection methods (such as PCR or culture performed on blood or skin samples) in patients with 1 skin lesions suggestive of but atypical for erythema migrans, performed on an acute-phase serum sample (followed by a convalescent-phase serum sample if the initial result is negative). C As per AAFP 2012 guidelines, obtain a two-tier serologic testing protocol using an ELISA initially, followed by the more specific Western blot for confirmation when the assay samples are positive or equivocal, for the diagnosis of Lyme disease. B Evaluation for Lyme disease (ECG): obtain a screening ECG as soon as possible in patients developing symptoms suggestive of Lyme carditis, such as dyspnea, dizziness, or syncope, and consider obtaining a thorough cardiovascular evaluation in an appropriate clinical setting. B Evaluation for Lyme disease (asymptomatic patients): do not test asymptomatic patients for exposure to Borrelia burgdorferi following an Ixodes species tick bite. D 3. Medical management Setting of care: evacuate patients developing systemic or high-risk symptoms (fever, generalized rash, arthralgias, cranial nerve palsy, dyspnea, or syncope) related to a suspected tick-borne illness to a higher level of medical care. B Management of erythema migrans: As per IDSA 2021 guidelines: Initiate oral doxycycline, amoxicillin, or cefuroxime axetil for the treatment of patients with erythema migrans. B Complete either a 10-day course of doxycycline or a 14-day course of amoxicillin or cefuroxime axetil rather than longer courses of antibiotics in patients with erythema migrans. B As per WMS 2021 guidelines, initiate doxycycline if the patient develops a fever, erythema migrans, or arthralgias within 30 days of the presumed tick bite. B Management of Lyme disease: https://web.pathway.md/diseases/recw93JaGLngp3rmf 2/5 6/24/23, 4:06 PM Tick bite Pathway Administer doxycycline as the preferred oral agent for the treatment of patients with early Lyme disease because of its activity against other tick-borne illnesses. B Do not offer prolonged antibiotic therapy beyond the standard recommendations in patients with chronic Lyme disease or post-Lyme disease syndrome. D 4. Nonpharmacologic interventions Removal of attached ticks: As per IDSA 2021 guidelines: Remove promptly the attached tick by mechanical means using a clean fine-tipped tweezer (or a comparable device) inserted between the tick body and the skin. B Do not burn the attached tick (with a match or other heat device) or apply noxious chemicals or petroleum products to coax its detachment. D As per WMS 2021 guidelines, remove ticks as soon as possible once discovered. Remove ticks within 36 hours of attachment in order to significantly reduce the risk of Lyme disease. B Show 4 more 5. Preventative measures Tick avoidance: As per IDSA 2021 guidelines: Advise using personal protective measures in individuals at risk of exposure to reduce the risk of tick exposure and infection with tick-borne pathogens. B Advise using DEET, picaridin, ethyl 3-(N-n butyl N- acetyl) aminopropionate (IR3535), oil of lemon eucalyptus, p methane 3, 8-diol, 2 undecanone, or permethrin for the prevention of tick bites. B As per WMS 2021 guidelines, advise avoiding areas with high grass or leaf litter, when feasible. Advise walking in the middle of trails when being in tick habitat, to mitigate the chance of contact with ticks. E Show 7 more As per AAFP 2012 guidelines, advise the following measures for the prevention of Lyme disease: avoiding areas with high tick burdens wearing protective clothing using tick repellants (such as diethyltoluamide) performing frequent body checks for ticks bathing following outdoor activities instituting environmental landscape modifications (such as grass mowing, deer exclusion fencing, removing leaf litters and woodpiles) to reduce the tick burden. B https://web.pathway.md/diseases/recw93JaGLngp3rmf 3/5 6/24/23, 4:06 PM Tick bite Pathway Immunization: Recognize that there are no vaccines for tick-borne encephalitis currently available in the United States, even though vaccines such as Encepur appear effective for inducing seroconversion against tick-borne encephalitis. B Recognize that Lyme vaccination is effective at reducing the risk of infection, although not currently available in the United States. B Post-exposure prophylaxis: As per IDSA 2021 guidelines: Administer antibiotic prophylaxis in adult and pediatric patients only within 72 hours of removal of an identified high-risk tick bite, but not for equivocal or low-risk tick bites. A Administer a single dose of oral doxycycline within 72 hours of tick removal in patients with high-risk Ixodes species bites in all age groups. B As per WMS 2021 guidelines, administer a single dose of 200 mg doxycycline PO within 72 hours after a high-risk tick bite to reduce the risk of Lyme disease. B Show 2 more As per AAFP 2012 guidelines, administer antimicrobial prophylaxis with a single 200 mg dose of doxycycline in adult patients with exposure to Ixodes scapularis if prophylaxis can be given within 72 hours of tick removal and there is at least a 20% rate of tick infection with Borrelia burgdorferi in the area. Consider administering antimicrobial prophylaxis with a single 4 mg/kg dose of doxycycline (maximal dose of 200 mg) in pediatric patients 8 years old. B 6. Quality improvement Educational programs: implement and encourage educational programs to change behavior and lower rates of tick-borne illnesses. B References 1. L Mullie. Investigation Algorithms. Pathway Editors. Open 2. Benjamin M Ho, Hillary E Davis, Joseph D Forrester et al. Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Management of Tick-Borne Illness in the United States. Wilderness Environ Med. 2021 Dec;32 4 474 494. Open 3. Paul M Lantos, Jeffrey Rumbaugh, Linda K Bockenstedt et al. Clinical Practice Guidelines by the Infectious Diseases Society of America IDSA , American Academy of Neurology AAN , and American College of Rheumatology ACR 2020 Guidelines for the Prevention, Diagnosis, and Treatment of Lyme Disease. Arthritis Care Res Hoboken). 2021 Jan;73 1 1 9. Open 4. Robert L Bratton, John W Whiteside, Michael J Hovan et al. Diagnosis and treatment of Lyme disease. Am Fam Physician. 2012 Jun 1;85 11 1086 1093. Open 5. R B Nadelman, J Nowakowski, D Fish et al. Prophylaxis with single-dose doxycycline for the prevention of Lyme disease after an Ixodes scapularis tick bite. N Engl J Med. 2001 Jul 12;345 2 79 84. Open https://web.pathway.md/diseases/recw93JaGLngp3rmf 4/5 6/24/23, 4:06 PM Tick bite Pathway https://web.pathway.md/diseases/recw93JaGLngp3rmf 5/5