Tick bite: Report of a rare case

Tick bites are uncommon and are vectors of a number of skin diseases; some are innocuous and others deleterious. Herein, we report a case of tick bite in a 50-year-old man who presented with an insect in the abdominal wall, unassociated with systemic involvement. Examination revealed the presence of a tick in the abdominal wall (near the right hypochondrium) with head embedded in it. There is an erythematous, edematous swelling surrounding the bite with elevated skin fold covering the head of the tick. Biopsy from the swelling after the removal of tick revealed foci of fibrinoid material with perivascular lymphocytes, neutrophils, and histiocytes in the dermis.

Keywords: Blood meal, Lyme disease, Rocky Mountain spotted fever, tick, vector

Ticks are small arachnids in the order parasitoformes.^[1] Approximately 850 different types of ticks have been enumerated in the literature and are widely distributed throughout the world,^[2] are vectors of many diseases. Most ticks do not carry diseases, and most tick bites do not cause serious health problems Ticks dwell and hide in low bush which allows them to physically contact the host.

A 50-year-old man came to the department as he noticed the presence of an insect in the abdominal wall. Not associated with pain, burning, fever, or muscle weakness. Examination revealed the presence of a tick in the anterior abdominal wall (near the right hypochondrium) with head embedded in it. Only body and four legs on the right side and two legs on the left side were visualized [Figure 1]. On trying to remove manually, the tick burrowed further leaving behind only the trunk [Figure 2]. There is an erythematous, edematous swelling surrounding the bite with elevated skin fold covering the head of the tick. The tick was removed with forceps, and the bite site was biopsied and sent for histopathological examination which showed foci of fibrinoid material with perivascular lymphocytes, neutrophils, and histiocytes in the dermis [Figure 3].

Tick bites occur most often during early spring to late summer. Usually, one gets tick bite while outdoors. Transmission of the disease depends on the several factors, particularly on the duration of the presence of tick in the host body and on whether the tick is infected or not.^[3]

They require a blood meal to grow and survive. Once a tick finds a host such as a human, a pet dog or cat, a deer, or a rabbit it attaches to it and burrows with its mouthparts into the exposed skin. It secretes “cementum” to firmly attach its mouthparts to the skin of the host and secrete saliva containing neurotoxins which prevent the host from feeling the pain and irritation of the bite. Then, it cuts the epidermis and enters it by its hypostome and keep the blood from clotting by excreting anticoagulant.^[4] Locally, the tick bite can cause erythema and induration but without pain. Similarly, the index case also did not experience pain despite signs of inflammation. Some people may develop an allergic reaction to a tick bite which may be mild with a few infuriating symptoms. In rare cases, anaphylaxis may occur. Notably, the index case did not exhibit allergic or anaphylactic reaction. Ticks may transmit diseases such as Lyme disease, Rocky Mountain spotted fever, tularemia, ehrlichiosis, relapsing fever, Colorado tick fever, and babesiosis. Systemic involvement has been reported the following tick bite which includes motor paralysis, encephalitis, and persistent atypical lymphocytic hyperplasia [Table 1].^{[5],[6],[7],[8],[9]} However, there is no evidence of systemic involvement in the index case. Treatment consists of removal of the tick with a fine-tipped tweezer and washing the bite site with 70% alcohol, iodine scrub or soap water, and watching for the signs of systemic involvement.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1755-6783.181663

[Figure 1], [Figure 2], [Figure 3]

[Table 1]