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ARTHROPOD BITES AND STINGS is a topic covered in the Harrison's Manual of Medicine.

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  • Epidemiology: Ticks are important carriers of vector-borne diseases (e.g., Lyme disease, babesiosis, anaplasmosis, ehrlichiosis) in the United States.
  • Etiology: While ticks feed on blood from their hosts, their secretions may produce local reactions, transmit diverse pathogens, induce a febrile illness, or cause paralysis. Soft ticks attach for <1 h; hard ticks can feed for >1 week.
  • Clinical features: Except for tick-borne diseases, most manifestations of tick bites are self-limited following tick removal.
    • Tick-induced fever, in the absence of pathogen transmission, is associated with headache, nausea, and malaise and usually resolves ≤36 h after the tick is removed.
    • Tick paralysis is an ascending flaccid paralysis due to a toxin in tick saliva that causes neuromuscular block and decreased nerve conduction.
      • Weakness begins symmetrically in the lower extremities ≤6 days after the tick’s attachment and ascends symmetrically, causing complete paralysis of the extremities and cranial nerves.
      • Deep tendon reflexes are decreased or absent, but sensory examination and LP yield normal findings.
      • Tick removal results in improvement within hours; failure to remove the tick may lead ultimately to respiratory paralysis and death.


  • Ticks should be removed with forceps applied close to the point of attachment, which should then be disinfected.
  • Pts bitten by a deer tick in Lyme disease–endemic regions can receive a prophylactic oral dose of doxycycline (200 mg) within 72 h of tick removal.
  • Tick removal within 36 h of attachment usually prevents transmission of the agents of Lyme disease, babesiosis, anaplasmosis, and ehrlichiosis.

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Loscalzo, Joseph, et al., editors. "ARTHROPOD BITES and STINGS." Harrison's Manual of Medicine, 19th ed., McGraw Hill Inc., 2017. harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623531/all/ARTHROPOD_BITES_AND_STINGS.
ARTHROPOD BITES AND STINGS. In: Loscalzo J, Jameson JL, Longo DL, et al, eds. Harrison's Manual of Medicine. 19th ed. McGraw Hill Inc.; 2017. https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623531/all/ARTHROPOD_BITES_AND_STINGS. Accessed April 18, 2019.
ARTHROPOD BITES AND STINGS. (2017). In Loscalzo, J., Jameson, J. L., Longo, D. L., Hauser, S. L., Fauci, A. S., & Kasper, D. L. (Eds.), Harrison's Manual of Medicine. Available from https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623531/all/ARTHROPOD_BITES_AND_STINGS
ARTHROPOD BITES and STINGS [Internet]. In: Loscalzo J, Jameson JL, Longo DL, Hauser SL, Fauci AS, Kasper DL, editors. Harrison's Manual of Medicine. McGraw Hill Inc.; 2017. [cited 2019 April 18]. Available from: https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623531/all/ARTHROPOD_BITES_AND_STINGS.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - ARTHROPOD BITES AND STINGS ID - 623531 ED - Loscalzo,Joseph, ED - Jameson,J Larry, ED - Longo,Dan L, ED - Hauser,Stephen L, ED - Fauci,Anthony S, ED - Kasper,Dennis L, BT - Harrison's Manual of Medicine UR - https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623531/all/ARTHROPOD_BITES_AND_STINGS PB - McGraw Hill Inc. ET - 19 DB - Harrison's Manual of Medicine DP - Unbound Medicine ER -