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Tick bite

Definition

Ticks are bugs that can attach to you as you brush past bushes, plants, and grass. Once on you, ticks often move to a warm, moist place on your body, like the armpits, groin, and hair. There, they typically attach firmly to your skin and begin to draw blood. Avoiding ticks is important because they can infect you with bacteria and other organisms that cause illness.

Ticks can be fairly large, about the size of a pencil eraser, or so small that they are almost impossible to see. There are about 850 different types of ticks. Most tick bites are harmless, but some can cause mild to serious health conditions.

This article describes the effects of a tick bite.

This article is for information only. DO NOT use it to treat or manage a tick bite. If you or someone you are with is bitten by a tick, call your local emergency number (such as 911), or your local poison center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States.

Poisonous Ingredient

Hard- and soft-bodied female ticks are believed to make a poison that can cause tick paralysis in children.

Most ticks do not carry diseases, but some carry bacteria or other organisms that can cause:

These and other illnesses may cause heart, nervous system, kidney, adrenal gland, and liver damage, and may cause death.

Where Found

Ticks live in wooded areas or grassy fields.

Symptoms

Watch for symptoms of tick-borne diseases in the weeks after a tick bite. These include muscle or joint aches, stiff neck, headache, weakness, fever, swollen lymph nodes, and other flu-like symptoms. Watch for a red spot or rash starting at the site of the bite.

The symptoms below are from the bite itself, not from the diseases a bite may cause. Some of the symptoms are caused by one variety of tick or another, but may not be common to all ticks.

  • Stopped breathing
  • Difficulty breathing
  • Blisters
  • Rash
  • Severe pain at site, lasting several weeks (from some kinds of ticks)
  • Swelling at site (from some kinds of ticks)
  • Weakness
  • Uncoordinated movement

Home Care

Below is the proper way to remove an attached tick:

  • Use tweezers to grasp the tick as close to the skin surface as possible. Gloved or protected fingers may be used if no tweezers are available.
  • Pull straight up gently but firmly, using steady pressure. Do not jerk or twist. Do not squeeze or crush the body of the tick. Fluids from the tick may contain infectious agents.
  • Clean the skin thoroughly with soap and water after removing the tick.
  • Wash your hands with soap and water.

If possible, place the tick in a closed container and take it to the emergency room.

If the mouthparts or any parts of the tick remain in the skin, they will usually grow out without causing any problems, but local infection is possible.

Before Calling Emergency

Have this information ready:

  • Person's age, weight, and condition
  • Time the tick bite occurred
  • Part of the body affected

Poison Control

Your local poison center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

What to Expect at the Emergency Room

The symptoms will be treated. Long-term treatment may be needed if complications develop. Preventive antibiotics are often given to people who live in areas where Lyme disease is common.

The person may receive:

  • Blood and urine tests
  • Breathing support, including oxygen, a tube down the throat and a breathing machine (ventilator) in serious cases
  • Chest x-ray
  • ECG (electrocardiogram, or heart tracing)
  • Intravenous fluids (through a vein)
  • Medicines to treat symptoms

Outlook (Prognosis)

After tick removal and skin cleansing, observe the area for the development of a circular rash called "Erythema migrans" for up to 30 days following a tick bite. Contact your health care provider right away if a rash develops.

A tick usually has to be attached for 2 to 3 days before transmitting Lyme disease, so removal of the tick within that time often prevents Lyme transmission. Other infections may occur earlier from a tick bite.

Most tick bites are harmless. The outcome will depend on what type of infection the tick may have been carrying and how soon appropriate treatment was started. If you are bitten by a tick that carried a disease, long-term health effects may occur months or even years later.

Personal protection against bites may be achieved by avoiding areas where ticks are known to be present and applying insect repellents.

To protect yourself against ticks, try to stay away from areas where ticks are known to live. If you are in an area that harbors ticks, apply insect repellant to your body and wear protective clothing. Examine your skin for signs of tick bites or ticks after your travels.

Gallery

Lyme disease - erythema migrans
Erythema migrans is the initial lesion of Lyme disease, and often appears at the site of the infecting tick bite. It is a red, enlarging rash, flat or slightly raised, and may reach from 4 to 20 inches (12 to 35 cm) across (the average rash is 6 inches, or 17 cm). (Image courtesy of the Centers for Disease Control and Prevention.)
Lyme disease
Having a tick attached to your body isn't just getting a little too close to nature. The tick can make you seriously ill with Lyme disease. Lyme disease is caused by bacteria called Borrelia burgdorferi. Blacklegged ticks carry these bacteria. The ticks pick up the bacteria when they bite mice or deer that are infected with Lyme disease. You can get the disease if you are bitten by an infected tick, mostly in northeastern states and on the West Coast. The good news is that usually a tick has to be attached to your body for 24 to 36 hours to infect you. The bad news is that blacklegged ticks are so small they're almost impossible to see. Many people with Lyme disease never even see a tick on their body. But most people bitten by a tick do NOT get Lyme disease. So, how do you know for sure that you have Lyme disease? The flu-like symptoms of Lyme disease usually start days or weeks after you've been bitten. You might have Itching all over your body; Chills, fever, and light headedness; Or perhaps a Headache, muscle pain, and a stiff neck. You'll probably see a bull's eye rash on your body. It can get pretty big. After a few weeks, the muscles in your face might feel weak or even paralyzed. Your knees and other joints may swell and hurt. You might even notice your heart skipping some beats. Eventually, your muscles might move strangely, you may feel numbness or tingling, and you may start to have trouble speaking. A doctor will test your blood for antibodies that are trying to fight the bacteria in your blood. One of these tests is called the ELISA test, and you'll often have a second test called the Western blot test to confirm you have Lyme disease. To treat Lyme disease, you may need to take antibiotics for up to a month. Pain medicines from the drug store can help soothe your joint stiffness. If it's caught early, Lyme disease is pretty easily treated. Without treatment, you can have heart, muscle, and even nerve problems. So the next time you're out in the woods or high grass, wear protective clothing, and do check yourself for ticks once you get home.
Lyme disease
Having a tick attached to your body isn't just getting a little too close to nature. The tick can make you seriously ill with Lyme disease. Lyme disease is caused by bacteria called Borrelia burgdorferi. Blacklegged ticks carry these bacteria. The ticks pick up the bacteria when they bite mice or deer that are infected with Lyme disease. You can get the disease if you are bitten by an infected tick, mostly in northeastern states and on the West Coast. The good news is that usually a tick has to be attached to your body for 24 to 36 hours to infect you. The bad news is that blacklegged ticks are so small they're almost impossible to see. Many people with Lyme disease never even see a tick on their body. But most people bitten by a tick do NOT get Lyme disease. So, how do you know for sure that you have Lyme disease? The flu-like symptoms of Lyme disease usually start days or weeks after you've been bitten. You might have Itching all over your body; Chills, fever, and light headedness; Or perhaps a Headache, muscle pain, and a stiff neck. You'll probably see a bull's eye rash on your body. It can get pretty big. After a few weeks, the muscles in your face might feel weak or even paralyzed. Your knees and other joints may swell and hurt. You might even notice your heart skipping some beats. Eventually, your muscles might move strangely, you may feel numbness or tingling, and you may start to have trouble speaking. A doctor will test your blood for antibodies that are trying to fight the bacteria in your blood. One of these tests is called the ELISA test, and you'll often have a second test called the Western blot test to confirm you have Lyme disease. To treat Lyme disease, you may need to take antibiotics for up to a month. Pain medicines from the drug store can help soothe your joint stiffness. If it's caught early, Lyme disease is pretty easily treated. Without treatment, you can have heart, muscle, and even nerve problems. So the next time you're out in the woods or high grass, wear protective clothing, and do check yourself for ticks once you get home.
Lyme disease
Having a tick attached to your body isn't just getting a little too close to nature. The tick can make you seriously ill with Lyme disease. Lyme disease is caused by bacteria called Borrelia burgdorferi. Blacklegged ticks carry these bacteria. The ticks pick up the bacteria when they bite mice or deer that are infected with Lyme disease. You can get the disease if you are bitten by an infected tick, mostly in northeastern states and on the West Coast. The good news is that usually a tick has to be attached to your body for 24 to 36 hours to infect you. The bad news is that blacklegged ticks are so small they're almost impossible to see. Many people with Lyme disease never even see a tick on their body. But most people bitten by a tick do NOT get Lyme disease. So, how do you know for sure that you have Lyme disease? The flu-like symptoms of Lyme disease usually start days or weeks after you've been bitten. You might have Itching all over your body; Chills, fever, and light headedness; Or perhaps a Headache, muscle pain, and a stiff neck. You'll probably see a bull's eye rash on your body. It can get pretty big. After a few weeks, the muscles in your face might feel weak or even paralyzed. Your knees and other joints may swell and hurt. You might even notice your heart skipping some beats. Eventually, your muscles might move strangely, you may feel numbness or tingling, and you may start to have trouble speaking. A doctor will test your blood for antibodies that are trying to fight the bacteria in your blood. One of these tests is called the ELISA test, and you'll often have a second test called the Western blot test to confirm you have Lyme disease. To treat Lyme disease, you may need to take antibiotics for up to a month. Pain medicines from the drug store can help soothe your joint stiffness. If it's caught early, Lyme disease is pretty easily treated. Without treatment, you can have heart, muscle, and even nerve problems. So the next time you're out in the woods or high grass, wear protective clothing, and do check yourself for ticks once you get home.
Lyme disease - erythema migrans
Erythema migrans is the initial lesion of Lyme disease, and often appears at the site of the infecting tick bite. It is a red, enlarging rash, flat or slightly raised, and may reach from 4 to 20 inches (12 to 35 cm) across (the average rash is 6 inches, or 17 cm). (Image courtesy of the Centers for Disease Control and Prevention.)
Lyme disease
Having a tick attached to your body isn't just getting a little too close to nature. The tick can make you seriously ill with Lyme disease. Lyme disease is caused by bacteria called Borrelia burgdorferi. Blacklegged ticks carry these bacteria. The ticks pick up the bacteria when they bite mice or deer that are infected with Lyme disease. You can get the disease if you are bitten by an infected tick, mostly in northeastern states and on the West Coast. The good news is that usually a tick has to be attached to your body for 24 to 36 hours to infect you. The bad news is that blacklegged ticks are so small they're almost impossible to see. Many people with Lyme disease never even see a tick on their body. But most people bitten by a tick do NOT get Lyme disease. So, how do you know for sure that you have Lyme disease? The flu-like symptoms of Lyme disease usually start days or weeks after you've been bitten. You might have Itching all over your body; Chills, fever, and light headedness; Or perhaps a Headache, muscle pain, and a stiff neck. You'll probably see a bull's eye rash on your body. It can get pretty big. After a few weeks, the muscles in your face might feel weak or even paralyzed. Your knees and other joints may swell and hurt. You might even notice your heart skipping some beats. Eventually, your muscles might move strangely, you may feel numbness or tingling, and you may start to have trouble speaking. A doctor will test your blood for antibodies that are trying to fight the bacteria in your blood. One of these tests is called the ELISA test, and you'll often have a second test called the Western blot test to confirm you have Lyme disease. To treat Lyme disease, you may need to take antibiotics for up to a month. Pain medicines from the drug store can help soothe your joint stiffness. If it's caught early, Lyme disease is pretty easily treated. Without treatment, you can have heart, muscle, and even nerve problems. So the next time you're out in the woods or high grass, wear protective clothing, and do check yourself for ticks once you get home.
Lyme disease - erythema migrans
Erythema migrans is the initial lesion of Lyme disease, and often appears at the site of the infecting tick bite. It is a red, enlarging rash, flat or slightly raised, and may reach from 4 to 20 inches (12 to 35 cm) across (the average rash is 6 inches, or 17 cm). (Image courtesy of the Centers for Disease Control and Prevention.)
Lyme disease
The most common early sign of lyme disease is the appearance of a rash on the skin that looks like a bulls eye. The rash begins as a reddened area near the area of the tick bite. As the rash gets bigger, it clears in the center and develops a red ring around the outer perimeter. Other symptoms include muscle or joint aches, stiff neck, headache, weakness, fever, swollen lymph nodes and other flu-like symptoms.
Lyme disease
The most common early sign of lyme disease is the appearance of a rash on the skin that looks like a bulls eye. The rash begins as a reddened area near the area of the tick bite. As the rash gets bigger, it clears in the center and develops a red ring around the outer perimeter. Other symptoms include muscle or joint aches, stiff neck, headache, weakness, fever, swollen lymph nodes and other flu-like symptoms.

References

Bryant K. Tickborne infections. In: Long SS, Prober CG, Fischer M, eds. Principles and Practice of Pediatric Infectious Diseases. 5th ed. Philadelphia, PA: Elsevier; 2018:chap 90.

Cummins GA, Traub SJ. Tick-borne diseases. In: Auerbach PS, Cushing TA, Harris NS, eds. Auerbach's Wilderness Medicine. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 42.

James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM. Parasitic infestations, stings, and bites. In: James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds. Andrews' Diseases of the Skin: Clinical Dermatology. 13th ed. Philadelphia, PA: Elsevier; 2020:chap 20.

Needham GR. Evaluation of five popular methods for tick removal. Pediatrics. Jun;75(6):997-1002. PMID: 4000801 pubmed.ncbi.nlm.nih.gov/4000801/.

Otten EJ. Venomous animal injuries. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 55.

Last reviewed July 20, 2021 by Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team..

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