A 5-year-old girl in suburban Cincinnati, Ohio, was rushed to the hospital this month when she suddenly had trouble moving, swallowing and breathing. Averey Mell's family said she went to bed healthy one day and then couldn’t keep her balance the next.
"I actually thought she had vertigo. She was really dizzy and couldn't walk straight," Sami Mell, Averey’s mother, told TODAY.
“I fell face first into the bathroom,” Averey told Fox19 Now.
As her condition deteriorated, she had to be admitted to the intensive care unit of Cincinnati Children’s Hospital and placed on a ventilator.
Sami Mell described what happened next on her Facebook page.
“When we got to ICU I noticed a lump in her hair. It was a tick. I searched her and found another at the back of her head in [the] neckline,” she wrote.
The hidden creatures finally helped doctors diagnose tick paralysis.
When the engorged ticks, which Mell described as almost the size of a quarter, were removed, Averey quickly improved. The girl is now back home and back to normal, her family said. A similar case was recently reported in Colorado.
What is tick paralysis?
The cases highlight a rare, but potentially deadly condition caused by a neurotoxin found in the salivary glands of several species of female ticks, including the Rocky Mountain wood tick, the American dog tick, the Lone Star tick, the Gulf Coast tick and occasionally the deer tick.
When the tick attaches itself to a human to feed on blood, the poison can enter a person’s bloodstream and — if the tick isn’t removed in time — attack the nervous system. It can progress to the loss of muscle function, respiratory failure and death.
Anyone can be affected, but doctors tend to see tick paralysis more often in children, especially girls whose long hair may conceal ticks hiding behind the ear or on the scalp, said Dr. Leslie Simon, chair of emergency medicine at the Mayo Clinic in Jacksonville, Florida, and associate professor at the Mayo Clinic Alix School of Medicine.
“It’s absolutely amazing” that the little creatures can produce such a poison, Simon told TODAY. “It’s just incredibly powerful, but neurotoxins are like that. Sometimes, it takes just a tiny little dose to have huge effects on a patient.”
If the tick is removed quickly, a person won’t develop the disease. But if the female tick stays on the body for four or five days, the illness can start. The biggest risk factor is the length of time the tick is attached, Simon said.
What are the symptoms?
The first warning sign is usually difficulty walking. Patients feel weak and gradually lose motor skills, with the paralysis starting in their legs and then traveling upwards in the body.
Eventually, patients may not be able to breathe or swallow on their own, and need to be placed on a ventilator.
“As it progresses, if the patients aren’t treated, they tend to die from respiratory failure,” Simon said.
Tick paralysis is rare in humans — the last time TODAY highlighted a case was in 2017 — but it has about a 12% fatality rate if it’s not detected in time.
There are no lab tests or imaging tests for the condition. The only way to detect it is to spot the attached tick on a patient who has the symptoms. Doctors are trained to look for ticks in any patient who presents with acute motor weakness, Simon noted.
How is it treated?
The only treatment is to remove the tick. Doctors also offer supportive care if patients have progressed to the point where they can’t breathe on their own.
Tick paralysis is not an infection, so there are no drugs to treat it. When the tick is removed, the neurotoxin is flushed out of the body.
“[Recovery] is remarkably rapid. Usually within a few hours they’re significantly improved and will progressively improve over a couple of days,” Simon said. “The expectation is they’ll have a full recovery.”
How to prevent tick paralysis:
The key is to prevent tick bites in the first place. Parents should make sure kids are using suitable insect repellent when playing outside and have their pants tucked into their socks for extra protection, Simon said.
Check for ticks when children get back inside: “The most common area for kids is on their scalp behind their ears, but also look in between their fingers and places that aren’t obvious because that’s where ticks like to hide. Warm, moist spots,” Simon noted.
When ticks are removed quickly, there’s little risk for tick paralysis.