Two cases of hard tick (Acari: Ixodidae) infestations

Abstract

Hard ticks (Acari: Ixodidae) may carry pathogens causing various infectious diseases. We report two cases of tick bites that presented with different clinical features.

The first patient is a 69-year-old woman who presented with vertigo. One week after mountain climbing, she developed general fatigue, headache, high fever, vertigo, and a generalized rash. She was suspected of having vestibular neuritis, and admitted to our institution. Blood tests revealed thrombocytopenia, and increased levels of C-reactive protein, aspartate aminotransferase, alanine transaminase, and lactate dehydrogenase. Upon consultation with the Department of Internal Medicine, she was suspected of having Japanese spotted fever. Her condition improved upon initiation of minocycline management. The diagnosis of Japanese spotted fever was confirmed via a polymerase chain reaction test of the eschar on her back, which was believed to be the spot where she was bitten.

The second patient is a 78-year-old woman who presented with right otalgia, one day after working in a bamboo forest. A white spherical mass attached to the external auditory canal entrance was observed. Due to the suspicion of a tick bite, she was referred to a dermatologist. The dermatologist noted the presence of a blood-sucking Amblyomma testudinarium on the right external auditory canal. The tick was completely removed.

Although tick bites are not commonly observed by otolaryngologists, these bites present with various pathologies. Thus, it is recommended to know the features and treatments of tick bites.