Although rare, generalised tick paralysis can be fatal if left untreated ( 7). Two types of tick paralysis have been described: generalised and isolated tick paralysis. Studies in mice have shown worsening toxicity dependent on the duration of tick feeding, peaking at 4–5 days ( 8). Vector transmitted Rickettsia has been reported in Australia and most significantly neuromuscular paralysis has been well characterised ( 5- 7).įemale Ixodes Holocyclus produce a holocyclotoxin from the salivary glands, a neurotoxin that acts similarly to botulinum toxin by inhibiting acetylcholine release pre-synaptically at the neuromuscular junction ( 4). The clinical presentation following tick bite can vary with some experiencing a mild localised allergic reaction and others anaphylaxis. When fully engorged a tick can be anywhere from 200–600 times its original weight ( 1). Females host on human blood, whilst males host on female ticks. Each stage requires a new host in order to moult and evolve, thus requiring three hosts to complete their life cycle. Ticks have a life cycle consisting of four stages: egg, larva, nymph and adult. The need for moist, humid conditions limits the distribution of ticks most prevalently seen between September and March, associated with the Australian northern-easterly weather. Only a few of these ticks are capable of human paralysis, with three species endemic to Australia the most potent worldwide being the Ixodes Holocyclus located on the eastern coast of Australia and the less toxic Ixodes Cornuatus in Tasmania and Victoria and Ixodes Hirsti in South Australia ( 2- 4). It is populated by a unique variety of wildlife including approximately seventy species of ticks, sixteen of which feed on both humans and domestic animals ( 1). Received: 06 December 2020 Accepted: 20 August 2021 Published: 15 December 2021.Īustralia is a biodiverse continent centred between the Indian and South Pacific Oceans. Keywords: Facial nerve palsy tick bite Australia intra-aural case report Careful examination of the face, scalp and EAC should be conducted in patients presenting with otalgia and facial nerve palsy, particularly in tropical areas, to exclude the possibility of tick infestation. Tick paralysis is a severe, but preventable disease. One patient died from respiratory arrest following generalized paralysis. Six patients had partial recovery at time of follow up. Thirteen studies were analysed for time to recovery, with an average time of 19 days. Thirty-eight patients had complete recovery of facial palsy. House-Brackmann classification was utilised in 7 patients 4 patients with grade 4, 1 patient with grade 3, and 2 patients with grade 2 facial nerve palsy. A complete ipsilateral facial nerve palsy was present in 45 patients, notably in 16 patients this occurred following tick removal. Forty-one patients presented with a single tick within the external auditory canal (EAC), three had a single tick located on the temple or forehead region, three had post-auricular ticks and one patient had a remarkable 44 ticks removed from the face, scalp, neck, back and limbs. Ten studies estimated the possible duration between tick bite and facial nerve palsy, averaging 8.9 days. Patients’ ages ranged from 1 to 84 years of age.
Eighteen articles included in the review comprised a total of 48 patients. Utilising the following key words: “Ixodes”, “Facial paralysis”, “Tick bite”, and “Australia”. A review of the literature was conducted using MEDLINE and EMBASE databases for relevant literature published between 19.
A novel case of an intra-aural paralysis tick bite resulting in unilateral facial nerve palsy is also discussed. Abstract: We present a literature review examining the research surrounding tick paralysis resulting in facial nerve palsy.
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