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Tick Removal With Liquid Nitrogen

Tick Removal With Liquid Nitrogen Lyme disease is a tick-borne zoonosis caused by Borrelia burgdorferi. A causative organism is transmitted via tick bite, Ixodes ricinus in Europe and neighboring parts of North Africa, and Ixodes scapularis and Ixodes pacificus on the west coast of North America. Erythema chronicum migrans is the first, the most common, and the most specific clinical manifestation and a defining criterion for Lyme disease.1 The risk of disease transmission significantly increases after 24 hours of tick attachment.2 Therefore, it is recommended that the tick be immediately and completely removed as soon as possible; the removal should include the whole tick, including the mouth parts and the cement the tick has secreted to secure its attachment to the skin. Attempts to remove small tick remnants may result in trauma and a secondary skin infection. Ideally, the tick removal procedure should not allow for infective body fluids to escape through the tick head into the wound site; touching the tick during the removal attempt is believed to irritate the tick and cause it to force more liquid into the wound.3 Among reported methods of tick removal,2,4 surgical removal with fine curved forceps to avoid squeezing the body of the tick seems to be the preferred one5; however, there is limited or no evidence that any of these methods allow for complete and timely tick removal and subsequently decrease B burgdorferi transmission.1 Report of a Case A 66-year-old patient presented to our outpatient clinic after short holidays spent in Alsace, France, with a painless tick bite over his left clavicular region. The tick had been attached for at least 5 days and was growing steadily, according to the patient. At clinical examination, there was a tick measuring 1 × 1 cm surrounded by an erythematous plaque. The rest of the clinical examination findings were normal except for acrally distributed vitiligo, for which patient was receiving psoralen plus UV-A therapy. We removed the tick by simply freezing it with liquid nitrogen (Cry-Ac: Brymill Cryogenic Systems) for approximately 20 seconds (Figure). Freezing resulted in rapid contraction of tick's body and a complete and immediate detachment of the parasite. The patient was prescribed doxycycline, 200 mg/d, for 14 days to treat erythema chronicum migrans, and the erythematous plaque was completely cleared by 3-week follow-up. View LargeDownload Figure: Freezing the tick with liquid nitrogen. Comment We report herein a very simple method of complete tick removal by freezing the parasite with liquid nitrogen. The method is absolutely effective, painless, noninvasive, safe, rapid, and very easy to apply at least in settings equipped with liquid nitrogen. We are not aware of any report in the literature proposing freezing with liquid nitrogen as a tick-removal method. We highly encourage this technique because in our experience, it is an effective, “one-shot” simple method of tick removal, especially convenient in areas where ticks are endemic, such as Alsace in France. Back to top Article Information Correspondence: Dr Pavlovic, Service de Dermatologie, Hopital Tenon, 4, rue de la Chine, 75020 Paris, France (mira.pavlovic@ganascia.name). Conflict of Interest Disclosures: None reported. References 1. Roupakias S, Mitsakou P, Nimer AA. Tick removal. J Prev Med Hyg. 2011;52(1):40-4421710824PubMedGoogle Scholar 2. Fingerle V, Wilske B. Ticks, tick bites and how best to remove the tick [in German]. MMW Fortschr Med. 2006;148(25):30-3216859157PubMedGoogle Scholar 3. Roupakias S, Mitsakou P, Al Nimer A. Surgical tick removal. Wilderness Environ Med. 2012;23(1):97-9922137906PubMedGoogle ScholarCrossref 4. Gammons M, Salam G. Tick removal. Am Fam Physician. 2002;66(4):643-64512201558PubMedGoogle Scholar 5. McGrath M, Buchan-Hepburn G. Tick bite: a case study. Aust Fam Physician. 2012;41(3):125-12622396925PubMedGoogle Scholar http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Dermatology American Medical Association

Tick Removal With Liquid Nitrogen

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Tick Removal With Liquid Nitrogen

Abstract

Lyme disease is a tick-borne zoonosis caused by Borrelia burgdorferi. A causative organism is transmitted via tick bite, Ixodes ricinus in Europe and neighboring parts of North Africa, and Ixodes scapularis and Ixodes pacificus on the west coast of North America. Erythema chronicum migrans is the first, the most common, and the most specific clinical manifestation and a defining criterion for Lyme disease.1 The risk of disease transmission significantly increases after 24 hours of tick...
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References (17)

Publisher
American Medical Association
Copyright
Copyright © 2013 American Medical Association. All Rights Reserved.
ISSN
2168-6068
eISSN
2168-6084
DOI
10.1001/jamadermatol.2013.2553
Publisher site
See Article on Publisher Site

Abstract

Lyme disease is a tick-borne zoonosis caused by Borrelia burgdorferi. A causative organism is transmitted via tick bite, Ixodes ricinus in Europe and neighboring parts of North Africa, and Ixodes scapularis and Ixodes pacificus on the west coast of North America. Erythema chronicum migrans is the first, the most common, and the most specific clinical manifestation and a defining criterion for Lyme disease.1 The risk of disease transmission significantly increases after 24 hours of tick attachment.2 Therefore, it is recommended that the tick be immediately and completely removed as soon as possible; the removal should include the whole tick, including the mouth parts and the cement the tick has secreted to secure its attachment to the skin. Attempts to remove small tick remnants may result in trauma and a secondary skin infection. Ideally, the tick removal procedure should not allow for infective body fluids to escape through the tick head into the wound site; touching the tick during the removal attempt is believed to irritate the tick and cause it to force more liquid into the wound.3 Among reported methods of tick removal,2,4 surgical removal with fine curved forceps to avoid squeezing the body of the tick seems to be the preferred one5; however, there is limited or no evidence that any of these methods allow for complete and timely tick removal and subsequently decrease B burgdorferi transmission.1 Report of a Case A 66-year-old patient presented to our outpatient clinic after short holidays spent in Alsace, France, with a painless tick bite over his left clavicular region. The tick had been attached for at least 5 days and was growing steadily, according to the patient. At clinical examination, there was a tick measuring 1 × 1 cm surrounded by an erythematous plaque. The rest of the clinical examination findings were normal except for acrally distributed vitiligo, for which patient was receiving psoralen plus UV-A therapy. We removed the tick by simply freezing it with liquid nitrogen (Cry-Ac: Brymill Cryogenic Systems) for approximately 20 seconds (Figure). Freezing resulted in rapid contraction of tick's body and a complete and immediate detachment of the parasite. The patient was prescribed doxycycline, 200 mg/d, for 14 days to treat erythema chronicum migrans, and the erythematous plaque was completely cleared by 3-week follow-up. View LargeDownload Figure: Freezing the tick with liquid nitrogen. Comment We report herein a very simple method of complete tick removal by freezing the parasite with liquid nitrogen. The method is absolutely effective, painless, noninvasive, safe, rapid, and very easy to apply at least in settings equipped with liquid nitrogen. We are not aware of any report in the literature proposing freezing with liquid nitrogen as a tick-removal method. We highly encourage this technique because in our experience, it is an effective, “one-shot” simple method of tick removal, especially convenient in areas where ticks are endemic, such as Alsace in France. Back to top Article Information Correspondence: Dr Pavlovic, Service de Dermatologie, Hopital Tenon, 4, rue de la Chine, 75020 Paris, France (mira.pavlovic@ganascia.name). Conflict of Interest Disclosures: None reported. References 1. Roupakias S, Mitsakou P, Nimer AA. Tick removal. J Prev Med Hyg. 2011;52(1):40-4421710824PubMedGoogle Scholar 2. Fingerle V, Wilske B. Ticks, tick bites and how best to remove the tick [in German]. MMW Fortschr Med. 2006;148(25):30-3216859157PubMedGoogle Scholar 3. Roupakias S, Mitsakou P, Al Nimer A. Surgical tick removal. Wilderness Environ Med. 2012;23(1):97-9922137906PubMedGoogle ScholarCrossref 4. Gammons M, Salam G. Tick removal. Am Fam Physician. 2002;66(4):643-64512201558PubMedGoogle Scholar 5. McGrath M, Buchan-Hepburn G. Tick bite: a case study. Aust Fam Physician. 2012;41(3):125-12622396925PubMedGoogle Scholar

Journal

JAMA Dermatology – American Medical Association

Published: May 1, 2013

Keywords: liquid nitrogen,tick removal

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