Wednesday, December 07, 2005

A Hunter in Deer Season

The Hunter as Hunted

[Your comments are welcomed]

This 72 year old man was deer hunting on December 2, 2006. He remembers sitting on a log for 45 minutes and feeling as if he was being bitten. Later that day, his hunting companion removed three ticks from him. He presented on Monday, December 5 for an evaluation. The picture is taken from his left hip. The tick was gently removed and photographed with a paper clip.





Since the tick was attached for around three days, I elected to treat the patient with doxycycline 100 mg. bid for 10 days. The tick was sent to the lab for identification. I may get serologies in a few weeks. ADDENDUM: The tick was identified as a deer tick, Ioxides dammini.

Rationale for Treatment (from www.emedicine.com)
Ten days of doxycycline seem innocuous enough.
Although most patients do not require treatment, consider tick bite prophylaxis on a case-by-case basis. Base the decision on the species of the tick, duration of attachment (degree of engorgement of the tick is a surrogate marker), geography (percentage of ticks infected where the bite took place), method of tick removal, anxiety level of patient, and pregnancy (lower threshold to treat pregnant women).
After performing this exercise in clinical decision-making, one may decide to treat a given patient with prophylactic antibiotics. In the studies mentioned previously, no patient in the treatment group (which received 10 d of antibiotic treatment) had the disease. Historically, if one were to choose to treat, 10 days of oral amoxicillin, doxycycline, or cefuroxime axetil would seem prudent, depending on patient factors such as age, allergy, and pregnancy.
In one of the most recent studies (2001), a single 200-mg dose of doxycycline was used for prophylaxis with excellent results.

1 comment:

  1. Nice photos. The title reminds me a famous Rubaei by Khayyam:
    The palace where Jamshid held his cup
    The doe and the fox now rest and sup
    Bahram who hunted game non-stop
    Was hunted by death when his time was up.

    ReplyDelete

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