Tick Paralysis: Clinician Notes

This page condenses the VSOS team’s approach to tick paralysis: Early antiserum administration, early airway protection, objective monitoring (including blood gases in at-risk cases), and practical inpatient care (full clip and repeated tick searches, eye care, oxygen/ventilation, nutrition support). Preventatives aren’t fool-proof; multiple ticks are common and may be found later.

VSOS provides 24/7 critical care oversight, ICU with invasive ventilation, and ambulance transfer at any stage (including anaesthetised/intubated patients).

• Tick paralysis is treatable, including cases requiring life support. 
• Expect continued deterioration for 24-48 h after antiserum, plan to monitor closely over this time.
• The primary cause of death is respiratory dysfunction (aspiration pneumonia, ventilatory pump failure, upper airway obstruction).
   

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• Diaphragmatic paresis (ventilatory failure) is often not visible externally; do not rely on observation alone. Patient’s can be hypoventilating, have an elevated blood CO2, but appear to breathing without effort.
• For deteriorating/borderline cases, frequent blood gas analysis is needed to detect/manage hypoventilation (arterial or jugular venous PCO2).
• Early airway protection improves outcomes; consider early induction of anaesthesia when gag is lost, particularly if there is any regurgitation.
• Aspiration pneumonia often kills these patients, or requires them to be on a ventilator sooner than a patient with normal ventilatory function.
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• Hospitalisation: mild cases, 48 - 72 h; severe cases 1-3 weeks.
• Supportive care commonly includes:
  • IV fluids and sedation for comfort and full-body clipping (enables repeated searches).
  • Repeated tick searches throughout hospitalisation; multiple ticks are common.
  • Oxygen therapy; mechanical ventilation for critical cases.
  • IV antibiotics where pneumonia is present/suspected (nearly all cases);
  • Prokinetic & gastroprotective medications
  • Thoracic imaging as needed.
  • Eye care: corneal ulceration is very common; ocular care is vital!
  • Nutrition support; tube feeding in severe cases.
  • Nursing care: bladder/eye care, body care, comfort positioning.

• Cats: more prone to upper airway obstruction due to laryngeal weakness.
• Dogs: more proneto ventilatory failure from diaphragmatic paresis.
• Both susceptible to megaoesophagus & regurgitation.
• Tick location influences signs e.g., periocular ticks ? exposure keratitis; ventral neck ticks may trigger laryngeal paralysis in dogs before diaphragmatic paralysis.

• > 70% of ticks are found from the neck up. Prioritise head/neck/shoulders, but search the whole patient.
• Full clip is reasonable and often recommended, especially for long coats.
• Perform multiple, ongoing searches during the stay; after antiserum, ticks may migrate and become more apparent.

• Modern preventatives are not fool-proof. 
• We are seeing breakthrough cases, so maintain a high index of suspicion.

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• No access to 24hr monitoring, blood gases, oxygen, antiserum or ventilatory support.
• Deterioration or expected deterioration in the 24-48 h post-antiserum.
• Suspected ventilatory failure, significant airway compromise, or rising CO? risk.
• Don’t get caught by the silent killer; escalate before overt failure.
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• 24/7 critical care specialist oversight for severe tick cases.
• ICU with invasive ventilation and advanced monitoring; team highly trained in ventilation.
• Ambulance transfer at any stage from your practice, including anaesthetised patients, with a critical care team on board.
• Proven outcomes: our longest ventilated tick case was 14 days with a successful discharge.

VSOS Ambulance and ICU are on standby for you, here when you need us.