Do I have tick bite fever and could it be serious?

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Summer is the time we tend to spend more time outdoors. 

Of course not everyone who is outside will get tick bite fever, but it’s smart to be careful during tick season. The good news is that if caught early, this very uncomfortable condition is easily treated.

Dr Ryan O’Meara, specialist physician and Head of the Emergency Centre at Mediclinic Milnerton, says tick bite fever is caused by the Rickettsia bacteria, which is transmitted by ticks – either through bites, or if the body of the tick is crushed in an open wound[RH1] . “You’re most at risk when you spend time outside – on farms, hiking or camping, for example.”

Symptoms of tick bite fever

If you suspect tick bite fever, it’s crucial to tell your healthcare professional you’ve been active outdoors. This is because many of the symptoms, like fever, headache and myalgia (muscle pain), swollen painful glands and fatigue, are common to other infections and illnesses, too. These symptoms usually appear 5-7 days after exposure, although they may take longer to develop.

Dr Isabel van der Merwe, a general practitioner and Head of the Emergency Centre at Mediclinic George, adds that other symptoms include a fine rash that typically appears 2-3 days after the onset of fever, and may spread over your palms and the soles of your feet. Most telling, however, is the presence of an “eschar”, a dark scab or crust that marks the site of the tick bite.

An eschar is a dead patch of skin surrounded by inflamed tissue. It may not be immediately visible if it’s hidden in your scalp or body hair. However, the eschar is an important symptom in diagnosis, Dr O’Meara says, because although tests to confirm the disease are available, results take time to develop – and in most cases treatment will have started before these are available.

Why it’s important to treat tick bite fever

Early treatment is crucial, Dr Van der Merwe emphasises, as severe cases of tick bite fever may progress to meningo-encephalitis (inflammation of the brain tissue). Other serious complications like confusion, coma, pneumonia, bleeding, kidney and liver failure, and myocarditis (inflammation of the heart muscle), may also develop.

If you want to confirm the diagnosis, your doctor may do blood tests as well as a skin biopsy of the rash for PCR testing, which is more sensitive. “Note, though, that a negative PCR result doesn’t exclude tick bite fever,” Dr Van der Merwe cautions.

If your doctor suspects tick bite fever, they will prescribe a course of doxycycline. Dr O’Meara says you may be given alternative antibiotics if you’re allergic to the medication or pregnant. They may also recommend other treatment to relieve symptoms like headaches and fever.

Once you’ve started taking doxycycline, you should start to feel better within 2-3 days, says Dr O’Meara. “This medication is usually highly effective, so other diagnoses may be considered if there’s no improvement within this time.”

Tick bite fever in children

Dr Van der Merwe explains that children will experience similar symptoms to adults, although they are often milder and they may not present with a rash. Treatment may be slightly different, because doxycycline is not recommended for young children with mild disease. Your doctor may prescribe azithromycin in these patients.

The good news is that not all tick bites result in tick bite fever, so unless you or your child develop symptoms, there’s no need to take prophylactic antibiotics, even if you notice a bite.

Simple preventive measures

It’s important to note that there’s not yet a vaccine or prophylaxis available to prevent tick bite fever. That’s why it’s wise to take practical precautions. For example, if you’re heading into an area where there’s long grass, wear long trousers – tucked into your sock for extra protection – and long sleeves. Apply plenty of insect repellant.

It’s also a good idea to scan your body for ticks after outdoor activity, especially since they need to stay attached to the body for more than 24 hours in order to transmit infection. If you do find one, Dr Van der Merwe advises removing it immediately by following a simple process:

• Grab the tick at the base of its body to avoid squashing it, which may transmit infection.
• Wash the area with soap and water.
• Apply disinfectant.

You can also take preventive measures to control tick populations around your home. Always exterminate rodents from your property, keep grass short, and use regular tick control treatments on your pets.

“If you’ve spent time outdoors and start experiencing symptoms, see a doctor as soon as possible,” Dr Van der Merwe reiterates. “This is even more important if your symptoms don’t resolve, or if they’re accompanied by an eschar. Early treatment will put an end to your discomfort and prevent more severe disease complications.”