Tick are Back in Annapolis

Tick are Back in Annapolis

Annapolis Primary Care Update: Maryland Ticks Are Back

In an Annapolis primary care update released today, Maryland ticks are back! Evolve Direct Primary Care has prepared a quick list of the most important facts to know about tick bites, specific to Annapolis, Maryland.

How to remove a tick

  • Use fine-tipped tweezers to grasp the tick as close to the skin’s surfremove-aace as possible.
  • Pull upward with steady, even pressure. Don’t twist or jerk the tick; this can cause the mouth-parts to break off and remain in the skin. If this happens, remove the mouth-parts with tweezers. If you are unable to remove the mouth easily with clean tweezers, leave it alone and let the skin heal.
  • After removing the tick, thoroughly clean the bite area and your hands with rubbing alcohol or soap and water.remove-b
  • Dispose of a live tick by submersing it in alcohol, placing it in a sealed bag/container, wrapping it tightly in tape, or flushing it down the toilet. Never crush a tick with your fingers.
  • Other ways to remove ticks, such as using a hot match head or painting the tick with nail polish, gasoline, or other materials, are not advised. Such treatments can cause the tick to release more fluids back into the bite.

What to do after a tick bite

Lyme disease is not usually transmitted within the first 48 to 72 hours of tick attachment. The likelihood of transmission is increased if the tick is engorged and/or has been attached for at least 72 hours.

For children under 8 years old, NO antibiotics are recommended, per the ISDA. See below.

For adults, all following criteria must be met for prophylactic antibiotics:
•Attached tick identified as deer tick
•Tick is estimated to have been attached for ≥36 hours
•Prophylaxis is begun within 72 hours of tick removal
•Local rate of infection of ticks with B. burgdorferi is ≥20 percent (Annapolis, Maryland qualifies rate is over 20%)
•Doxycycline is not contraindicated (ie, the patient is not <8 years of age, pregnant, or lactating)

The IDSA does not recommend prophylaxis with an alternate antibiotic for the following reasons (this includes children under age of 8 and anyone allergic or intolerant to Doxycycline 200mg one time dose):

  • No data to support short course of another antibiotic
  • Longer courses of antibiotics may lead to adverse effects
  • Standard antibiotic treatment is highly effective if Lyme disease actually occurs
  • The risk of developing a serious complication of Lyme disease after a recognized tick bite is extremely low

What are the symptoms of tick disease such as Lyme?

The most common symptoms of tick-related illnesses are:

  • Fever/chills
  • Headache, fatigue, and muscle aches
  • Rash: Depends on whether Lyme, Rocky Mountain spotted fever, Ehrlichiosis or Tularemia (see below)


EM or Eyrthema Migrans, the typical rash of Lyme Disease, occurs in 75-80% of infected people, usually at the site of the tick bite.

EM or Eyrthema Migrans, the typical rash of Lyme Disease, occurs in 75-80% of infected people, usually at the site of the tick bite.

  • Rash may appear within 3-30 days, typically before the onset of fever.
  • Rash is the first sign of infection and is usually a circular rash called erythema migrans or EM.
  • Occurs in approx 70-80% of infected persons and begins at the tick bite. Warm, but not usually painful.
  • Some people develop additional EM lesions in other areas of the body several days later.


Rocky Mountain spotted fever (RMSF)

  • Rash varies greatly from person to person in appearance, location, and time of onset.
  • About 10% of people with RMSF never develop a rash.
  • Rash begins 2-5 days after onset of fever as small, flat, pink, non-itchy spots (macules) on the
    RMSF petechial rash

    RMSF petechial rash

    wrists, forearms, and ankles and spreads to the trunk. It sometimes involves the palms and soles.

  • The red to purple, spotted (petechial) rash of RMSF is usually not seen until the sixth day or later after onset of symptoms and occurs in 35-60% of patients with the infection.


Ulcer of Tularemia

Ulcer of Tularemia

Ulcer forms at the site of bite and is accompanied by swelling of lymph glands, usually in the armpit or groin.





  • Rash occurs in only 30% of adults (up to 60% of children)

    Rash of Ehrlichiosis

    Rash of Ehrlichiosis

  • Rash is macular to maculopapular to petechial, and may appear after the onset of fever.



So see your doctor immediately if you have been bitten by a tick and experience any of the symptoms described here.

How to prevent tick bites

Ticks CAN be present all year. Be extra vigilant in warmer months (April-September)

  • Avoid wooded and bushy areas with high grass and leaf litter.
  • Walk in the center of trails.
  • Repel Ticks with DEET or Permethrin
    • Use repellents that contain 20-30% DEET (N, N-diethyl-m-toluamide) on exposed skin and clothing
    • Use products that contain permethrin on clothing. Treat clothing and gear, such as boots, pants, socks and tents with products containing 0.5% permethrin. It remains protective through several washings.
    • Pre-treated clothing is available and may be protective longer.
  • Find and Remove Ticks from Your Body
    • Bathe or shower as soon as possible after coming indoors (preferably within two hours)
    • Conduct a full-body tick check using a hand-held or full-length mirror.
    • Parents should check their children for ticks under the arms, in ears, belly button, behind knees, between the legs, around the waist, and especially in their hair.
      • Examine gear and pets. Ticks can ride into the home on clothing and pets, then attach to a person later, so carefully examine pets, coats, and day packs.
        Tumble clothes in a dryer on high heat for an hour to kill remaining ticks


Where are these diseases found?

TickborneDiseases pg 4 TickborneDiseases pg 4


Excellent Resources for further learning

Best resource: CDC’s “Tickborne Diseases PDF”. The section on Lyme is fantastic!


Mayo Clinic

Kids Health



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More information from the CDC’s Lyme Disease page below:


More information from CDC

More information from CDC


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