Question of the Day Wednesday September 13, 2017

Answer: The cited article notes: “The classic presentation is that of an acute symmetric ascending flaccid paralysis that evolves over hours to days, sometimes preceded by prodromal symptoms, including paresthesias, restlessness, irritability, fatigue, and myalgias. These symptoms are followed hours later by flaccid weakness that generally begins in the lower extremities. Fever is absent. The deep tendon reflexes are diminished or absent. If the tick continues to feed, the weakness ascends to the upper extremities over the ensuing 12 to 24 hours. At this stage, the muscles supplied by the lower cranial nerves and then the upper cranial nerves become weak. Finally, the respiratory muscles fail. Without intervention, patients will probably die of respiratory failure. This phase occurs when the tick may have fed to repletion and dropped off, accounting for the patients who may recover without endotracheal intubation and mechanical ventilation. Patients have a normal mental status until hypoxia and hypercarbia supervene.” (Edlow JA and McGillicuddy DC. Tick paralysis. 2008 Infect Dis Clin N Am 22:397-413)