Home' Australian Pharmacist : Australian Pharmacist February 2012 Contents 118 Australian Pharmacist February 2012 I ©Pharmaceutical Society of Australia Ltd.
The articles in this series are independently researched and compiled by PSA commissioned authors and peer reviewed.
COUNSELLING IN PRACTICE
5. Department of Health, Government of South Australia. Public
Health Fact Sheet – Ticks: Prevention and treatment [revised Oct
2008]. At: www.health.sa.gov.au/pehs/PDF-files/ph-factsheet-
6. Australasian Society of Clinical Immunology and Allergy (ASCIA).
Tick allergy [revised Jun 2010]. At: www.allergy.org.au/content/
7. Torres M, Carey V. Review of public health advice about
ticks. New South Wales Public Health Bulletin [online] 2004;
15(12):212–15. At: www.publish.csiro.au/?paper=NB04047
8. Wet Tropics Management Authority and the Queensland
Environmental Protection Agency. Tropical fact sheets:
Common Cryptosphere Arachnids [online]. 2011. At: www.
9. Van Nunen SA, O’Connor KS, Clarke LR, et al. An association
between tick bite reactions and red meat allergy in humans.
MJA [online]. 2009; 190 (9):510–11 . At: www.mja.com.au/public/
10. Commins SP, James HR, Kelly EA, et al. The relevance of tick
bites to the production of IgE antibodies to the mammalian
oligosaccharide galactose-α-1,3-galactose. J Allergy Clin
Immunol [online]. 2011; 127(5):1286–93 .e6. At: www.ncbi.nlm.
11. Dyer J, Einsiedel L, Ferguson P, et al. A new focus of
Rickettsia honei spotted fever in South Australia. MJA
[online]. 2005; 182(5):231–34. At: www.mja.com.au/public/
12. Doggett S, Russell R, Lawrence R, Dickeson D. Lyme
Disease fact sheet [online]. Sydney: Department of Medical
Entomology, University of Sydney and Westmead Hospital;
13. Karl McManus Foundation for Lyme Disease Research &
Awareness website. At: www.karlmcmanusfoundation.org.au/
14. International Lyme and Associated Diseases Society (ILADS).
Lyme Disease Primary Care brochure [online]. 2011. At: www.
15. Harris P, ed. Mosby’s dictionary of medicine, nursing & health
professions. 2nd Australian & New Zealand edn. Sydney :
Elsevier Australia; 2010.
16. Hartley M. Tick bites [revised Jun 2011]. DermNet NZ [online].
2011. At: http://dermnetnz.org/arthropods/tick-bites.html
17. Clinical knowledge summaries. Insect stings and bites.
National Institute for Health and Clinical Excellence [online].
2011. At: www.cks.nhs.uk/insect_bites_and_stings
18. Correspondence from Dr Ken Winkel, Director Australian
Venom Research Unit, University of Melbourne.
19. Clinical Toxinology Resources Website. First aid for Tick
bites (paralysis ticks) [on. Adelaide: Toxinology Department,
Women’s & Children’s Hospital; 2011. At: www.toxinology.com/
20. Poirier MP, Causey AL. Tick Paralysis Syndrome in a 5-Year-Old
Girl. South Med J [online]. 2000; 93(4). At: www.medscape.
21. eTG complete [online]. Australian spotted fevers and scrub
typhus. Melbourne: Therapeutic Guidelines Ltd; 2011.
22. Wormser GP, Dattwyler RJ, Shapiro ED, et al. The Clinical
Assessment, Treatment, and Prevention of Lyme Disease,
Human Granulocytic Anaplasmosis, and Babesiosis: Clinical
Practice Guidelines by the Infectious Diseases Society of
America. Clin Infect Dis [online]. 2006; 43(9):1089–134.
23. Borreliosis and Associated Diseases Awareness UK. Bacterial
Infections: Borreliosis (Lyme disease) [online]. 2011.
24. Patient UK. PatientPlus: Jarisch-Herxheimer Reaction [online].
25. Tick Removal [revised May 2011]. Centers for Disease Control
and Prevention [online]. At: www.cdc.gov/ticks/removing_a_
26. Celenza A, Rogers IR. The “Knot Method” of Tick Removal.
Wilderness Environ Med [online]. 2002; 13(2):179–80 . At: www.
27. Envenomation – tick bite. Australian Resuscitation Council.
Guideline 9.4 .4 [online]. February 2007. At: www.resus.org.au/
1. From a public health perspective,
the most important tick species in
Australia is the ‘paralysis tick’, Ixodes
holocyclus. Which of the following
statements regarding I. holocyclus
a) Only larval and adult paralysis ticks
require a blood meal from a host, not
b) Paralysis ticks can tolerate a wide
range of weather conditions, including
dryness and extremes of temperature.
c) I. holocyclus occurs in a 30–100 km
wide coastal band extending from Far
North Queensland to Victoria.
d) Once it has found a host, the paralysis
tick secretes a cement-like substance
to fasten itself to the host.
2. What is the cause of tick paralysis?
a) Injection of Borrelia spirochaetes in the
saliva of I. holocyclus ticks.
b) Injection of neurotoxins in the saliva of
I. holocyclus ticks.
c) An allergic reaction to proteins injected
in the saliva of I. holocyclus ticks.
d) Injection of Rickettsia australis in the
saliva of I. holocyclus ticks.
3. Which of the following are MOST
LIKELY to be early symptoms of tick
a) The appearance of a characteristic
erythema migrans rash accompanied by
fever, fatigue, headaches and myalgia.
b) Weakness, difficulty walking, lethargy
c) The appearance of an eschar with a
black necrotic centre accompanied by
fever, stiff neck, nausea and vomiting.
d) Localised erythema, itching and
swelling at the site of the tick bite.
4. Which of the following would be the
MOST APPROPRIATE way to remove
a) Dab the tick with methylated spirits,
wait for five minutes, and then pull it
out with fine-tipped tweezers.
b) Apply Lyclear cream to the tick and
then leave it until it drops off naturally.
c) Soak for 30 minutes in a bath
containing sodium bicarbonate, and
then scrape the tick off.
d) Use fine-tipped tweezers to grasp the
tick as close to the skin as possible and
pull upward steadily and evenly until it
5. Which of the following is an
APPROPRIATE strategy for
preventing tick bites?
a) Before visiting a known tick area, apply
an insect repellent containing DEET or
picaridin to clothing and skin.
b) When visiting a known tick area, wear
shorts and a short-sleeved shirt, so
that any ticks crawling on the arms and
legs can be seen and removed.
c) When visiting a known tick area, wear
dark-coloured clothes, as ticks are
attracted to light-coloured clothing.
d) On returning from a known tick area,
ticks found on clothing can be killed
by hanging the clothes out in the sun
for half an hour.
6. What is the current recommended
treatment for tick paralysis?
b) Tick antitoxin.
c) Supportive management and tick
d) Doxycycline or azithromycin.
7. Patients being treated for Lyme
disease may experience the Jarisch-
Herxheimer reaction, which is:
a) An allergic reaction to cefuroxime axetil.
b) Characterised by nausea, vomiting
c) Caused by the release of toxins by large
number of larval I. holocyclus ticks.
d) Caused by the release of toxins by
large numbers of Borrelia spirochaetes.
8. Queensland tick typhus:
a) Is also known as Flinders Island
b) Is a tick-borne infection caused by
c) Often results in the development of an
eschar with a black necrotic centre and
red areola at the site of the bite.
d) Is treated with IV vancomycin.
A score of 7 out of 8 attracts 1.5 CPD credit.
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