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Tick Paralysis - April 25 1996 I Vol 45 No 16 MORBIoIIrAND...

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Unformatted text preview: April. 25, 1996 I Vol. 45/ No. 16 MORBIoIIrAND MORTALITY a: assists-nets? “’95 " ‘ ' 1.- ., Un‘ted States and Worldwide, i WEEKggEPORT ' 1995-96 Season, and Composition "-9?" of the 1996—97 influenza Vaccine $.35; a. . v y; 330 Multidrug-Resistant Tuberculosis ' ’ ”w“ augraaléon anglgv Ward — d a ri , pain. 1—1995. ’""*°g,°“dm.,,d':,”§“'n$, fizmmg",”m'i’o¥°dm'gfiggdw 333 Adult Blood Lead Epidemiology and Surveillance — United States, Fourth Quarter. 1995 335 Notice to Readers Tick Paralysis 4- Washington, 1995 Trek paralysis {tick toxicosisl—one of the eight most common tickborne diseases in the United States (1 l—is an'acute, ascending, flaccid motor paralysis that can be con- ' fused with Guillain-Barré syndrome, botulism, and" myasthenia gravis. This report ' summarizes the results of the investigation of a case of tick paralysis in Washington. On April. 10, 1995, a 2-year-old girl Who resided in Asotin County, Washington, was taken to the emergency department of a regional hospital because of a 2~day history of unsteady gait, difficulty standing, and reluctance to walk. Other than a recent his— tory of 'cough, she had been healthy and had'not been‘injured. On physical examina- tion, she was afebril'e, alert, and aetive but 'could stand only briefly before requiring assistance. Cranial nerve fu nction was intact. However, she exhibited marked extrem- ity and mild truncal ataxia, and deep tendon reflexes were absent. She was admitted with a tentative diagnosis of either Guillain-Barré syndrome or postinfectious polyradiculopathy. Within several hours of heapitalization, she had onset of drooling and .Mpnea. A , nurse incidentally detected an engorged tick on the girl's'hairline byan ear and re- moved the tick. Within 7 hours after tick removal, tachypnea subsided and reflexes 'were present but diminished. The patient recovered fully and was discharged on April -11. The tick species was not identified. Reported by:.E Haas, D Anderson, R Neu, Asotin County Health Dept, Clarkston, Washington. N Berkheiser, MD, Saint Joseph Regional Medical Center, Lewiston, Idaho. J Grendon, DVM, P Shoemaker, J Kobayashi, MD, P Stehr—Green, DrPH, State Epidemiologist, Washington State Dept of Health. Div of Field Epidemiology, Epidemiology Program Office, CDC. Editorial Note: Tick pa raiysis occurs worldwide and is caused by the introduction of a neUrotoxinelaborated into humans during attachment of and feeding by the female of several tick species-in Nonh America, tick paralysis occurs most commonly in the Rocky Mountain and northwestern regions of the United States and in western Can— ada. Most cases have been reported among girls aged <10 years during April—June, when nymphs and mature wood ticks are most prevalent (2 ). Although tick paralysis is a reportable disease in Washington, surveillance is passive, and only 10 cases were reported during 1987—1995. " ‘ _ f " , , - - in the United States, this disease is associated with Dermacentor an‘dersoni (Rocky Mountain wood tick), D. variabilis (American dog tick), Amblyomma americanum _ (Lone Star tick), A. maculatum, lxodes scapularis (black—legged tick}, and l. pacificus - "I’W‘KI’I' .. n 'IFTYV'w'Ier causal-vs. ,uF—amfim . tm‘mlfl‘waj ..._.r..__........-..,,....m......_.m..w4;, . 326 Tick Paralysis —- Continued sent with symmetrical paralysis. References 1. Spach DH. Liles WC, Campbelt GL. Quick RE, Anderson DE, Fritsche TR. Tick-borne diseases _ in the United States. N Engl J Med 1993;329:935-47. 2. CDC. Tick paralysis—Wisconsin. MMWR 1981;30:217-8. 3. CDC. Tick paralysis—Georgia. MMWR 197726311. 4. Goths R, Kunze K, Hoogstraal H. The mechanisms of pathogenicity in the tick paralyses. J Med Entomol 1979;16:357-653. ' 5. Kocan AA. Tick paralysis. J Am Vet Med Assoc 1988;192:1498-500. 6. Schmitt N, Bowmer EJ, Gregson JD. Tick paralysis in British Columbia. Can Med Assoc -: J 1969;100:417—21. 7. Needharn GR. Evaiuation of five popular methods for tick removal. Pediatrics 1985;75:997- ti 1002. Update: Influenza Activity -— United States and Worldwide, 1995-96 Season, and Composition of the 1996-97 Influenza Vaccine To monitor influenza activit strains of influenza viruses, CDC conducts surveillance in collaboration with the World Health Organization (WHO) and its international network of collaborating laboratories and with state and local health departments in the United States. This report surntnaé rizes surveillance for influenza in the United States and worldwide during the 1995—96 season and describes the composition of the 1996—97 influema Varmint: . ..._ «mm—u...“- .1. mt may..._~........._.,..._.-..... ........._.-~..n I ‘ . ...
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