Symptoms of a Tick Bite

Tick bite signs and symptoms include red, inflamed skin with a dark dot in the center. The dot is the live tick; it remains attached until it is removed or it falls off naturally after three to six days. Ticks can attach anywhere on your body, but they favor hard-to-see places such as the groin, armpits, and scalp.

It is not always possible to avoid a tick bite, especially during the warmer months when you are outside. Even with a thorough inspection of your clothes, skin, and hair, it can be difficult to spot a tick before it bites because even adult ticks may be only the size of a poppyseed.

This article discusses the symptoms and complications of a tick bite, and when you should see a healthcare provider.

Frequent Symptoms of Tick Bites

The first symptoms of a tick bite include redness and inflammation at the bite site. If the tick is still attached, it will appear as a dark, hard spot in the center of the bite. The bites don't usually hurt, but they may feel itchy.

After the tick has been removed, watch for symptoms that indicate disease. The first sign typically is a rash.

Rash

Types of tick bite-related rashes include:

• Erythema migrans (EM) or Lyme disease rash: The EM rash develops in about 70% to 80% of cases. It is usually not painful or itchy. The rash will appear between three to 30 days after the bite and may gradually expand to 12 inches (30 centimeters) or more. It looks like a bull's-eye in most cases.
• Southern tick–associated rash illness (STARI): This rash is nearly identical to the EM rash, but it is caused by the lone star tick.
• Rocky Mountain spotted fever (RMSF) rash: Around 10% to 15% of people infected will not have a rash. Most others will develop a rash after a fever. The rash usually is small, flat, pink, and not itchy on areas like your wrists, forearms, and ankles. It can later present as tiny red or purple spots.
• Tularemia: Rather than a proper rash, you may see an ulcer forming at the bite site. You may also experience swelling of nearby lymph nodes.
• Ehrlichiosis: This rash can take many shapes and vary widely in appearance. It occurs in 30% of adult patients and 60% of children who are bitten by an infected tick.  

Other Symptoms

Symptoms that can occur in the absence of or in addition to a rash after a tick bite include:

• Fever and chills
• Headache
• Muscle and joint aches
• Swollen lymph nodes
• Full body rash
• Fatigue

Rare Symptoms of Tick Bites

A tick bite, in rare cases, can lead to tick paralysis. This type of paralysis is believed to be caused by a toxin in tick saliva. The good news is that the symptoms are temporary. After removing the tick, the symptoms should subside.

Rare symptoms may begin between four and seven days after tick attachment and can include:

• General feelings of sickness 
• Weakness
• Progressive neurological deficits, such as coordination issues, swallowing difficulties, and slurred speech
• Acute, ascending flaccid paralysis (rapid onset of weakness or paralysis and reduced muscle tone)

Symptoms that don’t resolve could be a sign that something else, such as a neurological condition, is causing your symptoms. Examples include Guillain-Barré syndrome (a rare autoimmune disorder that attacks the nerves) and botulism (acute food poisoning that can cause muscle weakness and paralysis).

Complications of Tick Bites

Complications from a tick bite depend on which pathogen the tick is carrying and whether you are infected after exposure.

Health complications can include:

• Spotted fevers ranging from mild to life-threatening: Unless it is RMSF, you will notice a dark scab at the tick bite site along with the typical symptoms. Examples include the newly found 364D rickettsiosis.
• Anaplasmosis: Along with typical symptoms, you can expect nausea, vomiting, diarrhea, and loss of appetite.
• Tick-borne relapsing fever: Found in 15 states, this condition has recurring symptoms that follow a predictable pattern of fever for three days, then seven days of being fever-free, then another three days with fever, and so on until antibiotic treatment is started.
• Babesiosis: Similar to malaria, this disease affects red blood cells. Symptoms include high fever, chills, and dark urine.

When to See a Healthcare Provider

If you have a tick bite, take a picture of the area as soon as possible so you have a baseline to which you can compare changes. 

You should also call your healthcare provider if:

• You think the tick has been attached to you for several hours or even a day.
• Part of the tick remains under your skin.
• You see a rash developing around the bite area, especially a bull's-eye rash.
• You see a rash on other areas of your body.
• You begin to develop flu-like symptoms after a tick bite, including fever, headache, fatigue, stiff neck or back, or achy muscles or joints.
• The bite area looks red, feels warm to the touch, is painful, starts spreading, or begins oozing pus.
• Symptoms persist despite treatment.

Summary

There are many types of tick-borne illnesses, but the symptoms of a tick bite are very similar. Many people do not develop symptoms after they're bitten by a tick. However, if you have symptoms and live in a tick-prone area, it's best to call your healthcare provider to get an evaluation.