These Are the Tick Bite Symptoms You Need to Know, According to Experts
The telltale bulls-eye rash is one indicator—but it's not the only sign.
When you find a tick crawling through your hair or stuck to your skin, two thoughts probably pop into your mind mind immediately: How do I get this thing off of me? And: Should I be freaking out right now?
Good news: The majority of tick bites are painless or only cause a little redness, itching, and swelling. They can be treated at home by removing the tick and cleaning the area.
However, with increasing rates of tick-borne diseases, per the Centers for Disease Control and Prevention, it's understandable to feel concerned about a close call. Generally, it takes a tick at least three days to transmit Lyme disease, though some other infections can be passed on within a few hours or minutes, according to the Mayo Clinic.
If you plan to spend lots of time in your backyard or hiking this spring and summer, it helps to be able to differentiate between mild and serious symptoms of a tick bite—and how to avoid these creepy crawlers in the first place. Here's what you need to know.
What are ticks and where do they usually bite you?
Ticks are tiny, blood-sucking parasites, according to the US National Library of Medicine's MedlinePlus resource. That means they latch onto animals and humans to feast on their blood. Some ticks are so small that they can be difficult to see with the naked eye—but ticks can grow in size after a feast.
Although ticks can be found nearly everywhere in the US, they're especially abundant in ecotones, or transitional areas from one dominant type of vegetation to another, David Claborn, DPH, an expert in vector-borne diseases and director of the Master of Public Health program at Missouri State University, tells Health. The space between heavily-wooded areas and open meadows or your yard as well as wild game trails, for example, are major hot spots for ticks, per the CDC.
Because they're attracted to warm, moist locations, ticks often crawl from piles of leaves or thick brush onto your body and then gravitate toward toasty spots like your armpits, groin, or hair, says MedlinePlus. Once they've settled in, they hunker down to draw blood for several minutes to a few days.
What are the symptoms of a tick bite?
One important thing to remember: Not all ticks carry disease—but you should still find and remove any ticks on your body after being outside just in case.
When a "normal" (read: not disease-carrying) tick bites you, it injects a small amount of a chemical to thin your blood to make it easier for the tick to ingest. That chemical may cause a mild allergic skin reaction. According to a review by the Brazilian Society of Dermatology, those immediate reactions can include:
- A small red spot at the bite site
- Minor swelling
Usually, these are nothing to worry about, and there's no need to contact a healthcare provider if you're not having any other symptoms, Luis A. Marcos, MD, MPH, associate professor of clinical medicine in the division of infectious diseases in the Renaissance School of Medicine at Stony Brook University, tells Health.
That said, you should be on the lookout for symptoms that crop up after a tick bite—the CDC recommends watching and waiting for 30 days to see if you develop any additional symptoms that could signal a tick-borne disease. The main symptom of a possible infection is a fever, says Dr. Marcos. Generally speaking, symptoms of a tick-borne disease can include:
- A fever of 101 degrees Fahrenheit (38.3 degrees Celsius) or higher
- A skin reaction or rash that's over a centimeter in size
- A red, pink, or salmon-colored halo-shaped or bulls-eye rash surrounding the bite site
- Flu-like symptoms such as chills, sweats, headache, muscle aches, fatigue, joint pain or swollen lymph nodes
- Signs of infection like oozing or red streaks from the bite site
Any of those symptoms following a suspected tick bite are a cue to seek medical attention, Aaron Hartman, MD, a family medicine physician based in Virginia, tells Health.
Outside of a local reaction or later symptoms of a tick-borne disease, you should also see a doctor immediately if you show any signs of a severe allergic reaction from a tick bite (aka anaphylaxis) or tick paralysis, which is extremely rare, per the CDC. Those symptoms can include:
- Chest pain
- Wheezing or trouble breathing
- Heart palpitations
- Nausea or vomiting
- Paralysis or the inability to move different parts of your body
- A severe headache
What are the symptoms of specific tick-borne diseases to look out for?
Though there are some more general symptoms of tick-borne illnesses to watch for after a bite or suspected bite, they can also vary depending on the specific vector- or tick-borne disease you may be dealing with.
"Lyme disease is the most common vector-borne disease in the United States, with over 30,000 cases each year," says Dr. Marcos. The most high-risk areas for Lyme disease are in the northeast and upper Midwest, per the CDC.
In up to 80% of cases, a characteristic bulls-eye rash can appears up to 30 days after a tick bite, usually within about a week, the CDC says. It's generally not itchy or painful, but it may be warm to the touch and expand over a period of several days.
Other initial signs of Lyme disease include:
- Fever and chills
- Muscle and joint aches
- Swollen lymph nodes
When treated early with the appropriate antibiotics, the CDC says people with Lyme disease usually recover "rapidly and completely." Early treatment can also help prevent late Lyme disease. Other more serious versions of Lyme disease—like neurologic Lyme disease, Lyme carditis, or Lyme arthritis, may require more longer courses of treatment.
Rocky Mountain spotted fever
Rocky Mountain spotted fever (RMSF) is relatively rare, says Dr. Marcos. While it's been on the rise over the past two decades, there were fewer than 6,000 cases in the U.S. in 2018, per the CDC. People have caught RMSF throughout the contiguous US, but five states account for over half of all cases: Arkansas, Missouri, North Carolina, Tennessee, and Virginia.
"When you have it, you're not just walking in the streets—you're sick with a high fever, and it hits you fast," says Dr. Marcos. Initial symptoms are similar to those of Lyme disease: a fever, headache, nausea and vomiting, muscle pain. Within two to four days of developing a fever, most people also have a rash which can vary in appearance from splotchy red to a flush of tiny red dots.
RMSF can rapidly develop into a life-threatening illness or causes permanent disability such as the loss of arms, fingers, or toes due to damage to blood vessels, per the CDC. So if you fall ill after spending time in tick country, contact a healthcare provider as soon as possible.
Colorado tick fever
If you feel like you're coming down with something one day to two weeks after a hiking trip out west, it's possible you could have Colorado tick fever (CTF), says Dr. Marcos. The virus is primarily found in Colorado, Utah, Montana, and Wyoming.
Common symptoms include a fever, chills, headache, muscle aches, and generalized discomfort, the CDC says. While you may have lingering fatigue or weakness for several weeks, the illness tends to be mild, resolving on its own.
Tularemia, a very rare infectious disease, can be transmitted by ticks throughout the US. Initial symptoms include a fever which can be as high as 104 degrees Fahrenheit as well as a skin ulcer (open sore or wound) at the site of the bite which may be very painful, says Dr. Marcos.
Cases of tularemia range from mild to life-threatening, but most can be treated with antibiotics, according to the CDC.
Ehrlichiosis is carried by the lone star tick, and cases tend to occur in the southeastern and south-central parts of the US, spanning from the east coast to Texas.
According to the CDC, initial signs of infection include fever, chills, headache, fatigue, muscle aches, nausea, vomiting, and diarrhea, and, more commonly in children, a splotchy or pinpoint-like rash (though symptoms can vary widely).
If you're very young, old, or have a weakened immune system, you could be at higher risk of developing severe illness, notes Dr. Marcos. However, when caught early, ehrlichiosis can be treated with antibiotics.
How are tick bites treated and prevented?
The best game plan to prevent tick-borne diseases is to avoid ticks in the first place. Here's how the CDC recommends doing that:
- Stay on the beaten path. Avoid wandering off trails or into tall grasses, and keep your grass well-trimmed in your yard.
- Cover up. Wear long sleeves and pants, and tuck pant legs or leggings into long socks.
- Use a strong tick repellent. Regularly apply and reapply tick sprays registered by the Environmental Protection Agency (EPA) that contain DEET, picaridin, IR3535, oil of lemon eucalyptus (OLE), para-menthane-diol (PMD), or 2-undecanone.
- Tick-proof your gear. Keep ticks off your clothes, boots, tent, blankets and more with a specially-formulated 0.5% permethrin spray (which naturally irritates on contact) such as Sawyer Products Permethrin Premium Clothing Insect Repellent. Or buy pre-treated threads from a company like Insect Shield.
- Do a full-body check. To ensure you're tick-free, scan under your arms and knees, in and around your ears and hair, between your legs, and everywhere else. Don't forget to check pets, too.
- Wash them off. After spending time in tick territory, take a shower as soon as you can and throw your clothes in the laundry on high heat to zap any crawlers.
If you do happen to find a tick on you, the best way to remove it is to use a small pair of tweezers or a tick key to gently grasp onto the head and pull it away from your body, says Dr. Hartman. Then, thoroughly clean the area with soap and water or an antiseptic like rubbing alcohol.
If you become sick after being bitten, your doctor can determine the best treatment plan depending on the cause and severity of your illness.
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