Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Tick Attachment Sites

Tick Removal : Picture of a Tick BiteThe first issue of Volume 19 of the journal Wilderness & Environmental Medicine has just been published. It contains some very interesting information, some of which I will share with you in this and another post.

In an article entitled "Tick Attachment Sites," Abdulkadir Gunduz and his colleagues looked at the location of attached ticks in 67 patients who presented to their emergency department with a history of tick bites. They noted that 20% of the ticks were attached to regions of the body that patients could not themselves visualize. Since it is important to remove attached ticks before they become embedded, and as soon as possible to minimize the transfer of infectious agents or toxic (salivary) fluids, this highlights the need for a full body inspection of any person who has recently traveled in endemic (for ticks) country.

In Turkey, there is concern for transmission of fatal cases of Crimean-Congo hemorrhagic fever from the tick genus Hyalomma, while in the U.S., we are more familiar with the genera Amblyoma, Dermacentor, and Ixodes, and the disorders of Lyme disease, Rocky Mountain spotted fever, ehrlichiosis, and tick paralysis.

In this particular study, the most common tick attachment sites were the lower limbs, follwed by the lower abdomen and genital region, then the back (at the level of the chest), and the buttocks. Given that most people would not be able to spot a tick, which may be very tiny if in a juvenile form, in some of these (and other) locations, it is prudent if traveling through tick country to have someone you trust perform a "tick check," or use a mirror if one is available. If a tick appears to be attached and cannot be removed by the human host in its entirely, then he or she should get assistance for its removal.

photo of tick courtesy of

Preview the 25th Anniversary & Annual Meeting of the Wilderness Medical Society, which will be held in Snowmass, Colorado July 25-30, 2008.

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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.