Tick paralysis induced by Ixodes gibbosus: enigmatic cases in domestic mammals from Cyprus.

Tick paralysis is a potentially fatal condition caused by toxins produced and secreted by tick salivary glands. This survey presents clinical and epidemiological observations of tick paralysis cases in domestic animals in Cyprus. Local veterinarians report typical tick paralysis cases occurring in goats, sheep, dogs, and cats. The animals suffering from paralysis are free from other neurological diseases, have blood and biochemical parameters within normal ranges, and recover fast by simply removing the ticks found predominantly on the head and around the neck. Tick paralysis cases occur in a specific geographic area of Cyprus (Akamas peninsula), from September through March, but not every year. Instead, the phenomenon has 2 periodic cycles of occurrence, a 3- and a 7-year cycle. The 2 cycles are differentiated by severity based on the number of affected animals and the resulting losses. As described for other tick-borne diseases, these cyclic patterns may be attributed to external factors, self-oscillations of the disease system, or the combined action of these mechanisms. Ticks collected from a recent paralysis case in a goat were morphologically and molecularly identified as Ixodes gibbosus. Efforts should be made to characterize the specific toxins involved in tick paralysis and to develop a vaccine, which could prevent significant losses of small ruminants, especially in free-ranging farming systems, a prevalent management approach observed in Cyprus and various regions worldwide.

Ophthalmic findings associated with Australian tick paralysis (holocyclotoxicity) in hospitalized domestic dogs and cats.

OBJECTIVE: To describe ophthalmic findings in hospitalized canine and feline patients with tick paralysis (TP) and investigate possible predisposing factors. ANIMALS STUDIED: Forty-seven dogs and 28 cats hospitalized with TP assessed with an ophthalmic examination performed by an ABVO resident. METHODS: Dogs and cats were hospitalized with TP from October 2021 to January 2022 and had an ophthalmic examination performed by an ABVO resident. Patient signalment data, information regarding tick number and location, hospitalization duration, medications used, and patient paralysis grades were recorded. Statistical analysis was performed to correlate findings. RESULTS: Corneal ulcers developed in up to 34.8% of dogs and up to 42.9% of cats hospitalized with TP. An absent palpebral reflex ipsilaterally increased the odds of a concurrent corneal ulcer being present by 14.7× in dogs and 20.1× in cats (p < .0001). Palpebral reflexes were absent in 38.3% of dogs and 35.7% of cats hospitalized with TP and were correlated with more severe gait paralysis (p = .01) and respiratory paralysis (p = .005) in dogs, and respiratory paralysis in cats (p = .041). STT-1 findings <10 mm/min were present in 27.7% of dogs and 57.1% of cats examined and were associated with increasing gait paralysis (p = .017) and respiratory paralysis (p = .007) in dogs, and increasing gait paralysis in cats (p = .017). CONCLUSIONS: Simple corneal ulcers, loss of a complete palpebral reflex, and reduced STT-1 scores frequently occurred in dogs and cats hospitalized for TP. The frequency of these findings increased as the degree of patient paralysis increased.

Prospective Study of 506 Dogs with Tick Paralysis: Investigating Measures of Severity and Clinical Signs as Predictors of Mortality and Assessing the Benefits of Different Therapeutics.

Survey data from 42 Australian eastern seaboard veterinary practices involving 506 cases are reported with regard to clinical signs, disease severity, mortality, use of pharmaceuticals, and recovery times. New measures of disease severity (visual analogue scales (VAS) and facial expressions) were tested alongside "gold standard" measures (neuromuscular junction (NMJ) scores). Univariable and multivariable logistic regression analyses were conducted to evaluate associations between variables. The VAS scores were progressive, prognostic (especially the respiratory scores) and correlated with the NMJ scores. The presence of inspiratory dyspnoea and crackles on the day of hospitalisation, progressing to expiratory dyspnoea and an expiratory wheeze 24 h later, were highly predictive of mortality. Altered facial features on hospital admission were also highly predictive of mortality. The previously used respiratory score (using various clinical signs) was not predictive of mortality. Older animals had a higher mortality rate, and no gender or breed susceptibility was found. The only pharmaceuticals that were positively associated with mortality were tick antiserum and, in severe cases, antibiotics. The use of many pharmaceutical products (acepromazine, atropine, steroids, antihistamines, antiemetics, diuretics, and S8 anti-anxiety and sedation drugs) had no effect on mortality. More drug classes were used with increasing clinical severity and specific factors (e.g., vomiting/retching, hydration) affected the period of hospitalisation. Geographic variation in respiratory signs and toxicity scores was evident, whereas mortality and disease severity were not different across regions.

Tick Paralysis: A Thorough Examination May Prevent Unnecessary Harm.

Tick paralysis is a relatively uncommon tick-borne illness that is often overlooked and misdiagnosed. Therefore, it is not unusual for cases to undergo unnecessary work-up and interventions that may delay correct diagnosis and treatment, placing the patient at risk for catastrophic consequences. We present the case of a four-year-old female who developed ascending flaccid paralysis, initially misdiagnosed with Guillain-Barré syndrome (GBS). She was placed in the pediatric intensive care unit (PICU) for mechanical ventilation after failing to respond to intravenous immunoglobulin (IVIG) administration and plasmapheresis. Later in her hospital course, she was correctly diagnosed to have tick paralysis.

Static anisocoria in cats and dogs with naturally occurring tick paralysis (Ixodes holocyclus).

OBJECTIVE: To characterise the novel occurrence and neuro-ophthalmological features of static anisocoria in cats and dogs with tick paralysis (TP) (Ixodes holocyclus) due to a single tick located remote from the head and neck. DESIGN: Observational case series with retrospective analysis. METHODS: Medical records were reviewed from 69 cats and 169 dogs treated for TP from a suburban veterinary hospital in Newcastle, New South Whales, between September 2005 and October 2021. RESULTS: Anisocoria was observed in 2/18 (11.1%) cats and 3/30 (10.0%) dogs with a single tick located remote from the head and neck. These proportions were not different when compared within species to 4 of 28 (14.3%) cats and 16 of 98 (16.3%) dogs with aniscocoria with a single tick located on the head and neck region (P = 1 and 0.56 respectively). Anisocoria arose from pupillary efferent dysfunction and included unilateral oculoparasympathetic dysfunction (internal ophthalmoplegia) in one dog, unilateral oculosympathetic dysfunction (Horner's syndrome) in one cat and one dog, and a combination of bilateral, but asymmetric, oculosympathetic and oculoparasympathetic dysfunction in one cat and one dog. CONCLUSION: It is proposed that anisocoria in cases of TP with a tick located remote from the head and neck is due to an intrinsic latent asymmetry in the safety factor for pupillary efferent function that is unmasked by a systemically distributed holocyclotoxin inhibiting neural transmission within this system, and this is the prevailing pathomechanism, rather than a direct local effect, underscoring anisocoria with a tick located on the head or neck.

Reduced incidence of tick paralysis cases in dogs and cats at two emergency clinics in South-East Queensland since 2015: new generation prophylactics as possible explanatory variables.

INTRODUCTION: This study aimed to determine the incidence of canine and feline tick paralysis cases presenting to two veterinary emergency hospitals before and after the introduction of new generation prophylactic acaricides. METHODS: This was a retrospective study, investigating the number of tick paralysis cases presenting to two emergency and critical care veterinary hospitals in South-East Queensland, from 2008 to 2021. A total of 10,914 dogs and 3696 cats were included over the course of the study. To assess if the introduction of new generation prophylactics in 2015 has coincided with any variation in case numbers, data for each species were analysed graphically and numerically in the first instance, then interrupted time series analyses were performed for the dog and cat data independently. RESULTS: Accounting for seasonal and climatic variation, we estimated a 54.8% reduction in dog (95% CI 45.3%-62.7%) and 44% reduction in cat (95% CI 19.5%-46%) tick paralysis cases presenting to these two clinics. This reduction corresponded with the timing of new generation prophylactic agents being introduced, including isoxazolines and imidacloprid/flumethrin impregnated collars. CONCLUSION: In the population studied, a significant reduction in the incidence of tick paralysis cases treated by veterinarians has occurred from 2015 onwards and was found to be associated with the timing of the release of new generation acaricidal products.

Neuroimaging in Tick Paralysis: Looking Outside the Box.

Tick paralysis is a rare but potentially deadly form of muscle paralysis caused by a neurotoxin transmitted through the saliva of gravid, engorged female ticks of various species. Often, there is an initial misdiagnosis or delay in diagnosis due to the rarity of the diagnosis, the obscure location of the tick, and the disease's clinical similarity to Guillain-Barre syndrome. We report the case of a 4-year-old girl with tick paralysis in whom the tick was not found until 2 days after hospital admission. Upon the review of the imaging, it was discovered that the tick was visible on the MRI of the brain that had been reported as normal.

Pulmonary Histopathology in Cats and Dogs with Fatal Tick Paralysis.

The objective of this study was to evaluate critically the nature and prevalence of histological pulmonary lesions in dogs and cats that had died or were euthanized because of tick paralysis. A retrospective and prospective case study of 11 cats and 23 dogs was carried out. Retrospective cases were gathered from the Veterinary Laboratory Services database at The University of Queensland (UQ). Prospective cases were provided by Veterinary Specialist Services and UQ VETs Small Animal Hospital. Lung and other tissue samples were collected for histopathological analysis. All tick intoxicated animals demonstrated evidence of pulmonary parenchymal changes: alveolar oedema, interstitial and alveolar congestion and alveolar fibrin exudation. Eleven of 23 (48%) dogs exhibited mild to severe bronchopneumonia. A lower rate (18%) of bronchopneumonia was found in cats, with one case of aspiration pneumonia. A novel pulmonary histological grading scheme was developed to evaluate the correlation between clinical presentation and histopathological changes. Novel extrapulmonary lesions in cats included hepatic necrosis and acute renal tubular necrosis attributed to hypoxia. We concluded that both dogs and cats with high clinical grade tick paralysis are extremely likely to have pulmonary pathology. High-protein oedema and fibrin exudation are predicted to be present in most cases of canine and feline tick paralysis.

Safety and efficacy of a purified canine immunoglobulin G formulation for treatment of 76 cats clinically affected by the Australian paralysis tick (Ixodes holocyclus).

Acute adverse reactions in cats administered unrefined canine paralysis tick (Ixodes holocyclus) antiserum are commonly observed by veterinarians and can lead to significant morbidity and potentially fatal. A purified antiserum canine IgG concentrate was chromatographically prepared and aseptically formulated in single doses containing the equivalent of 5 mL of unrefined tick antiserum (TAS). The IgG was used for slow intravenous infusion into clinically affected cats at multiple veterinary clinics on the eastern seaboard of Australia. Overall, 72/76 (95%) of cats survived hospital discharge, an efficacy comparable to published data. A subset of 22 cats previously treated with unrefined TAS and considered high risk were included in the dataset. The safety profile was excellent with 0/76 acute adverse reactions although 2/76 (2.6%) developed mild facial swelling within 2 h of infusion that responded to the antihistamine. In conclusion, cats intravenously infused with purified IgG from canine TAS did not exhibit the expected frequency of acute adverse reactions during infusion and it was both safe and effective for the treatment of tick paralysis in cats.

Elective cricothyrotomy in a dog with transient laryngeal paralysis secondary to Australian paralysis tick (Ixodes holocyclus) envenomation.

The tube cricothyrotomy (CTT) has recently been introduced to small animal medicine as a viable surgical airway access procedure; however, there are no reports documenting its clinical use. The author's objective is to describe the clinical application, complications, and management of an elective CTT in a dog. Furthermore, the characteristics of CTT that may be clinically advantageous over temporary tube tracheostomy (TT) will be discussed. A 2-year-old female spayed German shepherd dog required mechanical ventilation (MV) due to unsustainable work of breathing as a result of tick paralysis and aspiration pneumonia. After successful weaning from MV, the dog was diagnosed with laryngeal paralysis. A surgical airway was performed using CTT to allow extubation and patient management whilst conscious. Complications included frequent tube suctioning due to accumulation of airway secretions in the tube and a single dislodgement event. The dog made an uneventful recovery with complete stoma healing by the second intention within 15 days. To the authors' knowledge, this is the first clinical report of an elective CTT performed to successfully manage upper airway obstruction in the dog. Its efficacy, clinical management and patient outcome are described.

Harm or protection? The adaptive function of tick toxins.

The existence of tick toxins is an old enigma that has intrigued scientists for a long time. The adaptive value of using deadly toxins for predatory animals is obvious: they try to kill the prey in the most effective way or protect themselves from their natural enemies. Ticks, however, are blood-sucking parasites, and it seems paradoxical that they have toxins similar to spiders, scorpions and snakes. Based on published data, here we examine the potential adaptive function of different types of toxins produced by soft and hard ticks. We hypothesize that there are diverse evolutionary roles behind (a) to attack and reduce the tick-transmitted pathogens inside the vertebrate host systemically to protect the tick, (b) to paralyse the host to stop grooming, (c) to speed up host heartbeat to improve blood supply and (d) to inhibit the process of necroptosis to prevent the rejection of hard ticks. We will provide published evidence that supports the above-mentioned hypotheses, and we will give an outlook how these new scientific results might be applied in modern pharmacology and medicine.

Apparent Ixodes tick paralysis in a cat from North America.

CASE SUMMARY: A 2-year-old castrated male domestic longhair cat presented for acute, diffuse, flaccid paralysis. Thoracic and abdominal radiographs, biochemistry panel and complete blood count were unremarkable. Titers to Toxoplasma gondii, myasthenia gravis radioimmunoassay testing and creatinine kinase levels were within normal limits. The most likely differentials included acute toxicity (coral snake envenomation, organophosphate toxicity), botulism and, less likely, acute polyradiculoneuritis. A thorough physical examination revealed a single engorged tick attached to the ventral neck of the cat, which was later identified as an adult female Ixodes species. Topical fipronil and (S)-methoprene was administered. Over the next 48 h, the cat recovered full motor function and at 5 days post-tick removal the cat had resumed all normal activities. RELEVANCE AND NOVEL INFORMATION: Tick paralysis is considered endemic in Australia by bites from, most commonly, the Ixodes holocyclus tick. However, this phenomenon is rarely reported in the USA. This is the first report of a domestic cat suffering from acute tick paralysis in North America.

A Rare Fatal Cause of Acute Areflexic Quadriparesis in the Tropics.

BACKGROUND: Crimean-Congo hemorrhagic fever is a sporadic zoonotic viral illness recently becoming endemic in regions in the western parts of India. It usually presents as a viral hemorrhagic fever with severe liver and kidney failure. CASE REPORT: An 18-year-old male from the western part of Rajasthan presented with rapidly progressing areflexic weakness of limbs a week after brief fever. He deteriorated rapidly with drowsiness, fulminant liver failure, and acute kidney injury with high creatine kinase. He also developed thrombocytopenia and hemorrhage from various sites. Workup for viral hemorrhagic fever revealed IgM positivity for Crimean-Congo hemorrhagic fever. The patient kept worsening and died of multiorgan failure and diffuse alveolar bleeding after 14 days. CONCLUSIONS: This report highlights the need to expand the differential diagnoses in the commonly encountered presentation of acute quadriparesis to include the possibility of tick-borne diseases like Crimean-Congo hemorrhagic fever in the setting of bleeding diathesis and acute hepatorenal syndrome.

Tick paralysis in dogs and cats in Australia: treatment and prevention deliverables from 100 years of research.

This review of tick paralysis caused by Ixodes holocyclus in Australia addresses the question: What are the key discoveries that have enabled effective treatment and prevention of tick paralysis in dogs and cats? Critical examination of 100 years of literature reveals that arguably only three achievements have advanced treatment and prevention of tick paralysis in animals. First, the most significant treatment advance was the commercial availability of tick antiserum in the 1930s. Hyperimmune serum currently remains the only specific anti-paralysis tick therapy available to veterinarians in Australia. Second, advances in veterinary critical care have increased survival rates of the most severely affected dogs and cats. Critical care advancements have been enabled through specialised veterinary hospitals that can provide appropriate care 24 h a day, and advanced training of veterinarians, veterinary nurses and technicians. Third, perhaps that biggest advance of all in the last 100 years of research has been the commercial availability of the isooxazoline class of acaricidal preventatives in Australia specifically for I. holocyclus. This highly effective class of preventatives offers long duration of action, low cost, spot-on or oral formulations and a low rate of adverse reactions. Animal owners and veterinarians now have the most useful tool of all - a reliable preventative. This review reveals the key events in research over the last 100 years and the tortuous pathway to delivering better treatment and preventative options for this enigmatic Australian parasite.

ARGAS (PERSICARGAS) GIGANTEUS SOFT TICK INFECTION WITH RICKETTSIA HOOGSTRAALI AND RELAPSING FEVER BORRELIA ON WILD AVIAN SPECIES OF THE DESERT SOUTHWEST, USA.

Changing climatic conditions and the northward expansion of ticks and pathogens are of immense importance to human, animal, and environmental health assessment and risk management. From 2014 through 2015, a wildlife rehabilitation center in south-central Arizona, US noted soft ticks (Argasidae) infesting 23 birds, including Cooper's Hawks (Accipiter cooperii), Gray Hawks (Buteo plagiatus), Harris's Hawks (Parabuteo unicinctus), Red-tailed Hawks (Buteo jamaicensis), Great Horned Owls (Bubo virginianus), Common Ravens (Corvus corax), and a Greater Roadrunner (Geococcyx californianus), during the late summer seasonal rainy seasons. The parasites numbered in the hundreds on individual birds. Infested birds were moribund, obtunded, or paralyzed on presentation, with no prior histories of illness or evidence of trauma. Tick and avian blood samples were collected for vector-borne pathogen analysis focusing on the molecular detection of Rickettsia and Borrelia species. Ticks were identified as the neotropical species of soft tick, Argas (Persicargas) giganteus; their occurrence in the southern US on raptors represented an expansion of host range. Pathogen testing of ticks showed that 41% of 54 ticks were infected with Rickettsia hoogstraalii and 23% of 26 ticks were infected with a relapsing fever Borrelia; both agents are associated with uncertain health consequences. Among the blood samples, one was infected with the same Borrelia spp.; this Red-tailed Hawk also had Borrelia-positive ticks. With supportive therapy, the majority of birds, 74% (17/23), recovered and were released or permanent residents. The management of soft tick-infested birds and mitigation of future disease risk will require additional characterizations of these poorly studied soft ticks and their associated pathogens.

Human Tick-Borne Diseases in Australia.

There are 17 human-biting ticks known in Australia. The bites of Ixodes holocyclus, Ornithodoros capensis, and Ornithodoros gurneyi can cause paralysis, inflammation, and severe local and systemic reactions in humans, respectively. Six ticks, including Amblyomma triguttatum, Bothriocroton hydrosauri, Haemaphysalis novaeguineae, Ixodes cornuatus, Ixodes holocyclus, and Ixodes tasmani may transmit Coxiella burnetii, Rickettsia australis, Rickettsia honei, or Rickettsia honei subsp. marmionii. These bacterial pathogens cause Q fever, Queensland tick typhus (QTT), Flinders Island spotted fever (FISF), and Australian spotted fever (ASF). It is also believed that babesiosis can be transmitted by ticks to humans in Australia. In addition, Argas robertsi, Haemaphysalis bancrofti, Haemaphysalis longicornis, Ixodes hirsti, Rhipicephalus australis, and Rhipicephalus sanguineus ticks may play active roles in transmission of other pathogens that already exist or could potentially be introduced into Australia. These pathogens include Anaplasma spp., Bartonella spp., Burkholderia spp., Francisella spp., Dera Ghazi Khan virus (DGKV), tick-borne encephalitis virus (TBEV), Lake Clarendon virus (LCV), Saumarez Reef virus (SREV), Upolu virus (UPOV), or Vinegar Hill virus (VINHV). It is important to regularly update clinicians' knowledge about tick-borne infections because these bacteria and arboviruses are pathogens of humans that may cause fatal illness. An increase in the incidence of tick-borne infections of human may be observed in the future due to changes in demography, climate change, and increase in travel and shipments and even migratory patterns of birds or other animals. Moreover, the geographical conditions of Australia are favorable for many exotic ticks, which may become endemic to Australia given an opportunity. There are some human pathogens, such as Rickettsia conorii and Rickettsia rickettsii that are not currently present in Australia, but can be transmitted by some human-biting ticks found in Australia, such as Rhipicephalus sanguineus, if they enter and establish in this country. Despite these threats, our knowledge of Australian ticks and tick-borne diseases is in its infancy.

Tick Paralysis: Solving an Enigma.

In comparison to other arachnids, ticks are major vectors of disease, but less than 8% of the known species are capable of inducing paralysis, as compared to the ~99⁻100% arachnids that belong to venomous classes. When considering the potential monophyly of venomous Arachnida, this review reflects on the implications regarding the classification of ticks as venomous animals and the possible origin of toxins. The origin of tick toxins is compared with scorpion and spider toxins and venoms based on their significance, functionality, and structure in the search to find homologous venomous characters. Phenotypic evaluation of paralysis, as caused by different ticks, demonstrated the need for expansion on existing molecular data of pure isolated tick toxins because of differences and discrepancies in available data. The use of in-vivo, in-vitro, and in-silico assays for the purification and characterization of paralysis toxins were critically considered, in view of what may be considered to be a paralysis toxin. Purified toxins should exhibit physiologically relevant activity to distinguish them from other tick-derived proteins. A reductionist approach to identify defined tick proteins will remain as paramount in the search for defined anti-paralysis vaccines.

Tick paralysis

Tick paralysis is caused by neurotoxins secreted by adult female ticks, primarily in North America and on the east coast of Australia. Sporadic illness is also recorded in Europe and Africa. In the European countries, including Poland, there are 6 species of ticks capable of causing tick paralysis. The disease occurs in people of all ages, but is most commonly diagnosed in children under 8 years of age. Paralysis can take different forms - from rare isolated cranial nerve infections to quadriplegia and respiratory muscles paralysis. After the tick remove, the symptoms resolve spontaneously. In severe cases with paralysis of respiratory muscles, when there is no possibility of mechanical ventilation, the disease may lead to death.

Are recreational areas a risk factor for tick paralysis in urban environments?

In Australia, tick paralysis in dogs (caused by a toxin in the saliva of Ixodes species during feeding) is a serious, distressing condition, and untreated it is often fatal. The aim of this study was to quantify the association between parkland (recreational or natural) in an urban area and the occurrence of canine tick paralysis. Brisbane, as a large urban centre located within the zone of paralysis tick habitat along the east coast of Australia, was selected as the study area. Postcodes selected for inclusion were those defined as being of an urban character (Australian Bureau of Statistics). The number of natural and recreational parkland polygons and total land area per postcode were derived. Tick paralysis case data for the selected postcodes were extracted from a national companion animal disease surveillance database. Between October 2010 and January 2017, 1650 cases of tick paralysis in dogs were reported and included in this study. Significant correlations were found between the number of reported cases per postcode and parklands: natural counts, 0.584 (P < 0.0001); natural area, 0.293 (P = 0.0075); recreational counts, 0.297 (P = 0.0151); and recreational area, 0.241 (P = 0.0286). Four disease clusters were also detected within the study area. All of these were located on the edges of the study area - either coastal or on the urban fringe; no clusters were identified within the core urban zone of the study area. Of the disease cases included in this study, strong seasonality was evidence: 68% of all cases were identified in spring. Within urban environments, areas of natural vegetation in particular appear to pose a risk for tick paralysis in dogs. This evidence can be used by veterinarians and dog owners to reduce the impact of tick paralysis by raising awareness of risk areas so as to enhance prevention via chemoprophylaxis and targeted searches of pet dogs for attached ticks.

A Retrospective Cohort Study of Tick Paralysis in British Columbia.

BACKGROUND: Tick paralysis is a frequently overlooked severe disease characterized by bilateral ascending flaccid paralysis caused by a neurotoxin produced by feeding ticks. We aimed to characterize suspected tick paralysis cases documented at the BC Centre for Disease Control (BCCDC) in British Columbia (BC) from 1993 to 2016 and reviewed prevention, diagnosis, and treatment considerations. METHODS: Demographic, geographic, and clinical data from test requisition forms for ticks submitted to the BCCDC Public Health Laboratory (PHL) from patients across BC between 1993 and 2016 for suspected human and animal tick paralysis were reviewed. Descriptive statistics were generated to characterize tick paralysis cases in BC, including tick species implicated, seasonality of disease, and regional differences. RESULTS: From 1993 to 2016, there were 56 cases of suspected tick paralysis with at least one tick specimen submitted for testing at the BCCDC PHL. Humans and animals were involved in 43% and 57% of cases, respectively. The majority of cases involved a Dermacentor andersoni tick (48 cases or 86%) and occurred between the months of April and June (49 cases or 88%). Among known locations of tick acquisition, the Interior region of BC was disproportionately affected, with 25 cases (69%) of tick bites occurring in that area. CONCLUSIONS: Tick paralysis is a rare condition in BC. The region of highest risk is the Interior, particularly during the spring and summer months. Increasing awareness of tick paralysis among healthcare workers and the general public is paramount to preventing morbidity and mortality from this rare disease.