“Too (Two) T(r)icky Situation”

Sir, A 58-year-old male resident of Udhampur, India, presented with complaints of insects attached to the right-hand side of his chest since the day traveled to a forest. Examination revealed two moving ticks 2 mm apart attached to the right-hand side of the chest with their mouth parts overlying erythematous and oedematous skin [Figure 1, Supplementary Video]. The ticks were removed using fine, curved forceps, grasped as close as possible to the surface of the skin to allow complete removal of the mouthparts, and gently pulled away at a 45-degree angle without twisting, jerking, crushing, puncturing, or squeezing. Entomological evaluation revealed these to be brown dog ticks (Rhipicephalus sanguineus). The bite site healed over the next two weeks with topical mupirocin ointment without any residual scar. A fortnightly review over two months did not reveal evidence of fever or any systemic symptoms suggestive of tick-borne illness.Figure 1: Two different-sized ticks 2 mm apart are attached to the right-hand side of the chest with their mouth parts overlying erythematous and oedematous skin. [(a): Naked eye view; (b): Dermlite DL4 dermoscope, polarized, 10x] {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video Clip 1","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_xz44sg6n"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} Learning point: Ticks, while sucking blood from the host, may transmit a variety of diseases such as Lyme disease, tick-borne relapsing fever, and various viral and rickettsial infections. Hence, during their removal, it is to be ensured that there is a) no twisting, jerking, crushing, puncturing, or squeezing of ticks, as their body tissue and fluids may contain potential infectious agents, b) no rough pulling lest the mouthparts are left in situ leading to the probability of local irritation and foreign body granuloma formation, c) no topical applicants, including petroleum jelly, ether, iodine, spirit, chloroform, kerosene, petrol, etc. are used lest the tick regurgitates, leading to the spread of infectious agents. Data availability statement All data generated or analyzed is included in this article. Further enquiries can be directed to the corresponding author. Author contribution All the authors contributed to conception and design of the work, defining the intellectual content, literature search, acquisition and analysis of data; manuscript preparation, editing, review and final approval of the version to be published. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.