LSU School of Public Health, New Orleans, LA, USA.
J Med Toxicol. 2010 Mar;6(1):15-21. doi: 10.1007/s13181-010-0028-3.
Tick paralysis (TP) is a neurotoxic poisoning primarily afflicting young girls in endemic regions. Recent case series of TP have described increasing misdiagnoses of TP as the Guillain-Barré syndrome (GBS). A meta-analysis of the scientific literature was conducted using Internet search engines to assess the evolving epidemiology of TP. Fifty well-documented cases of TP were analyzed over the period 1946-2006. Cases were stratified by demographics, clinical manifestations, and outcomes. Misdiagnoses were subjected to Yates-corrected chi-square analyses to detect statistically significant differences in proportions of misdiagnoses between earlier and later reporting periods. TP occurred seasonally and sporadically in individuals and in clusters of children and adults of both sexes in urban and rural locations. The case fatality rate (CFR) for TP was 6.0% over 60 years. The proportion of misdiagnoses of TP as GBS was significantly greater (chi(2) = 7.850, P = 0.005) in more recently collected series of TP cases, 1992-2006, than the proportion of misdiagnoses in earlier series, 1946-1996. TP was a potentially lethal poisoning that occurred in children and adults in a seasonally and regionally predictable fashion. TP was increasingly misdiagnosed as GBS during more recent reporting periods. Such misdiagnoses often directed unnecessary therapies such as central venous plasmapheresis with intravenous immunoglobulin G, delayed correct diagnosis, and tick removal, and could have increased CFRs. TP should be added to and quickly excluded from the differential diagnoses of acute ataxia and ascending flaccid paralysis, especially in children living in TP-endemic regions of the USA.
蜱瘫痪（TP）是一种神经毒性中毒，主要影响流行地区的年轻女孩。最近的蜱瘫痪病例系列描述了越来越多的误诊为格林-巴利综合征（GBS）的情况。使用互联网搜索引擎对科学文献进行了荟萃分析，以评估 TP 的流行病学演变。分析了 1946 年至 2006 年期间记录良好的 50 例 TP 病例。病例按人口统计学、临床表现和结局进行分层。对误诊病例进行了 Yates 校正的卡方分析，以检测报告期较早和较晚时误诊比例的统计学差异。TP 季节性和散发性地发生在个人和城市和农村地区的儿童和成人的集群中。TP 的病例死亡率（CFR）在 60 年期间为 6.0%。在最近收集的 TP 病例系列中，1992-2006 年，TP 误诊为 GBS 的比例明显更高（卡方=7.850，P=0.005），而在较早的系列中，1946-1996 年，误诊的比例更高。TP 是一种潜在的致命中毒，发生在儿童和成人中，具有季节性和区域性可预测性。在最近的报告期内，TP 越来越被误诊为 GBS。这种误诊通常会导致不必要的治疗，如中心静脉血浆置换联合静脉免疫球蛋白 G、延迟正确诊断和蜱虫清除，并且可能会增加 CFR。TP 应添加到急性共济失调和上升性弛缓性瘫痪的鉴别诊断中，并迅速排除在外，尤其是在美国 TP 流行地区的儿童中。
