CORRESPONDENCE Australian paralysis tick imported on a traveller returning to the UK Dear Madam, Ticks can transmit a variety of pathogens and bites can result in localised infections or allergic reactions. Patients can be exposed to ticks both in the UK and also during their travels overseas [1], the latter being often overlooked, particularly during the winter months. Public Health En- gland (PHE) runs a surveillance scheme that receives ticks from the public, clinicians and veterinarians for identifi- cation. This letter details an unusual tick submission from a patient in London. PHE entomologists identified the tick as a female Ixodes holocyclus (Australian Paralysis Tick) which is endemic to the east coast of Australia. Images of the tick were sent electronically to a Medical Entomologist in Australia who confirmed the identification. As well as being a vector of Rickettsia australis, it’s bite can cause local allergic reactions, intense swelling, pain or anaphylactic reactions. In rare cases, the release of a toxin during feeding can cause ascending flaccid paralysis which may result in coma or death, particularly in children [2,3] (Fig. 1). The patient reported travel to the East coast of Australia during December and recalled having a ‘small black lump’ in the groin area. Upon return to the UK, a practitioner was consulted on account of swelling. A course of antibiotics was prescribed for what was considered to be an infected wart or mole, but may possibly have been a reaction to an earlier tick bite. The patient later discovered a suspected tick on her lower leg so visited her local A&E department. A nurse concluded it was an infected skin tag, but further consultation with several doctors resulted in the tick finally being recognised and removed. A further course of antibi- otics and steroids was prescribed. This incident highlights the need to raise awareness of tick-bites and tick-borne diseases (TBD) associated with travellers. People bitten by a tick will often visit their local health service for advice, meaning health practi- tioners have a crucial role in reducing the risk of TBDs and managing tick-bites. Recognition of and correct removal of ticks should be followed by patient monitoring for several weeks. Identification of the tick species involved can also contribute significantly to risk assessing the pa- tient by determining vector status, stage and engorge- ment, as well as clinical associations with the particular species. Proper identification of ticks is essential to ensure that they are removed with the respective coun- tries health guidelines. In the case of Ixodes holocyclus, the risk of an allergic reaction increases with removal by tweezers and so killing the tick in situ is normally rec- ommended [4]. The Tick Recording Scheme improves our understanding of tick biting in the UK, as well as detecting ticks acquired abroad [5]. If you treat patients for tick-bites, we encourage you to contribute to the scheme by contacting tick@phe.gov.uk. Funding Authors Maaike Pietzsch, Kayleigh Hansford and Jolyon Medlock declare that the work described is a result of ongoing vector surveillance activities funded under PHE’s core grant in aid. Conflict of interest None. Figure 1 Female Ixodes holocyclus. Available online at www.sciencedirect.com ScienceDirect journal homepage: www.elsevierhealth.com/journals/tmid Travel Medicine and Infectious Disease (2014) 12, 196e197 1477-8939/$ - see front matter Crown Copyright ª 2014 Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.tmaid.2014.01.002