Recording intelligenceAI-generated brief · check the source for context

Trichomonas and Travelers' Skin Findings

57:40 recording · AUTO · 3 speakers

Listen to the original

Listen to the episode

Brief overview

The TWIP 263 case of three travellers' poppy-seed-sized skin findings resolves to ticks, all removed without illness.

  1. Poppy-seed-sized black dots on hikers are tick nymphsNymphs are poppy seed size and adults sesame seed size; the larger, variable ones are partially engorged.
  2. Attachment time, not travel map, drives the riskBorrelia transmission probably needs 36 to 48 hours, so how long the tick fed matters more than which country it came from.
  3. Do not order serology the day of the biteIgG takes about three weeks to turn positive and IgM is incredibly nonspecific; PCR can be used in the acute period.
Executive Summary AI
  • Daniel Griffin reveals the case from episode 261: a mom, a daughter and a son who found small dark objects the size of a poppy seed embedded in their skin, some larger and one mobile, with no rashes and no symptoms.2:33
  • Their travel history drives the discussion — a week on Harris and Lewis in the Outer Hebrides among deer, rabbits and sheep, then hiking around Loch Ness and the Cairngorms, Long Island on the Sunday and Cape Cod on the Wednesday, where they crawled under a fallen tree.3:20
  • Listener guesses were almost unanimous on ticks, with only one outlier arguing for body lice, and writers named Ixodes ricinus in Scotland and Ixodes scapularis and Dermacentor variabilis in the northeastern United States, along with Kira's figures of 50% of Long Island ticks, 38% on Cape Cod and 10% in Scotland carrying Lyme.36:20
  • Daniel explains the timing that matters: transmission of Borrelia burgdorferi probably takes 36 to 48 hours, 200 milligrams of doxycycline is the post-exposure prophylaxis studied for Lyme only, and knee-jerk serology is a trap because IgG takes three weeks to turn positive while IgM is nonspecific.41:39
  • The outcome was benign — the family removed all the ticks and nobody developed any problems — after which Christina Naula honours the Glasgow electron microscopist Lawrence Tetley as her hero and Daniel sets a new summer-camp scalp-check case.46:11
Key Quote
“You know, when I have a tick, I just pull it off and then I actually forget about it and hope for the best, which is maybe not the best approach.”
— Christina Naula36:55
Key Quote
“It probably takes 36 to 48 hours before there's transmission of that pathogen from the tick.”
— Daniel Griffin41:39
Key Quote
“Everybody did fine.”
— Daniel Griffin46:11