A person may not know that a tick bite has occurred for a variety of reasons. This makes exclusion of a tick-borne disease by history alone difficult.
Reasons why a tick bite may be missed:
(1) tick attachment site covered by hair
(2) tick attachment site is out of sight (back, behind ear, etc)
(3) nymph or larval form
(4) tick fed quickly and detached
(5) attachment occurred at night or in a low visibility situation
(6) poor visual acuity
(7) cursory exam
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Specialty: Infectious Diseases, Dermatology
