What happens if a tick is not removed?

The Immediate Consequences of an Unremoved Tick

Tick Attachment and Feeding Process

Ticks locate a host by detecting carbon dioxide, heat, and movement. Upon contact, the tick climbs onto the skin and inserts its hypostome, a barbed feeding tube, into the epidermis. Salivary secretions containing cement proteins solidify around the mouthparts, anchoring the parasite and preventing dislodgement. During attachment, the tick releases anticoagulants, vasodilators, and immunomodulatory molecules that facilitate uninterrupted blood intake.

Feeding proceeds in two phases. The first, a slow‑feeding period lasting several hours, allows the tick to establish a stable feeding site and begin pathogen transmission. The second, a rapid‑engorgement phase, can extend from one to several days, during which the tick’s body expands up to 100‑fold as it ingests blood. Saliva continuously introduces microorganisms, toxins, and allergic proteins into the host’s circulation.

If the parasite remains attached for the full feeding duration, the host faces increased risk of infection by bacteria, viruses, or protozoa transmitted through the tick’s saliva. Extended blood loss may lead to anemia, especially in small animals or children. Persistent exposure to salivary antigens can trigger hypersensitivity reactions, ranging from localized inflammation to systemic allergic responses. The cemented attachment also complicates removal, raising the likelihood of mouthpart retention and subsequent secondary infection.

Localized Reactions at the Bite Site

Itching and Irritation

When a tick remains attached, the bite site frequently becomes a source of persistent itching and irritation. The mouthparts embed deeply into the skin, releasing saliva that contains anticoagulants and anti‑inflammatory compounds. These substances provoke a localized immune response, manifesting as redness, swelling, and a pruritic sensation that may last for days or weeks.

Common manifestations include:

Intense itching that intensifies with heat or friction
Red, raised rash surrounding the attachment point
Secondary skin irritation from scratching, which can lead to excoriation or infection

Prolonged exposure to tick saliva increases the risk of allergic sensitization, resulting in heightened skin reactivity. In some cases, the irritation evolves into a chronic lesion known as a “tick bite granuloma,” characterized by persistent inflammation and delayed healing. Prompt removal reduces exposure to these irritants and minimizes the likelihood of long‑term dermatologic complications.

Redness and Swelling

Redness and swelling appear as the most immediate visible responses when a tick remains attached. The skin surrounding the attachment site turns pink to deep red within hours, often expanding outward as fluid accumulates in the interstitial tissue. The edema may feel firm or soft, depending on the degree of inflammatory infiltration.

The reaction originates from compounds in tick saliva. Anticoagulant proteins prevent clot formation, while immunomodulatory substances provoke vasodilation and increase capillary permeability. Together they generate a localized hyperemic zone and fluid shift that manifest as erythema and swelling.

If the attachment persists, the initial mild erythema can progress to a larger area of induration. Possible developments include:

Expanding cellulitis that exceeds the original bite margin
Formation of a tender, fluctuant pocket indicating abscess formation
Appearance of a central ulcer or necrotic spot
Accompanying systemic signs such as fever, chills, or malaise

Rapid enlargement, increasing pain, or the emergence of systemic symptoms warrants prompt medical assessment. Early removal of the tick reduces the intensity and duration of the inflammatory response, limiting the risk of secondary infection and preventing escalation to severe tissue damage.

Potential for Secondary Skin Infections

Leaving a tick attached creates a breach in the epidermis that permits bacterial invasion. The mouthparts act as a conduit for skin flora and environmental pathogens, increasing the likelihood of secondary infection.

Common secondary skin infections include:

Cellulitis, characterized by erythema, swelling, and warmth.
Erysipelas, presenting as a sharply demarcated, raised rash.
Necrotizing fasciitis, a rapidly progressing, tissue‑destroying condition.
Abscess formation, resulting in localized pus accumulation.

Pathogenesis involves prolonged attachment, during which the tick’s salivary secretions suppress local immune responses. This suppression, combined with mechanical disruption, facilitates entry of Staphylococcus aureus, Streptococcus pyogenes, and other opportunistic bacteria.

Management requires immediate removal of the arthropod, thorough cleansing of the bite site with antiseptic solution, and monitoring for signs of infection. Indications for medical intervention include increasing pain, expanding erythema, fever, or purulent discharge. Empiric antibiotic therapy targeting gram‑positive organisms is recommended when infection is suspected. Prompt treatment reduces the risk of complications such as tissue necrosis and systemic spread.

Long-Term Health Risks and Complications

Tick-Borne Diseases

Lyme Disease

A tick that remains attached for several days can transmit the bacterium Borrelia burgdorferi, the causative agent of Lyme disease. The pathogen enters the skin at the bite site and may disseminate through the bloodstream, leading to systemic infection.

Early manifestations appear within 3–30 days and include:

Erythema migrans: expanding red rash, often with central clearing
Flu‑like symptoms: fever, chills, fatigue, headache, muscle aches
Neck stiffness and facial nerve palsy in some cases

If untreated, the infection progresses to a disseminated stage. Typical findings are:

Multiple erythema migrans lesions on distant body areas
Cardiac involvement: atrioventricular block, myocarditis
Neurological complications: meningitis, radiculopathy, peripheral neuropathy
Joint inflammation: migratory arthralgia, later chronic arthritis, especially in large joints

Late disease may develop months to years after the initial bite. Persistent symptoms can include:

Chronic arthritis with joint swelling and pain
Neurocognitive deficits: memory loss, difficulty concentrating
Peripheral neuropathy with numbness or tingling

Prompt removal of the tick within 24 hours substantially reduces transmission risk. When removal is delayed, early antibiotic therapy (doxycycline, amoxicillin, or cefuroxime) remains the primary intervention to prevent progression. Failure to treat may result in irreversible tissue damage and prolonged disability.

Early Stage Symptoms

Early symptoms emerge within a few days after a tick remains attached. Common manifestations include:

Fever ranging from mild to high‑grade
Persistent headache
Generalized fatigue and malaise
Muscle or joint aches
Neck stiffness
Skin lesions such as a circular erythema or a spotted rash
Nausea or loss of appetite

These signs often indicate the initial phase of infections transmitted by ticks, for example «Lyme disease», «Rocky Mountain spotted fever», «Anaplasmosis», «Ehrlichiosis» or «Babesiosis». The rash associated with Lyme disease typically appears as a red expanding ring, while Rocky Mountain spotted fever may produce a petechial rash on the wrists and ankles. Joint pain may precede arthritis in later stages, but early joint discomfort is a frequent complaint.

Laboratory testing is most reliable after symptom onset; however, prompt medical evaluation can confirm exposure before severe complications develop. Early antimicrobial therapy reduces the risk of long‑term organ damage, neurological impairment, or persistent fatigue. Immediate attention to these initial signs therefore limits disease progression and improves prognosis.

Late Stage Complications

Failure to detach a tick can lead to a spectrum of serious health problems that emerge weeks to months after the initial bite. Pathogens transmitted during attachment may multiply, disseminate, and affect multiple organ systems, producing conditions that are difficult to treat and may cause permanent damage.

«Late‑stage complications» commonly include:

Chronic Lyme disease with persistent arthritis, especially in large joints, and irreversible joint erosion.
Neuroborreliosis presenting as peripheral neuropathy, facial palsy, or meningitis, often leaving lasting motor or sensory deficits.
Cardiac involvement such as atrioventricular block or myocarditis, which may progress to chronic arrhythmias.
Tick‑borne encephalitis resulting in cognitive impairment, memory loss, and persistent cerebellar ataxia.
Anaplasmosis or ehrlichiosis evolving into severe sepsis, renal failure, or prolonged fatigue syndrome.
Babesiosis leading to hemolytic anemia, splenomegaly, and chronic hemolysis.
Rocky Mountain spotted fever advancing to vasculitis, gangrene, or long‑term vascular insufficiency.

These outcomes arise because delayed removal permits prolonged feeding, increasing pathogen load and enhancing the likelihood of systemic invasion. Early diagnosis and prompt antimicrobial therapy reduce the risk, but once organ damage is established, management focuses on symptom control and rehabilitation rather than cure. Continuous monitoring for emerging signs remains essential for individuals who have experienced an untreated tick attachment.

Anaplasmosis

If a tick remains attached, the risk of transmitting Anaplasma phagocytophilum increases dramatically. The bacterium multiplies in the tick’s salivary glands and enters the host’s bloodstream during prolonged feeding. Early infection often presents with fever, chills, headache, and muscle aches; laboratory findings typically include leukopenia, thrombocytopenia, and elevated liver enzymes. Without prompt antimicrobial therapy, the disease can progress to severe complications such as respiratory failure, organ dysfunction, and, in rare cases, death.

Key points regarding untreated tick attachment and Anaplasmosis:

Transmission probability rises sharply after 24 hours of attachment.
Bacterial load in the host escalates, intensifying systemic inflammation.
Delayed diagnosis may obscure clinical picture, leading to mismanagement.
Standard treatment with doxycycline for 10–14 days reduces morbidity and mortality; postponement diminishes therapeutic efficacy.

Preventive measures focus on timely tick removal, thorough skin inspection after outdoor exposure, and immediate medical evaluation if symptoms develop. Early intervention limits bacterial dissemination and improves clinical outcomes.

Ehrlichiosis

If a tick stays attached, the risk of transmitting Ehrlichiosis rises sharply. The bacterium Ehrlichia sp. enters the bloodstream through the tick’s saliva, establishing infection within hours.

Early manifestations include fever, headache, muscle aches, and malaise. Laboratory findings often reveal low platelet count, elevated liver enzymes, and leukopenia. Without prompt antimicrobial therapy, the disease can progress to severe complications such as respiratory distress, kidney failure, and central nervous system involvement.

Effective management relies on early diagnosis and treatment with doxycycline. A typical regimen consists of 100 mg orally twice daily for 7–14 days. Delay in therapy increases mortality risk, especially in immunocompromised individuals.

Prevention strategies focus on rapid tick removal and habitat avoidance:

Inspect skin and clothing after outdoor exposure.
Use fine‑tipped tweezers to grasp the tick close to the skin and pull upward with steady pressure.
Apply EPA‑registered repellents containing DEET or picaridin.
Wear long sleeves and pants treated with permethrin in endemic areas.

«Ehrlichiosis» remains a preventable tick‑borne illness when timely removal and appropriate antibiotic treatment are implemented.

Rocky Mountain Spotted Fever

Rocky Mountain spotted fever (RMSF) is a bacterial infection caused by Rickettsia rickettsii, transmitted primarily by the bite of infected ticks. The disease is endemic in parts of North America where the American dog tick, Rocky Mountain wood tick, and brown dog tick serve as vectors.

When a tick remains attached, the probability of pathogen transmission rises sharply after 24 hours of feeding. Prolonged attachment provides the organism sufficient time to migrate from the tick’s salivary glands into the host’s bloodstream, initiating systemic infection.

Common clinical manifestations include:

Sudden fever and chills
Severe headache
Maculopapular rash, often beginning on wrists and ankles and spreading centrally
Muscle pain and nausea

If left untreated, RMSF can progress to multi‑organ dysfunction, including pulmonary edema, renal failure, and encephalitis. Mortality rates exceed 30 % in the absence of timely therapy, underscoring the disease’s potential severity.

Effective treatment relies on early administration of doxycycline, typically 100 mg orally or intravenously twice daily for 7–14 days. Prompt therapy markedly reduces complications and improves survival.

Preventive measures emphasize immediate removal of attached ticks, thorough skin inspection after outdoor exposure, and proper disposal of the tick. Removal should involve grasping the tick close to the skin with fine‑tipped tweezers and pulling upward with steady pressure, avoiding crushing the body. Prompt removal limits feeding duration, thereby decreasing the risk of RMSF transmission.

Powassan Virus

Leaving a tick attached increases the risk of transmitting Powassan virus, a rare but severe flavivirus endemic to North America. The virus is maintained in a natural cycle involving small mammals, particularly woodchucks and groundhogs, and hard‑tick species such as Ixodes scapularis and Ixodes cookei. Transmission can occur within 15 minutes of attachment, far faster than the typical 24–48 hours required for Lyme disease agents.

If infection occurs, the incubation period ranges from 1 to 5 weeks. Clinical presentation often includes:

High fever
Severe headache
Nausea and vomiting
Confusion or encephalitis
Focal neurological deficits
Long‑term sequelae such as memory loss, seizures, or motor impairment

Laboratory confirmation relies on reverse‑transcriptase polymerase chain reaction (RT‑PCR) or serologic testing for IgM and IgG antibodies. No specific antiviral therapy exists; supportive care in an intensive‑care setting addresses respiratory failure, seizures, and cerebral edema. Mortality rates approximate 10 %, and survivors frequently experience persistent neurological deficits.

Prevention hinges on prompt tick removal, regular body checks after outdoor exposure, and use of repellents containing DEET or permethrin. Public health messaging emphasizes that immediate removal reduces the probability of Powassan virus transmission, underscoring the urgency of thorough skin examinations following activities in wooded or brushy environments.

Alpha-gal Syndrome («Meat Allergy»)

Ticks that remain attached for several days continue to feed, delivering saliva that contains potent immunogenic molecules. Prolonged exposure raises the probability of sensitisation to the carbohydrate galactose‑α‑1,3‑galactose (α‑gal), the trigger of Alpha‑gal Syndrome, a delayed allergy to mammalian meat.

Alpha‑gal Syndrome manifests after a tick bite because the insect’s saliva introduces α‑gal into the bloodstream, prompting the immune system to produce specific IgE antibodies. Subsequent consumption of beef, pork, lamb or related products can provoke symptoms ranging from urticaria and gastrointestinal distress to life‑threatening anaphylaxis. The reaction typically appears three to six hours after ingestion, complicating diagnosis and emergency response.

If a tick is not removed promptly, the following outcomes become more likely:

Extended saliva exposure → higher IgE titres against α‑gal.
Increased risk of severe anaphylactic episodes upon meat consumption.
Development of chronic, unpredictable allergic responses.
Greater difficulty in distinguishing Alpha‑gal Syndrome from other food allergies.

Early tick extraction, ideally within 24 hours, limits saliva transfer and reduces the chance of sensitisation. Medical guidance recommends monitoring for delayed allergic reactions after any tick bite, especially in regions where the lone‑star tick is endemic.

Other Less Common Tick-Borne Illnesses

If a tick remains attached, pathogens that are not among the most frequently discussed can be transmitted. Several illnesses, though less prevalent, present significant clinical challenges.

Tularemia – caused by Francisella tularensis; symptoms include sudden fever, ulcerated skin lesions, and lymph node swelling. Transmission typically requires prolonged attachment, often exceeding 24 hours.
Powassan virus – a flavivirus that can produce encephalitis within days of a bite. Neurological deficits may develop rapidly, underscoring the danger of delayed removal.
Southern tick‑associated rash illness (STARI) – produces a circular rash resembling Lyme disease and mild systemic symptoms. Diagnosis is difficult because laboratory tests are unavailable.
Tick‑borne relapsing fever – caused by Borrelia species distinct from those that cause Lyme disease; episodes of high fever alternate with symptom‑free periods, and anemia may accompany each febrile spike.
Colorado tick fever – a coltivirus transmitted by Rocky Mountain wood ticks; patients experience abrupt fever, headache, and a maculopapular rash that may persist for a week.
Tick‑borne encephalitis – prevalent in parts of Europe and Asia; infection can progress from flu‑like illness to meningitis or encephalitis, especially when the tick remains attached for several days.

Each disease shares a common risk factor: failure to detach the arthropod promptly increases the likelihood of pathogen transfer. Early detection and removal reduce exposure time, thereby lowering the probability of infection. Clinical awareness of these rarer conditions supports timely diagnosis and appropriate treatment. «Prompt tick removal mitigates the threat of even uncommon tick‑borne pathogens».

Factors Influencing Disease Transmission

Duration of Tick Attachment

Ticks attach for a limited feeding period that varies among species. Adult Ixodes scapularis typically remain attached for 3–5 days, while nymphs feed for 2–3 days. Larvae complete attachment within 24–48 hours before detaching to molt.

Pathogen transmission correlates directly with attachment time. Most bacteria, such as Borrelia burgdorferi, require at least 24 hours of feeding to migrate from the tick’s midgut to the salivary glands. Viral agents, including Powassan virus, may be transmitted within 15 minutes, but the probability rises sharply after several hours.

Key duration thresholds:

< 24 hours – minimal risk for bacterial infections; viral transmission possible but rare.
24–48 hours – substantial increase in Lyme‑disease risk; other bacterial agents become probable.
 48 hours – cumulative risk for multiple pathogens; likelihood of severe outcomes escalates.

Extended attachment also leads to local tissue damage, inflammation, and secondary bacterial infection at the bite site. Prompt removal within the first day limits exposure to most tick‑borne diseases and reduces the chance of systemic complications. Monitoring the bite area for erythema, fever, or neurological symptoms remains essential even after early removal.

Tick Species and Geographical Location

Ticks transmit pathogens only while attached; prolonged attachment increases infection probability. Species differ in vector competence, and geographic distribution determines which pathogens are encountered.

Key tick species, their primary regions, and associated disease agents:

Ixodes scapularis – eastern United States, southeastern Canada; vectors Borrelia burgdorferi (Lyme disease), Anaplasma phagocytophilum.
Ixodes ricinus – Europe, North Africa, parts of the Middle East; transmits Borrelia burgdorferi complex, Tick‑borne encephalitis virus.
Dermacentor variabilis – central and eastern United States; carrier of Rickettsia rickettsii (Rocky Mountain spotted fever) and Francisella tularensis.
Dermacentor marginatus – Mediterranean basin, Central Asia; vectors Rickettsia conorii (Mediterranean spotted fever).
Amblyomma americanum – southeastern and south‑central United States; associated with Ehrlichia chaffeensis and Heartland virus.
Amblyomma cajennense – South America, Caribbean, parts of Central America; transmits Rickettsia rickettsii and Coxiella burnetii.
Rhipicephalus sanguineus – worldwide in temperate and tropical zones, especially urban environments; vector of Rickettsia conorii and Babesia canis.

In regions where these species dominate, failure to remove an attached tick within 24–48 hours markedly raises the chance of pathogen transmission. Prompt extraction reduces exposure time, limiting the likelihood of disease development.

Individual Immune Response

When a tick remains attached, the host’s immune system initiates a cascade of defensive actions.

The first response occurs at the bite site. Tissue injury triggers the release of pro‑inflammatory mediators, attracting neutrophils and macrophages that attempt to contain the foreign material. Cytokines such as interleukin‑1β and tumor‑necrosis factor‑α amplify vascular permeability, promoting edema and pain.

Tick saliva contains a complex mixture of proteins that interfere with these processes. Anti‑coagulants, complement inhibitors, and immunosuppressive peptides reduce the effectiveness of cellular infiltration and dampen cytokine signaling, allowing the parasite to feed for several days without immediate rejection.

Extended attachment increases antigen exposure. Dendritic cells capture tick‑derived proteins and present them to T‑cells, leading to the generation of specific IgG and IgE antibodies. In some individuals, repeated exposure provokes a delayed‑type hypersensitivity reaction, manifested by a persistent erythematous lesion that may enlarge despite the tick’s presence.

Pathogen transmission risk escalates with feeding duration. Borrelia, Anaplasma, and other agents exploit the immunomodulated environment to establish infection. The adaptive immune response then shifts toward pathogen‑specific mechanisms:

Production of pathogen‑targeted IgM followed by class‑switch to IgG.
Activation of CD4⁺ T‑helper cells that release interferon‑γ, enhancing macrophage killing capacity.
Mobilization of cytotoxic CD8⁺ T‑cells that recognize infected host cells.

Failure to detach the arthropod therefore creates a prolonged window for immune evasion, hypersensitivity development, and systemic infection. Timely removal limits antigen load, preserves the integrity of the initial inflammatory response, and reduces the probability of disease establishment.

Prevention and Proper Tick Removal

Best Practices for Tick Prevention

Repellents and Protective Clothing

Ticks can transmit pathogens within hours of attachment; prolonged feeding raises the probability of infection. Preventing attachment eliminates the need for removal and the associated health risks.

Effective chemical barriers include «DEET», «picaridin», «IR3535» and «permethrin». DEET and picaridin are applied to skin, providing protection for up to 8 hours. Permethrin is applied to clothing, where it remains active after several washes. All agents must be used according to label instructions to avoid dermal irritation.

Physical barriers rely on clothing that limits tick access to the skin. Recommended features are:

Long sleeves and trousers, tucked into socks or boots.
Light‑colored fabric to aid visual inspection.
Tight‑weave material, such as polyester or nylon, that prevents tick penetration.
Pre‑treated garments with permethrin for added insecticidal action.

Combining chemical repellents with appropriately designed clothing offers the highest level of protection, reducing the likelihood that a tick remains attached long enough to transmit disease.

Yard Management

Effective yard management directly influences the likelihood of ticks remaining attached to humans or pets. Maintaining low‑lying vegetation, eliminating leaf litter, and creating clear zones between wooded areas and recreational spaces reduce the habitat where ticks quest for hosts.

Leaving a tick attached increases the probability of pathogen transmission. Common agents include bacteria that cause Lyme disease, protozoa responsible for babesiosis, and viruses linked to tick‑borne encephalitis. Early attachment raises the risk of systemic infection, which may lead to persistent joint pain, neurological complications, or severe febrile illness. Prompt removal prevents these outcomes by interrupting the feeding cycle before pathogens are transferred.

Key practices for yard management:

Trim grass to a height of 4 inches or less; short grass discourages tick movement.
Remove brush, tall weeds, and leaf piles where humidity supports tick survival.
Install wood or stone mulches at least 6 inches wide to separate lawns from forested borders.
Apply targeted acaricides following local regulations; treat shaded, humid zones where ticks congregate.
Conduct regular inspections of high‑risk areas; document tick activity to adjust control measures.

Implementing these measures minimizes tick encounters, thereby lowering the incidence of disease resulting from unremoved ticks. Consistent attention to landscaping and chemical control creates an environment hostile to tick persistence, protecting both residents and animals from avoidable health threats.

Regular Tick Checks

Regular tick inspections involve systematic examination of the body after outdoor exposure, focusing on areas where ticks commonly attach: scalp, behind ears, armpits, groin, and between toes. Prompt detection allows immediate removal before pathogens can be transmitted.

If a tick remains attached, the risk of infection rises sharply. Pathogens such as Borrelia burgdorferi (Lyme disease), Anaplasma phagocytophilum (anaplasmosis), and Rickettsia species require several hours of feeding to migrate into the host bloodstream. Prolonged attachment therefore increases the probability of severe, sometimes irreversible, health complications, including neurological, cardiac, and joint disorders.

Practical routine for tick checks:

Perform inspection within 24 hours of leaving a tick‑infested environment.
Use a mirror or enlist assistance to view hard‑to‑reach zones.
Run fingertips over hair and skin to feel for small, rounded protrusions.
If a tick is found, grasp its head with fine tweezers and pull upward with steady pressure; avoid crushing the body.
Clean the bite site with antiseptic and monitor for rash, fever, or fatigue over the next weeks.

Neglecting regular examinations allows ticks to stay attached beyond the critical feeding window, facilitating pathogen transfer and potentially initiating chronic illness. Early detection through disciplined checks remains the most effective preventive measure.

Safe Tick Removal Techniques

Tools and Methods

Leaving a tick attached for several days increases the probability of pathogen transmission, causes local inflammation, and may lead to secondary bacterial infection. Early removal reduces these risks dramatically.

Effective removal relies on specific instruments. Recommended items include:

Fine‑point tweezers with a flat, non‑slipping surface
Tick‑removal hooks designed to grasp the mouthparts without crushing the body
Sterile forceps for handling removed specimens
Antiseptic wipes or solutions for site decontamination

The removal procedure follows a precise sequence. Grip the tick as close to the skin as possible, apply steady upward traction, and avoid twisting or squeezing the abdomen. After extraction, cleanse the bite area with an antiseptic, then store the specimen in a sealed container for potential laboratory identification. Discard tools in a biohazard‑compatible manner.

Post‑removal monitoring involves daily inspection of the bite site for redness, swelling, or rash, and observation for systemic symptoms such as fever, headache, or fatigue. If any signs of infection appear, seek medical evaluation promptly; laboratory testing for tick‑borne diseases may be indicated.

Aftercare and Monitoring

After extraction, the bite area must be cleansed with soap and water, followed by application of an antiseptic such as povidone‑iodine.

Monitoring begins immediately and continues for at least four weeks. Observe the site for:

Redness expanding beyond the initial margin
Swelling or a palpable lump
Development of a rash, especially a bull’s‑eye pattern
Fever, chills, headache, muscle aches, or joint pain

Symptoms appearing within the first two weeks often indicate early infection; persistence beyond three weeks warrants re‑evaluation.

If any of the listed signs emerge, contact a healthcare professional without delay. Prompt administration of appropriate antibiotics can prevent progression to systemic disease.

Document the date of the bite, the removal method, and any changes observed; this record assists clinicians in diagnosing tick‑borne illnesses accurately.