When a blacklegged tick bite is more than a bite

0.25 CME. For blacklegged tick bites, you will learn general management principles and how to distinguish asymptomatic and symptomatic bites.


Elizabeth Maloney, MD
Education Co-Director, Invisible International


Reports of known blacklegged tick bites appear to be a source of confusion for some clinicians. Only 20% or so of all patients with Lyme disease were aware of the bite that caused their infection. When a tick bite history is present, it is crucial to consider the bite in the broader clinical context. This activity will help physicians distinguish between symptomatic and asymptomatic blacklegged tick bites.

Learning objectives:

  1. Distinguish between asymptomatic and symptomatic blacklegged tick bites
  2. Employ general management principles for asymptomatic and symptomatic blacklegged tick bites

Learners may receive credit for this course through either the Accreditation Council for Continuing Medical Education (ACCME) or the American Academy of Family Physicians (AAFP).

Invisible International is accredited by the Accreditation Council for Continuing Medical education (ACCME) to provide continuing medical education for physicians.

Invisible International designates this enduring material activity for a maximum of 0.25 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

ACCME Activity Release Date: 8/1/2023; Expiration 7/31/2024.

Additionally, this session, When a blacklegged tick bite is more than a bite, is approved for 0.25 enduring AAFP Prescribed credits.

AAFP Prescribed credit is accepted by the American Medical Association as equivalent to AMA PRA Category 1 credit(s)™ toward the AMA Physician’s Recognition Award. When applying for the AMA PRA, Prescribed credit earned must be reported as Prescribed, not as Category 1.

The AAFP has reviewed One Health Medical Education for a Changing Climate and deemed it acceptable for AAFP credit. Term of approval is from 01/02/2024 to 01/01/2025. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosure to Learners

CME content presented to learners is free of commercial bias. No product, service, or therapeutic option will be over‐represented when comparing competing products, services, and therapeutic options. When appropriate, generic names or trade names from several companies will be used.  Unless otherwise noted, none of those who controlled content had any financial relationships with an ineligible company.  When a planner or faculty member has disclosed a relevant relationship, that relationship has been mitigated by review of all planning and presentation content.

Planner:  Elizabeth Lee-Lewandrowski, PhD, MPH, is a consultant for Quidel Ortho Diagnostic.

Evidence-based bibliography for further study

• https://phil.cdc.gov/QuickSearch.aspx?key=truekey=true 

• https://www.cdc.gov/ticks/tickbornediseases/tick-bite-prophylaxis.html. Last accessed March 30, 2019. 

• Steere AC, Sikand VK. The Presenting Manifestations of Lyme Disease and the Outcomes of Treatment. N Engl J Med 2003; 348:2472-2474. 

• Steere AC, Dhar A, Hernandez J, Fischer PA, Sikand VK, Schoen RT, et al. Systemic Symptoms without Erythema Migrans as the Presenting Picture of Early Lyme Disease. Am J Med 2003;114:58-62. 

• Smith RP, Schoen RT, Rahn DW, et al. Clinical characteristics and treatment outcome of early Lyme disease in patients with microbiologically confirmed erythema migrans. Ann Intern Med. 2002 Mar 19;136(6):421-428. 

• Tibbles CD, Edlow JA. Does this patient have erythema migrans? JAMA. 2007 Jun 20;297(23):2617-27. 

• Magid D, Schwartz B, Craft J, Schwartz JS. Prevention of Lyme disease after tick bites. A cost-effectiveness analysis. N Engl J Med. 1992 Aug 20;327(8):534-41. 

• Cameron D, Maloney E, Johnson L Evidence assessment and guideline recommendations in Lyme disease: the clinical management of known tick bites, erythema migrans rashes and persistent disease. Expert Rev Anti Infect Ther 2014 Sep; 12(9): 1103-1135. 

• Piesman J, Hojgaard A. Protective value of prophylactic antibiotic treatment of tick bite for Lyme disease prevention: an animal model. Ticks Tick Borne Dis. 2012 Jun;3(3):193- 196. 

• Wormser GP, Dattwyler RJ, Shapiro ED et al. The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2006; 43(9):1089-1134.

About Instructor

Elizabeth L. Maloney, MD

Dr. Elizabeth Maloney is a Minnesota family physician. She received her medical degree from the University of Minnesota in 1986 and completed her residency in family medicine at the University in 1989. Early in her career, she practiced in Guam, where lab and other testing modalities were often unavailable. It was here that she honed her clinical skills and learned to translate history and exam findings into clinical diagnoses and treatment plans. Dr. Maloney began reviewing the scientific literature on tick-borne diseases in earnest in 2006. Her initial review was an attempt to understand why some patients did not present or respond as described in review articles and conference lectures. When she discovered that Borrelia burgdorferi, the agent of Lyme disease, is a complex organism, the immune response to it is nuanced and there are gaps in the clinical understanding of Lyme disease, Dr. Maloney changed her focus towards educating medical professionals about tick-borne illnesses. Dr. Maloney began providing accredited continuing medical education courses on Lyme disease for physicians in 2007 and continues to do so. She has also developed similar education for nurses and mental health providers. She has published several papers in peer-reviewed medical journals and is frequently invited to speak to medical professionals across the US. She has served as a consultant to private organizations and government agencies in the US and Canada. In February 2018 she was selected to serve on the Pathogenesis, Transmission and Treatment subcommittee of the federally mandated Tick-borne Disease Working Group. Additionally, she recently accepted an invitation to serve on a peer review committee for the Canadian Institutes of Health Research.

12 Courses

Not Enrolled

Course Includes

  • 1 Lesson
  • 2 Quizzes
  • Course Certificate