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litlbren's avatar

Should I get a second opinion when my son has a bullseye rash from a tick bite and she does not administer an antibiotic right away?

Asked by litlbren (71points) July 29th, 2010

My 3 yr old son just developed a bullseye rash on his arm yesterday. I first noticed it 2 days ago when it was just a raised red spot..looked like a very large mosquito bite. Then yesterday it was much larger and the exact picture of a tick bite bullseye rash. I took him to the Dr immediately and she said it could be a tick bite but without a tick present she was unsure. She did bloodwork to check for Lyme disease but I think she should have at least started him on an antibiotic to play it safe. I suggested that and she refused. I am very worried…should I take him to get a 2nd opinion? If the BW can give a false negative…doesnt being cautious with an antibiotic make sense?!

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20 Answers

Adirondackwannabe's avatar

Run, don’t walk and get another opinion. That rash is one of the classic Lyme symptoms and the bloodwork will probably come back inconclusive at this early of a stage.

janbb's avatar

I know it used to be fairly standard to start antibiotics when there was a suspicion of Lyme’s Disease. Pediatricians are now more cautious about prescribing antibiotics, but this sounds like an indication for them in my non-expert view. I would look for a second opinion. Maybe one of our Fluther MDs will weigh in.

Adirondackwannabe's avatar

Let me see if Dr Dredd is in.

JLeslie's avatar

Do what makes you comfortable.

Bulls eye can be from various insects.

Ticks usually hang on, I find it odd that the tick is not there, Since he is 3 I assume you see his body every day, is it in an odd location that you might miss seeing a tick? But, I don’t really know how long ticks usually hang onto the skin.

I assume your son has no other symptoms, no fever, no pain?

I know there are several different ways of testing for lymes, and some are more accurate than others, you are right there can be false negatives.

Do you live in a state with high rates of Lymes disease?

litlbren's avatar

Yes..Pennsylvania. His grandma’s yard is moderately wooded (I noticed it when I picked him up from her house)and the day before we were at the Peninsula which is infested with deer ticks. For all I know he could have pulled it out himself and he wouldnt have told me. I tried asking him but you cant get an accurate answer from him. What other insects can give the same bullseye?

cockswain's avatar

Seems kind of dumb to not put him on an antibiotic, but maybe the doctor has a good reason. You should express your concerns to the doc and see what she says.

JLeslie's avatar

@litlbren I don’t know the other insects, I believe spiders, I could be wrong. I just know I have been bitten and had a bullseye before, my mother too, but it was itchy like a mosquito bite, your sons probably isn’t I’m guessing. I think ring worm can look like bullseye.

Chronic Lymes is a scary thing, so I can understand why you want to give him the drugs, I am not trying to be challenging. Shilolo would have the best info on the topic I think, if he will answer your question. Since he cannot evaluate your son it makes it difficult for doctors online obviously. Do you want a second opinion, or do you just want a doc who will give you the drugs just in case so you can stop worrying? I can understand both in this situation.

janbb's avatar

I have had the raised circle, no apparent tick and been pt on antibiotics. As I said above, I know pediatricians are being cautious, but potential Lyme’s is nothing to screw around with. I’ll send this to shilolo and see if he is around to weigh in.

And welcome to Fluther, @litlbren!

Adirondackwannabe's avatar

GA janbb. And thanks for reminding me of my manners. Welcome @litlbren

WestRiverrat's avatar

It could be an ant bite or a spider bite as well. But with this being a high risk of Lyme’s area, I would get a second opinion.

One reason the Dr may be reluctant is if it is not Lyme’s and she chooses the wrong antibiotic, it could have an adverse effect on the bite.

I know we have a lot of Hobo and Brown recluse spiders here. Their bite symptoms are almost identical, but if you treat for recluse and it is a hobo spider, you will make it worse.

rts486's avatar

Yes, get another opinion. The second doctor might agree with the first, then at least you know you’ll have two doctors agreeing; or the second can disagree and you can play it safe and start the antibiotics.

JLeslie's avatar

I will disagree with @WestRiverrat for a moment, a spider bite that was dangerous would typically be painful from what I understand, and the skin begins to necrotize, I believe you would probably see blisters at the area of the bite, and it would get worse and worse over time, very dangerous, can be life threatening. I’m pretty sure you would know if it was an emergency with this type of infection from a spider bite. So, having said that I don’t think the concern is whether he is given the wrong antibiotic, but whether he is given an unnecessary antibiotics. But, as I said I am not a doctor, hopefully a doctor will chime in.

WestRiverrat's avatar

@JLeslie that depends a lot on the type of spider in question. While all spiders carry venom, many are only mild irritants to humans.

JLeslie's avatar

@WestRiverrat I agree. I am saying if it was infected where antibiotics were needed, I believe the child would be in a lot of discomfort. I am not saying all spider bites need antibiotics.

Dutchess_III's avatar

Better safe than sorry. Of course, you know to make sure he gets every single one of his antibiotics until they’re gone.

Dr_Dredd's avatar

I also would have checked a Lyme titer. Thing is, though, the antibiotic most recommended in adults for Lyme (doxycycline) shouldn’t be used in kids under 8. Even amoxicillin, the antibiotic recommended for Lyme in kids, has its side effects. I don’t think it’s unreasonable to wait for the results of the antibody tests before starting the antibiotics.

Was the child having any other symptoms of acute Lyme disease (e.g. headache, joint pain)? That might make me give the antibiotics sooner.

Buttonstc's avatar

I would definitely get a second opinion, preferably from an infectious disease specialist. Or, if for some reason that’s not feasible, then I know that many allergists go through similar training in terms of Immunology (mine did I don’t think that’s uncommon) and would be better than just another GP.

The second Doc may or may not advise antibiotics bit I would think it’s DEFINITELY worth the effort and/or cost to get a second opinion. Preferably from someone with specialized training.

Lyme can have severe neurological effects from which recovery can be long and difficult and his young age leaves him especially vulnerable.

Get a second or even third opinion until you are at peace with the conclusions reached. This is your Mother’s instinct kicking in. Don’t let anybody talk you out of it. You need to be at peace about this, so do whatever it takes until you are.

shilolo's avatar

To answer your question, you apparently should get a second opinion (and probably another pediatrician) since you don’t trust this one. Now that we got that out of the way, I would say that (having not seen the rash), in general I would agree with your pediatrician’s actions (though the value of blood tests in this instance is low). First, not all rashes resulting from bug bites look like erythema migrans. You may think spreading redness from a bite is the same, but it is not. Second, to address the tick issue, people with lyme sometimes don’t feel the bite or see the tick because the juvenile or nymphal stage is more likely to bite humans, and these are smaller and harder to see. Indeed, many doctor visits on the East Coast are for tick bites, and the general consensus remains that antibiotic prophylaxis IS NOT recommended unless very specific criteria are met. Third, both the IDSA and American Academy of Pediatrics are not in favor of empiric treatment for even known tick bites, and in this instance you do not know if there was one or not.

Thus, the crux of the issue is whether the rash that you are concerned about is truly a manifestation of lyme or simply a reaction to another bug bite. Given that that is purely a clinical judgement, it would be difficult to know, definitively. Now, some might argue in favor of antibiotics, because, “what’s the harm?” Well, there are lots of side effects to antibiotics as this article about a woman who was treated for chronic lyme (even though she didn’t have lyme) demonstrates. Therefore, it seems that a watchful waiting approach (i.e. follow the rash, go back if any changes develop or the child develops symptoms, or if serology testing is positive) is very reasonable.

litlbren's avatar

Thank you for your msg…it definitely made me feel better. I did call my sons dr. and she had no problem giving him the antibiotic to make me feel better. She also assured me that the dose she will be giving him will not be harmful in any way if indeed it was not Lyme disease. So my mind is at ease now. I am definitely not an antibiotic freak, I avoid it at all costs. But in this case, where time is of the essence, and the bloodwork is untrustworthy in the beginning, it’s a no-brainer. Thank you ALL for your wonderful advice and taking the time to respond to my concern! I love FLUTHER!

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