Brandy Lemke seemed to be getting weaker by the minute. The 6-year-old lay in her bed in the intensive care unit (ICU), her eyelids drooping. A few days earlier, she'd been fine; now, she couldn't walk, she couldn't talk clearly, she couldn't sit up and the paralysis was spreading to the muscles she needed for breathing.
Carrie Davis Smith, a pediatric resident, had a hunch she couldn't shake. While another doctor inserted a needle into a vein in Brandy's groin, Smith pulled a chair close to the child's pillow. She began laboriously combing through Brandy's long, dark hair. She was searching for a tick.
The weakness had started one day in June 1998, with what Brandy told her mother was a "fuzzy" feeling in her fingers. When she begun to stagger and fall the next day, she was rushed from her pediatrician's office in Beach Island, S.C., to the Medical College of Georgia Children's Medical Center in nearby Augusta. When the little girl--unable to walk--was wheeled into the hospital, doctors quickly ordered scans of her head and neck, took samples of spinal fluid and stuck needles into the nerves of her arms. They were seeking possible causes of her sudden paralysis--a toxin, a tumor or hemorrhage in her spinal cord, even polio.
And they asked about tick bites. In rare cases, a female dog tick attached to the skin can cause rapidly progressive weakness known as "tick paralysis." "That was one of the first things that was mentioned," recalled Brandy's mother, Wendy Ennis. "I searched. My mom searched. The doctors had looked."
But they found nothing. Within 24 hours of entering the hospital, Brandy's breathing had become so labored that her doctors were afraid she'd soon need to be placed on a respirator. After much debate, they'd settled on a diagnosis: Guillain-Barre syndrome, a form of paralysis that occasionally occurs as a complication of certain infections or vaccinations and can last for weeks or months. It is treated with plasmapheresis, a process in which blood is removed from the body and filtered to remove antibodies--chemicals made by the immune system that are thought to attack the coverings of nerves and cause the paralysis. The doctors were inserting the needle in Brandy's groin so they could begin pumping her blood through a plasmapheresis machine.
Smith was shocked by how rapidly Brandy's condition was worsening. She kept remembering another little girl, also suffering from sudden paralysis, whom she'd seen as a third-year medical student. Late one night, Smith had found a pediatric resident combing the child's hair. "I asked her what she was doing," Smith recalled. "She said, 'I'm looking for a tick.' She never found one."
So now, Smith sat at the head of the bed and used an ordinary black plastic comb to carefully divide Brandy's long hair into thin sections. She worked her way over the right side of the head, then the left, peering at the scalp. She was about to give up when she spotted a small, round, tan object clinging to the skin at the crown, where the head had been resting on the pillow.
"Y'all!" said Smith, summoning the other members of the ICU team, who were busy threading the intravenous line into Brandy's groin. She showed them what she'd found. Then she hurried out to the waiting area to find Brandy's mother.
"She said, 'I found the tick on your daughter,' " Ennis recalled. "We were just so excited, because they had told us that if it was a tick, it would be okay."
The ICU team called Michael W. Felz, an associate professor of family medicine at the Medical College of Georgia, to remove the tick. Felz has published several articles on tick-borne illnesses in Georgia, and he has learned that the simplest way is the best. He said he grabs the tick with tweezers, close to the mouth parts, and pulls it straight out perpendicular to the skin.
Smith got to watch Brandy come back to life. "Between 8 and midnight, her speech dramatically improved," she recalled. "By 2 a.m., she could raise her hands over her head." In the hospital chart, Smith wrote in big letters, "Brandy is better!" By the following afternoon, the child had recovered completely.
Felz said tick paralysis is rare, but "probably more common than is reported." It can happen when a female tick, while feeding on blood and preparing to lay eggs, releases a toxin that enters the bloodstream and binds to fibers of nerves that control the muscles. If the tick isn't found and dislodged, it remains attached for five to seven days, until its eggs are mature. Then it drops off and lays the eggs. Some sufferers quickly recover once the tick drops off, but for others, it's too late. One review of 332 cases reported a death rate of 12 percent. In some cases, the tick has been discovered by a mortician.
Felz said two species of ticks present in the United States--Dermacentor variabilis, found in the East, and Dermacentor andersoni, found in the West--can cause tick paralysis. A member of the former species, commonly called a dog tick, bit Brandy. The ticks that carry Lyme disease don't cause tick paralysis, Felz noted.
Felz and Smith, with neurologist Thomas R. Swift, coauthored a report of Brandy's case that was published last week in the New England Journal of Medicine. Felz still has the tick he took from Brandy's head. Smith, who has opened a pediatric practice in Toccoa, Ga., keeps the comb and a picture of Brandy on a bulletin board in her office. Both remember that day as one of the proudest moments of their medical careers.
Brandy is a healthy second-grader in Jackson, S.C. She doesn't remember much of her ordeal. "She says she felt kind of dizzy and got real sick," said Ennis, "but the rest of it, she's not so sure."
As for Ennis, she still warns parents at every opportunity to watch for ticks--especially parents of little girls with long hair: "I say, 'Make sure you check your kids.' "
CAPTION: Brandy Lemke, 8 years old, hugs her mother, Wendy Ennis, outside their home in South Carolina. Two years ago Brandy was infected by a tick and quickly began to be paralyzed.