Tick Bites and CCHF Guide: How to Remove a Tick?

The first and most crucial step when a tick attaches to your body is to remove it as quickly as possible. If it will take you a few hours to reach a healthcare facility, pulling the tick straight up with tweezers without crushing it significantly reduces the risk of disease. The longer a tick remains attached, the higher the chance that dangerous viruses, such as Crimean-Congo Hemorrhagic Fever (CCHF), will enter your bloodstream.

• Not every tick causes CCHF; the primary carrier of the virus is the Hyalomma tick species.
• As soon as a tick is noticed, it should be removed with tweezers without touching it with bare hands or crushing its body.
• After removal, the area should be washed with soap and water, and you should visit a healthcare facility without delay.
• If fever, fatigue, or bleeding occurs within 10 days after a tick bite, seek immediate medical support.
• Although tick cases are common in Istanbul, current data shows no reported CCHF transmission from ticks in this region.

What Are Tick Bites and Crimean-Congo Hemorrhagic Fever (CCHF)?

A tick bite occurs when ticks, which live in nature and feed on blood, attach themselves to the human body. Because ticks secrete a mild anesthetic into the area where they attach, the bite is usually not felt. There are over 500 tick species identified worldwide and around 50 in Türkiye. However, not all of these carry diseases. One of the most serious conditions that can result from a tick bite is Crimean-Congo Hemorrhagic Fever (CCHF).

CCHF is a viral infection, primarily carried by the Hyalomma tick species, characterized by bleeding and potentially fatal outcomes. While the mortality rate for this disease ranges between 10 and 30 percent globally, it averages around 5 percent in Türkiye. This disease, which has been seen in our country for about 20 years, can lead to severe health problems if not treated early. The less time the tick remains attached to the body, the lower the probability of virus transmission.

Causes and Risk Factors

The main reason tick bites increase during the summer months is that ticks become more active in warm weather, and people spend more time in nature. Picnic areas, forests, fields, and green spaces with tall grass are the natural habitats of ticks. Those working in agriculture and animal husbandry, campers, and hikers are in the highest risk group.

Various environmental factors lie behind the recent increase in tick cases and CCHF. Changes in the ecological balance, the reduction of forest areas, and the decline in bird populations that feed on ticks pave the way for an uncontrolled increase in tick numbers. Furthermore, seasonal changes due to global warming cause ticks to spread across wider geographies. Tick cases are frequently encountered in metropolitan cities like Istanbul; however, the species carrying the CCHF virus are mostly concentrated in the regions of Amasya, Tokat, Samsun, Sivas, and Yozgat, known as the Kelkit Valley.

Tick Attachment and CCHF Symptoms

When a tick attaches to the body, there is usually no pain. Only mild redness and itching may be seen at the bite site. The real danger lies in the symptoms that emerge after the incubation period of the viruses the tick might carry. The incubation period for the CCHF virus generally ranges from 1 to 3 days, though it can extend up to 9 days. In the early stages of the disease, sudden high fever, severe headache, fatigue, and widespread muscle pain occur.

While back and muscle pains can develop due to the cold in winter, they can also be a sign of tick-borne infections during the summer. To understand the nature of winter pains, you can review our article Why Do Backaches Occur in Winter?. As CCHF progresses, digestive system complaints such as nausea, vomiting, diarrhea, and abdominal pain are added to the clinical picture. The most critical symptoms of the disease are bleeding in the gums, nose, or under the skin. Such bleeding is the clearest indicator that the virus is damaging coagulation cells (platelets).

How to Remove a Tick and Prevent the Disease?

When you notice a tick bite, if reaching a healthcare facility will take a few hours, you should remove the tick yourself. Because the tick has not yet fully engorged on blood, it is much easier to remove in the early stages. Using fine-tipped tweezers or a tissue, gently grasp the tick as close to the skin as possible. Pull it straight up without twisting, crushing, or handling it roughly. If the tick's mouthparts remain inside during removal, it does not pose a major risk; the real danger is the virus-laden fluid in the tick's stomach mixing with your blood. Wash the area with plenty of soap and water after the procedure.

To protect yourself from ticks, you should prefer light-colored and closed clothing when visiting green areas. Tucking your trouser legs into your socks provides a physical barrier. The protection offered by tick repellent lotions is limited; therefore, you should thoroughly check your entire body upon returning from nature. Ticks particularly prefer to attach to the legs, arms, the groin area, behind the knees, and armpits.

Diagnosis and Treatment Process After a Tick Bite

After the tick is removed, you must visit a healthcare facility without delay. At the hospital, blood tests are first performed to check liver enzymes and the status of coagulation cells (platelets). These initial test results are taken as a reference to monitor any changes that may occur in the following days. If CCHF is suspected, PCR tests are applied for a definitive diagnosis.

Currently, there is no specific antiviral drug or vaccine for CCHF. Treatment relies entirely on supportive approaches. Fluid loss in the body is replenished intravenously, and dropping platelets and proteins are replaced with blood product supplements. In severe cases, patients may need to be monitored in the intensive care unit. Once the disease is overcome, you can safely regain your mobility by getting support from our Physical Therapy and Rehabilitation department to recover your musculoskeletal system after prolonged bed rest.

Complications and Risk Groups

Although CCHF poses a risk to everyone, the course of the disease can be much more severe and fatal in certain groups. Children whose immune systems are not yet fully developed and elderly individuals with low body resistance are at particularly high risk. In people with chronic conditions such as heart disease, diabetes, and cancer, the organ damage caused by the virus progresses faster.

Elderly patients with chronic diseases or conditions like What is Osteoporosis? are more vulnerable to infections. The most serious complications of the disease include liver failure, kidney failure, severe internal bleeding, and shock. The collapse of the coagulation system is the primary factor that puts the patient's life in danger.

When to See a Doctor?

If you notice a tick on your body and are not confident about removing it, you should go to the nearest healthcare facility immediately. Even if you have removed the tick yourself, you must see a doctor to have basic blood tests done. The 10-day period following a tick bite is highly critical.

If you experience a sudden high fever, severe head and muscle aches, nausea, vomiting, or diarrhea within these 10 days, you should go to the emergency room. If you notice symptoms like bleeding gums, bruising under the skin, or nosebleeds, you must reach the hospital without delay. In case of confusion, shortness of breath, or active bleeding that cannot be stopped, you should immediately call the 112 emergency hotline and request an ambulance.

The Process at BHT CLINIC

The Infectious Diseases and Clinical Microbiology Department at BHT CLINIC İstanbul Tema Hastanesi offers fast and reliable diagnostic opportunities in cases of tick bites and suspected CCHF. Clinical Microbiology and Infectious Diseases Specialist Assist. Prof. Cengiz Uzun and our experienced medical staff meticulously plan all the necessary tests following tick contact.

Tick removal is performed under safe conditions in our hospital's 24/7 emergency department. Blood samples taken at the time of the first admission are accepted as a reference, and the patient's 10-day follow-up period is closely monitored. In the event of a possible infection, supportive treatments are initiated without delay in our hospital's fully equipped units. To avoid risking your health, you can get support from our specialist physicians in suspicious situations.

Frequently Asked Questions

What happens if a tick bites?

A tick bite is usually painless and only causes mild redness. However, if the tick carries microbes for diseases like Crimean-Congo Hemorrhagic Fever or Lyme, serious symptoms such as fever, fatigue, and bleeding may appear after the incubation period.

Should I go to the hospital after removing a tick?

Yes, even if the tick has been safely removed from the body, you must definitely visit a healthcare facility. Blood tests performed at the hospital are of great importance for the early diagnosis of a possible infection.

Is there a tick vaccine?

According to current medical data, there is no approved and widely used vaccine against Crimean-Congo Hemorrhagic Fever (CCHF). Therefore, the most effective way to prevent the disease is to avoid tick contact.

What should be done if the tick's head remains inside?

If the mouth or head part remains in the skin during tick removal, it does not pose a major risk on its own. The body usually expels or heals this part over time, like a small splinter; the most important thing is to prevent the fluid in the tick's body from mixing with the blood.

Do tick repellent sprays work?

Although tick repellent lotions and sprays provide a certain level of protection, they are not completely effective. The most reliable method is to wear closed clothing when going out into nature and to thoroughly check the entire body upon returning home.

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This article is for informational purposes only; please consult your physician for diagnosis and treatment.