Archive for July, 2018

Insights From the Geographic Spread of the Lyme Disease Epidemic

https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciy510/5039131?redirectedFrom=fulltext

Insights from the Geographic Spread of the Lyme Disease Epidemic

Taylor Eddens, Ph.D Daniel J Kaplan, M.D Alyce J M Anderson, Ph.D Andrew J Nowalk, M.D.,Ph.D Brian T Campfield, M.D
Clinical Infectious Diseases, ciy510, https://doi.org/10.1093/cid/ciy510
Published: 16 June 2018

Reproduced by permission of Oxford University Press on behalf of the Infectious Diseases Society of America. 9c) The Author(s) 2018. All rights reserved. For permissions, e-mail: journals.permissions@oup.com. Please visit: https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciy510/5039131

Abstract
Background
Lyme disease is the most common reportable zoonotic infection in the United States. Recent data suggests spread of the Ixodes tick vector and increasing incidence of Lyme disease in several states, including Pennsylvania. We sought to determine the clinical presentation and healthcare utilization patterns for pediatric Lyme disease in western Pennsylvania.

Methods
The electronic medical records of all patients with an ICD9 diagnosis of Lyme disease between 2003-2013 at Children’s Hospital of Pittsburgh were individually reviewed for cases meeting the 2011 CDC case definition for Lyme disease. 773 patients meeting these criteria were retrospectively analyzed for patient demographics, disease manifestations, and healthcare utilization.

Results
An exponential increase in Lyme disease occurred in the pediatric population of western Pennsylvania. There was a southwestward migration of Lyme cases, with a shift in concentration from rural to non-rural zip codes. Healthcare provider involvement also changed from subspecialists to primary care pediatricians(PCP) and emergency departments(ED). Patients from non-rural zip codes more commonly presented to the ED, while patients from rural zip codes utilized PCPs and EDs similarly.

Conclusions
The current study details the conversion of western Pennsylvania from a Lyme-naïve to a Lyme-epidemic area, highlighting changes in clinical presentation and healthcare utilization as the epidemic evolved. Presenting symptoms and provider-type differed between those from rural and non-rural zip codes. By understanding the temporospatial epidemiology, disease presentation and healthcare utilization of Lyme, the current study may inform future public health initiatives regionally while serving as an archetype for other areas at-risk for Lyme epidemics.

 

 

 

Category:

Lyme, Uncategorized

Lyme Meningoencephalitis Masquerading as Normal Pressure Hydrocephalus

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5984262/#__ffn_sectitle

Lyme Meningoencephalitis Masquerading as Normal Pressure Hydrocephalus

Monitoring Editor: Alexander Muacevic and John R Adler
Aakash Desai, Gaurav Manek, Anand M Krishnan, Corina Iorgoveanu, Ahmed Zaghloul

Abstract
Lyme disease is a tick-borne illness caused primarily by the spirochete Borrelia burgdorferi. The disease is most prevalent in forested areas endemic for Ixodes tick, which transmits the spirochete. Here, we describe a case of Lyme meningoencephalitis masquerading as normal pressure hydrocephalus (NPH) which initially presented with urinary incontinence, gait instability, and neurological decline. Due to its non-specific symptoms and low incidence, Lyme meningoencephalitis causing NPH like syndrome poses a diagnostic conundrum for clinicians. Awareness of this disease entity is key for prompt diagnosis and treatment.

____________

**Comment**

Normal Pressure Hydrocephalus (NPH), which normally affects older people, is a brain disorder where there’s too much cerebrospinal fluid in the brain’s ventricle which causes trouble reasoning, thinking and walking, as well as loss of bladder control.  There can also be personality & behavior changes, and apathy.  Brain imaging to detect enlarged ventricles as well as MRI’s help with diagnosis.  Causes include hemorrhages, inflammation, and infections, and unknown reasons.

In this case, the patient appeared to have NPH but was rather infected with Lyme.

I know many patients who have excruciating headaches that they would describe as meningal, including myself.  The entire lining of the head hurts.  Some even receive a Chiari diagnosis as the swelling can force the brain to go through the opening of the skull.  For me the best antibiotics were those like minocycline which cross the blood/brain barrier.  I honestly wondered if I’d ever have a day without this head pain.  Good, effective treatment eradicated this but doctors are woefully unprepared.  Please contact your local Lyme support group if you have symptoms for a list of ILADS trained doctors who understand the complexity of this disease and will treat accordingly.

For more:  https://madisonarealymesupportgroup.com/2016/04/02/chiari/

https://madisonarealymesupportgroup.com/2017/06/04/minocycline-for-ms-and-much-more/

 

Category:

Inflammation, Lyme, research, Ticks

Integrated Control of Juvenile Ixodes Scapularis Parasitizing Peromyscus Leucopus in Residential Settings in Connecticut, United States

https://www.ncbi.nlm.nih.gov/m/pubmed/29859885/

Integrated control of juvenile Ixodes scapularis parasitizing Peromyscus leucopus in residential settings in Connecticut, United States.

Williams SC, et al. Ticks Tick Borne Dis. 2018.

Abstract
Lyme disease continues to be the most common vector-borne disease in the United States with an estimated 330,000 human cases annually. In the eastern United States, the blacklegged tick, Ixodes scapularis, is the primary vector of the Lyme disease spirochete, Borrelia burgdorferi, and the white-footed mouse, Peromyscus leucopus, is a primary reservoir host. In four residential neighborhoods in Connecticut over three years, we tested the effectiveness of different low-toxicity integrated tick management approaches to control larval and nymphal I. scapularis parasitizing P. leucopus.

  • Combinations of white-tailed deer, Odocoileus virginianus, reduction,
  • broadcast application of the entomopathogenic fungus Metarhizium anisopliae,
  • distribution of fipronil-based rodent-targeted bait boxes were evaluated against an
  • experimental control

Deer reduction with no other intervention likely forced juvenile I. scapularis to obtain blood meals from available reservoir hosts, resulting in increased exposure of P. leucopus to B. burgdorferi compared to control sites. The M. anisopliae/bait box and the deer reduction/M. anisopliae/bait box treatment combinations resulted in 94% and 85% reductions in larvae parasitizing P. leucopus that tested positive for B. burgdorferi, respectively, compared to control. Deer reduction alone resulted in only a 3% reduction, likely because parasitizing juvenile I. scapularis were not targeted by bait box-delivered fipronil. Unless there is community support to reduce and maintain deer at very low densities (<5 deer/km2), it is clear that a combination of M. anisopliae/fipronil-based bait boxes offers an effective, localized, low-toxicity option for reducing I. scapularis parasitizing P. leucopus without complications from host switching.

_______________

For more on successful tick reduction methods:  https://madisonarealymesupportgroup.com/2018/04/03/fire-good-news-for-tick-reduction/

https://madisonarealymesupportgroup.com/2018/06/06/mc-bugg-z/

https://madisonarealymesupportgroup.com/2017/05/11/tick-prevention-and-removal-2017/

https://madisonarealymesupportgroup.com/2018/05/27/study-conforms-permethrin-causes-ticks-to-drop-off-clothing/

 

Category:

research, Testing, Ticks, Treatment

Splenic Rupture From Babesiosis, An Emerging Concern? A Systematic Review of Current Literature

https://www.sciencedirect.com/science/article/pii/S1877959X17303333?via%3Dihub

Splenic rupture from babesiosis, an emerging concern? A systematic review of current literature

Shuo Li, Bobby Goyal, Joseph D.Cooper, Ahmed Abdelbaki, Nishant Gupta, Yogesh Kumara

Abstract
Babesiosis is a relatively common tick-borne parasitic infection of erythrocytes primarily affecting the northeastern United States. Babesiosis’ prevalence and presentation have earned it the monikers “malaria of the northeast” and “Nantucket fever”. Clinical presentation ranges from asymptomatic infection to severe infection including acute respiratory distress syndrome (ARDS) and disseminated intravascular coagulopathy (DIC) or death. Since 2008, there have been a number of reports of splenic rupture in patients with the disease. We seek to provide a further understanding of this process, with the report of a case of splenic rupture followed by a systematic review of the current literature. We found that 87% of splenic rupture secondary to babesiosis occurred in male patients who are otherwise healthy, with an average of 56 years. Computed tomography is a reliable mode of diagnosis, and hemoperitoneum is the most common imaging finding. Patients with splenic rupture due to human babesiosis were successfully treated by various management strategies, such as conservative non-operative approach, splenic artery embolization, and splenectomy. The modality of treatment depends on patient’s clinical course and hemodynamic stability, although spleen conserving strategy should be considered first whenever possible.

______________

For more:  https://madisonarealymesupportgroup.com/2016/01/16/babesia-treatment/

https://madisonarealymesupportgroup.com/2018/01/24/phase-ii-malaria-meds-100-cured-good-for-babesia/

https://madisonarealymesupportgroup.com/2016/12/05/babesia-cure-update/

https://madisonarealymesupportgroup.com/2018/06/08/two-cases-of-babesia/

https://madisonarealymesupportgroup.com/2018/02/20/babesia-and-heart-issues/

https://madisonarealymesupportgroup.com/2018/05/31/widespread-babesiosis-in-canada/

https://madisonarealymesupportgroup.com/2018/03/07/babesia-tests-approved-by-fda-for-screening-purposes/

https://madisonarealymesupportgroup.com/2017/08/08/transfusion-transmitted-babesiosis-in-nonendemic-areas/

Category:

Babesia, Uncategorized

New UVA Study Tentatively Links Ticks to Heart Disease

https://news.virginia.edu/content/new-uva-study-tentatively-links-ticks-heart-disease?utm_source=DailyReport&utm_medium=email&utm_campaign=news

NEW UVA STUDY TENTATIVELY LINKS TICKS TO HEART DISEASE

The bite of the lone star tick had previously been shown to cause an allergy to red meat. Now it is linked with an increased risk of heart disease.

June 14, 2018 Josh Barney, jdb9a@virginia.edu

University of Virginia School of Medicine researchers have linked sensitivity to an allergen in red meat – a sensitivity spread by tick bites – with a buildup of fatty plaque in the arteries of the heart. This buildup may increase the risk of heart attacks and stroke.

The bite of the lone star tick can cause people to develop an allergic reaction to red meat. However, many people who do not exhibit symptoms of the allergy are still sensitive to the allergen found in meat. UVA’s new study linked sensitivity to the allergen with the increased plaque buildup, as measured by a blood test.

The researchers emphasize that their findings are preliminary, but say further research is warranted.

tick_story_da_inline_01
The research team drew from both allergists and cardiologists, and included, from left, Dr. Thomas Platts-Mills, Dr. Coleen McNamara, Dr. Jeff Wilson and Anh Nguyen. (Photo by Dan Addison, University Communications)

“This novel finding from a small group of subjects examined at the University of Virginia raises the intriguing possibility that asymptomatic allergy to red meat may be an under-recognized factor in heart disease,” said study leader Dr. Coleen McNamara of UVA’s Robert M. Berne Cardiovascular Research Center and UVA’s Division of Cardiovascular Medicine. “These preliminary findings underscore the need for further clinical studies in larger populations from diverse geographic regions.”

Allergens and Clogged Arteries

Looking at 118 patients, the researchers determined that those sensitive to the meat allergen had 30 percent more plaque accumulation inside their arteries than those without the sensitivity. Further, a higher percentage of the plaques had features characteristic of unstable plaques that are more likely to cause heart attacks.

With the meat allergy, people become sensitized to alpha-gal, a type of sugar found in red meat. People with the symptomatic form of the allergy can develop hives, stomach upset, have trouble breathing or exhibit other symptoms three to eight hours after consuming meat from mammals. (Poultry and fish do not trigger a reaction.)

What’s it like to develop a meat allergy?   https://makingofmedicine.virginia.edu/2018/03/29/the-meat-allergy-whats-it-like/

Other people can be sensitive to alpha-gal and not develop symptoms. In fact, far more people are thought to be in this latter group. For example, up to 20 percent of people in Central Virginia and other parts of the Southeast may be sensitized to alpha-gal, but not show symptoms.

The allergy to alpha-gal was first reported in 2009 by Dr. Thomas Platts-Mills, who heads UVA’s Division of Allergy and Clinical Immunology, and his colleague Dr. Scott Commins. Since then, there have been increasing numbers of cases of the meat allergy reported across the U.S., especially as the lone star tick’s territory grows. Previously found predominantly in the Southeast, the tick has now spread west and north, all the way into Canada.

UVA’s new study suggests that doctors could develop a blood test to benefit people sensitive to the allergen.

“This work raises the possibility that in the future a blood test could help predict individuals, even those without symptoms of red meat allergy, who might benefit from avoiding red meat. However, at the moment, red meat avoidance is only indicated for those with allergic symptoms,” said researcher Dr. Jeff Wilson of UVA’s allergy division.

Findings Published

The work represents a significant collaboration between allergy and cardiology experts at UVA. The researchers have published their findings in Arteriosclerosis, Thrombosis and Vascular Biology, a journal of the American Heart Association. The research team consisted of Wilson, Anh Nguyen, Alexander Schuyler, Commins, Angela Taylor, Platts-Mills and McNamara.

The work was supported by the National Institutes of Health, grants KO8-AI085190, K23-HL093118, RO1-AI 20565, PO1-HL55798, RO1-HL136098-01 and RO1-HL107490.

MEDIA CONTACT

Josh Barney
UVA Health System
jdb9a@virginia.edu 434-243-1988

________________

For more:  https://madisonarealymesupportgroup.com/2018/05/04/arkansas-woman-develops-deadly-meat-allergy-after-tick-bite/

https://madisonarealymesupportgroup.com/2017/01/12/tick-related-red-meat-allergy-found-in-minnesota-wisconsin/

https://madisonarealymesupportgroup.com/2018/06/27/alpha-gal-perioperative-management/

https://madisonarealymesupportgroup.com/2018/01/16/a-strange-itch-trouble-breathing-then-anaphylactic-shock/

 

Category:

Activism, Alpha Gal Meat Allergy, research, Testing, Ticks, Transmission