Archive for the ‘Activism’ Category

Drexel Prof: Lyme Persists

https://newsblog.drexel.edu/2017/07/18/qa-what-happens-when-lyme-disease-is-not-treated-early/ by Lauren Ingeno July 18, 2017

Original Title: I.pacificus(F)_55sRGBBlacklegged ticks are known vectors for the bacteria Borrelia burgdorferi, which is the pathogen responsible for Lyme disease. Summer is tick season. (CDC / James Gathany)

Pennsylvania is the Lyme disease epicenter, with over 7,000 cases diagnosed in 2015.

The disease is caused by the spirochete bacteria Borrelia burgdorferi, which is carried by ticks and then transmitted to humans. When treated early, antibiotics can cure most patients. But making a diagnosis is often challenging, and chronic symptoms — such as memory problems, digestive issues and joint conditions — can linger for years, even after treatment.

Chronic Lyme is a controversial issue, dividing frustrated patients and some in the medical community who do not view their disease as a persistent infection. The Infectious Diseases Society of America, for instance, does not recommend longer courses of antibiotics even when symptoms continue.

Garth Ehrlich, PhD, a professor of microbiology and immunology at Drexel University College of Medicine, studies how chronic bacterial pathogens prevail after antibiotic therapy, and he was recently quoted in an Associated Press story about a Lehigh Valley woman who contracted the disease.

Below, he weighs in about chronic Lyme disease and why it is so hard to eliminate.

 What is the connection between your research and Lyme disease?
Lyme disease, in its persistent form, is most likely due to the bacteria forming a biofilm. I study bacterial biofilms, which are multicellular forms of bacteria, providing for increased resistance to antibiotics. If Lyme disease patients are not treated early enough or long enough, then it is possible the bacteria will form biofilms, and their acute disease will become chronic.

How is Lyme disease currently treated, and does that treatment work?
In many cases, Lyme can be treated by antibiotics, but it does not necessarily mean the disease won’t become chronic. There are many factors that contribute to the course of the disease, including the overall health and immune status of the patient, as well as the particular strain of the Lyme disease bacteria that they contract.

Why is there disagreement among the medical and scientific communities about chronic Lyme disease?
A few physicians involved in characterizing the disease in the early stages of its recognition staked their reputations on the fact that it only had an acute phase. But the bacteria that causes Lyme is a spirochete, and spirochetes are primarily associated with chronic infections, like gum disease and syphilis.

How is Lyme disease diagnosed? What are the challenges?
There is a huge problem with diagnosing it, and there are many reasons why it is difficult. There are two stages for the standard testing: an ELISA (enzyme-linked immunosorbent assay) is used to detect antibodies against B. burgdorferi proteins and a Western blot (used to separate and identify specific antibody proteins), which is more specific and used for confirmation of the ELISA.

Scientists are working to develop DNA-based tests, but they are not widely available yet, and they won’t be perfect. The problem with both types of testing is that there is enormous variability among the bacterial strains that cause the disease. Thus, an assay based on one strain might very well miss variant strains. And different individuals mount more or less of an immune response to the infection. If the infection becomes focal, then you might not be able to detect it with a DNA blood test.

What do we need to do to better combat Lyme disease?
The most important thing is to develop better diagnostics. And the next most important thing is better therapeutics. My lab is trying to develop drugs against biofilm bacteria.

For media inquiries, contact Lauren Ingeno at lingeno@drexel.edu or 215.895.2614.

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**Comment**

Fantastic article revealing Oz behind the curtain:  biofilms.

I appreciate the careful wording about treating early – that it can cure most patients; however, the caveat is that treatment has to be early enough AND long enough.  I would add, and smart enough.  https://madisonarealymesupportgroup.com/2016/02/13/lyme-disease-treatment/

That said, there is an elephant in the room.  Since Eva Sapi discovered in vitro that doxycycline throws the spirochete into the cyst form, is it hiding out to reemerge later?  Many think so, and believe Lyme can be contributing to dementia and Alzheimer’s which means treatment should also include not only something that addresses biofilms, but something that addresses the non-cell wall form (even in acute cases).  For more:  https://madisonarealymesupportgroup.com/2016/06/03/borrelia-hiding-in-worms-causing-chronic-brain-diseases/

https://madisonarealymesupportgroup.com/2016/08/09/dr-paul-duray-research-fellowship-foundation-some-great-research-being-done-on-lyme-disease/

https://madisonarealymesupportgroup.com/2017/06/10/the-coming-pandemic-of-lyme-dementia/

The other elephant standing by the first is the prevalence of coinfections.  Research is absent on the compounding factors of coinfections.  For more:

https://madisonarealymesupportgroup.com/2017/05/01/co-infection-of-ticks-the-rule-rather-than-the-exception/

https://madisonarealymesupportgroup.com/2017/07/01/one-tick-bite-could-put-you-at-risk-for-at-least-6-different-diseases/

 

Of Birds and Ticks

http://mainepublic.org/post/battle-against-ticks-and-lyme-disease-scientists-look-skies#stream/0

In the Battle Against Ticks and Lyme Disease, Scientists Look to the Skies

 • JUL 3, 2017

As we head into the Maine outdoors this summer, the all-too-familiar warnings about how to avoid ticks reverberate in many of our heads.

Stay on the trail. Steer clear of wooded and brushy areas where ticks congregate.

But while most of us take pains to dodge the eight-legged pests, Chuck Lubelczyk heads straight for them.

As a field biologist at the Maine Medical Center Research Institute’s Lyme and Vector-Borne Disease Laboratory, he studies the spread of diseases carried by ticks, as well as by mosquitoes. That means venturing out into the fields, forests and coastlines of Maine to collect the bugs and evaluate where they pose the most risk to humans.

On a recent June day, Lubelczyk trudged into the greenery of the Wells Reserve, a 2,250-acre spread in York County headquartered at a restored saltwater farm. He partnered with researchers from the Biodiversity Research Institute in Portland to collect ticks from creatures less often associated with them: birds.

The team, assisted by several interns, set up wide nets to ensnare the birds as they flew through the area. They then delicately extricated them, tucked the birds into breathable collection bags, and toted them to a shady picnic table for easier handling. Using tweezers, the team plucked off each tick — typically feasting around the birds’ eyes, bills, and throats — and preserved the bugs for later testing at the lab.

Lubelczyk held up a vial containing at least 50 tiny nymphal deer ticks swirling in a preservative solution. They’d been tweezed off a single bird, a towhee, that morning.

Once free of ticks, the birds were then safely released to continue on their way.

https://bangordailynews.com/video/ticks-on-migratory-birds/ (Video here)

While mice, chipmunks and deer get most of the attention as hosts for ticks, “Not a lot of people talk about the bird issue,” he said. “They’re understudied in a big way, I think. They do have a real role to play.”

Ticks are an annoyance to birds, but they don’t transmit disease to them or slowly and lethally drain them of blood, as researchers have seen among moose calves in Maine. But birds facilitate the spread of ticks, picking them up in Maryland, Connecticut and other eastern states as they fly north in the spring, Lubelczyk explained.

“As they’re migrating, they’re either dropping the ticks off as they fly or when they land. They’re kind of seeding them along migration patterns.”

Emerging diseases

By tracking the birds and the ticks they carry, researchers hope to predict where Lyme and other tick-borne diseases are most likely to accelerate. Lyme is now present in every county in the state, after hitting a record of 1,488 cases in 2016, but ticks are just getting established in areas such as Aroostook and Washington counties, Lubelczyk said.

Along with Lyme, Lubelczyk tested the ticks for other two other emerging diseases, anaplasmosis and the rare but potentially devastating Powassan virus. Powassan, carried by both the deer tick and the groundhog or woodchuck tick, recently sickened two people in midcoast Maine, following the death in 2013 of a Rockland-area woman.

A recent survey Lubelczyk led found the virus in ticks crawling around southern Maine, Augusta and on Swan’s Island in Hancock County.

In the modest Scarborough lab, medical entomologist Rebecca Robich furthered the findings of that survey. Clad in a white coat and blue gloves, she cloned a tiny band of the Powassan virus’ inactivated RNA, using a sample derived from the ticks that tested positive in the survey. Robich began the work, designed to confirm the earlier test results, last winter.

She expects to know conclusively within the next month what percentage of the sampled ticks were infected with Powassan, she said.

“We’re this close to finishing,” Robich said.

Growing exposure

Ticks have become so prevalent in Maine that Lubelcyzk and his colleagues are increasingly called upon to educate the public about the health risks the arachnids pose. That includes speaking at community forums, town meetings, garden clubs and even to groups of employees.

“They’re widespread enough now that DOT, CMP, people like that are bumping into them on a regular basis,” he said. “Even people like law enforcement. The warden service, regular police with police dogs, they’re exposed.”

Their outreach also includes plenty of phone calls to the lab, fielded by its small staff of four, not counting summer interns.

“If somebody calls, we never really turn them down,” he said.

Many people don’t realize that the lab no longer identifies ticks for the public, Lubelczyk said. Now located in Scarborough along with MMC’s medical and psychiatric research centers, the lab formerly operated in South Portland, where it identified a tick’s species for anyone who walked in the door or mailed a sample. The University of Maine Cooperative Extension in Orono has since taken over that service (it does not test ticks for disease).

“It’s very hard to say no to someone when they’re really frantic because they found a tick on themselves, or their child, or even their pet,” he said. “And they’re sitting out in the parking lot.”

So far this season, the lab has fielded numerous calls from worried residents only to discover after viewing a photograph that the tick in question is a dog tick, not a deer tick. Maine is home to 15 species of ticks, and the dog tick is not among those that transmit disease to humans, at least in this region.

Through its outreach work, the lab has also found itself at the center of debates about how to manage ticks. Lubelczyk recalled a town forum on Long Island a couple of years ago that grew tense as residents discussed the use of pesticides.

“As soon as the topic of any kind of spray was brought up, not even by us, by somebody else, the fishing community was dead set against it,” he said. “Understandably, they’re worried about the stock. It really makes that difficult because you start to have divisions in how to control the ticks.”

The lab’s research on the role of birds in spreading tick-borne disease is similarly delicate, because many birds are under threat ecologically, Lubelczyk said.

“No one really cares if you try to target mice. Birds are federally protected in a lot of cases,” he said.

That other biting pest

Educating the public represents a large part of the lab’s mission but only a small part of its budget. Its outreach work is funded largely through small grants from foundations, Lubelczyk said.

Most of its research funding is targeted toward mosquitoes rather than ticks, boosted by the federal government’s initiative to combat the Zika virus, he said. While Zika hasn’t appeared in Maine, warming temperatures due to future climate change could make the state habitable for one of the mosquito species that carries it.

Lubelczyk explained this as he stood in the lab’s testing area, next to a large freezer storing petri dishes packed with frozen mosquitoes. A piece of yellow tape affixed to the door warned, “Not for food.”

While Lyme is far more prevalent, diseases carried by mosquitoes, such as West Nile virus and Eastern Equine Encephalitis, can lead to more acute illness. Both can cause inflammation of the brain and other serious complications.

Funding for tick research is generally less reliable, Lubelczyk said. The recent Powassan survey, for example, was funded by the Maine Outdoor Heritage Fund, which collects money through the sale of instant scratch lottery tickets.

A continuing threat

The lab’s role in helping to prevent tick-borne diseases has only grown as the tick population and the diseases they carry spread. The incidence of Lyme in Maine is among the highest rates in the country, averaging 82.5 cases per 100,000 people between 2013 and 2015.

Anaplasmosis and babesiosis are less common but becoming increasingly worrisome.

Lubelczyk understands the illnesses on both a professional and personal level. He contracted Lyme several years ago, after a deer tick latched onto him while he made a pitstop on the way home from work one steamy July day, he said. He had just changed into shorts and sandals and jumped out of his car for 30 seconds to hang a mosquito trap in Wells, he recalled.

A day and a half later, he spotted the tick bite. After a round of antibiotics, he recovered, Lubelczyk said.

His usual garb for field work includes long sleeves and pants treated with permethrin, along with gaiters over his boots.

“It’s embarrassing,” he said, wincing. “We always talk about wearing appropriate clothing.”

_____________________

**Comment**

I’m thankful someone is dealing with the bird issue in relation to tick propagation as I believe it will be found to be much more of an issue than previously thought.  It would help explain why folks insist they’ve been infected while near trees as birds would drop them onto trees (as well as various rodents).  Like deer, birds serve primarily as transits that can spread ticks far and wide.

While Lubelczyk doesn’t feel dog ticks are important carriers (at least in his area) – he’s mistaken.  Every tick should be suspect until proven otherwise.  Think about it:  they all exchange bodily fluids with their hosts.  Dog ticks are known to carry Tularemia, https://www.cdc.gov/ticks/diseases/index.html Rocky Mountain Spotted Fever, Ehrlichia, Mediterranean Spotted Fever, Babesia in dogs (which should also make it suspect for humans), and potentially Bartonella.  http://labs.russell.wisc.edu/wisconsin-ticks/rhipicephalus-sangineus/  No, it would not be wise to think of the Dog Tick in friendly terms.  Remember that ticks are moving all over the place defying commonly held beliefs about geography.  And while folks fighting for research grants want to promote and blame the supposed “global warming” mentioned in this article, there are many who disagree for good reasons:  https://madisonarealymesupportgroup.com/2017/07/08/global-warming-numbers-fudged/

https://madisonarealymesupportgroup.com/2017/08/14/canadian-tick-expert-climate-change-is-not-behind-lyme-disease/  John explains, “The climate change range expansion model is what the authorities have been using to rationalize how they have done nothing for more than thirty years. It’s a huge cover-up scheme that goes back to the 1980’s. The grandiose scheme was a nefarious plot to let doctors off the hook from having to deal with this debilitating disease. I caught onto it very quickly. Most people have been victims of it ever since.”
“This climate change ‘theory’ is all part of a well-planned scheme. Even the ticks are smarter than the people who’ve concocted this thing,” he says.
“Climate change has nothing to do with tick movement. Blacklegged ticks are ecoadaptive, and tolerate wide temperature fluctuations. On hot summer days, these ticks descend into the cool, moist leaf litter and rehydrate. In winter, they descend into the leaf litter, and are comfortable under an insulating blanket of snow. Ticks have antifreeze-like compounds in their bodies, and can tolerate a wide range of temperatures. For instance, at Kenora, Ontario, the air temperature peaks at 36°C and dips to –44°C, and blacklegged ticks survive successfully.

Also, please note that although there has only been one Zika death in an elderly man with a preexisting health condition in the continental U.S., all the funding is going to it and mosquito research.  This is causing untold harm here where Lyme is causing around 400,000 new cases per year.  There is no official tally on all the other coinfections that often come with Lyme as they aren’t even reportable in many states but are a crucial detail in understanding the complexity of Lyme/MSIDS.  People are often infected with numerous pathogens.  https://madisonarealymesupportgroup.com/2017/07/01/one-tick-bite-could-put-you-at-risk-for-at-least-6-different-diseases/

To treat this complex as a one organism/one disease would be folly.  

Also, he claims that West Nile virus and Eastern Equine Encephalitis, can lead to more acute illness, I would disagree again.  Lyme (borrelia), Babesia, Bartonella, Mycoplasma, and numerous other viruses, and funguses have killed people outright.  Heart block, encephalitis, meningitis, and other serious illnesses are caused by TBI’s. Powassan can be transmitted in under 15 minutes and can kill. Rocky Mountain Spotted Fever is another killer.  There is much to show that if the non-cell wall and biofilm formation of borrelia isn’t successfully dealt with, it could lead to dementia or Alzheimer’s in the future:  https://madisonarealymesupportgroup.com/2017/06/10/the-coming-pandemic-of-lyme-dementia/, https://madisonarealymesupportgroup.com/2016/06/03/borrelia-hiding-in-worms-causing-chronic-brain-diseases/, https://madisonarealymesupportgroup.com/2016/08/09/dr-paul-duray-research-fellowship-foundation-some-great-research-being-done-on-lyme-disease/, https://madisonarealymesupportgroup.com/2016/06/09/alzheimers-byproduct-of-infection/, https://madisonarealymesupportgroup.com/2017/01/18/a-bug-for-alzheimers/

And of course, while many cases of Lyme (borrelia) don’t kill immediately, it can make you want to die and disrupt life in such a way people commit suicide.  https://madisonarealymesupportgroup.com/2017/06/20/suicide-lyme-and-associated-diseases/, https://madisonarealymesupportgroup.com/2017/07/26/can-lyme-steal-your-mind/

If that isn’t serious, I don’t know what is.  We need to completely kill the idea that Lyme/MSIDS isn’t a severe disease(s).

 

 

 

Reliability of Lyme Testing

 Contagion Live

Published on Aug 8, 2017

Robert C. Bransfield, MD, DLFAPA; Peter L. Salgo, MD; Samuel Shor, MD, FACP; and Leonard Sigal, MD, explain the 2-tiered Lyme disease testing system, and debate the reliability of using certain laboratory tests to confirm a diagnosis.

 

Excellent article on Lyme testing:  https://www.lymedisease.org/lyme-basics/lyme-disease/diagnosis/

 

Challenges in Diagnosing Lyme Disease

 Contagion Live

Published on Aug 10, 2017

Panelists Peter L. Salgo, MD; Patricia V. Smith; Robert C. Bransfield, MD, DLFAPA; Samuel Shor, MD, FACP; and Leonard Sigal, MD, provide insight regarding geographic considerations, the key criteria for evaluating multi-systemic manifestations, and making a Lyme disease diagnosis.

Emerging Lyme Tests

http://www.contagionlive.com/peer-exchange/lyme-disease-exploring-the-impact-and-controversey/emerging-tests-for-lyme-disease?sp=&sthash.ROBeS4FW.mjjo

Emerging Tests for Lyme Disease

AUG 14, 2017 | PANELISTS: PETER L. SALGO, MD; ROBERT C. BRANSFIELD, MD, DLFAPA; SAMUEL SHOR, MD, FACP; LEONARD SIGAL, MD; PATRICIA V. SMITH
**Comment**
Favorite statement:  “They want to stick with a 2-tier, antiquated test that, again, is probably missing at least 50% of our patients. So, for a lot of what we’re talking about, in reality, we’re not going to accomplish it unless the CDC moves off the dime.”
Transcript:
Peter L. Salgo, MD: My concern as a clinician is that, when you start describing everything as a potential consequence of a particular disease, now you’ve taken away diagnostic specificity, right? If everything can be caused by it, I don’t know what to make of that.

Robert C. Bransfield, MD, DLFAPA: It can be specific patterns. There are only 3 specific symptoms: the expanding erythema-migrans rash, acrodermatitis chronica atrophicans (ACA) rashes, and ACA deterioration, which you rarely see; I’ve seen it a half-dozen times. The skin gets paper thin in the wrists and the ankles. And Hyperacusis, which is that loud noises can cause nausea, sometimes vomiting, and dizziness, you only see [this] with syphilis and Lyme disease; those are the only 3 truly specific things. Here’s the problem. Diseases that are easy to find, we’ve already figured them out. What we’re left with are the things that have multiple contributors, multiple pathophysiologic pathways, and multiple manifestations. So, 2 new patients end up with exactly the same symptoms. We have to have a different disease model for complex diseases that is different than what we’re used to having, where the disease is a simple clear thing that you can diagnose with one process. We have to think of the statistical probability of symptoms and pattern recognition. It takes a more complicated way of adding all this together.

Leonard Sigal, MD: And you’re not talking about actually making a calculation of statistical likelihood. This is all that is going on in your brain.

Robert C. Bransfield, MD, DLFAPA: Right.

Leonard Sigal, MD: Right?

Samuel Shor, MD, FACP: That’s the art of medicine.

Peter L. Salgo, MD: Are there other tests that we could do? We’ve got the ELISA test. We’ve got these other 2 tests. What else is out there that can help you nail this?

Samuel Shor, MD, FACP: We’re involved in the study of 2 tests that are very promising. One is called the Nanotrap, which looks at a highly specific protein called OspA that is found across multiple strains of Borrelia. And what this technology does is super concentrate, in a urine sample, the presence of this protein and then further tests it, and, it’s 1000-fold more sensitive than the standard Western Blot. In our 2015 paper that was published in the Journal of Translational Medicine, in the preliminary erythema-migrans patients—who are very often negative in the ELISA test because they haven’t had the time to respond immunologically—24 out of 24 were positive with the Nanotrap test.

Peter L. Salgo, MD: Let me play the devil’s advocate and say that when you make a test sufficiently sensitive, it may become insufficiently diagnostic. That is, everybody turns positive.

Samuel Shor, MD, FACP: No, it’s highly specific.

Peter L. Salgo, MD: Tell me about it.

Samuel Shor, MD, FACP: It’s highly specific, and as far as the authors of this study feel, the false positivity is very low.

Peter L. Salgo, MD: But does that mean that you’ve been exposed or that you’re actively infected?

Samuel Shor, MD, FACP: It’s an antigen, so you’re actively infected. There are studies to show that an infection should be cleared and no antigen should be present within 72 hours of that infection being cleared by the body.

Peter L. Salgo, MD: So, the obvious question that comes to mind is, if somebody who’s positive by that study is given appropriate antibiotics, improves clinically, does that study then become negative?

Samuel Shor, MD, FACP: Yes, it has. And, in fact, I provided the test to 100 patients with chronic disease, 42% of whom were positive, and 1 of whom was an MS patient who was symptomatic when she was first studied and asymptomatic when she was subsequently studied. She was positive initially and negative afterwards.

Peter L. Salgo, MD: All this suggests that patients with ongoing Lyme disease-related issues—and I’m being very careful with the syntax—often wind up with a lot of different doctors, a lot of different clinical situations. The provider path here is an issue.

Leonard Sigal, MD: Can we just return to testing here for a moment? Because that is a fascinating new technology. There is a polymerase chain reaction that’s available. It’s not often used, and it shouldn’t be used. It’s a research tool, but it’s not the sort of thing that the average clinician should be ordering. There was a technology that the late Michael Brunner and I worked on back at Robert Wood Johnson University looking for immune complexes. An immune complex can only be formed if there’s an antigen and antibodies against it. So, we concentrated on immune complexes, broke them up, and then looked for an antigen, OspA, as well as an antibody against Borrelia burgdorferi. We found it to be a remarkably useful tool in diagnosing people who had active infection, some of whom were seronegative, and people who had been treated and were now asymptomatic, because they had been treated appropriately and gotten rid of the Borrelia. The problem is that it’s a tedious sort of technology: very useful, but not easily done. And so, that’s what we’re looking [at] for now: a technology that’s sensitive and specific, which is a very difficult balance to manage, and a technology that can be ramped up to make it a commercial tool.

Samuel Shor, MD, FACP: We are actively involved in the FDA approval of erythema-migrans patients, to the goal of having a CLIA-waived in-office test with that technology. We have to keep in mind we’re 24 months away from that, but that’s the goal.

Peter L. Salgo, MD: Wouldn’t that be great. We wouldn’t be having this broadcast if we had the Lyme disease test.

Leonard Sigal, MD: Yes, we would.

Peter L. Salgo, MD: We’d have a different broadcast.

Leonard Sigal, MD: There are other things we could talk about.

Patricia V. Smith: I’d like to address this issue because it’s frustrating sitting here. I’ve been involved in this setting for 33 years, and I look at what has happened. You can all talk about these tests, and I certainly was going to bring up what Dr. Sigal mentioned because we had funded Dr. Schutzer at UMDNJ, who initially looked at those immune complexes. He actually proposed that test to the CDC, and they didn’t want to hear about it.

Peter L. Salgo, MD: Why?

Patricia V. Smith: Well, that’s a good question. What I’m saying to you is that the CDC is very reluctant to move on to new technology. I’ve been invited out there, twice, to Fort Collins. We’ve brought it up as advocates. The physicians have brought it up; researchers have brought it up. They want to stick with a 2-tier, antiquated test that, again, is probably missing at least 50% of our patients. So, for a lot of what we’re talking about, in reality, we’re not going to accomplish it unless the CDC moves off the dime.

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