Archive for the ‘Anaplasmosis’ Category

Mapping Tick-borne Disease Risk in Wisconsin

https://www.sph.umn.edu/news/mapping-tick-borne-disease-risk-in-wisconsin/

A deer tick on a leaf.

Mapping tick-borne disease risk in Wisconsin

PhD student Austin Rau analyzed the cases of three serious — but lesser-known — tick-borne diseases in Wisconsin and found that they are increasing, moving, and varying over time across the state.

CHARLIE PLAIN | SEPTEMBER 22, 2020

Lyme disease is easily the most well-known type of tick-borne infection, but there are others that make people sick as well. Recently, a new study from the School of Public Health analyzed the cases of three other serious — but lesser-known — tick-borne diseases in Wisconsin and found that they are increasing, moving, and varying over time.

Austin Rau smiling in front of a tree.
Study lead author and PhD student Austin Rau

“Compared to Lyme disease, less research has been completed on non-Lyme tick-borne infections and awareness of these diseases is lower,” says lead author and PhD student Austin Rau. “If you ask most people, they couldn’t name what the second most-common tick-borne disease is.”

The study was published in The International Journal of Environmental Research and Public Health and was co-authored by SPH Assistant Professors Jesse Berman and Jonathan Oliver and Associate Professor Claudia Muñoz-Zanzi.

For the study, Rau and his team examined patient data from the Marshfield Clinic Healthcare System, which serves north and central Wisconsin. They analyzed patient electronic medical records for the period of 2000-2016 for clinic laboratory results confirming or supporting cases of three non-Lyme diseases from ticks: anaplasmosis, babesiosis, and ehrlichiosis. All three diseases are bacterial or parasitic infections from the bite of deer ticks and can be difficult to diagnose. In most cases, the infections produce on-going flu-like symptoms. 

Rau used his specialized training in geographical information systems and spatial analysis to map where the nearly 3,000 patients diagnosed with the diseases lived in order to determine the risk of having a positive laboratory test result in those areas.

Anaplasmosis

  • 2,728 cases of anaplasmosis were identified. 
  • People in northern Wisconsin were at greatest risk for having a positive laboratory test result.
  • The risk area for anaplasmosis shifted from west to east the study years.
  • The years of greatest risk were 2010-2016.
  • June to August were found to be peak months for positive laboratory test results, with a five times greater risk compared to other months.

Babesiosis

  • 213 cases of babesiosis were identified.
  • People in northwest Wisconsin were at greatest risk for having a positive laboratory test result.
  • The area of greatest risk was in the southern part of the clinic’s territory at the start of the study period before shifting north and then west over time.
  • The years of greatest risk were 2011-2013.
  • July to August were peak months for positive laboratory test results, raising the risk for babesiosis by seven times compared to other months.

Ehrlichiosis

  • Only 15 cases of ehrlichiosis were identified.
  • The number of cases were too small to determine any significant trends.

“It’s interesting to see that the two diseases — anaplasmosis and babesiosis — had differentgeographic patterns of risk — why is that,” asks Rau. “It could be due to a difference in infection prevalence among the ticks for these two diseases. It could also be because of the movement of ticks and animals they attach onto, such as white-tailed deer.”

According to the researchers, the behaviors of people likely are an important factor as well, and activities, such as hiking and hunting, could increase their risk of being infected by a tick.

Rau says the study’s methods and findings can help healthcare providers in Wisconsin and other regions where ticks live to determine potential hot spots and better prepare for tick season.

“It’s helpful for physicians and public health workers to know the months and geographic areas that pose the highest risk so that they can expect and be on the lookout for cases,” says Rau. “It’s also good for people to know when and where their risk of possible infection is higher so they can take appropriate measures to prevent tick bites.”

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**Comment**

Updates:

Warmer temperatures mean that adult deer ticks are now active. Be sure to start tick checks whenever you have been outside.

https://www.wiscontext.org/encountering-backyard-bloodsuckers-tick-app-tracks

**Warning** There are a number of inaccuracies within the article.

Excerpt:

With peak tick season imminent in the upper Midwest, researchers at the University of Wisconsin-Madison are hopeful more people will download and use a free smartphone app that helps track and identify the tiny blood-sucking arachnids.

The Tick App launched in Wisconsin in time for the 2018 tick season, and more than 600 people in the state have downloaded it so far. The app is part of a behavioral study being carried out by researchers at UW-Madison and Columbia University in New York who are seeking to better understand where and how people encounter ticks. They’re particularly interested in finding out what activities people are doing (and where they’re doing them) when they encounter black-legged (or deer) ticks (Ixodes scapularis), which often carry the bacterium that causes Lyme disease.

About 20-30% of deer ticks can be infected with Borrelia burgdorferi, the disease-causing bacterium, explained Lyric Bartholomay, who studies diseases in ticks and other invertebrates in the Department of Pathobiological Sciences at the UW-Madison School of Veterinary Medicine. Bartholomay spoke about the Tick App and tick-borne diseases during a May 29, 2019 interview on Wisconsin Public Radio’s The Morning Show.

For more on Wisconsin ticks.

10 Top Causes of Symptoms in Chronic Lyme Disease

https://www.prohealth.com/library/ten-common-causes-of-symptoms-in-chronic-lyme-disease-8558

10 Top Causes Of Symptoms In Chronic Lyme Disease

(Please see link above for full article.  Excerpts below)

1) Mold toxicity

Real Time labs is among the most accurate of labs for mold testing. Effective mold toxin binders include the medication cholestyramine and activated charcoal.

2) Parasitic Infections

Parasitic infections are often not detectable on conventional lab tests, and may not even show up in sophisticated stool tests; therefore, using multiple forms of testing to detect parasites, such as electrodermal screening tools such as the Zyto or muscle testing, is important, along with lab testing with reputable labs such as Doctors’ Data.

3) Hormone and Neurotransmitter Imbalances

Replenishing the body’s stores of these chemicals can therefore profoundly support the healing process and Lyme doctors will commonly prescribe bio-identical hormones such as pregnenolone, DHEA and thyroid hormone to their patients, along with amino acids such as L-tyrosine, GABA and 5-HTP, which the body uses to make neurotransmitters. To make these amino acids work in the body, supplemental co-factors such as P5P, SAMe, and methyl B-12 are also sometimes important.

4) Vitamin and Mineral Deficiencies

Common deficiencies include magnesium, Vitamins D, C and B-vitamins; zinc and iron—among others. Supplementation with these nutrients can help to support the body during healing. (For more information on common nutritional deficiencies in Lyme disease and supplements that support the body, I encourage you to check out my 2012 book Beyond Lyme Disease).

5) Inflammation

Reducing inflammation involves mitigating all of its causes, such as removing pathogens and toxins from the body, and downregulating the immune response with nutrients and tools such as low-dose immunotherapy. High-quality, natural anti-inflammatory substances such as curcumin may also be helpful for supporting the body’s inflammatory response.

6) Mitochondrial Dysfunction

Supporting the mitochondria with supplements such as L-carnitine and CO Q-10 can help to mitigate fatigue and other symptoms related to mitochondrial dysfunction.

7) Emotional Trauma

Many studies have proven that trauma suppresses immune function and when prolonged, can open the door to chronic health challenges.

8) A Poor Diet

Removing allergenic foods and consuming fresh, organic “real” food, such as non-GMO, antibiotic, pesticide, and hormone-free meats, poultry, eggs, and other proteins; non-starchy veggies and low-glycemic fruits, along with healthy fats such as olive and coconut oil, can help to alleviate symptoms caused by food.

9) Poor Gastrointestinal Function

Supplementing with GI nutrients such as hydrochloric acid, digestive enzymes and probiotics may help to support gastrointestinal function in those with Lyme.

10) Environmental Toxicity

Sauna therapy, rebounding, coffee enemas, liver cleanses, and taking toxin binders such as zeolite, chlorella, EDTA, activated charcoal—among others, are just a few ways to remove toxins from the body.  Ideally, you’ll want to work with a practitioner who can test your body for toxins and prescribe a regimen in conjunction with Lyme disease treatment based on your needs. The same holds for the other causes of symptoms described here.

This article was first published on ProHealth.com on April 26, 2016 and was updated on September 22, 2020.


Connie Strasheim is the author of multiple wellness books, including three on Lyme disease. She is also a medical copywriter, editor and healing prayer minister. Her passion is to help people with complex chronic illnesses find freedom from disease and soul-spirit sickness using whole body medicine and prayer, and she collaborates with some of the world’s best integrative doctors to do this. In addition to Lyme disease, Connie’s books focus on cancer, nutrition, detoxification and spiritual healing. You can learn more about her work at: ConnieStrasheim.

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**Comment**

Not mentioned is Lyme itself, and the many other potential players.  While parasites apart from Lyme is mentioned, dealing with the infections is paramount.  Of course these infections are indirectly affected by the things listed in the helpful article, but never underestimate the infection(s) themselves.  Good, effective, savvy treatment is required.

For more:

What Are Lyme Disease Co-Infections?

https://danielcameronmd.com/lyme-disease-co-infections/

WHAT ARE LYME DISEASE CO-INFECTIONS?

lyme disease co-infections

When Lyme disease was first discovered in 1975, it was the only known tick-borne illness recognized by clinicians. The disease, which is caused by an infection with the bacterium Borrelia burgdorferi, is transmitted through the bite of a black-legged (I. scapularis) tick.

Today, ticks harbor multiple infectious pathogens that can be transmitted to humans through a tick bite or tainted blood transfusion. The Centers for Disease Control and Prevention (CDC) now reports that “a single tick can transmit multiple pathogens, including bacteria, viruses, and parasites.” [1] This can result in patients developing what is referred to as Lyme disease “co-infections.”

In fact, between 2004 and 2016, the CDC identified 7 new tick-borne microbes capable of infecting humans. [1]

While most Lyme disease co-infections are acquired through the bite of an infected tick, several can be transmitted through contaminated blood transfusions. One investigation concluded, “Aside from a Babesia infection, Anaplasma is the most frequent transfusion-transmitted [tick-borne agent] with rapidly increasing clinical cases.” [2]

Ticks harbor multiple pathogens

According to a study in Suffolk County, Long Island, more than half (67%) of the ticks collected were harboring at least one pathogen. The causative agent of Lyme disease, Borrelia burgdorferi was the most prevalent (57% in adults; 27% in nymphs), followed by Babesia microti (14% in adults; 15% in nymphs).

Another study indicates that “co-infection occurs in up to 28% of black-legged ticks” in Lyme endemic areas of the United States.

Furthermore, researchers found that among infected ticks collected, 45% were co-infected and carried up to 5 different pathogens. The most prevalent co-infections included Bartonella henselae (17.6%) and Rickettsia of the spotted fever group (16.8%).

Lyme disease with co-infections

Researchers from Columbia University, Tufts Medical Center, and Yale School of Medicine examined the extent of co-infections in patients diagnosed with Lyme disease. Their findings are alarming.

  • 40% of Lyme disease patients had concurrent Babesia
  • 1 in 3 patients with Babesia had concurrent Anaplasmosis
  • Two-thirds of patients with Babesiosis experienced concurrent Lyme disease and one-third experienced concurrent Anaplasmosis

Recognizing and treating co-infections

As tick populations explode and expand into new geographic regions and cases of Lyme disease continue to soar, there is growing and warranted concern surrounding the medical communities’ ability to recognize, diagnose, and treat Lyme disease co-infections.

Sanchez-Vicente points out that nearly 1 in 4 black-legged ticks tested in their study had multiple infections. This finding “justifies the modification of the clinical approach to tick-borne diseases to cover all infection possibilities.”

Unfortunately, testing for co-infections rarely occurs. One study found that out of nearly 3 million specimens, only 17% were tested for non-Lyme tick-borne diseases.

Yet, an accurate diagnosis is critical, given that patients may require different treatment depending upon the type of co-infection. For instance, antibiotics prescribed for Lyme disease may be ineffective in treating parasitic or viral tick-borne diseases such as Babesia.

Most common co-infections

Lyme disease is the most common tick-borne illness in the United States. But it’s no longer the only threat. Lyme disease co-infections are becoming the norm, not the exception. The most frequently diagnosed tick-borne co-infections include Babesia, Anaplasmosis, Ehrlichia, Bartonella, Southern Tick-Associated Rash Illness (STARI), and Borrelia miyamotoi.

BABESIA

Babesia is a parasite that infects red blood cells. This parasitic infection is usually transmitted by a tick bite but can be acquired through a contaminated blood transfusion. There have also been reports of congenital transmission of Babesiosis, although rare.

Saetre describes two cases of infants with congenital babesiosis born to mothers with prepartum Lyme disease and subclinical Babesia microti infection. [3] Additionally, congenital transmission has been described in 7 previous cases, in which the infants presented with fever, anemia, and thrombocytopenia. [3]

Read more: Transfusion-transmitted Babesiosis popping up in more states in USA

Most cases of Babesia involve the strains: Babesia microti and Babesia duncani.

Symptoms typically include irregular fevers, chills, sweats, lethargy, headaches, nausea, body aches, fatigue, and in some cases, shortness of breath. But manifestations can vary.

A case series published in the Nurse Practitioner Journal demonstrates the difficulty in diagnosing the disease, as it can cause a wide range of clinical presentations.

Babesia and Lyme disease

Babesia is often present with Lyme disease and can increase the severity of Lyme disease. One study found patients co-infected with Lyme disease and Babesia experienced fatigue, headache, sweats, chills, anorexia, emotional lability, nausea, conjunctivitis, and splenomegaly more frequently than those with Lyme disease alone.

Listen to PODCAST: Delayed onset of Babesia in a Lyme disease patient

Babesia can also increase the duration of illness with Lyme disease. One study found that 50% of co-infected patients were symptomatic for 3 months or longer, compared to only 4% of patients who had Lyme disease alone.

Testing and treatment

Babesia can also be difficult to diagnose with current testing. The parasite was detected microscopically in as few as one-third of patients with Babesia. Specific amplifiable DNA and IgM antibody were more likely to be positive.

The reliability of tests for Babesia in actual practice remains to be determined.

Babesia is treated with a combination of anti-malaria medications and antibiotics such as Atovaquone with azithromycin.

EHRLICHIA

Ehrlichia is a tick-borne bacteria that infects white blood cells, but it has been found in spleen, lymph node, and kidney tissue samples. An infection with Ehrlichia can lead to Ehrlichiosis.

The infection is caused by Ehrlichia chaffeensis and Ehrlichia chagrins. The bacteria is transmitted by the Lone Star tick (Amblyomma americanum) and the black-legged tick (Ixodes scapularis).

Ehrlichia is typically transmitted by a tick bite. Only rarely, has the infection been associated with blood transfusion or organ transplant cases. According to the CDC, there have been two confirmed instances of infection occurring after kidney transplants from a common donor.

Symptoms and Treatment

Symptoms may include fatigue, fevers, headaches, and muscle aches. It can be treated with antibiotics doxycycline, minocycline, and Rifampin.

If left untreated, the disease can become severe and require hospitalization.

ANAPLASMOSIS

Anaplasmosis was previously known as Human Granulocytic Ehrlichiosis or HGE. The disease can be difficult to distinguish from Ehrlichiosis, Lyme disease, and other tick-borne illnesses.

This emerging infectious disease remains under-recognized in many areas of the United States. [4] It is caused by the bacteria Anaplasma phagocytophilum.

Anaplasmosis is spread by tick bites from the black-legged tick and western black-legged tick. Although it is reportedly rare, anaplasmosis has been transmitted through contaminated blood transfusions.

In fact, Mohan and Leiby contend that aside from a Babesia infection, “Anaplasma is the most frequent transfusion-transmitted [tick-borne agent] with rapidly increasing clinical cases.” [2]

In general, most infections with anaplasmosis are mild, “however, up to 36% of patients require hospitalization, with 3% of those having life-threatening complications.” [5]

Symptoms may include headaches, fevers, chills, malaise, and muscle aches. There have been a few reported cases describing pulmonary complications, as well. In fact, one study recommends that “anaplasmosis be included in the differential diagnosis for atypical respiratory presentations.” [5]

And although uncommon, there have been patients with anaplasmosis who did not exhibit any symptoms (asymptomatic). “It is, therefore, crucial for clinicians to be aware of potential asymptomatic anaplasmosis following a tick bite,” writes Yoo and colleagues. [6]

Anaplasmosis can be treated with antibiotics such as doxycycline, minocycline, and Rifampin.

BARTONELLA

Various Bartonella species have been found in black-legged ticks in northern New Jersey and in western black-legged ticks in California.

Bartonella can be contracted through a cat scratch or bite, causing “cat scratch fever.” But it can also be transmitted by a tick bite. In fact, “ticks and small rodents are known hosts of Bartonella and play a significant role in the preservation and circulation of Bartonella in nature.” [7]

Psychiatric presentations and other symptoms

Some patients exhibit a streak-mark rash that resembles stretch marks. Symptoms may include fever, headaches, fatigue, and swollen glands.

Several studies indicate an association between Bartonella and psychiatric symptoms. Investigators describe case studies of patients with new-onset psychiatric symptoms such as sudden agitation, panic attacks, and treatment-resistant depression possibly due to Bartonella.

Another case study highlights a young boy with a Bartonella infection who developed neuropsychiatric symptoms and was later diagnosed with pediatric acute-onset neuropsychiatric syndrome (PANS), a type of basal ganglia encephalitis. [8]

Bartonella can be treated with antibiotics such as doxycycline, minocycline, azithromycin, trimethoprim-sulfamethoxazole, clarithromycin, and Rifampin.

SOUTHERN TICK ASSOCIATED RASH ILLNESS (STARI)

STARI is an emerging tick-borne illness related to Lyme disease and was identified in the southeastern and south-central United States.

STARI is believed to be transmitted by the Lone Star tick; however, it is not officially confirmed as of yet.

The hallmark sign of STARI is an EM-like rash similar to that seen in Lyme disease. Symptoms may include fevers, headaches, stiff neck, joint pain, and fatigue.

The long term consequences and treatment of the illness have not been established.

It is not known whether antibiotic treatment is necessary or beneficial. Nevertheless, because STARI resembles early Lyme disease, physicians will often treat patients with oral antibiotics.

BORRELIA MIYAMOTOI

B. miyamotoi is increasingly being recognized as the agent of a nonspecific febrile illness often misdiagnosed as acute Lyme disease without rash, or as ehrlichiosis.” [9]

Borrelia miyamotoi (BMD) is a spiral-shaped bacteria that causes tick-borne relapsing fevers. However, investigators point out, Borrelia miyamotoi “should not be assumed to be biologically similar to the true relapsing fever spirochetes maintained by argasid (“soft”) ticks, nor to cause typical relapsing fever.” [9]

It appears to be a common infection in areas endemic for Lyme disease. [9]

Symptoms and prevalence

A 2011 study found the disease to generally present with more systemic signs and symptoms, particularly headache and fever, compared to Lyme disease. [10]

“Virtually all patients presented with fever … fatigue, and headache …. The next most common signs and symptoms were myalgia, chills, nausea and arthralgia, characterizing 30%–60% of the patients.” [10]

Other investigators report that “patients infected with B. miyamotoi in the United States typically do not have a rash.” But they may present with “a fever in conjunction with headache (96%), myalgia (84%), arthralgia (76%), and malaise/fatigue (82%).”

READ MORE: Tiny larval ticks can transmit Borrelia miyamotoi

The prevalence of the disease is unknown but investigators report that  “studies in New England suggest that Borrelia miyamotoi infection may be as common as anaplasmosis and babesiosis.

They also point out:

  • “Human cases are likely to be found wherever Lyme disease is endemic.”
  • “B. miyamotoi may cause serious complications, including meningoencephalitis in immunocompromised hosts.”
  • “Several studies suggest that B. miyamotoi may be transmitted through blood transfusion, consistent with the high levels of spirochetemia that occur with Borrelia species that cause relapsing fever.”

Borrelia miyamotoi is particularly concerning given that the bacterium can be transmitted to a person within the first 24 hours of tick attachment. And “the probability of transmission increases with every day an infected tick is allowed to remain attached.”

Diagnostic testing is limited. Although the CDC recommends using PCR and antibody-based tests to confirm a diagnose of B. miyamotoi, a recent study finds blood smears have poor sensitivity for confirming the disease. [9] And there is no FDA approved diagnostic test for the disease.

Treatment thus far is similar to that of Lyme disease. Studies show that doxycycline and amoxicillin have effectively treated B. miyamotoi infection in patients.

Remember, tick-borne co-infections are the norm, not the exception.

Editor’s Note: Practitioners should consider co-infections in the diagnosis when a patient’s symptoms are severe, persistent, and resistant to antibiotic therapy. Physicians have found that co-infections typically exacerbate Lyme disease symptoms.

References:
  1. CDC Vital Signs, Weekly / May 4, 2018 / 67(17);496–501. https://www.cdc.gov/mmwr/volumes/67/wr/mm6717e1.htm
  2. Mohan KVK, Leiby DA. Emerging tick-borne diseases and blood safety: summary of a public workshop. Transfusion. 2020 Jul;60(7):1624-1632. doi: 10.1111/trf.15752. Epub 2020 Mar 24. PMID: 32208532.
  3. Kirsten Saetre, Neetu Godhwani, Mazen Maria, Darshan Patel, Guiqing Wang, Karl I Li, Gary P Wormser, Sheila M Nolan, Congenital Babesiosis After Maternal Infection With Borrelia burgdorferi and Babesia microti, Journal of the Pediatric Infectious Diseases Society, Volume 7, Issue 1, March 2018, Pages e1–e5, https://doi.org/10.1093/jpids/pix074
  4. Rocco JM, Mallarino-Haeger C, McCurry D, Shah N. Severe anaplasmosis represents a treatable cause of secondary hemophagocytic lymphohistiocytosis: Two cases and review of literature. Ticks Tick Borne Dis. 2020 Sep;11(5):101468. doi: 10.1016/j.ttbdis.2020.101468. Epub 2020 May 23. PMID: 32723647.
  5. Jose E Rivera, Katelyn Young, Tae Sung Kwon, Paula A McKenzie, Michelle A Grant, Darrell A McBride, Anaplasmosis Presenting With Respiratory Symptoms and Pneumonitis, Open Forum Infectious Diseases, Volume 7, Issue 8, August 2020, ofaa265, https://doi.org/10.1093/ofid/ofaa265
  6. Yoo J, Chung JH, Kim CM, Yun NR, Kim DM. Asymptomatic-anaplasmosis confirmation using genetic and serological tests and possible coinfection with spotted fever group Rickettsia: a case report. BMC Infect Dis. 2020;20(1):458. Published 2020 Jun 30. doi:10.1186/s12879-020-05170-9
  7. Hao L, Yuan D, Guo L, et al. Molecular detection of Bartonella in ixodid ticks collected from yaks and plateau pikas (Ochotona curzoniae) in Shiqu County, China. BMC Vet Res. 2020;16(1):235. Published 2020 Jul 9. doi:10.1186/s12917-020-02452-x
  8. Breitschwerdt EB, Greenberg R, Maggi RG, Mozayeni BR, Lewis A, Bradley JM. Bartonella henselae Bloodstream Infection in a Boy With Pediatric Acute-Onset Neuropsychiatric Syndrome. J Cent Nerv Syst Dis. 2019;11:1179573519832014. Published 2019 Mar 18. doi:10.1177/1179573519832014
  9. Telford SR, Goethert HK, Molloy PJ, Berardi V. Blood Smears Have Poor Sensitivity for Confirming Borrelia miyamotoi Disease. J Clin Microbiol. 2019 Feb 27;57(3):e01468-18. doi: 10.1128/JCM.01468-18. PMID: 30626663; PMCID: PMC6425185.
  10. Telford SR, Goethert HK, Molloy PJ, Berardi V. Blood Smears Have Poor Sensitivity for Confirming Borrelia miyamotoi Disease. J Clin Microbiol. 2019 Feb 27;57(3):e01468-18. doi: 10.1128/JCM.01468-18. PMID: 30626663; PMCID: PMC6425185.

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For more:

Stealth Infections & Their Detection

Dr.-Schwarzbach-Stealth-Infections-and-their-Detection (1)  pdf here

iu-105

Armin Schwarzbach PhD

Medical doctor and Specialist for Laboratory Medicine

Augsburg, Germany

AONM Annual Conference London, November 19th 2017

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**Comment**

Excellent presentation on the following stealth pathogens:

  • Mycoplasma
  • Bartonella
  • Babesia
  • Ehrlichia/Anaplasma
  • Chlamydia pneumoniae
  • Yersinia
  • Coxsackie viruses (B1, A7, A16) and many others 
  • Borrelia burgdorferi , in all its forms

While Dr. Schwarzbach wants to blame “ecosystem disruption” for the mess we are in, I think it more likely to be due to laboratory experimentation/manipulation (bioweaponization), dropping ticks from airplanes, and migratory birds and animals transporting ticks far and wide:

https://madisonarealymesupportgroup.com/2020/09/25/why-should-we-care-about-lyme-disease-a-colorful-tale-of-government-conflicts-of-interest-probable-bioweaponization-and-pathogen-complexity/

Tick Bite – Letter to the Editor

https://www.bmj.com/content/370/bmj.m3029/rr-3

Tick bite

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3029 (Published 13 August 2020)Cite this as: BMJ 2020;370:m3029

21 August 2020
Habib ur Rehman
Physician
Saskatchewan Health Authority
Suite 100, 2550 12th Ave, Regina, SK, S4P 3X1, Canada

Rapid Response:

Re: Tick bite

Dear Editor

Razai et al, in their consultation on tick bite, missed an important message to learners (1).

  • As the incidence of Lyme disease increases, there is also greater likelihood of co-transmission of other pathogens carried by I scapularis and I pacificus ticks.
  • Since symptoms of these co infections are non-specific and may overlap with Lyme’s disease, accurate diagnosis becomes more difficult. It is therefore important that a high level of suspicion is maintained for these co-infections so patients receive accurate diagnosis and adequate treatment.

The most common infectious agents transmitted by Ixodes species ticks in North America that have the potential for co-infection with B burgdorferi are Anaplasma phagocytophilum, Babesia species, deer tick (Powassan) virus, Borrelia miyamotoi, and the Ehrlichia muris–like agent (2).

A phagocytophilum is transmitted by the same Ixodes ticks as B burgdorferi in the United States and causes fever, chills, headache, myalgia, and fatigue arising 1 to 3 weeks following tick exposure. Most cases are mild and self-limited. However, severe manifestations may include respiratory failure, adult respiratory distress syndrome, peripheral neuropathy, rhabdomyolysis, acute renal failure, pancreatitis, and coagulopathies.

It has been found that in Wisconsin, approximately 3% of I scapularis ticks examined were co-infected with B burgdorferi and A phagocytophilum (3). A similar study in 11,000 ticks in public parks of New York State’s Hudson Valley Region found that co-infection rates of nymphs and adults were 0.5% and 6.3%, respectively (4).

The frequency of humans with Lyme disease simultaneously co-infected with A phagocytophilum from various studies ranges from 2% to 10% (5,6). Similirly, Babesiosis is transmitted through the bite of infected I scapularis and I pacificus ticks. Most patients are asymptomatic or have mild, self-limited disease but may be complicated by renal failure, acute respiratory distress, and shock.

In a study of patients with Lyme disease from southern New England, approximately 10% were co-infected with babesiosis (7).

Unlike Lyme disease and Anaplasmosis, doxycycline is not an effective treatment of babesiosis and requires atovaquone and azithromycin or combination of clindamycin with quinine, making it imperitive to consider this diagnosis in mind in patients with tick bite.

Of the 3 species of Ehrlichia in United States, only E muris–like (EML) agent is transmitted by I scapularis is the vector of this emerging pathogen(8).

Possible co-infections should be considered in any patients who are diagnosed with tick bite or Lyme disease, especially those who have unexplained leukopenia, thrombocytopenia, or anemia, or who fail to respond to treatment for Lyme’s disease.

References:
1- Razai MS, Doerholt K, Galiza E, Oakeshott P. Tick bite. BMJ 2020;370:m3029
2- Caulfield AJ, Pritt BS. Lyme disease Coinfections in the United States. Clin Lab Med 2015;35:827–846.
3- Lee, X, Coyle DR, Johnson DK, et al. Prevalence of Borrelia burgdorferi and Anaplasma phagocytophilum in Ixodes scapularis (Acari: Ixodidae) nymphs collected in managed red pine forests in Wisconsin. J Med Entomol 2014;51:694-701.
4- Prusinski MA, Kokas JE, Hukey KT, et al. Prevalence of Borrelia burgdorferi (Spoirochets: Spirochaetaceae), Anaplasma phagocytophilum (Rickettsiales: Anaplasmataceae), and Babesia microti (Piroplasmida: Babesiidae) in Ixodes scapularis (Acari: Ixodidae) collected from recreational lands in the Hudson Valley Region, New York State. J Med Entomol 2014;51:226-36.
5- Horowitz HW, Aguero-Rosenfeld ME, Holmgren D, et al. Lyme disease and human granulocytic anaplasmosis coinfection: impact of case definition on coinfection rates and illness severity. Clin Infect Dis 2013;56;93-9.
6- Steere AC, McHugh G, Suarez C, et al. Prospective study of coinfection in patients with erythema migrans. Clin Infect Dis 2003;36:1078-81.
7- Krause PJ, Telford SR, Spielman A, et al. Concurrent Lyme disease and babesiosis – evidence for increased severity and duration of illness. JAMA 1996;275:1657-60.
8- Pritt BS, McFadden JD, Stromdah E, et al. Emergence of a novel Ehrlichia sp. agent
pathogenic for humans in the Midwestern United States. 6th International Meeting
on Rickettsiae and Rickettsial Diseases. Heraklion (Greece), June 5–7, 2011.

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**Comment**

This important letter to the editor highlights many contentious issues Lyme/MSIDS patients have to muddle through.  From where I sit, I disagree with the author’s statements that these infections are ‘mild and self-limited’, but I deal with sick people – not healthy.  If there’s one thing I DO know, it’s that these infections have been downplayed for far too long, and it’s been a real problem.  Patients haven’t been taken seriously for over 40 years!

The consideration of coinfections; unfortunately, is not common in mainstream medicine regarding Lyme/MSIDS.  They still treat this as a one germ disease with doxycycline curing it, when nothing could be further from the truth:  https://madisonarealymesupportgroup.com/2018/10/30/study-shows-lyme-msids-patients-infected-with-many-pathogens-and-explains-why-we-are-so-sick/