Archive for the ‘Anaplasmosis’ Category

Tick-Borne Myopericarditis With Positive Anaplasma, Lyme, and EBV Serology

https://www.cureus.com/articles/163816-tick-borne-myopericarditis-with-positive-anaplasma-lyme-and-epstein-barr-virus-ebv-serology-a-case-report#!/

Tick-Borne Myopericarditis With Positive Anaplasma, Lyme, and Epstein Barr Virus (EBV) Serology: A Case Report

Hassaan Arshad • Bashar Oudah • Aliaa Mousa • Tigran Kakhktsyan • Mohammad Abu-Abaa • Ashish Agarwal

Published: June 14, 2023

DOI: 10.7759/cureus.40440 

Peer-Reviewed

Cite this article as: Arshad H, Oudah B, Mousa A, et al. (June 14, 2023) Tick-Borne Myopericarditis With Positive Anaplasma, Lyme, and Epstein Barr Virus (EBV) Serology: A Case Report. Cureus 15(6): e40440. doi:10.7759/cureus.4044

Abstract

Myopericarditis has been reported only rarely in those with anaplasmosis and is typically difficult to diagnose. Lyme carditis can also be difficult to diagnose as it is relatively rare but potentially fatal and usually has nonspecific manifestations. We are presenting a 61-year-old male patient who presented in New Jersey, United States with unremitting fever, chills, and myalgia for two weeks along with nausea, vomiting, and diarrhea. Investigations were suggestive of perimyocarditis as was indicated by diffuse ST segment elevation on electrocardiography (EKG) with the presence of small pericardial effusion on echocardiography. A mild troponin leakage was also seen. This progressed to septic shock that required vasopressor therapy. Further history-taking revealed recent tick exposure and prompted empirical initiation of doxycycline. This proved to be successful with fever defervescence and clinical improvement. Serological tests confirmed both acute Lyme and anaplasma infections along with positive serology of Epstein Barr virus (EBV). This case highlights an uncommon presentation of carditis in acute Lyme and anaplasma infections with the associated false-positive serology of EBV. 

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**Comment**

Again, not uncommon, just uncommonly reported.  How many cases must be reported before it is no longer rare?  It is also known in Lymeland that those with concurrent infections have more severe cases requiring longer treatment with many medications.

Yet sadly, the authors state:

“Both anaplasma and Lyme carditis usually have a good prognosis and can resolve spontaneously without intervention.”

Are you for real?

It’s statements like these that continue to undermine any forward progress as it supports an antiquated belief that these are simple nuisance illnesses that will go away on their own. Recent case studies have shown that chronically infected patients were helped with combo treatments given for a longer period of time.

Another glaring problem: not seeing a tick or rash. How many patients have similar presentations but because they don’t recall a tick bite they are misdiagnosed with something else?

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Category:

Anaplasmosis, Lyme, Viruses

Paralyzed by Lyme, They Were Helped With Combo Treatments

https://www.lymedisease.org/remission-from-lyme-paralysis/

Paralyzed by Lyme, they were helped with combo treatments

By Lonnie Marcum

July 19, 2023

A new study from France looks at the use of combination antibiotics and anti-parasitic treatments in patients with limb paralysis as a result of tick-borne infections, including Lyme disease.

Approximately 70% of the patients in this study showed complete remission of symptoms after long-term treatment—a statistic that lines up with the MyLymeData treatment study.

The paper entitled, Complete Remission in Paralytic Late Tick-Borne Neurological Disease Comprising Mixed Involvement of Borrelia, Babesia, Anaplasma, and Bartonella: Use of Long-Term Treatments with Antibiotics and Antiparasitics in a Series of 10 Cases was published in Antibiotics.

The inclusion criteria for this study required a score of 4 or more on the Kurtzke EDSS disability scale; positive blood tests for one or more tick-borne pathogen (including Borrelia burgdorferi, Babesia, Anaplasma or Bartonella); and chronic general symptoms including fatigue, pain, and cognitive deficits lasting six or more months.

The Extended Disability Status Scale (EDSS) is a tool commonly used to quantify the level of disability in patients with multiple sclerosis. The EDSS grades six bodily functions, including visual, brain, bowel/bladder and sensory functions, as well as the patients’ ability to walk and take care of themselves.

All 10 of the patients that qualified for this study were severely disabled with partial or complete paralysis in at least one limb. Five of the 10 required a wheelchair for mobility, and four required assistive devices like walking sticks to get around.

Complete remission for 7 out of 10

Following extended treatment, seven out of 10 patients (70%) showed complete remission of symptoms. Among the nine patients with positive Borrelia serology (along with co-infections), 77% obtained complete remission.

The treatment administered varied according to the patient’s infection profile. The majority of the patients received repeated oral regimens of azithromycin-doxycycline and azithromycin-doxycycline-rifampin plus a minimum of three 35-day cycles of IV ceftriaxone. The eight patients co-infected with Babesia (a parasite) were also administered anti-parasitic cycles of atovaquone–azithromycin. The mean duration of treatment was 20 months +/- 6 months. (Trouillas 2023)

Historically, patients with late-stage Lyme disease have poor outcomes to single regimens of 10-day IV ceftriaxone. (I’ve previously written about brain inflammation, and small fiber neuropathy found in patients with continuing symptoms after short-term treatment for Lyme disease.)

And we have decades of strong evidence that under-treatment with single antibiotics is consistent with persistent infection in animal studies. (Embers 2012)

Two weeks isn’t enough

As far back as 1990, Dr. Allen Steere co-authored a paper on patients with persistent late-stage neurological Lyme disease.

In this paper Dr. Steere and his co-authors state:

Months to years after the initial infection with B. burgdorferi, patients with Lyme disease may have chronic encephalopathy, polyneuropathy, or less commonly, leukoencephalitis. These chronic neurologic abnormalities usually improve with antibiotic therapy.
…
Six months after a two-week course of intravenous ceftriaxone (2 g daily), 17 patients (63 percent) had improvement, 6 (22 percent) had improvement but then relapsed, and 4 (15 percent) had no change in their condition.
…
Six months after treatment, more than one third of the patients either had relapsed or were no better. In addition, more than half had previously received antibiotic therapy thought to be appropriate for their stage of disease and still had progression of the illness. The likely reason for relapse is failure to eradicate the spirochete completely with a two-week course of intravenous ceftriaxone therapy. (Logigian 1990)

MyLymeData

In fact, the MyLymeData study validates that longer antibiotic treatment durations are associated with moderate to a very great deal of improvement. (Johnson 2020)

MyLymeData is currently the largest observational study of patients using real-world data to analyze the response to treatment of chronic Lyme disease patients. The majority of patients (57%) reported treatment durations of four or more months,

The results of this new French study demonstrate the importance of clinicians being able to continue treatment until a patient’s symptoms have resolved. It is clear, at least in this study, that the presence of co-infections greatly compounds one’s disease progress and treatment options.

LymeSci is written by Lonnie Marcum, a Licensed Physical Therapist and mother of a daughter with Lyme. She served two terms on a subcommittee of the federal Tick-Borne Disease Working Group. Follow her on Twitter: @LonnieRhea  Email her at: lmarcum@lymedisease.org.

References

Embers ME, Barthold SW, Borda JT, Bowers L, Doyle L, Hodzic E, et al. Persistence of Borrelia burgdorferi in Rhesus Macaques following Antibiotic Treatment of Disseminated Infection. PLoS ONE. 2012;7(1):e29914. Available at: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0029914.

 Johnson, L.; Shapiro, M.; Stricker, R.B.; Vendrow, J.; Haddock, J.; Needell, D. Antibiotic Treatment Response in Chronic Lyme Disease: Why Do Some Patients Improve While Others Do Not? Healthcare 2020, 8, 383. https://www.mdpi.com/2227-9032/8/4/383

Logigian EL, Kaplan RF, Steere AC. Chronic neurologic manifestations of Lyme disease. N Engl J Med. 1990 Nov 22;323(21):1438-44. doi: 10.1056/NEJM199011223232102. PMID: 2172819.

Trouillas P, Franck M. Complete Remission in Paralytic Late Tick-Borne Neurological Disease Comprising Mixed Involvement of Borrelia, Babesia, Anaplasma, and Bartonella: Use of Long-Term Treatments with Antibiotics and Antiparasitics in a Series of 10 Cases. Antibiotics. 2023; 12(6):1021. https://doi.org/10.3390/antibiotics12061021

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Category:

Anaplasmosis, Babesia, Bartonella, Lyme, research, Treatment

CDC’s New Online Tool Gives Useful, If Slightly Flawed, Information

https://www.lymedisease.org/cdc-tick-bite-data-tracker/

CDC’s new online tool gives useful, if slightly flawed, information

May 16, 2023

By Lonnie Marcum

The CDC has recently updated its website regarding ticks and their diseases.

The changes include a new online tool called the Tick Bite Data Tracker.  It allows users to track and visualize tick-borne disease data in the United States, advancing our ability to raise awareness.

The new tool provides information on diseases transmitted by ticks such as Lyme disease, anaplasmosis, Rocky Mountain spotted fever, and ehrlichiosis.

The CDC webpage also gives information on the most common North American types of ticks and 16 known diseases transmitted by ticks such as babesiosis, Borrelia miyamotoi, Powassan virus, STARI, Colorado tick fever and more.

In addition, the CDC offers an updated page on Alpha-gal syndrome, an allergy to red meat and products derived from mammals. The condition is triggered by the bite of a tick.

National collaboration

The Tick Bite Data Tracker is part of the National Syndromic Surveillance Program (NSSP) which is a collaboration among the CDC, local health agencies, state health departments and private sector partners. The NSSP allows these partners to collect, share and analyze electronic healthcare data in near real-time as it is processed.

Because there is no medical diagnostic ICD code for “tick bite,” the emergency department visits for tick bites are identified by specific words used in the medical record. For example, “tick” or “tick” and “bite.”

The Tick Bite Data Tracker includes interactive maps, graphs and tables that allow users to explore the data in different ways. Users can view data on a national or state level, as well as by county or even zip code in some areas.

One of the most interesting aspects of this new site is the ability to track emergency department visits for tick bites by week and month. This eliminates the strict reporting criteria that adversely affects statistics in lower incidence states like Florida, Texas and California.

What we see on the Tick Bite Data Tracker is simply the number of persons per 100,000 with reported tick bites who sought care in an emergency room. The new data can indicate when tick bites are most common in a region, and unlike other CDC surveillance data, it is updated weekly, rather than annually.

Tick bites peak in Spring

You can clearly see in the graph below how tick bites peak in the spring in almost all regions of the United States.

Unfortunately, the CDC lumps every state west of Nebraska as the “West.” Therefore, areas with higher incidence of tick bites, like California, are averaged with areas of lower incidence like Wyoming—giving an inaccurate picture.

In my opinion, at the very least, the CDC should have divided this huge region into the southwest and northwest to offer better representation of what is happening in those zones—but that’s another topic.

The site also points out several limitations of the tracker tool: “Results might not be generalizable to emergency departments that are not contributing data to the BioSense Platform. The keywords used to identify tick bite visits may under- or overestimate emergency department visits related to tick bites because of differences in coding, reporting, and availability of chief complaint text data between jurisdictions or over time. Finally, aggregated data by region might be less useful than state or local data.”

So essentially, you have to take this data for what it is: a slightly flawed tool that gives us a glimpse into what is happening in the tick-borne disease world.

Lyme Awareness Month is an opportunity to educate the public about the risks of Lyme disease and promote strategies for prevention and early detection. I hope you’ll use the Tick Bite Data Tracker, as well as additional information spread throughout the pages of our website to spread awareness.

LymeSci is written by Lonnie Marcum, a Licensed Physical Therapist and mother of a daughter with Lyme. She served two terms on a subcommittee of the federal Tick-Borne Disease Working Group. Follow her on Twitter: @LonnieRhea  Email her at: lmarcum@lymedisease.org.

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**Comment**

A flawed tool that will  continued to be used against patients like the Iron Curtain.

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Category:

Activism, Alpha Gal Meat Allergy, Anaplasmosis, Babesia, Borrelia Miyamotoi (Relapsing Fever Group), Ehrlichiosis, Lyme, Rocky Mountain Spotted Fever, Ticks, Viruses

CPAC Warns: Lyme Risk Higher Than Ever

https://www.lymedisease.org/capc-parasite-forecast-2023/

CAPC warns that Lyme disease risk is higher than ever

April 20, 2023

The nonprofit Companion Animal Parasite Council (CAPC) — the nation’s leading source on parasitic diseases that threaten the health of pets and people — is warning that the risk of Lyme disease is higher than ever.

In its 2023 Parasite Forecast, CAPC documents how the blacklegged ticks that spread Lyme disease are expanding into new geographical areas. This increases the risk of Lyme disease outside of historically endemic places like the Northeast and Upper Midwest.

Parasite infections are real and can be harmful and even deadly to pets and people. Lyme disease is a predominant One Health issue, an approach calling for the collaborative efforts of multiple disciplines working to attain optimal health for animals, people and the environment.

11 years of forecasts

“Because of the zoonotic potential of pathogens like Lyme disease, we started providing annual forecasts eleven years ago to alert communities about the risks they pose to people and pets,” says Dr. Christopher Carpenter, DVM, and Chief Executive Officer of CAPC.

“Lyme disease, in particular, is an important One Health pathogen that occurs in both veterinary and human medical settings. CAPC’s Pet Parasite Forecast is critical to alerting pet owners, veterinarians and physicians to the risks this year and reinforcing CAPC’s recommendation that all pets need to be annually tested and protected year-round.”

In its 2023 annual forecast, CAPC reports the risk of acquiring Lyme disease in 2023 is elevated due to the expansive nature of the blacklegged tick vector (Ixodes scapularis).

This increase in Lyme prevalence can be attributed to land use, human population growth, urbanization, and changes in wildlife host density and location. Risks have also increased due to rehoming of pets, as well as changes in:

  • Distribution and prevalence of vector (tick) populations
  • Shifting wildlife populations and their infiltration into newly developed and reclaimed areas
  • Short- and long-term changes in climatic conditions
  • Changes in habitat due to natural or human-induced processes

Lyme Disease Forecast

For 2023, CAPC predicts Lyme disease is a high threat and continues to expand southward and westward outside of the historically high-risk areas in the Northeast and Upper Midwest, including Wisconsin, Minnesota and the upper peninsula of Michigan.

There is a higher-than-average seroprevalence predicted in northeastern Tennessee, western Michigan and Ohio, with high-risk “hot spots” expected in northwestern and southwestern Michigan, and southern and northeastern Ohio.

A higher-than-normal risk is also expected in North Dakota, northeastern South Dakota, Iowa, Illinois, and eastern Kentucky. The southward movement of Lyme is evident in the increasing risk in the Carolinas and Tennessee.

In addition, CAPC reports a northern expansion into Canada, including southern regions of Ontario, Quebec and Manitoba, as well as on New Brunswick and Nova Scotia, due to increased Lyme detection in Canadian dogs. Pets living in or traveling to these areas are considered at high risk.

Testing and Prevention Strategies

The 2023 forecasts – supported by ongoing research by parasitologists and statisticians in leading academic institutions across the United States – highlight areas where more should be done to lower the risk of companion animals’ exposure to disease vectors, such as ticks.

The foundation of these prevention strategies are recommendations that veterinarians and pet owners test their pets annually for disease and protect their pets with products that kill or repel ticks year-round.

A vaccination for Lyme disease should always be considered for pets in high-risk areas. Lyme disease, in particular, is an important One Health pathogen that impacts the health of both pets and people.

Veterinarians play an important role in preventing zoonotic disease in pets, as well as people, by implementing effective parasite control programs. In regions with historically high prevalence and in forecasted regions of increased risk, veterinarians should reinforce their recommendations of aggressive tick control.

CAPC One Health Study

Research conducted by CAPC underscores the value of CAPC’s prevalence maps and emphasizes the importance of a One Health approach to tick-borne diseases. In 2019, a CAPC study confirmed dogs safeguard humans serving as sentinels to alert humans where they are at greatest risk for tick-borne Lyme disease.

“With dogs being tested annually for exposure to the pathogen that causes Lyme disease, we were able to study over seven years of nationwide canine diagnostic data, representing more than 16 million data points — something difficult to achieve when studying ticks and the environment directly. And unlike the challenges with access to human medical records, anonymous veterinary data does not have these privacy concerns,” said Dr. Michael Yabsley, a CAPC Board Member and professor in the Department of Population Health, College of Veterinary Medicine and Warnell School of Forestry and Natural Resources at the University of Georgia.

Results from the study – “Quantifying the relationship between human Lyme disease and Borrelia burgdorferi exposure in domestic dogs” – published in the prestigious, peer-reviewed Geospatial Health quantified the relationship between incidences of tick exposure in domestic dogs to human Lyme disease. The model established in this research broke new ground by giving residents, travelers and health care providers a county-level map to help them identify areas of high Lyme risk across the country.

“By combining sophisticated statistical modeling with this invaluable canine data, we’re enabling veterinary medicine to benefit human medicine,” said Dr. Stella Self, assistant professor in the Department of Epidemiology and Biostatistics at University of South Carolina. “This research represents the first step on the long road to developing a forecast for human Lyme disease.”

30-Day Forecast Maps for Pet Owners

Pet owners who want to monitor the activity in their county throughout the year have access to 30-Day Parasite Forecast Maps at http://www.petdiseasealerts.org. These maps, developed exclusively by CAPC, provide a local forecast for every county in the continental United States on a monthly basis. This free service helps to remind pet owners of the continuous risk in their area and the importance of annual parasite testing and year-round protection.

“Because tick-borne diseases like Lyme are ever-changing, the 30-Day Pet Parasite forecasts at http://www.petdiseasealerts.org are an invaluable tool to protect both pets and people with monthly updates that show the risk for Lyme disease in their area,” said Dr. Rick Marrinson, Past President/Board Member for CAPC and owner of Longwood Veterinary Clinic in Longwood, Florida.

Other Parasite Spread in 2023

In addition to Lyme disease, CAPC forecasts that heartworm disease, which is transmitted by mosquitoes, and tick-borne diseases ehrlichiosis and anaplasmosis, continue to spread throughout the United States in 2023. Veterinarians and pet owners are encouraged to discuss how to effectively address the increased prevalence. Annual testing and year-round use of preventive products remains the best means of providing comprehensive parasite control and disease prevention.

How the Forecasts are Created

The annual CAPC Pet Parasite Forecasts are a collaborative effort between parasitologists and statisticians in leading academic institutions across the United States. These scientists engage in ongoing research and data interpretation to better understand and monitor vector-borne disease agent transmission and changing life cycles of parasites. The forecasts are based on many factors, including temperature, precipitation, and population density.

About the Companion Animal Parasite Council

The Companion Animal Parasite Council is an independent not-for-profit foundation comprised of parasitologists, veterinarians, as well as medical, public health and other professionals, who provide information for the optimal control of internal and external parasites that threaten the health of pets and people.

Formed in 2002, CAPC works to help veterinary professionals and pet owners develop the best practices in parasite management that protect pets from parasitic infections and reduce the risk of zoonotic parasite transmission.

SOURCE OF PRESS RELEASE: The Companion Animal Parasite Council 

Category:

Activism, Anaplasmosis, Ehrlichiosis, Lyme, research, Testing, Ticks

CA Ticks Spread Lyme But That’s Not the Whole Story

https://www.globallymealliance.org/blog/california-ticks-can-spread-lyme-disease-but-thats-not-the-whole-story

California Ticks Can Spread Lyme Disease…But That’s Not the Whole Story

by Paul Killinger on February 24, 2023

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If you find a tick bite from an Ixodes tick in California, it’s important to consider possible exposure to pathogens that cause more than Lyme disease

Originally published on Medzulabs.org 

The risk of contracting Lyme disease from a tick bite in California has been well-documented, though there is still a long way to go in educating health providers and the broader community in the exposure risk from a tick bite. TickReport’s surveillance of ticks from California (and Oregon and Washington) goes back as far as 2006 and has expanded in recent years.

What ticks are endemic (commonly and consistently found in wild populations) to California and other West Coast states?

That’s a big question, and there are a few dozen species from different genera or families. Many of those species are specialist feeders and—if everything goes “right” in their life cycle—they will only feed on certain wild mammals, birds, or lizards and will bite humans very rarely. That’s doesn’t mean that finding one of these “specialists” attached to ourselves or a family member is impossible: it’s just much less common (and a topic we’ll try to visit soon in another post).

Our surveillance shows that the majority (91.5%) of human or human-adjacent (dogs, cats, horses, etc) tick bites are caused by the following ticks:

  • Ixodes pacificus (“Western black-legged tick,” a close relative of the Deer tick in the Eastern U.S.)
  • Dermacentor variabilis (“American dog tick”)
  • Dermacentor occidentalis (“Pacific Coast tick”)
  • Dermacentor andersoni (“Rocky Mountain Wood tick”)
  • Ixodes spinipalpis
  • Ixodes angustus
What pathogens can these ticks transmit to humans?

Vector competence (the ability of a vector like a tick to transmit a given disease-causing pathogen) tends to run along genus lines, so species within the Ixodes genus tend to be able to transmit pathogens X and Y but not Z, while Dermacentor species tend to transmit Z but not X and Y.

The most common pathogen found in California ticks is Borrelia burgdorferi, which causes Lyme disease in humans and pets. But there’s more than Lyme in those hills! If you find a tick bite from an Ixodes tick in California, it’s also important to consider possible exposure to these pathogens:

  • Borrelia miyamotoi: a bacterium that can cause hard tick relapsing fever—sometimes called Borrelia miyamotoi disease.
  • Anaplasma phagocytophilum: a bacterium that can cause Human granulocyctic Anaplasmosis.
*For every two ticks we find infected with Borrelia burgdorferi (Lyme disease bacteria), we detect one (or more) of these other pathogens

It’s vital that both tick surveillance and diagnostic approaches keep these non-Lyme pathogens in mind. For every two ticks we find infected with Borrelia burgdorferi (Lyme disease bacteria), we detect one (or more) of these other pathogens, so be sure to resist Lyme Tunnel Vision when responding to a tick bite! Common diagnostic tests for Lyme disease have a specific focus on Lyme disease and will not detect infection by these other pathogens if present. Make sure you and your doctor are considering the whole story of a tick bite.

To learn more about the pathogens we find in West Coast ticks, browse our real-time testing data at TickReport.com/stats. If you find and remove a tick, arrange for fast and accurate identification and testing at TickReport.com.
The above material is provided for information purposes only. The material (a) is not nor should be considered, or used as a substitute for, medical advice, diagnosis, or treatment, nor (b) does it necessarily represent endorsement by or an official position of Global Lyme Alliance, Inc. or any of its directors, officers, advisors or volunteers. Advice on the testing, treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history. 

Paul Killinger oversees tick surveillance and pathogen testing at the TickReport testing lab in Amherst, Massachusetts. He has led the lab's public health education and outreach since 2018.

Category:

Activism, Anaplasmosis, Borrelia Miyamotoi (Relapsing Fever Group), Lyme, research, Testing, Ticks, Transmission