Archive for the ‘Anaplasmosis’ Category

Emerging Tick-Borne Diseases & Blood Safety: Summary of a Public Workshop

. 2020 Mar 24.

doi: 10.1111/trf.15752. Online ahead of print.

Emerging Tick-Borne Diseases and Blood Safety: Summary of a Public Workshop

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Tick-borne agents of disease continue to emerge and subsequently expand their geographic distribution. The threat to blood safety by tick-borne agents is ever increasing and requires constant surveillance concomitant with implementation of appropriate intervention methods. In April 2017, the Food and Drug Administration organized a public workshop on emerging tick-borne pathogens (excluding Babesia microti and Lyme disease) designed to provide updates on the current understanding of emerging tick-borne diseases, thereby allowing for extended discussions to determine if decisions regarding mitigation strategies need to be made proactively. Subject matter experts and other stakeholders participated in this workshop to discuss issues of biology, epidemiology, and clinical burden of tick-borne agents, risk of transfusion-transmission, surveillance, and considerations for decision making in implementing safety interventions. Herein, we summarize the scientific presentations, panel discussions, and considerations going forward.



I only had access to the abstract, but Dr. Cameron writes more fully on the workshop here:

Interestingly, according to the abstract, they excluded Babesia and Lyme, which are arguably two of the largest problems. It was pointed out that 200 cases of Babesia were transmitted through blood transfusions at the time of the workshop and that Anaplasma is next with increasing clinical cases.

Evidently there have been no reported cases of Lyme transmitted through the blood supply.


Other tick-borne pathogens have been transmitted through donated blood, but these occurrences are rare. (Or rarely reported)

  • 11 cases: A. phagocytophilum, responsible for Anaplasmosis (transmitted by the Ixodes ticks)
  • 2 cases: Tick-borne encephalitis virus complex (TBEV, Powassan virus, DTV), (transmitted by the Ixodes ticks)
  • 1 case: Colorado tick-fever virus (transmitted by Rocky Mountain wood ticks)
  • 1 case: Rickettsia rickettsii, the agent of Rocky Mountain Spotted Fever (transmitted by the Lone Star tick)
  • 1 case: Ehrlichia ewingii (transmitted by the Lone Star tick)

In addition, “two emerging [tick-borne agents] − B. miyamotoi and Powassan virus were discussed − for B. miyamotoi,cases have steadily increased since 2014.”

For more:


Anaplasma in Early Lyme Manifested by EM Skin Lesions

[Online ahead of print]

Assessment of Anaplasma Phagocytophilum Presence in Early Lyme Borreliosis Manifested by Erythema Migrans Skin Lesions


Background: To investigate to what extent early Lyme borreliosis patients with erythema migrans are infected with Anaplasma phagocytophilum.

Methods: 310 patients from Poland with erythema migrans were included in the study. One hundred and eighty-three patients (59%) agreed to have both skin biopsy and blood samples analysed for Borrelia burgdorferi, A. phagocytophilum and ‘Candidatus Neoehrlichia mikurensis’, with PCR. Positive samples were confirmed with sequencing.


  • B. burgdorferi DNA was detected in 49.7% of the skin samples 
  • B. b was detected in 1.1% of the blood samples
  • A. phagocytophilum DNA was found in 7.1% blood samples
  • A. phagocytophilium was found 8.2% of the skin biopsies
  • in four patients, A. phagocytophilum DNA was detected only in blood
  • in one case A. phagocytophilum DNA was found simultaneously in blood and skin and additionally in this patients’ blood Borrelia DNA was detected.
  • in four skin samples B. burgdorferi DNA was detected simultaneously with A. phagocytophilum DNA, indicative of a co-infection.

Conclusions: A. phagocytophilum may be present in early Lyme borreliosis characterized by erythema migrans and should always be considered as a differential diagnostic following a tick bite and considered in treatment schemes, as these differs (in early stage of Lyme borreliosis doxycycline, amoxicillin, cefuroxime axetil and azithromycin are recommended, while in anaplasmosis the most effective courses of treatment are doxycycline, rifampin and levofloxacin). Consequently, the role of A. phagocytophilum in erythema migrans should be further studied.



Please note that only 1% of patients had Bb in the blood – yet blood tests are precisely what our renowned CDC uses as the determination of infection.  Having the EM rash is clinical PROOF you have Lyme disease.  Period.  No testing required. End of discussion. Unfortunately, many never have the rash:

Also note that one again the EM rash IS required criteria for the study as well as being an early Lyme patient.

There’s oodles and oodles of research on this patient group. What we desperately need is for researchers to wake up and do work on those who don’t get the rash and are left to smolder for months and years before being diagnosed.

As to the rash, anywhere from 25%-80% get it despite the CDC stating 80% get it: and 1976circularletterpdf (first ever patient group – only 25% had the rash)


For more:


Rickettsiosis in Children – A Review

2020 Feb 28. doi: 10.1007/s12098-020-03216-z. [Epub ahead of print]

Rickettsioses in Children – A Review.


Rickettsial diseases, caused by a variety of obligate intracellular, Gram-negative bacteria from the genera Rickettsia, Orientia, Ehrlichia, Neorickettsia, Neoehrlichia, and Anaplasma are considered some of the most covert emerging and re-emerging diseases. Scrub typhus, murine flea-borne typhus and Indian tick typhus are commonly being reported and during the last decade. Scrub typhus (ST) has emerged as a serious public health problem in India. Rickettsial infections are generally incapacitating and difficult to diagnose; untreated cases have case fatality rates as high as 30-45% with multiple organ dysfunction, if the specific treatment is delayed. Early clinical suspicion, timely diagnosis followed by institution of specific antimicrobial therapy shortens the course of the disease, lowers the risk of complications and reduces morbidity and mortality due to rickettsial diseases. Still there is large gap in our knowledge of Rickettsioses and the vast variability and non-specific presentation of these have often made it difficult to diagnose clinically. The present review describes the epidemiology, clinical manifestations, diagnostic modalities and treatment of Scrub typhus which is a vastly underdiagnosed entity and clinicians should suspect and test for the disease more often.


For more:


74-Year Old Woman With Triple Tick Attack Podcast  Go here for Podcast


Lyme Disease Podcast: 74-year-old woman with a triple tick attack

Welcome to an Inside Lyme case study. I find that the best way to get to know Lyme disease is through reviewing actual cases. In this case study, I will be discussing a 74-year-old woman with a triple tick attack. This case series will be discussed on my Facebook and made available on podcast and YouTube.

In this episode, I will be discussing a 74-year-old woman with a triple tick attack.

This case was described in the journal Cureus, written by Kumar and colleagues in 2019.

A 74-year-old woman had underlying medical problems.  She was a smoker with chronic obstructive pulmonary disease (COPD). She also had hypertension. She was initially treated for pneumonia with ceftriaxone and azithromycin. She was also treated for Babesia.

Her red blood test contained parasites typical of Babesia.  That is, they were able to see a parasite typical of Babesia under the microscope. Babesia is a disease from a parasite found in a deer tick. This is the same deer tick that carries the spirochete that causes Lyme disease.  Over 9% of her red cells contained parasites typical of Babesia.

The doctors added atovaquone for Babesia.  Atovaquone is marked under the name Mepron in the US. The doctors also added doxycycline over concerns that the woman might also be infected with Lyme disease. She was quite ill.  She was also placed on a respirator.  She required medications to raise her blood pressure.

The doctors prescribed erythrocytapheresis due to the severity of her illness and the high number of parasites in her red cells. During erythrocytapheresis, some of the red blood cells are removed and replaced with blood from a donor. The number of parasites dropped from 9 to 5.54 percent, but the woman remained in shock. Her kidneys function worsened, which was believed due to hemolysis.

The woman’s blood test was positive for Lyme disease and Anaplasmosis.

There have been a number of studies showing three or more pathogenic infections in the same tick. 

The doctor made one last antibiotic change.  The doctors changed the treatment for Babesia from atovaquone and azithromycin to clindamycin and quinine.  Clindamycin and quinine are still used for difficult to treat cases of Babesia. She improved enough to take her off the respirator. Her blood counts and kidney function returned to normal after 14 days of treatment.

There have been a number of studies showing three or more pathogenic infections in the same tick.  “The incidence of a three pathogen infection is rare” writes Kumar. In actual practice, I have seen individuals with three pathogens who have not been published.

I support the Kumar’s call for a low level of suspicion; “A low threshold for suspicion should be held for a co-infection when patients exhibit a presentation that would be atypical for single pathogen exposure. A delay in diagnosis can lead to prolonged disease duration and increases the comorbidities associated with the infectious state.”

I agree with the doctor’s concerns with the reliability of testing for Babesia.  Kumar writes,  “A blood smear is the gold standard for the diagnosis of Babesiosis, however, if a patient has a low level of parasitic load, PCR is more sensitive.”

Kumar also raised concerns about the reliability of testing for Anaplasmosis.  Anaplasmosis has been seen in red cells in some patients.  “PCR and serological testing are also available, which are more sensitive than a thin smear.”

Finally, Dr. Kumar advised a longer course of treatment for Babesia.  “In case of immunocompromised individuals who are at risk of relapsing Babesia, treatment for a total of six weeks is preferred, including a period of two weeks after parasites are no longer visible on a thin smear” writes Kumar.

What can we learn from this case?

  1. It is important to look for a tick-borne infection even in patients with an underlying illness.
  2. Patients can suffer from more than one tick-borne infection at the same time.
  3. Their illness can be severe.

What questions does this case raise?

  1. Would Babesia have been discovered without seeing the parasite under the microscope?
  2. What is the best combination of treatment and length of treatment to prevent long-term complications?


In my practice, each individual requires a careful assessment. That is why I order tests a broad range of tests, including blood counts, liver and kidney function, thyroid disease, lupus, and rheumatoid arthritis in addition to tests for tick-borne infections. I also arrange consultations such as neurologists, rheumatologists, and ophthalmologists.

Many patients are complex, as highlighted in this Inside Lyme Podcast series.

We need more doctors with skills diagnosing and treating individuals with more than one tick-borne infection. We could use a reliable test to determine who has a tick-borne infection and when tick-borne infections have resolved. We need to determine the best course of treatment to prevent chronic illness. We hope a professional can use this case to remind them to look for more than one tick-borne infection and treat them accordingly.

We also need to give doctors the freedom to treat these difficult cases without undue interference by colleagues, insurance companies, medical societies, and medical boards.

Inside Lyme Podcast Series

This Inside Lyme case series will be discussed on my Facebook and made available on podcast and YouTube.  As always, it is your likes, comments, and shares that help spread the word about this series and our work. If you can, please leave a review on iTunes or wherever else you get your podcasts.

Sign up for our newsletter to keep up with our cases.

  1. Kumar M, Sharma A, Grover P. Triple Tick Attack. Cureus. 2019;11(2):e4064.



A few details:

  • She was an avid gardner
  • It doesn’t specify if she saw a tick or not.  The title is misleading because it infers she was bitten 3 separate times when in fact 1 tick bite could transmit all 3 pathogens simultaneously.
  • The study states that it is COMMON to be infected with 2 pathogens but that being infected with 3 is rare, but that risk increases in endemic areas (like Wisconsin). It is my experience that infection with 3 pathogens or more in WI is fairly common.
  • Dr. Horowitz recommends treating Babesia for 9 months to a year.
  • They don’t state it but ALL Lyme/MSIDS patients are immunocompromised, which means we typically need longer treatment. Mainstream medicine completely ignores this issue.
  • The study states: A treatment duration of a total of 10 days has been shown to be highly effective in treating both Lyme disease and human granulocytic anaplasmosis [12-13].  I couldn’t disagree more.  The study in reference #12 studied 10 days of treatment to eradicate the EM rash.  It’s common knowledge that the disappearance of EM rash does not mean a systemic infection is eradicated.  In fact, the EM rash has been known to disappear without any treatment what so ever!  The study in reference #13 is really about the increased disease severity in those with Anaplasmosis who had a delay in treatment. The study also admitted that their study may have excluded those with PCR-negative cases as well as the fact they are assuming disease course and severity doesn’t differ with different species.







Cats Carry All Types of Ticks & Tick-Borne Diseases


Did you know the cat you may be cuddling with on your couch every evening could be infected with a host of tick-borne diseases? Unlike our canine friends, cats are typically not symptomatic when it comes to such diseases. But as researchers have found, that doesn’t mean they are free from disease.

Updated: April 22, 2019

In a study by Shannon and colleagues, 160 ticks and blood samples were collected from 70 healthy cats brought to the Mid Atlantic Cat Hospital in Queenstown, Maryland. [1]

The authors found that the cats were carrying 3 species of ticks including 83 Lone Star ticks (Amblyomma americanum), 7 American dog ticks (Dermacentor variabilis) and 70 black-legged ticks (Ixodes scapularis.)

Out of the 160 ticks, 22 (13.8%) tested positive by PCR for Bartonella spp., Borrelia burgdorferi, or Borrelia miyamotoi. However, only 25 of the 70 cats were able to be fully tested.

Nine of those cats (36%) were positive for exposure to at least one of the following tick-borne pathogens: Borrelia burgdorferi, Ehrlichia ewingii, Anaplasma phagocytophilum, Borrelia miyamotoi, Bartonella clarridgeiae and Bartonella henselae.

“We also found at least one cat blood sample to test positive for antibodies to each of the four tick-borne agents we screened for,” the authors state.

According to the authors’ review of the literature, the risk to pet owners is unclear. “Pet ownership has been implicated in vector-borne pathogen transmission and has been identified as a potential risk factor for such diseases in some studies, but not others.”

Nevertheless, screening for ticks may prove helpful, providing advanced warning of disease risk to humans “upon recognition of an uncommon or unexpected pathogen in a pet or pet-derived parasite,” Shannon concludes.

Author’s note: Keeping your cat indoors can prevent it from picking up ticks that could be passed onto you or other family members. 

  1. Shannon AB, Rucinsky R, Gaff HD, Brinkerhoff RJ. Borrelia miyamotoi, Other Vector-Borne Agents in Cat Blood and Ticks in Eastern Maryland. EcoHealth. 2017.



For some reason many people believe cats are immune to tick bites.  This article clearly shows this to be a fallacy.  Besides being bitten by ticks and infected with the pathogens within them, cats are known for carrying and transmitting Bartonella:

As you can see from these links, Bartonella is far more than swollen lymph nodes, and many do not even present with that symptom at all.  If you suspect Bartonella, please print and fill out this questionnaire:  If you have a preponderance of symptoms, take this to your doctor and discuss it.  For Bartonella treatments see:

In my experience, not only do many Lyme patients also have Bartonella, it is often harder to resolve than Lyme.  Testing for these coinfections is just as abysmal as Lyme testing is so knowing symptoms is a must for a clinical diagnosis as many will never test positive.  This website is full of patients who had Bartonella who were negative on testing.