Archive for the ‘Anaplasmosis’ Category

First Longhorned Tick Confirmed in Arkansas

http://www.4029tv.com/article/first-longhorned-tick-confirmed-in-arkansas/21274301  (News Video here)

First Longhorned Tick confirmed in Arkansas

The USDA confirmed the presence of the Longhorned Tick in Arkansas for the first time.

The tick came from a dog in Benton County, according to the Arkansas Agriculture Department.

The Longhorned Tick is an exotic East Asian tick associated with bacterial and viral disease of both humans and animals. The USDA considers it a serious threat to livestock.

The tick is also believed to cause diseases in humans, including severe fever with thrombocytopenia syndrome. That disease was described in a 2014 CDC dispatch as “a newly emerging infectious disease.”

Multiorgan failure occurs in severe cases, and 6%-30% of case-patients die,” according to the dispatch.

The Longhorned Tick was first confirmed to be in the United States in November 2017, when a specimen was identified in New Jersey. It has also been found in Virginia and West Virginia.

Longhorned Ticks are very small and resemble tiny spiders. The Arkansas Agriculture Department warns they can easily go unnoticed on animals and people.

The department asks that animal owners, veterinarians and farmers notify the Arkansas Agriculture Department if they notice unusual ticks or ticks that occur in large numbers on a single animal.

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**Comment**

The spread of the “tick from hell” has begun.  The reason we need to take note of this particular tick:  https://madisonarealymesupportgroup.com/2018/03/01/asian-ticks-mysteriously-turn-up-in-new-jersey/

 

  1. IT CLONES ITSELF & MULTIPLIES QUICKLY…..
  2. It can drain cattle of their blood:  https://madisonarealymesupportgroup.com/2018/03/12/asian-tick-found-in-new-jersey-can-kill-cattle-by-draining-them-of-blood/
  3. It spreads SFTS (sever fever with thrombocytopenia syndrome), “an emerging hemorrhagic fever,” causing fever, fatigue, headache, nausea, muscle pain, diarrhea, vomiting, abdominal pain, disease of the lymph nodes, and conjunctival congestion, but the potential impact of this tick on tickborne illness is not yet known. In other parts of the world, this Longhorned tick, also called the East Asian or bush tick, has been associated with several tickborne diseases, such as spotted fever rickettsioses, Anaplasma, Ehrlichia, and Borrelia, the causative agent of Lyme Disease.
  4. A top ecologist wonders if infection by this tick has gone undetected in the past.
  5. There isn’t a systematic national method to look for invasive ticks.
  6. It’s quickly showing up in other states:  https://madisonarealymesupportgroup.com/2018/05/26/tick-from-hell-now-sited-in-west-virginia/
  7. It survives cold temps:  https://madisonarealymesupportgroup.com/2018/04/21/ticks-from-hell-survived-the-winter/  (Again, the spread infection has ZIPPO to do with climate change)

For a 2016 literature review on SFTS:  http://infectious-diseases-and-treatment.imedpub.com/research-advances-on-epidemiology-of-severefever-with-thrombocytopenia-syndrome-asystematic-review-of-the-literature.php?aid=17986

Although the clinical symptoms of SFTS and HGA are similar to each other, but the treatment methods of the two diseases are totally different. Doctors notice that the biggest difference between the clinical symptom of SFTS and HGA is that SFTS patients generally without skin rash, the dermorrhagia is also not seriously, and few massive hemorrhage cases were reported [23]. It is also reported that SFTS patients had gastrointestinal symptoms, such as nausea, vomiting, and diarrhea, which are rarely observed in HGA patients [2]. So these differences can be used as the auxiliary basis of differential diagnosis.

At present, there is still no specific vaccine or antiviral therapy for SFTSV infection. Supportive treatment, including plasma, platelet, granulocyte colony stimulating factor (GCSF), recombinant human interleukin 11, and gamma globulin is the most essential part of case treatment [44]. Meanwhile, some measures were taken to maintain water, electrolyte balance and treat complications are also very important.

Ribavirin is reported to be effective for treating Crimean-Congo Hemorrhagic Fever (CCHF) infections and hemorrhagic fever with renal syndrome, but it is still inadequate to judge the effect of ribavirin on SFTS patients because of the study limitation without adequate parameters were investigated [45]. Host immune responses play an important role in determining the severity and clinical outcome in patients with infection by SFTSV.

For Viral treatment options:  https://madisonarealymesupportgroup.com/2016/03/28/combating-viruses/

 

Where Ticks Are and What They Carry – Science Conversation With Dr. Cameron

http://danielcameronmd.com/lyme-disease-science-conversation-ticks-diseases-they-carry/  Approx. 50 Min

Dr. Daniel Cameron, a leading Lyme disease expert, discusses where are the ticks and what are the diseases they carry.

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**Comment**

The word is finally getting out.  TICKS ARE EVERYWHERE!

Beaches:  https://madisonarealymesupportgroup.com/2018/06/07/ticks-on-beaches/

Rocks and picnic benches:  https://madisonarealymesupportgroup.com/2017/03/13/ticks-found-on-rocks/

Caves:  https://madisonarealymesupportgroup.com/2018/04/23/tick-borne-relapsing-fever-found-in-austin-texas-caves/, and https://madisonarealymesupportgroup.com/2017/10/27/israeli-kids-get-lyme-disease-from-ticks-in-caves/

Birds:  https://madisonarealymesupportgroup.com/2017/08/17/of-birds-and-ticks/

California:  https://madisonarealymesupportgroup.com/2018/05/19/infected-ticks-in-california-its-complicated/

In the South:  https://madisonarealymesupportgroup.com/2018/05/31/no-lyme-in-the-south-guess-again/, and https://madisonarealymesupportgroup.com/2017/10/06/remembering-dr-masters-the-rebel-for-lyme-patients-who-took-on-the-cdc-single-handedly/, and https://madisonarealymesupportgroup.com/2017/03/02/hold-the-press-arkansas-has-lyme/

Southern Hemisphere:  https://madisonarealymesupportgroup.com/2018/02/06/lyme-in-the-southern-hemisphere-sexual-transmission/

Australia:  https://madisonarealymesupportgroup.com/2016/11/03/ld-not-in-australia-here-we-go-again/

And everywhere else…..

Remember, there are 300 strains and counting of Borrelia worldwide and 100 strains and counting in the U.S.  Current CDC two-tiered testing tests for ONE strain!  Do the math….

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

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

 

 

 

 

NYC Issues Tick-borne Disease Advisory

http://www1.nyc.gov/assets/doh/downloads/pdf/han/advisory/2018/advisory8-tickborne-disease.pdf

NEW YORK CITY DEPARTMENT OF HEALTH AND MENTAL HYGIENE

Mary T. Bassett, MD, MPH

Commissioner

2018 DOHMH Advisory #8: Tickborne Disease Advisory

Please share with your colleagues in Internal and Family Medicine, Pediatrics, Infectious Disease, Infection Control, Laboratory Medicine, Hematology, Cardiology, Neurology, Rheumatology, Critical Care and Emergency Medicine.

  •   Tickborne diseases, with the exception of Rocky Mountain spotted fever (RMSF), are associated primarily with travel outside of New York City (NYC). Locally acquired cases of Lyme disease and babesiosis continue to be reported from Staten Island and smaller numbers have been reported from the Bronx.
  •   Isolated cases of locally acquired anaplasmosis and ehrlichiosis have also been reported from Staten Island.
  •   The following tickborne diseases are reportable in NYC: Lyme disease, RMSF, babesiosis, anaplasmosis, ehrlichiosis, and Powassan disease.
  •   Refer to the Reference Manual for Physicians on Tickborne Diseases in the New York City Area for extensive details and guidance on identification, diagnosis, treatment and prevention available at: http://www1.nyc.gov/assets/doh/downloads/pdf/ehs/tick-borne-dx-physician.pdf. Call 311 to order copies.

    May 30, 2018 Dear Colleagues,

    New York City (NYC) clinicians should be on the alert for patients with tickborne diseases. This advisory presents key epidemiologic findings regarding reportable tickborne diseases in NYC and reminds clinicians of reporting requirements. Please refer to the revised 3rd edition of the Reference Manual for Physicians on Tickborne Diseases in the New York City Area for details and guidance on identification, diagnosis, treatment and prevention available at: http://www1.nyc.gov/assets/doh/downloads/pdf/ehs/tick-borne-dx-physician.pdf or call 311 to order copies.

    Recent travel to upstate NY, Long Island, and other parts of New England should prompt consideration of tickborne diseases. A history of a tick bite is not a prerequisite for considering tickborne diseases for patients with compatible illness, since only a small proportion of patients diagnosed with these diseases recall being bitten by a tick. The following tickborne diseases are reportable in NYC:

Disease

Organism

Vector

Endemic US States

Ticks in NYC

Lyme disease

Borrelia burgdorferi

Ixodes scapularis

(blacklegged or deer tick)

Northeast, mid-Atlantic, and Upper Midwest esp. CT, DE, ME, MD, MA, NH, NJ, NY, PA, RI, VT, VA, WV & MN, WI

Blacklegged tick found in Staten Island and northern Bronx.

Babesiosis

Babesia microti

Northeast & MN, WI

Anaplasmosis

Anaplasma phagocytophilum

Northeast, esp. NY, CT, NJ, RI & MN, WI

Ehrlichiosis

Ehrlichia chaffeensis

Amblyomma americanum

(lone star tick)

Southeast and south-central

Lone star tick has become more common in Staten Island and limited areas of the Bronx

Rocky Mountain spotted fever

Rickettsia rickettsii

Dermacentor variabilis

(American dog tick)

Throughout US, esp. NC, OK, AR, TN, MO

Dog tick found in all 5 boroughs

Powassan disease

Powassan or deer tick virus

Ixodes cookei (groundhog tick) or Ixodes scapularis

Cases reported from CT, MN, WI, NY, ME, MA, NH, NJ, PA, NC, RI, & VA, 2004-2016

Groundhog tick not identified in NYC; blacklegged tick see above

NYC Tickborne Disease Epidemiology

Tickborne diseases in NYC have been trending upward since 2000, with fluctuations from year to year. In 2017, the number of anaplasmosis and babesiosis cases approximately doubled in all boroughs except Queens, compared to 2016. There was a slight increase in Lyme disease cases in Brooklyn, Manhattan, and Queens. (Figure and Tables 1-5). Incidence rates of tickborne diseases are typically significantly higher in residents of Manhattan compared with other boroughs. However, since 2015, Staten Island has had the highest incidence rate of Lyme disease in NYC, which may be due to an increasing number of locally acquired cases. A subset of Lyme diseases cases, those with a physician reported erythema migrans (EM) lesion with onset between April 1 and October 31, are interviewed to assess travel. EM is a reliable indicator of recent infection and is used to identify locally acquired cases. Most interviewed cases with EM report a history of travel outside the City during the incubation period, most commonly to upstate New York, Long Island, Connecticut, Pennsylvania, New Jersey, and Massachusetts. Approximately half of interviewed Lyme disease patients with EM in Staten Island reported no history of travel during the incubation period (Table 4a). Local transmission of babesiosis was also reported in the Bronx and Staten Island and there was one report each of locally acquired anaplasmosis and ehrlichiosis in Staten Island residents. Blacklegged ticks collected in the Bronx and Staten Island have tested positive for Borrelia burgdorferi and Babesia microti (see tick surveillance below). Locally acquired RMSF cases while rare, have been reported in the past from all five boroughs.

Tickborne diseases may also be transmitted via blood transfusion. In 2017, there was one transfusion-associated babesiosis case and the first anaplasmosis case acquired from a blood transfusion in NYC. The incubation period for transfusion-associated babesiosis is two to nine weeks. Consider babesiosis in the differential diagnosis for patients with febrile illnesses and/or hemolytic anemia who have received blood components or transplanted organs in the preceding three months. Because these patients often have co-morbidities, and the potential exists for infection with other pathogens, consideration of babesiosis as a possible etiology may be delayed.

NYC Tick Surveillance Data

Information on tick populations in NYC is limited. Tick surveillance is conducted by the Health Department in select parks. In 2018, monthly tick surveillance will occur in 17 parks in NYC. Another 15 sites will be surveyed during high tick activity season from May to July.

 Ixodes scapularis (blacklegged tick or deer tick) has become widely established in Staten Island, and focal areas of the Bronx including Pelham Bay Park and Hunter Island. It is not established in other areas of NYC.

  • In 2016, ticks collected from parks in the Bronx (47%) and Staten Island (19%) tested positive for Borrelia burgdorferi. While 2017 tick testing results are not yet available, the density of blacklegged ticks doubled from 2016 to 2017 in areas of Staten Island (0.86 to 1.57 ticks/100m2) and the Bronx (4.13 to 9.37 ticks/100m2).
  • A much smaller number of ticks in the Bronx and Staten Island tested positive for Anaplasma phagocytophilum (0.06-10%), Babesia microti (0-6%) and the emerging pathogen, Borrelia miyamotoi (2%).
  • Significant numbers of I. scapularis ticks are found in counties and states surrounding NYC. Testing of ticks collected in the Hudson Valley by the New York State Department of Health (NYSDOH) found infection rates as high as 40-50% for Borrelia burgdorferi, 1-3% for Babesia microti and 7-15% for Anaplasma phagocytophilum.
  • One tick collected in the Bronx tested positive for Powassan virus in 2016, the first year Powassan viral testing was performed; however no human infections have been identified among NYC residents. In NY State, approximately 1 to 3 human cases are reported annually.

Dermacentor variabilis (American dog tick) has been detected in all boroughs of NYC.

Amblyomma americanum (lone star tick) has become widely established in Staten Island and in focal areas of the Bronx.

Clinical Guidelines
Detailed guidance on how to identify, diagnose and treat tickborne diseases can be found online in reference manuals for health care providers from the NYC Health Department, the Centers for Disease Control and Prevention (CDC), and the Infectious Diseases Society of America (IDSA) (see links below). Blood smear and polymerase chain reaction (PCR) should be used to diagnose babesiosis. Anaplasmosis and ehrlichiosis are best diagnosed using PCR during the first week of illness as antibodies may not be detectable for up to 10 days after illness onset. Paired serology demonstrating a four- fold change in IgG by immunofluorescence assay (IFA) can be used to diagnose anaplasmosis, ehrlichiosis, and RMSF. A clinical diagnosis of Lyme disease can be made in patients who present with an erythema migrans (EM) rash, which is often present before antibodies are detectable. Serologic testing for Lyme disease should adhere to the CDC recommended two-step process, in which an enzyme immunoassay (EIA) that is positive or equivocal is followed by a Western blot test (if Western blot is negative, no further testing is needed).
Tick Bite Management and Lyme Disease Prophylaxis

Attached ticks should be removed promptly with fine-tipped tweezers, ensuring that mouthparts have not been left in the skin. Guidelines developed by the IDSA support limited use of a single dose of doxycycline for adults and children  8 years old* as prophylaxis for Lyme disease when all of the following conditions are met:

  • Patient has traveled to a Lyme-endemic region
  • Tick has been attached for ≥36 hours, based on engorgement or history
  • Prophylaxis can be started within 72 hours of tick removal
  • Tick can be reliably identified as I. scapularis**
  • Patient does not have any contraindications to treatment with doxycycline
*Currently there is no guidance for excluded age groups.
**Doctors in endemic areas often learn to recognize deer ticks. For visual reference providers can refer to the DOHMH website.
Resources on the DOHMH and other websites

DOHMH – http://www1.nyc.gov/site/doh/health/health-topics/zoonotic-and-vectorborne-diseases.page http://www1.nyc.gov/site/doh/health/health-topics/ticks.page

Includes links to:

  •  Tickborne Diseases in the NYC Area: A Physician’s Reference Manual, 3rd edition. Call 311 to order copies. 
  • All About Ticks: A Workbook for Kids and Their Parents (English and Spanish). Call 311 to order copies.
  •  Information on ticks, tick bite prevention and repellents

CDChttp://www.cdc.gov/ticks/index.html

Includes links to:

  • CDC Tickborne Diseases of the United States: A Reference Manual for Health Care Providers, 4th edition (2017)  Webinars on novel and emerging tickborne diseases
  •  CDC videos on Medscape

IDSA Clinical Practice Guidelineshttps://academic.oup.com/cid/article/43/9/1089/422463
TICK ENCOUNTER RESOURCE CENTER OF THE UNIVERSITY OF RHODE ISLAND http://www.tickencounter.org/ NYS DOHhttps://www.health.ny.gov/diseases/communicable/lyme/

  •  Tick removal video
Reporting Cases

Clinicians and laboratories must report all cases of Lyme disease, babesiosis, RMSF, ehrlichiosis, anaplasmosis, and Powassan disease to the NYC Health Department. Cases of transfusion-associated tickborne diseases must also be reported to the NYSDOH Blood and Tissue Resources Program at 518-485-5341 and your hospital’s transfusion service.

Report cases to DOHMH by logging into Reporting Central via NYCMED, or complete the Universal Reporting Form:  http://www1.nyc.gov/assets/doh/downloads/pdf/hcp/urf-0803.pdf and mail or fax to 347-396-2632, or call the Provider Access Line at 1-866-692-3641. If a provider does not already have a NYCMED account, register at the NYCMED link above. Once logged in, Reporting Central can be found in the ‘My Applications’ section. See the Reporting Central New User Guide (PDF):  http://www1.nyc.gov/assets/doh/downloads/pdf/hcp/reporting-central-new-user-guide.pdf

 

FIGURE. Tickborne Diseases in New York City Residents by Year of Diagnosis  (See link for table)

 

TABLES 1-5. Number of NYC Confirmed and Probable Tickborne Disease Cases by Borough and Year 1. Anaplasmosis (See link for table)

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**Comment**

While alerting clinicians to the importance of considering TBD (tick borne diseases) is a good thing, only giving info from the CDC/IDSA is a huge mistake.  There is a Lyme war going on with two polarized sides believing different things.  To only put one viewpoint is extremely biased and unscientific.

The same old garbage is repeated here and the same old rotten tests.  The only people helped by this advisory are the ones lucky enough to test positive on a test that misses at least half of the cases.

As they say, “Garbage in, garbage out.”

For the ILADS guidelines, please see:  http://ilads.org/lyme/treatment-guideline.php  If you suspect TBD, please contact your local Lyme support groups as well as ILADS.  The IDSA and CDC will only prolong your suffering.

Update on TBD’s in Travelers

https://www.ncbi.nlm.nih.gov/m/pubmed/29789953/

Update on Tick-Borne Bacterial Diseases in Travelers.

Review article

Eldin C, et al. Curr Infect Dis Rep. 2018.

Abstract

PURPOSE OF REVIEW: Ticks are the second most important vectors of infectious diseases after mosquitoes worldwide. The growth of international tourism including in rural and remote places increasingly exposes travelers to tick bite. Our aim was to review the main tick-borne infectious diseases reported in travelers in the past 5 years.

RECENT FINDINGS: In recent years, tick-borne bacterial diseases have emerged in travelers including spotted fever group (SFG) rickettsioses, borrelioses, and diseases caused by bacteria of the Anaplasmataceae family. African tick-bite fever, due to Rickettsia africae, is the most frequent agent reported in travelers returned from Sub-Saharan areas. Other SFG agents are increasingly reported in travelers, and clinicians should be aware of them. Lyme disease can be misdiagnosed in Southern countries. Organisms causing tick-borne relapsing fever are neglected pathogens worldwide, and reports in travelers have allowed the description of new species. Infections due to Anaplasmataceae bacteria are more rarely described in travelers, but a new species of Neoehrlichia has recently been detected in a traveler. The treatment of these infections relies on doxycycline, and travelers should be informed before the trip about prevention measures against tick bites.

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**Comment**

This review clearly shows how much work still needs to be done.  To boil down this complex illness to a round of doxycycline shows a simplistic understanding of these pathogens on steroids.  Mainstream researchers still haven’t gotten the memo that Eva Sapi reported about doxy throwing the spirochete into the non-cell wall form or the information that both pathologist Alan McDonald and microbiologist Tom Greer are finding spirochetes hiding in worms in the brains of folks with dementia and Alzheimer’s.

To announce doxy as the “one side fits all” treatment is truly uninformed.

While doxy is a great front-line drug, patients need to be monitored closely for symptoms.  Since testing is so poor, doctors should also be educated on:  https://madisonarealymesupportgroup.com/2017/09/05/empirical-validation-of-the-horowitz-questionnaire-for-suspected-lyme-disease/  Print out and complete the symptom check lists and take them with you to your appointment.

Remember, Lyme is the rock star we all know by name.  There are many wanna-be’s just as powerful often at play:  https://madisonarealymesupportgroup.com/2017/07/01/one-tick-bite-could-put-you-at-risk-for-at-least-6-different-diseases/  The number is actually 18 and counting.

Please encourage doctors to become educated.  It’s our only hope.

https://madisonarealymesupportgroup.com/2018/02/19/calling-all-doctors-please-become-educated-regarding-tick-borne-illness-heres-how/

Here is an example of good Lyme treatment:  https://madisonarealymesupportgroup.com/2016/02/13/lyme-disease-treatment/

Type other pathogens into the search bar to get other treatment suggestions.  Feel free to copy these off and share with your practitioner.

 

 

 

 

Ticks From U.S. Cats: Patterns of Infestation & Infection With Pathogens

https://www.sciencedirect.com/science/article/pii/S0304401718301596?via%3Dihub

Ticks from cats in the United States: patterns of infestation and infection with pathogens

Under a Creative Commons license
open access

Highlights

Tick infestations were documented on 332 cats from 18 states in the United States.

Adult and immature stages of IxodesAmblyomma, and Dermacentor were recovered.

Molecular assays documented infection with at least one pathogen in 17.1% of ticks.

One in 5 cats with ticks spent ≤30% time outdoors; 10 were reportedly indoor only.

Results show cats at risk of tick infestation and exposure to tick-borne pathogens.

Abstract

Ticks are an important but under recognized parasitic threat to cats in many areas of the United States. To characterize the species and stages of ticks most commonly recovered from cats and determine the prevalence of disease agents in the ticks, we conducted a survey of ticks removed from cats at veterinary practices in 18 states from April 2016 – June 2017.

A total of 796 ticks were submitted from 332 cats from 41 different veterinary practices. A single tick was submitted from the majority of cats, with a mean infestation intensity of 2.4 (range 1–46). The most common tick was Ixodes scapularis, accounting for 422/796 (53.0%) ticks submitted, followed by Amblyomma americanum (224/796; 28.1%) and Dermacentor variabilis (131/796; 16.5%); a few I. pacificusI. banksiD. occidentalisA. maculatumRhipicephalus sanguineus, and Otobius megnini were also submitted.

A majority of ticks were adults (593/796; 74.5%); females predominated in all adult tick submissions including I. scapularis (277/327; 84.7% female), A. americanum(66/128; 51.6% female), and D. variabilis (75/126; 59.5% female). Immature ticks included 186 nymphs and 17 larvae and were primarily I. scapularis and A. americanum.

Adult I. scapularis were most reported to be attached to the dorsal head and neck; A. americanum to the abdomen and perianal region; and D. variabilis to the back and ear. Ticks were collected in every month; the largest number of submissions were in May and June (42.5% of ticks) and October and November (35.9% of ticks). Adults of I. scapularis were most commonly submitted October through DecemberA. americanum March through June, and D. variabilis May through July.

Cats with ticks were predominantly male (58.8%) and altered (76.2%), and most reportedly spent >30% of time outdoors, although 64/294 (21.8%) for which lifestyle estimates were provided were reported to live primarily (≤30% of time outside; n = 54) or entirely (100%; n = 10) indoors.

Assay of ticks removed from cats revealed I. scapularis were infected with Borrelia burgdorferi (25.7%) and Anaplasma phagocytophilum(4.4%); A. americanum were infected with Ehrlichia chaffeensis (1.3%); and D. variabilis were infected with spotted fever group Rickettsia spp. (3.1%). No ticks in this study tested positive for Cytauxzoon felis.

Pet cats, including those that live primarily indoors, are at risk of tick infestation, potentially exposed to tick-borne disease agents, and would benefit from routine tick control.

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**Comment**

Some interesting points:

  1. Ticks were found on cats year-round
  2. The majority of ticks were ADULTS
  3. This study points out we need to essentially throw out the idea you can only get a tick bite in the spring and fall.  It also points out that adult ticks are to be taken just as seriously as nymphs.
  4. According to the study, molecular assays were used and the following pathogens found.  It says nothing of Bartonella, which is unfortunate.  We really need to determine why so many humans are infected with it.

Table 4. Pathogens detected in adult ticks recovered from cats.

Tick Pathogen % positive (No. positive/No. tested)
Ixodes scapularis Anaplasma phagocytophilum 4.4% (12/272)
Borrelia burgdorferi 25.7% (70/272)
Amblyomma americanum Cytauxzoon felis 0% (0/121)
Ehrlichia chaffeensis 1.7% (2/121)
Ehrlichia ewingii 0% (0/121)
Dermacentor variabilis Cytauxzoon felis 0% (0/123)
Rickettsia spp. 3.1% (4/123)