Archive for the ‘Anaplasmosis’ Category

Unlike Mosquitoes, Ticks Year Long Threat

http://www.omaha.com/living/move-over-mosquitoes-tick-fight-takes-attention/article_996c6495-f986-59cf-8649-6bfd46fc4209.html

According to the Companion Animal Parasite Council (CAPC) 2016 is going to be a banner year for ticks, with the CDC listing 15 different tick borne diseases (TBI’s) which range from debilitating to fatal.

The council sates that they thrive everywhere from wooded areas to gardens, landscape plants and even backyard grasses with most people coming into contact with them in their own backyards.

The article states a big help in lowering the tick population is by deterring deer from your living area by planting vegetation deer don’t like to building a tall fence, although they can jump over fences as high as 10 feet. They state a foliar spray such as Bobbex Deer Repellent is effective year-round and supposedly safe for use around children and pets and won’t wash off from rain or snow. It was found to be 93% effective in deterring deer when compared to other like repellents.

According to Sam Telford, a professor of infectious diseases at Tufts, “One or two years of severe weather may depress their numbers, but remember….the successful feeding of one female tick on a deer translates to 2,000 eggs.”

Many believe that ticks are not active in the winter. Unfortunately, this is a myth.

https://madisonarealymesupportgroup.com/2016/01/20/polar-vorticks/

Category:

Anaplasmosis, Babesia, Bartonella, Lyme, Mycoplasma, research, Ticks, Viruses

TBI’s in Florida

http://doi.org/10.1016/j.ttbdis.2016.09.016

Abstract

Tick-borne diseases are an emerging public health threat in the United States. In Florida, there has been public attention directed towards the possibility of locally acquired Borrelia burgdorferi sensu stricto, the causative agent of Lyme disease, in association with the lone star tick. The aim of this study was to determine the prevalence of ticks and the pathogens they carry and potentially transmit, such as B. burgdorferi, in a highly utilized teaching and research forest in North Central Florida.

Ticks were collected by dragging and flagging methods over a four month period in early 2014, identified, and tested by PCR for multiple pathogens including Anaplasma, Borrelia, Rickettsia, and Ehrlichia species. During the study period the following ticks were collected: 2506 (96.5%) Amblyomma americanum L., 64 (2.5%) Ixodes scapularis Say, 19 (0.7%) Dermacentor variabilis Say, and 5 (0.2%) Ixodes affinis Neuman.

Neither Borrelia spp. (0/846) nor Anaplasma spp. (0/69; Ixodes spp. only) were detected by PCR in any of the ticks tested. However, Rickettsia DNA was present in 53.7% (86/160), 62.5% (40/64), 60.0% (3/5) and 31.6% (6/19) of A. americanum, I. scapularis, I. affinis and D. variabilis, respectively. Furthermore, E. chaffeensis and E. ewingii DNA were detected in 1.3% and 4.4% of adult A. americanum specimens tested, respectively.

Although receiving an A. americanum bite is likely in wooded areas in North Central Florida due to the abundance of this tick, the risk of contracting a tick-borne pathogen in this specific area during the spring season appears to be low. The potential for pathogen prevalence to be highly variable exists, even within a single geographical site and longitudinal studies are needed to assess how tick-borne pathogen prevalence is changing over time in North Central Florida.

Category:

Anaplasmosis, Lyme, Ticks

Dr. Zubcevik Challenges TBI Standard of Care

http://www.mvtimes.com/2016/07/13/visiting-physician-sheds-new-light-lyme-disease/

Dr. Nevena Zubcevik, attending physician at Harvard Medical School and co-director of Dean Center for Tick Borne Illness at Spaulding Rehabilitation Hospital, http://spauldingrehab.org/research-and-clinical-trials/lyme-disease/, recently spoke at a weekly meeting of clinicians, which was open to the public at Martha’s Vineyard Hospital.

In standing room only, Zubcevic admonished that singer/actor Kris Kristofferson’s recent cure of dementia, once diagnosed and properly treated for Lyme Disease, should be a lesson for medical professionals.  https://madisonarealymesupportgroup.com/2016/06/09/alzheimers-byproduct-of-infection/.  She also stated that children present differently than adults, with headache being the most common symptom but to get them tested if they are acting out, experiencing mood issues, irritability, and fatigue.  (They need to be tested; however, with sensitive testing that Lyme Literate Doctors – LLMD’s use.  One lab that offers these tests is Igenex Labs in CA.  The best way to get good information is to contact a Lyme Support Group in your state.  They have all the information regarding LLMD’s, testing, costs, and educational materials.)

She explained of a haunting case of a young male institutionalized for schizophrenia. After proper testing for Lyme Disease, he started daily antibiotics and within six months he was normal.

For more information on how borrelia, the causative agent of Lyme Disease, and various coinfections can and often do affect the brain see: https://madisonarealymesupportgroup.com/2015/10/18/psychiatric-lymemsids/ .  Also, see Amy Hilfiger’s story: https://madisonarealymesupportgroup.com/2016/07/01/ally-hilfiger-on-fox-5-ny/, as well as how Toxoplasmosis can affect the brain: https://madisonarealymesupportgroup.com/2016/05/21/toxoplasmosis/.

She also debunked myths.

*Studies show you can get Anaplasmosis in 15 minutes from tick attachment, 10 minutes for Powassan virus, and that it is UNKNOWN how long it takes for the various strains of borrelia (LD). https://www.youtube.com/watch?v=296pVc5Zbxw&index=2&list=UUTXTo-yWGZkRwrQ9X6X7E0A

*Doxycycline CAN be given to children, infants, and pregnant women.
http://www.ncbi.nlm.nih.gov/pubmed/26680308  (no correlation between the use of doxycycline and teratogenic effects during pregnancy or dental staining in children was found)

*A two-day course of Doxy has little to no prophylactic value, and that the proper course is 100-200mg twice a day for 20 days, regardless of engorgement time.

*The current testing misses 69 out of 100 patients who have LD, and doesn’t pick up borrelia miyamotoi at all, not to mention other strains. Miyamotoi is prevalent in Massachusetts.

*The “classic” bullseye rash only happens 20% of the time and when it does present can look like a spider bite or bruise.

*Patients often have coinfections which tests do not pick up. These coinfections make patient cases extremely difficult and complex.

She also stated that borrelia can go into tissue, travel in the bloodstream and is twice the speed of a white blood cell which means it can swim against the flow of blood and evade the white cell by quickly burrowing into tissue, thereby avoiding the immune system.

She stated that having LD is a body-wide toxic war – leaving the patient feeling miserable, and that while she is fairly new to this field, she sees no controversy – that animal studies clearly show persistence after treatment and that human tests do too.

She mentions the work of Dr. Ying Zhang of Johns Hopkins Lyme Center and that his work has indicated that current treatments may not clear persisters. Due to this research she feels a combination of several antibiotics, particularly new combinations, are promising.

Zubcevik found that a patient with chronic LD, when given a PET scan, showed blue and purple, indicating atrophy, whereas after six months of IV antibiotics, presented with yellow and green, indicating metabolically active regions.

Zubcevik has patients who have been ignored, beaten down, and who have lost the will to live. They show signs of post-traumatic stress and have destroyed marriages often leaving them alone. They break down crying with she tells them she believes them.

Category:

Anaplasmosis, Clinic, Lyme, Psychological Aspects, research, Toxoplasmosis, Treatment, Viruses

Why We Can’t Get Better

Most MSIDS (multi systemic infectious disease syndrome – or Lyme with friends) sufferers are familiar with Dr. Horowitz, a famous and gifted LLMD (Lyme Literate Doctor) who wrote the book, “Why I Can’t Get Better?  Solving the Mystery of Lyme and Chronic Disease.”  I just noticed you can get it new for $7.99 – the best eight bucks you’ll ever spend!  I warn you; however, it’s deep and it’s wide, and you will be looking up a few terms unless you’re a M.D. http://www.amazon.com/Better-Solving-Mystery-Chronic-Disease/dp/1250019400

In fact, he’s the person who came up with the term MSIDS as it more adequately explains what’s going on in most patients diagnosed with “Lyme Disease,” as research shows we are typically infected with multiple pathogens making our treatment pictures far more complex than most GP’s realize and is also a very good reason why people don’t get better.  This issue is what he discusses in the following videos.  For some of you, you just can’t get on top of things – even after years of treatment.  There can be numerous reasons for this but the following videos may enlighten both you and your doctor.

Working with an LLMD is definitely a partnership.  In the beginning, unless you’ve watched someone go down this pot-hole riddled road, you know very little other than the fact that your body’s going to hell in a hand basket!  As time progresses, you talk to others, watch videos, read books, and become an on-line researcher learning things you never in your wildest dreams would have thought about learning (the life-cycles of ticks).

For those of you who are new to the journey, you want to get someone you know up to speed quickly, or if you need a refresher course, these videos will do it.  Horowitz is engaging, intelligent, and funny.  The first video is only 8 minutes long and explains the nuts and bolts of how he came to his current knowledge.

The second video is an hour long, but definitely worth watching.  In a much more detailed fashion, it explains many symptoms of the various coinfections that could be holding up your progress unless you are dealing with them.  Watch these videos, take notes, and go back to your doctor and discuss these possibilities.  Remember, testing for all of these pathogens is extremely poor and not to be solely relied upon for diagnosis.  It’s important to “study thy enemy,” so you understand him and know how to combat him.  In this case the more you know about the various pathogens and how they affect the human body the better.

Published on Nov 3, 2014
At the “Symposium on Tick-borne Diseases” held May 17, 2014 at the Hyatt in Cambridge, Maryland, Dr. Richard Horowitz provided insights into the many diseases humans are contracting from ticks, and he helps us to differentiate between the different illnesses. The event was hosted by the Lyme Disease Association of the Eastern Shore of Maryland (soon to be the Lyme Disease Association of Delmarva), a 501(c)(3) non-profit organization providing educational resources on tick-borne diseases. This and other videos from the Symposium were made possible by a very generous private donation for which we are very thankful to have received. The wonderful videographer/editor for the event was Bryan Krandle (krandle86@yahoo.com). If you enjoy having wonderful resources like the videos from this conference, please consider a donation to the LDAESM, P.O. Box 5360, Salisbury, Maryland 21802. Thank you!

Category:

Anaplasmosis, Babesia, Bartonella, Lyme, Mycoplasma, Treatment, Uncategorized, Viruses

Anaplasmosis Treatment

3-phagocytophilum

Ultrastructure of A.phagocytophilum by transmission
electron microscopy. Photo by V.Popov, reprinted
from Dumler JS et al. Human granulocytic
anaplasmosis and Anaplasma phagocytophilum.
Emerg Infect Dis;11:1828-34.

http://www.health.state.mn.us/divs/idepc/diseases/anaplasmosis/hcp.html

Human anaplasmosis (HA), formerly known as human granulocytic ehrlichiosis (HGE), is a small, obligate, gram-negative bacterial disease that is unusual in its tropism to neutrophils, and is caused by Anaplasma phagocytophilum, a rickettsial bacterium. It was first recognized in 1990, when a western Wisconsin patient developed a severe febrile illness following a tick bite and died two weeks later; however, it has been known to cause disease in animals since 1932. Human ehrlichiosis, a similar disease, is caused by Ehrlichia chaffeensis and is found throughout much of southeastern and south-central United States. Another related form of ehrlichiosis caused by the Ehrlichia muris-like agent was identified in Minnesota and Wisconsin patients in 2009. The median age of patients with HGA is around 50 years old. Over 4000 total cases have been reported in the CDC’s Morbidity and Mortality Weekly since the disease became nationally reportable; as with most tick-borne diseases, the true incidence is suspected to be considerably higher.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2882064/   Cases occur year-round, with a peak incidence during June and July, perhaps reflecting the shorter arthropod season in these northern states or the relative importance of the nymphal stage of Ixodes ticks in disease transmission. Given the ubiquity of the tick vector, it is not surprising that cases of HGA have been confirmed world-wide, including Europe and Asia (China, Siberian Russia, and Korea).

In dogs, persistent infection has been reported to last over 10 years and in the absence of treatment can persist for the life of the dog. Other strains persist for months and then are naturally cleared.

Transmission:
http://www.health.state.mn.us/divs/idepc/diseases/anaplasmosis/hcp.html
http://www.capcvet.org/capc-recommendations/ehrlichia-spp-and-anaplasma-spp1/ Anaplasmosis is known to be transmitted to humans by Ixodes scapularis (blacklegged tick or deer tick), the same tick that transmits Lyme disease (borrelia). It can also be transmitted via blood transfusion and contaminated needles or surgical instruments.  

Symptoms:

Onset of illness occurs 5 to 21 days after exposure to an infected tick. Infection can range from asymptomatic infection to fatal disease. Common signs and symptoms include fever (often over 102°F), chills, headache, and myalgias.  Nausea, vomiting, anorexia, acute weight loss, abdominal pain, cough, diarrhea, and change in mental status are reported less frequently. Highly suggestive laboratory findings include leukopenia – a decrease in white blood cells making you more susceptible to infection (WBC< 4,500/mm³), thrombocytopenia  – a decrease in platelets causing bruising and bleeding (platelets <150,000/mm³), and increased aminotransferase levels – relating to liver damage. Most of the damage it causes appears to be related to host inflammatory processes, as there is little evidence of a correlation between the number of organisms and host disease severity.

http://www.columbia-lyme.org/patients/tbd_ehrli-anapla.html

Compared with HME (human monocytic ehrlichiosis), HGA (human granulocytic anaplasmosis) appears less likely to involve the central nervous system, but peripheral neuropathies are more common and can last weeks to months. Among the neurologic findings reported in the medical literature are facial palsy, demyelinating polyneuropathy and brachial plexopathy. Respiratory distress syndrome and a septic or toxic shock-like syndrome have been reported, but appear to be less common than in HME. The overall fatality rate from HGA also seems to be slightly lower than that of HME, with most of the deaths resulting from opportunistic infections (for example, herpes simplex esophagitis, Candida pneumonitis, and pulmonary aspergillosis) in immunocompromised patients.

Unusual presentations may be the result of coinfections with Borrelia burgdorferi (Lyme disease agent) and/or Babesia microti (babesiosis agent), as a single feeding tick may transmit multiple disease agents.

Cases of HA acquired through blood transfusions have been documented. Include HA in the rule-out for patients who develop a febrile illness with thrombocytopenia following blood transfusion. Suspected transfusion-associated anaplasmosis should be reported.

Prevalence:

A large survey by Lymedisease.org found that 53% stated they had coinfections and 30% responded they had two or more coinfections.  Similar results were found in Canada.  While the most common coinfections found in Canada were Bartonella (36%) and Babesia (19%), Anaplasma took third place (13%).  https://www.lymedisease.org/lymepolicywonk-study-finds-coinfections-in-lyme-disease-common-2/ Here in the U.S. the results showed that 5% of patients with Lyme also had Anaplasmosis; however, please realize most doctors are not looking for this, the testing is poor, many states don’t require reporting and many cases go unreported. In 2014, there were 2800 confirmed cases of HA.  Rhode Island, Minnesota, Connecticut, Wisconsin, New York and Maryland are the hotbeds.  https://www.cdc.gov/mmwr/volumes/65/rr/pdfs/rr6502.pdf

Master Herbalist, Stephen Buhner, in his book Natural Treatments for Lyme Coinfections (Anaplasma, Babesia, and Ehrlichia states on page 24, “In other words, if you want to successfully treat someone who is infected with a vector-borne infection you need to realize up front that it is usually the case that coinfection has occurred and you have to look at the interactive picture, not merely single infectious agents.”  Demonstrating another unique interplay, one study found that ticks express an antifreeze type substance to enhance survival when they are infected with Anaplasma. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2929727/  In the world of microbes there is definitely a “You scratch my back, I’ll scratch yours.”

Tests:

http://www.columbia-lyme.org/patients/tbd_ehrli-anapla.html
Standard blood tests in HGA usually reveal findings similar to those seen in HME: leukopenia, thrombocytopenia and liver function abnormalities (elevated transaminases). However, the hematological abnormalities frequently resolve by the second week of symptoms, so their absence should be interpreted in that context if patients are presenting later in the course of their illness. In general, empiric antibiotic treatment should be considered for patients in endemic areas who present with an acute febrile illness suggestive of HGA. For specific diagnosis, Wright or Giemsa-stained blood smears have a slightly higher yield than with HME, but are still not optimal for general clinical utility, given that there appears to be a wide variation (25-75%) in the sensitivity of these tests in visualizing morulae in host neutrophils. More helpful, but not always available, are polymerase chain reaction (PCR) tests, which are estimated to have a sensitivity of 67-90%. Prior antibiotic therapy dramatically reduces the sensitivity of both  of these diagnostic methods. Serologic testing is useful to confirm the diagnosis of anaplasmosis. The most commonly used method is indirect immunofluorescence (IFA) of IgM and IgG anti-A. phagocytophilum antibodies. Seroconversion is perhaps the most sensitive laboratory evidence of A. phagocytophilum infection, but is not always obtained in a timely enough manner to provide useful input on clinical (i.e., treatment) decisions.

According to the CDC:
Any two of the following three tests for evidence of infection with Anaplasma phagocytophilum are recommended:
*An indirect immunofluorescence assay (IFA) is the principal test used to detect HA infection. Acute and convalescent phase serum samples can be evaluated to look for a four-fold change in antibody titer to A. phagocytophilum.
*Intracellular inclusions (morulae) also may be visualized in granulocytes on Wright- or Giemsa- stained blood smears.
*Polymerase chain reaction (PCR) assays are being used increasingly to detect A. phagocytophilum DNA.

According to animal studies, morulae are usually difficult to find in blood smears, even during the acute stage of disease. It is also stated that serology may be helpful in identifying antibodies but may not detect early infections during the acute phase of disease.

88_anaplasma316x316Courtesy of Lymestats.org

Treatment: Discuss all treatments with your health care professional

http://www.columbia-lyme.org/patients/tbd_ehrli-anapla.html
The optimal dose and duration of antibiotic treatment for anaplasmosis has not been definitively established, but it is clear that A. phagocytophilum is highly sensitive to tetracyclines. Thus, oral doxycycline is the recommended treatment, at the same dose used for Ehrlichia infections: 200 mg/day in two divided doses. The usual treatment duration is 5-10 days, which is extended if there is suspected coinfection with B. burgdorferi, the agent of Lyme disease. In any case, treatment should continue for at least three days after the patient’s fever resolves. Response to treatment is usually rapid; if the patient remains febrile more than two or three days after initiation of doxycycline therapy, the diagnosis should be revisited.
As with Ehrlichia infections, rifampin is used in cases where doxycycline is contraindicated, such as pregnancy or allergy. Rifampin has also been used successfully in pediatric cases, and thus is sometimes employed in mild cases of pediatric A. phagocytophilum infection. If coinfection with B. burgdorferi is suspected in a pediatric case, doxycycline is sometimes used as an initial treatment for 3-5 days, with another antibiotic employed thereafter to complete the somewhat longer recommended treatment period for early Lyme disease.

Treatment according to the CDC: (Notice the dose is lowered)

http://www.cdc.gov/rmsf/doxycycline/index.html

HA patients typically respond dramatically to doxycycline therapy (100 mg twice daily until the patient is afebrile for at least 3 days). Other tetracycline drugs also are likely to be effective. In general patients with suspect HA and unexplained fever after a tick exposure should receive empiric doxycycline therapy while diagnostic tests are pending, particularly if they experience leukopenia and/or thrombocytopenia.
http://www.jpeds.com/article/S0022-3476(15)00135-3/pdf?ext=.pdf

According to the CDC, Doxycycline is the most effective antibiotic for the treatment of suspected rickettsial infections for all ages, including Rocky Mountain Spotted Fever, and delay in treatment may lead to severe illness and/or death. Children are five times more likely than adults to die from RMSP and a new study found that short courses of doxy can be used in children without causing tooth staining or weakening of tooth enamel. Prior to this, doctors were reticent using Doxy due to studies in the 50’s showing a link between Tetracycline (binds to calcium) use in young children and tooth weakening and staining. Doxy, a newer medication, binds to calcium less readily and, according to the CDC, if used in the correct dose and duration for rickettsial diseases, should cause no harm. It’s also the treatment of choice according to the American Academy of Pediatrics (AAP). Doxycycline treatment should be continued for at least 3 days after fever resolves, and the usual duration of therapy is 7-10 days.  Chloramphenicol is considered a second-line therapeutic agent, as it is significantly less effective at preventing fatal outcome; other broad-spectrum antimicrobial agents typically used to treat sepsis are not effective at preventing fatal outcome due to RMS.

http://www.ilads.org/lyme/what-to-do-if-bit-by-tick.php
According to ILADS (International Lyme and Associated Diseases Society) Doxycycline has the advantage of treating numerous tick borne illnesses such as Lyme (borrelia), Ehrlichia, Anaplasma, Q Fever, and Rocky Mountain Spotted Fever. They state the downside is that Doxy causes significant sun sensitization, can be hard on the stomach, and the usual dosing may not reach therapeutic levels.
Recent data suggests that treatment may not clear organisms in animals.

If you find a doctor willing to become properly educated on tick borne illness, please give them this link:  https://madisonarealymesupportgroup.com/2017/06/20/help-doctors-get-educated-on-lyme-and-tick-borne-illness/

Category:

Anaplasmosis, Anaplasmosis Treatment, Lyme, Treatment, Uncategorized