Archive for the ‘Anaplasmosis’ Category

Tick Bite Leads to Multiple Co-infections

https://danielcameronmd.com/tick-bite-multiple-co-infections/

Tick bite leads to multiple co-infections

Man in hospital bed with co-infections from a tick bite.

In their case report “One man, three tick-borne illnesses” Grant and colleagues describe a 70-year-old man who was admitted to the emergency department with ongoing fevers, ankle edema and nausea. [1] One month earlier he noticed a small raised red lesion on his left ankle, which he believed was an insect bite.

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“Two days after noting this ankle lesion, the patient noticed an erythematous rash on his neck and chest,” the authors explain. He was prescribed an antihistamine and 7-day course of trimethoprim–sulfamethoxazole.

The rash resolved after 5 days of antibiotic treatment, but the man continued to have pain and swelling in his ankle.  The pain spread to his left hip and he was “diagnosed with sciatica and prescribed gabapentin.”

The patient had reportedly travelled to an endemic area of the United States. And was therefore, suspected of having a tick-borne illness.

“Physicians must maintain a high level of suspicion for co-infection, as untreated disease can result in long term and sometimes life-threatening sequelae,” the authors suggest.

He tested positive for Borrelia burgdorferi, Anaplasma phagocytophilum and Babesia microti serologies.

The patient’s symptoms improved with treatment, but one year later, he continued to have symptoms of neuropathy at the site of the presumed insect bite.

References:
  1. Grant L, Mohamedy I, Loertscher L. One man, three tick-borne illnesses. BMJ Case Rep. 2021 Apr 16;14(4):e241004. doi: 10.1136/bcr-2020-241004. PMID: 33863772; PMCID: PMC8055128.

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**Comment**

A perfect example of how mainstream medicine is hopelessly lost in its own hubris.

  1. Seven days of treatment of anything will not solve this
  2. trimethoprim–sulfamethoxazole, commonly known as Bactrim DS will not touch Babesia at all
  3. Bactrim DS, while a great drug, should not be the first choice for Lyme disease – and he had a clear EM rash, which is diagnostic for Lyme – no testing required
  4. It is common knowledge that the EM rash will wax and wane all on its own and should never be used to determine if treatment is working or not
  5. Doxycycline is still the best front-line drug for both Lyme and Anaplasmosis, but is far from sufficient in and of itself
  6. It is not surprising at all that this poor man continued to suffer with neuropathy, which they will undoubtedly blame on anything but tick-borne illness and it will never occur to them in a million years to treat him with numerous antimicrobials simultaneously for far longer than 7 days.  Myopia is a a very real condition

For more:

For Lyme treatment:  https://madisonarealymesupportgroup.com/2016/02/13/lyme-disease-treatment/

For Anaplasmosis treatment:  https://madisonarealymesupportgroup.com/category/anaplasmosis-treatment/

For Babesia Treatment:  https://madisonarealymesupportgroup.com/category/babesia-treatment/

Category:

Anaplasmosis, Babesia, Lyme, research

New Guidance for Treatment of Lyme & Other TBD in Pregnancy

https://www.lymedisease.org/lyme-pregnancy-guidance/

New guidance for treatment of Lyme and other TBD in pregnancy

Oct. 27, 2021

from the Lyme Disease Association website:

In a recently published review article,* authors provide a comprehensive summary of treatment options for pregnant patients with less common bacterial, fungal, and viral infections, including several tick-borne diseases (Lyme disease, ehrlichiosis, human granulocytic anaplasmosis, human monocytic ehrlichiosis, babesiosis, and Rocky Mountain spotted fever).

This review provides guidance to clinicians based on the most recently published evidence-based research and expert recommendations.

The review included a search of MEDLINE (inception to March 2021); clinical practice guidelines (both national and international); the CDC website; and additional references from bibliographies of noteworthy articles. The review also provides a list of medications on the WHO Essential Medications List that are used to treat the above infections (*Alyssa P. Gould et al., Drugs in Context-peer reviewed).

A summary of key treatment recommendations from the review article for several tick-borne diseases during pregnancy are as follows:

Lyme disease:

  • Treatment of gestational Lyme disease is essential to reduce adverse outcomes in pregnancy. The data shows adverse outcomes in treated pregnancy is (11–16%) compared to untreated disease (50–60%).
  • Doxycycline should not routinely be used in pregnancy for Lyme disease in order to avoid adverse side effects including transient suppression of bone growth and staining of developing teeth, especially with proven alternatives.
  • Amoxicillin is the preferred treatment in the absence of neurological manifestations or atrioventricular heart block.
  • Ceftriaxone is typically reserved for patients with severe neurological or cardiac manifestations.
  • One study noted a non-significant increase in adverse pregnancy outcomes, such as pregnancy loss, among orally treated (31.6%) compared to parenterally treated (12.1%) pregnant patients.
  • Alternative oral therapy is cefuroxime axetil and parenteral therapies include penicillin G or cefotaxime.
  • Late Lyme disease (often manifesting as Lyme arthritis) may be managed with oral or parenteral β-lactams.

Ehrlichiosis & Anaplasmosis:

  • If infections with anaplasmosis or ehrlichiosis is suspected, treatment should be initiated due to the likelihood of complications and potential for vertical transmission of disease.
  • Rifampin has shown in vitro activity against ehrlichia and has been used successfully in limited case reports of pregnant women with anaplasmosis.
  • Doxycycline has been used successfully to treat ehrlichiosis.
  • Due to a lack of data, these pregnant patients should be closely monitored for resolution of disease.
  • The addition of amoxicillin or cefuroxime is suggested if coinfection with Lyme disease is suspected, as rifampin does not have activity against B. burgdorferi.

Babesiosis:

  • Patients with suspected babesiosis should be treated due to potential complications, including possible vertical transmission to the fetus.
  • Combination therapy is preferred with clindamycin plus quinine.
  • Longer treatment courses or retreatment may be needed in cases with symptoms and/or parasitaemia persisting >3 months. Resolution of parasitaemia should be used to determine treatment course.

Rocky Mountain spotted fever (RMSF):

  • RMSF cases are associated with poor outcomes for the fetus, regardless of the treatment.
  • Prevention is crucial for pregnant patients, and treatment should be provided within 3–5 days of exposure.
  • Doxycycline is the preferred therapy. Treatment course is typically 5–7 days or 3 days after fever resolution.
  • Chloramphenicol is a proposed alternative treatment; but there are concerns for significant adverse effects, including myelosuppression, aplastic anaemia, and grey baby syndrome, specifically at or near birth, and it is associated with higher mortality in RMSF. (chloramphenicol is not available orally in the US).

Read the full review article here.

Read other LDA articles regarding treatment here

Related posts:

  1. IDSA issues new, separate treatment guidelines for babesiosis
  2. TOUCHED BY LYME: CDC allows “possibility” of mother-fetus Lyme transmission
  3. Lyme Disease Co-Infections
  4. IDSA publishes new Lyme disease treatment guidelines

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**Comment**

Please remember there is great controversy in treating Lyme/MSIDS, even among experienced Lyme literate doctors.  There is quite a bit of trial and error involved as testing is so abysmal.  Wise clinicians diagnose and treat this clinically based upon symptoms, not solely upon testing.  Often, once treatment for Lyme starts and the pathogen load is reduced, other coinfections become noticeable requiring other medications.

For more:

Category:

Anaplasmosis, Babesia, Ehrlichiosis, Lyme, Pregnancy, Rocky Mountain Spotted Fever, Treatment

New Maps Show Where Citizen Scientists Found Infected Ticks

https://www.lymedisease.org/balf-interactive-tick-maps/

New maps show where citizen scientists found infected ticks

Want an easy way to see where disease-carrying ticks have been found throughout the United States?

Check out the new interactive tick maps recently launched by the Bay Area Lyme Foundation.

The maps are based on data published in mSphere, a multidisciplinary open-access journal of the American Society for Microbiology.

The information came from ticks submitted by citizen scientists as part of BALF’s Free Tick Testing Program, which ran from 2016 to 2019.

The study found infected Ixodes ticks in 116 counties which were not previously identified by the Centers for Disease Control as having them.

The testing program collected more than 20,400 ticks. 8,954 were Ixodes ticks, capable of carrying the most common tick-borne pathogens.

The research was conducted through a partnership between Bay Area Lyme Foundation, Northern Arizona University, Colorado State University and the Translational Genomics Research Institute (TGen).

The study evaluated the distribution and prevalence of the four most common tick–borne pathogens:

  • Borrelia burgdorferi sensu lato, the group which causes Lyme disease
  • Borrelia miyamotoi, which causes tick-borne relapsing fever
  • Anaplasma phagocytophilum, which causes human granulocytic anaplasmosis
  • protozoan pathogen, Babesia microti.

The program tested two types of ticks:

  • Ixodes scapularis, also known as the blacklegged tick or the deer tick, which are found in the Northeast, Midwest and South;
  • Ixodes pacificus, also known as the western blacklegged tick, which lives in the West
The interactive maps only represent data from this citizen science study. They do not represent the total risk of tick-borne infections in the US.

An eye-opening look

“These maps will be eye-opening for many Americans as it makes it easy to see that ticks carrying disease-causing bacteria can be commonly found across the US,” stated Tanner Porter, MS, a research associate at TGen and the lead author on the study.

“If you aren’t aware of the possibility of ticks, either in your backyard or whilst traveling, you are unlikely to look for them – but an unseen tick can still transmit a pathogen and cause disease. It is important for everyone to know to look for ticks, be aware of the pathogens that they carry, and takes steps to mitigate their risk.”

This new study expands on previous research identifying ticks capable of carrying Lyme and other tick-borne diseases in 83 counties (in 24 states) where these ticks had not been previously recorded.  These included:  Alabama, Arizona, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Minnesota, Montana, Missouri, Nevada, North Carolina, Ohio, Oregon, South Carolina, Tennessee, Texas, Utah, Virginia, Washington, and Wisconsin.

The study builds on recently released CDC data that added 100 counties to the list of those with disease-carrying ticks.

PRESS RELEASE SOURCE: Bay Area Lyme Foundation

Category:

Anaplasmosis, Babesia, Borrelia Miyamotoi (Relapsing Fever Group), Lyme, Ticks

Detection of Anaplasma phagocytophilum, Babesia odocoilei, Babesia sp., Borrelia burgdorferi Sensu Lato, and Hepatozoon canis in Ixodes scapularis Ticks Collected in Eastern Canada

Scott et al. 2021, 5 pathogens-1

Detection of Anaplasma phagocytophilum, Babesia odocoilei, Babesia sp., Borrelia burgdorferi Sensu Lato, and Hepatozoon canis in Ixodes scapularis Ticks Collected in Eastern Canada

John D. Scott 1,* and Risa R. Pesapane 2,3

https://doi.org/10.3390/pathogens10101265
Received: 27 August 2021
Accepted: 21 September 2021
Published: 1 October 2021


Abstract:

Tick-borne pathogens cause infectious diseases that inflict much societal and financial hardship worldwide. Blacklegged ticks, Ixodes scapularis, are primary vectors of several epizootic and
zoonotic pathogens. The aim sets forth the pathogens and their prevalence. In Ontario and Quebec,
113 I. scapularis ticks were collected from songbirds, mammals, including humans, and by flagging.
PCR and DNA sequencing detected five different microorganisms:

  • Anaplasma phagocytophilum,1 (0.9%)
  • Babesia odocoilei, 17 (15.3%)
  • Babesia microti-like sp., 1 (0.9%)
  • Borrelia burgdorferi sensu lato (Bbsl), 29 (26.1%)
  • Hepatozoon canis, 1 (0.9%)

Five coinfections of Bbsl and Babesia odocoilei occurred. Notably, H. canis was documented for the first time in Canada and, at the same time, demonstrates the first transstadial passage of H. canis in I. scapularis. Transstadial passage of Bbsl and B. odocoilei was also witnessed. A novel undescribed piroplasm (Babesia microti-like) was detected. An established population of I. scapularis ticks was detected at Ste-Anne-de-Bellevue, Quebec. Because songbirds widely disperse I. scapularis larvae and nymphs, exposure in an endemic area is not required to contract tick-borne zoonoses. Based on the diversity of zoonotic pathogens in I. scapularis ticks, clinicians need to be aware that people who are bitten by I. scapularis ticks may require select antimicrobial regimens.

Category:

Anaplasmosis, Babesia, Lyme, research, Ticks

Single Tick Bite Leads to 3 Diseases in Elderly Woman

https://danielcameronmd.com/tick-bite-causes-3-diseases-elderly-woman/

Single tick bite leads to 3 diseases in elderly woman

Health aid helping old woman in bed who had a tick bite and Lyme disease.

In their article “Triple Tick Attack,” doctors describe the case of a 74-year-old woman living in Connecticut who developed three tick-borne diseases as the result of a single tick bite. While Lyme disease is the most common tick-borne illness, ticks can transmit other bacterium, causing various “co-infections,” which can be difficult to diagnose.

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The woman was an avid gardener, who had a history of COPD (chronic obstructive pulmonary disease) and high blood pressure. She was admitted to the hospital with dyspnea, fatigue, and a cough productive of yellowish mucoid sputum.

The patient also had significant altered mental status, pallor, and peripheral edema. A lung examination revealed bibasilar crackles, Kumar explains. [1]

She was treated empirically for community-acquired pneumonia, and was prescribed ceftriaxone and azithromycin.

The woman no history of a rash or tick bite. However, lab tests later revealed the presence of 3 tick-borne pathogens.

“We present a case of triple infection with babesiosis, Lyme disease, and anaplasmosis treated with antibiotics and red blood cell (RBC) exchange (erythrocytapheresis).”¹

1) Babesia − This tick-borne disease is caused by a tiny parasite that infects the red blood cells.

“A peripheral blood smear revealed the presence of intracytoplasmic parasites consistent with Babesia,” writes Kumar. Consequently, the woman was started on azithromycin and atovaquone.

Further testing revealed that she had severe babesiosis. Her parasitic load was so high (9.04%) that she required a red blood cell (RBC) exchange (erythrocytapheresis).

Repeat testing, however, found the parasitic load remained high (6.54%), which required a second round of RBC exchange.

“Antimicrobials were changed to clindamycin, quinine, and doxycycline for a total of 14 days,” writes Kumar.

2) Borrelia burgdorferi − The bacteria that causes Lyme disease. Serologic tests were positive. The patient was prescribed doxycycline.

3) Anaplasma − The bacteria that causes anaplasmosis, formerly known as human granulocytic ehrlichiosis (HGE). The patient’s anaplasma titers were positive.

“Patients presenting with an atypical clinical picture of a single pathogen or a lack of improvement with antibiotics after 48 hours require further testing for the presence of other infections,” the authors suggest. “A delay in the diagnosis can lead to an increased risk of complications and disease duration.”

In another case report, Grant and colleagues describe a 70-year-old man who presented to the emergency room with “fevers, ankle edema and nausea following a presumed insect bite on his ankle 1 month prior.”²

Test results revealed the man was positive for Lyme disease, Babesia microti, and Anaplasmosis.

His symptoms resolved completely following treatment with doxycycline, atovaquone and azithromycin.

The authors suggest, “Co-infection with Lyme disease and another tick-borne illness is common, and testing for co-infection should be performed in patients with >24 hours of symptoms despite appropriate treatment, as well as unexplained laboratory abnormalities.”

Related Articles:

One bite, six diseases: all from the same tick 
First-line combination therapy for tick-borne illnesses
Video: Co-infections of Lyme disease

References:
  1. Kumar M, Sharma A, Grover P. Triple Tick Attack. Cureus. 2019;11(2):e4064.
  2. Grant L, Mohamedy I, Loertscher L. BMJ Case Rep 2021;14:e241004. doi:10.1136/bcr-2020-
    241004

For more:

Category:

Anaplasmosis, Babesia, Lyme