Archive for the ‘Babesia’ Category

Tickborne Diseases – Confronting a Growing Threat

Tickborne Diseases — Confronting a Growing Threat

Catharine I. Paules, M.D., Hilary D. Marston, M.D., M.P.H., Marshall E. Bloom, M.D., and Anthony S. Fauci, M.D.

July 25, 2018, at

Every spring, public health officials prepare for an upsurge in vectorborne diseases. As mosquito-borne illnesses have notoriously surged in the Americas, the U.S. incidence of tickborne infections has risen insidiously, triggering heightened attention from clinicians and researchers.


Common Ticks Associated with Lyme Disease in North America.

According to the Centers for Disease Control and Prevention (CDC), the number of reported cases of tickborne disease has more than doubled over the past 13 years.1 Bacteria cause most tickborne diseases in the United States, and Lyme disease accounts for 82% of reported cases, although other bacteria (including Ehrlichia chaffeensis, Anaplasma phagocytophilum, and Rickettsia rickettsii) and parasites (such as Babesia microti) also cause substantial morbidity and mortality. In 1982, Willy Burgdorfer, a microbiologist at the Rocky Mountain Laboratories of the National Institute of Allergy and Infectious Diseases, identified the causative organism of Lyme disease, a spirochete eponymously named Borrelia burgdorferi. B. burgdorferi (which causes disease in North America and Europe) and B. afzelii and B. garinii (found in Europe and Asia) are the most common agents of Lyme disease. The recently identified B. mayonii has been described as a cause of Lyme disease in the upper midwestern United States. Spirochetes that cause Lyme disease are carried by hard-bodied ticks (see graphic), notably Ixodes scapularis in the northeastern United States, I. pacificus in western states, I. ricinus in Europe, and I. persulcatus in eastern Europe and Asia. B. miyamotoi, a borrelia spirochete found in Europe, North America, and Asia, more closely related to the agents of tickborne relapsing fever, is also transmitted by I. scapularis and should be considered in the differential diagnosis of febrile illness occurring after a tick bite.

Patterns of spirochete enzootic transmission are geographically influenced and involve both small-mammal reservoir hosts, such as white-footed mice, and larger animals, such as white-tailed deer, which are critical for adult tick feeding. The rising incidence and expanding distribution of Lyme disease in the United States are probably multifactorial, but increased density and range of the tick vectors play a key role. The geographic range of I. scapularis is apparently increasing: by 2015, it had been detected in nearly 50% more U.S counties than in 1996.

Lyme disease’s clinical manifestations range from relatively mild, nonspecific findings and classic erythema migrans rash in early disease to more severe manifestations, including neurologic disease and carditis (often with heart block) in early disseminated disease, and arthritis, which may occur many months after infection (late disease). Although most cases are successfully treated with antibiotics, 10 to 20% of patients report lingering symptoms after receiving appropriate therapy.2 Despite more than four decades of research, gaps remain in our understanding of Lyme disease pathogenesis, particularly its role in these less well-defined, post-treatment symptoms.

Meanwhile, tickborne viral infections are also on the rise and could cause serious illness and death.1 One example is Powassan virus (POWV), the only known North American tickborne encephalitis-causing flavivirus.3 POWV was recognized as a human pathogen in 1958 after being isolated from the brain of a child who died of encephalitis in Powassan, Ontario. People infected with POWV often have a febrile illness that can be followed by progressive and severe neurologic manifestations, resulting in death in 10 to 15% of cases and long-term sequelae in 50 to 70% of survivors.3 An antigenically similar virus, POWV lineage II, or deer tick virus, was discovered in New England in 1997. Both POWV subtypes are linked to human disease, but their distinct enzootic cycles may affect their likelihood of causing such disease. Lineage II seems to be maintained in an enzootic cycle between I. scapularis and white-footed mice — which may portend increased human transmission, because I. scapularis is the primary vector of other serious pathogens, including B. burgdorferi. Whereas only 20 U.S. cases of POWV infection were reported before 2006,3 99 were reported between 2006 and 2016. Other tickborne encephalitis flaviviruses cause thousands of cases of neuroinvasive illness in Europe and Asia each year, despite the availability of effective vaccines in those regions. The increase in POWV cases coupled with the apparent expansion of the I. scapularis range highlight the need for increased attention to this emerging virus.

The public health burden of tickborne pathogens is considerably underestimated. For example, the CDC reports approximately 30,000 cases of Lyme disease per year but estimates that the true incidence is 10 times that number.1 Multiple factors contribute to this discrepancy, including limitations in surveillance and reporting systems and constraints imposed by available diagnostics, which rely heavily on serologic assays.4 Diagnostic utility is affected by variability among laboratories, timing of specimen collection, suboptimal sensitivity during early infection, imperfect use of diagnostics (particularly in persons with low probability of disease), inability of a single test to identify coinfections in patients with acute infection, and the cumbersome nature of some assays. Current diagnostics also have difficulty distinguishing acute from past infection — a serious challenge in diseases characterized by nonspecific clinical findings. Moreover, tests may remain positive even after resolution of infection, leading to diagnostic uncertainty during subsequent unrelated illnesses. For less common tickborne pathogens such as POWV, serologic testing can be performed only in specialized laboratories, and currently available tests fail to identify novel tickborne organisms.
Such limitations have led researchers to explore new technologies. For example, one of the multiplex serologic platforms that have been developed can detect antibodies to more than 170,000 distinct epitopes, allowing researchers to distinguish eight tickborne pathogens.4 In addition to its utility in screening simultaneously for multiple pathogens, this assay offers enhanced pathogen detection, particularly in specimens collected during early disease. Further studies are needed to determine such assays’ applicability in clinical practice.

Nonserologic platform technologies may also improve diagnostic capabilities, particularly in identifying emerging pathogens. Two previously unknown tickborne RNA viruses, Heartland virus and Bourbon virus, were discovered by researchers using next-generation sequencing to help link organisms with sets of unexplained clinical symptoms. The development and widespread implementation of next-generation diagnostics will be critical to understanding the driving factors behind epidemiologic trends and the full clinical scope of tickborne disease. In addition, sensitive, specific and, where possible, point-of-care assays will facilitate appropriate clinical care for infected persons, guide long-term preventive efforts, and aid in testing of new therapeutics and vaccines.

In the United States, prevention and management of tickborne diseases include measures to reduce tick exposure, such as avoiding or controlling the vector itself, plus prompt, evidence-based treatment of infections. Although effective therapies are available for common tickborne bacteria and parasites, there are none for tickborne viruses such as POWV.

The biggest gap, however, is in vaccines: there are no licensed vaccines for humans targeting any U.S. tickborne pathogen. One vaccine that was previously marketed to prevent Lyme disease, LYMErix, generated an immune response against the OspA lipoprotein of B. burgdorferi, and antibodies consumed by the tick during a blood meal targeted the spirochete in the vector.5 Nonetheless, the manufacturer withdrew LYMErix from the market for a combination of reasons, including falling sales, liability concerns, and reports suggesting it might be linked to autoimmune arthritis, although studies supported the vaccine’s safety. Similar concerns will probably affect development of other Lyme disease vaccines.5

Historically, infectious-disease vaccines have targeted specific pathogens, but another strategy would be to target the vector.5 This approach could reduce transmission of multiple pathogens simultaneously by exploiting a common variable, such as vector salivary components. Phase 1 clinical trials are under way to evaluate mosquito salivary-protein–based vaccines in healthy volunteers living in areas where most mosquito-borne diseases are not endemic. Since tick saliva also contains proteins conserved among various tick species, this approach is being explored for multiple tickborne diseases.5

The burden of tickborne diseases seems likely to continue to grow substantially. Prevention and management are hampered by suboptimal diagnostics, lack of treatment options for emerging viruses, and a paucity of vaccines. If public health and biomedical research professionals accelerate their efforts to address this threat, we may be able to fill these gaps. Meanwhile, clinicians should advise patients to use insect repellent and wear long pants when walking in the woods or tending their gardens — and check themselves for ticks when they are done.


While this article repeats much of the same verbiage that’s been repeated for years, particularly the vaccine push, they are ignoring the following:

  1. Many TBI’s are congenitally transmitted:
  2. There is a real probability of sexual transmission:
  3. While they mention Ehrlichia, Anaplasma, Rickettsia, and Babesia, there are many other players that are hardly getting a byline.  For a list to date:  This is an important issue because to date the medical world is looking at this complex illness as a one pathogen one drug illness when nothing could be further from the truth.  No one has done any research on the complexity of being infected with more than one pathogen.  It will reveal the CDC’s guidelines of 21 days of doxy to be utter stupidity.
  4. Also, worth mentioning is that only a few of these are reportable illnesses so there is absolutely no data on how prevalent any of this is.  Surveillance is a real problem.
  5. Regarding what ticks are where….this ancient verbiage needs to change.  Ticks are moving everywhere.  This is on record in numerous places:
  6. No tick is a good tick.  They all need blood meals and have the potential to transmit disease.  
  7. This article is silent about the Asian Longhorned tick that propagates itself by cloning and can drain cattle of their blood.  Found in six states so far it was recently found on a child in New Jersey:  Word in the tick world is it had NOT bitten the child and tested negative for pathogens.  What is concerning is that it is known to transmit SFTS virus and Japanese spotted fever in Asia. This story is a reminder that this tick is NOT just a livestock problem and that a normal child going about a normal day with NO contact with livestock had this tick on her.  Another clear reminder that it is foolish to put any of this in a box.
  8. They need to emphasize that the “classic erythema migrans rash” while indicative of Lyme, is unseen or variable in many patients.
  9. Constraints in testing is a true problem but an even bigger problem is untrained and uneducated medical professionals.  This stuff may never test clearly.  Get over it.  Get trained to know what to look for!
  10. The Lyme vaccine was a bust.  It still is.  Unless safety concerns are dealt with we want nothing to do with any vaccine.
  11. All I know is that mosquitoes and Zika get more attention that this modern day 21st century plague that is creeping everywhere and is a true pandemic.  It still isn’t being seriously dealt with or researched.  What research is being done is same – o – same -o stuff we already know.  Study the tough stuff – the unanswered questions or things that are just repeated as a mantra for decades.
We need answers out here not repeated gibberish that isn’t helping patients.

The one thing I didn’t deal with that I will point out now is this regurgitated number in the NEJM article of 10-20% of patients moving on to chronic/persistent Lyme. The following informative article written by Lorraine Johnson points out this number to be considerably higher which corresponds to my experience as a patient advocate: Excerpt below:

Besides the staggering financial cost to this 21st century plague, this paper, based on estimates of treatment failure rates associated with early and late Lyme, estimates that 35-50% of those who contract Lyme will develop persistent or chronic disease.

Let that sink in.

And in the Hopkins study found 63% developed late/chronic Lyme symptoms.

For some time I’ve been rankled by the repeated CDC statement that only 10-20% of patents go on to develop chronic symptoms. This mantra in turn is then repeated by everyone else.

While still an estimate, I’d say 35 to over 60% is a tad higher than 10-20%, wouldn’t you? It also better reflects the patient group I deal with on a daily basis. I can tell you this – it’s a far greater number than imagined and is only going to worsen.



Citizen Scientists Help Track Tick Borne Illness Exposure

Who got bit? By mailing in 16,000 ticks, citizen scientists help track disease exposures

Study offers new insight into potential exposure to tick-borne diseases

Date:  July 12, 2018
Source:  Colorado State University
A bite from a disease-carrying tick can transmit a serious, potentially fatal infection, such as Lyme disease. But many ticks go unnoticed and unreported. Now, with the help of citizen scientists, ecologists are offering better insight into people’s and animals’ potential exposure to tick-borne diseases — not just the disease reporting and prevalence that’s only tracked when people get sick.

Western black-legged ticks.
Credit: Ervic Aquino/California Department of Public Health

A bite from a disease-carrying tick can transmit a serious, potentially fatal infection, such as Lyme disease. But many ticks go unnoticed and unreported.

Now, with the help of citizen scientists, ecologists at Colorado State University and Northern Arizona University are offering better insight into people’s and animals’ potential exposure to tick-borne diseases — not just the disease reporting and prevalence tracking that only occur when people get sick.

The result is a study published in the open-access journal PLOS ONE. The team was funded by the Bay Area Lyme Foundation, a nonprofit organization dedicated to informing the public about Lyme disease and finding a cure. Foundation officials urge people to take tick bites seriously, since early detection is key to treating most conditions.

The study’s lead authors are Daniel Salkeld, a research scientist in CSU’s Department of Biology, and longtime collaborator Nathan Nieto of Northern Arizona University.

“Our study may be a new way of understanding exposure to tick-borne diseases,” explained Salkeld, a disease ecologist. “Normally the approach is to rely on reported disease cases, or to look at ticks in natural habitats. Our data represent that in-between, middle ground: It shows when people or animals got bitten, and where, and what they got exposed to.”

Salkeld and Nieto’s study examined over 16,000 ticks sent in by citizen scientists from 49 states (all but Alaska) and Puerto Rico. Nearly 90 percent of the ticks were reported to have been removed from either humans or dogs. The researchers tested for several bacteria, including those that cause Lyme disease and babesiosis. One of the pathogens they tested for, Borrelia miyamotoi, was discovered relatively recently, and is not typically tracked by public health officials.

In their data, the researchers found 83 counties, in 24 states, where ticks carrying disease-causing bacteria had never been previously documented. The scientists’ original goal was to collect about 2,000 ticks, and they expected most to come from California’s San Francisco Bay Area. The nationwide response to their experiment underscores the public’s intense interest in better understanding tick diseases.

“The overwhelming participation from residents throughout the country and the surprising number of counties impacted demonstrates that a great need exists throughout the country for this information,” said Nieto, who led the diagnostic testing of each tick received in the mail. “This study offers a unique and very valuable perspective, as it looks at risk to humans that goes beyond the physician-reported infection rates and involved ticks that were found on or near people.

The researchers stress that citizen science data has limitations; some of their findings may be tied to human error, or lack of access to information. For example, the citizen scientists reported where they lived, and where the ticks were found, but not where they had traveled recently.

Tick scientists like Salkeld and Nieto can typically collect around 100 ticks for a localized study. Inviting citizen scientists to send in ticks opened up a whole new way of seeing how such ticks are distributed, and their activity patterns. Approaches like this could lead to new insights such as how diseases spread, and new human pathogens yet to be discovered.

“For example, we could start to look at what species of ticks are active, when, and where,” Salkeld said. “And how does this differ from across the north or south, or the Midwest to California? There could be all kinds of subtle variations.”

Story Source:

Materials provided by Colorado State University. Note: Content may be edited for style and length.

Journal Reference:

  1. Nathan C. Nieto, W. Tanner Porter, Julie C. Wachara, Thomas J. Lowrey, Luke Martin, Peter J. Motyka, Daniel J. Salkeld. Using citizen science to describe the prevalence and distribution of tick bite and exposure to tick-borne diseases in the United States. PLOS ONE, 2018; 13 (7): e0199644 DOI: 10.1371/journal.pone.0199644
Related article:
  • ticks in places they weren’t supposed to be
  • ticks are born carrying disease and do not require a blood meal to pick it up 
  • ALL life stages of common ticks (deer, Western black-legged, and lone star) carry the bacteria that cases Lyme disease
  • they found Babesia in 26 counties across 10 states which
  • isn’t even a reportable illness to the public health department  
  • all of this blows holes in commonly held doctrine 

Canada is also making use of citizen scientists for the tick borne illness problem:




Ticks That Carry Lyme Disease Are Spreading Fast

By Dennis Thompson HealthDay July 13, 2018, 5:25 PM

Ticks that carry Lyme disease are spreading fast“>  (News story here)

Think you live in a place that’s free from disease-carrying ticks? Don’t be so sure.

Citizen scientists found ticks capable of transmitting Lyme disease and other tick-borne illnesses in dozens of places across the United States where the pests had never previously been recorded, a new study reports.

All told, disease-carrying ticks were detected in 83 counties where they’d never been found before across 24 states.

The numbers reflect a rise in tick populations across the country, said study author Nate Nieto. He’s an associate professor with Northern Arizona University’s department of biological sciences.

“People should be aware of ticks and tick-borne disease, even when they may think there’s not a recorded incidence of a tick in a county,” Nieto said. “These things, they’re not obeying borders. They’re going by biology. If they get moved there by a deer or bird or people or pets, they’re going to establish themselves and start growing.”

The massive nationwide study also provides evidence that ticks are born carrying infectious diseases, rather than picking germs up from the animals upon which they feed, said Wendy Adams, research grant director for the Bay Area Lyme Foundation, in California.

All life stages of the most commonly encountered ticks — the deer tick, the western black-legged tick and the lone star tick — carried the bacteria that causes Lyme disease, Adams said.

“That’s important, because that would say that a tick doesn’t need to acquire an infection from a blood meal. It’s born with the infection,” Adams explained.

These findings are the result of an unexpectedly successful effort by the Bay Area Lyme Foundation to collect tick samples from across the country.

Between January 2016 and August 2017, the foundation and Northern Arizona University offered free tick identification and testing to the general public. People were encouraged to send in ticks they found on themselves, their pets or around their communities.

The scientists’ original goal was to collect about 2,000 ticks. They wound up with more than 16,000, sent in by people from every state except Alaska.

“We got such a phenomenal participation,” Nieto said. “Two weeks in May, we got almost 2,000 packages per week. That is just powerful data.”

People found ticks in areas not represented in tracking maps maintained by the U.S. Centers for Disease Control and Prevention, the researchers discovered.

Most of these new areas were right next to counties with known tick populations, Adams said.

“Ticks are spreading. Tick populations have exploded,” Adams said. “This is good data to show the extent of that. It’s a message to people that even if you think ticks aren’t a problem, they could be.”

The 24 states that contain counties with newly documented populations of deer ticks or Western black-legged ticks are 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.

Further, ticks were found in states where they simply weren’t supposed to be, Adams said. Lone star ticks were found in California and black-legged ticks were found in Nevada, both for the first time ever.

People also found ticks carrying Babesia — microscopic parasites that infect red blood cells and cause the potentially life-threatening disease babesiosis — in 26 counties across 10 states in which the public health department does not require physicians to report cases of the disease.

The new study “highlights the geographic variability of ticks and the pathogens they carry,” said Dr. Paul Auwaerter, clinical director of infectious diseases at Johns Hopkins Medicine in Baltimore.

Surveillance is increasingly important as we see climate and environmental changes, because we do see expanding ranges of ticks. We’ve seen that with Lyme disease. We’ve seen that with babesiosis,” said Auwaerter, president of the Infectious Diseases Society of America.

Adams agreed, suggesting that more funding should be directed to these sorts of crowd-sourced tracking efforts.

“We have to invest federal dollars to examine the spread of ticks,” she said.

In the meantime, the Bay Area Lyme Foundation suggests that people protect themselves from ticks by:

  • Wearing light-colored clothes to make ticks more visible.
  • Do regular tick checks after being in a tick-infested area, and shower immediately after to wash away ticks that might be crawling on you.
  • Consider using tick repellents like DEET for skin and permethrin for clothing.
  • Talk with your doctor if you develop any symptoms following a tick bite.

The new study was published online July 12 in the journal PLOS One.“> (News story here on Lyme Disease in Dogs)



There has NEVER been a minimum time established for ticks to transmit the Lyme bacterium (or any other pathogen for that matter), so to exclaim with certainty that if the tick drops off the dog before 24 hours they will not get infected is pure conjecture. 

For more on that issue:

Research on transmission times as well as transmission modes are desperately needed.

This article points out that ticks don’t require a blood meal that they can be BORN infected.  This is important information to disseminate as many still believe a blood meal is required for them to become infected.

 A telling quote:  “These things are not obeying borders.”

Nope.  And they never have.  This tick border thing is a man-made constructed paradigm that has never been accurate, but it’s fit the CDC/NIH/IDSA narrative. (go to page 6 and read about Speilman’s maps which are faulty but have ruled like the Iron Curtain, and have been used to keep folks from being diagnosed and treated)

Time to pull the blinders off and look at this thing as the PANDEMIC it truly is.

Recently, Wisconsin had it’s first death from Rocky Mountain Spotted Fever, transmitted by the Lone Star Tick that isn’t supposed to be in Wisconsin at all:

The climate-change issue is another man-made paradigm regarding ticks who will be the last species on the planet besides the IRS:

We don’t need any more climate studies regarding ticks.  What we need to know is how this thing is transmitted (sexual, congenital, via breastmilk as well as other bugs, etc), testing that picks up all the pathogens, how long it takes for transmission, how to control ticks, what effectively kills the pathogens, and how to get our treatments paid for by insurance).

So thankful they brought up Babesia; however, there are 18 and counting pathogens spread by ticks and we need mandatory reporting for ALL of them as well as proper and effective treatments paid for by insurance:

Great work Bay Area Lyme Foundation!

We Have No Idea How Bad the US Tick Problem Is


WHEN RICK OSTFELD gets bitten by a tick, he knows right away. After decades studying tick-borne diseases as an ecologist at the Cary Institute of Ecosystem Studies in Millbrook, New York, Ostfeld has been bitten more than 100 times, and his body now reacts to tick saliva with an intense burning sensation. He’s an exception. Most people don’t even notice that they’ve been bitten until after the pest has had time to suck up a blood meal and transfer any infections it has circulating in its spit.

Around the world, diseases spread by ticks are on the rise. Reported cases of Lyme, the most common US tick-borne illness, have quadrupled since the 1990s. Other life-threatening infections like anaplasmosis, babesiosis, and Rocky Mountain spotted fever are increasing in incidence even more quickly than Lyme. Meat allergies caused by tick bites have skyrocketed from a few dozen a decade ago to more than 5,000 in the US alone, according to experts. And new tick-borne pathogens are emerging at a troubling clip; since 2004, seven new viruses and bugs transmitted through tick bite have shown up in humans in the US.

Scientists don’t know exactly which combination of factors—shifting climate patterns, human sprawl, deforestation—is leading to more ticks in more places. But there’s no denying the recent population explosion, especially of the species that carries Lyme disease: the black-legged tick.

“Whole new communities are being engulfed by this tick every year,” says Ostfeld. “And that means more people getting sick.

Tick science, surveillance, and management efforts have so far not kept pace. But the country’s increasingly dire tick-borne disease burden has begun to galvanize a groundswell of research interest and funding.

In 1942, Congress established the CDC specifically to prevent malaria, a public health crisis spreading through mosquitoes. Which is why many US states and counties today still have active surveillance programs for skeeters. The Centers for Disease Control and Prevention uses data from these government entities to regularly update distribution maps, track emerging threats (like Zika), and coordinate control efforts. No such system exists for ticks.

Public health departments are required to report back to the CDC on Lyme and six other tick-borne infections. Those cases combined with county-level surveys and some published academic studies make up the bulk of what the agency knows about national tick distribution. But this data, patchy and stuck in time, doesn’t do a lot to help public health officials on the ground.

“We’ve got national maps, but we don’t have detailed local information about where the worst areas for ticks are located,” says Ben Beard, chief of the CDC’s bacterial diseases branch in the division of vector-borne diseases. “The reason for that is there has never been public funding to support systematic tick surveillance efforts.

That’s something Beard is trying to change. He says the CDC is currently in the process of organizing a nationwide surveillance program, which could launch within the year. It will pull data collected by state health departments and the CDC’s five regional centers about tick prevalence and the pathogens they’re carrying to build a better picture of where outbreaks and hot spots are developing, especially on the expanding edge of tick populations.

The CDC is also a few years into a massive nationwide study it’s conducting with the Mayo Clinic, which will eventually enroll 30,000 people who’ve been bitten by ticks. Each one will be tested for known tick diseases, and next-generation sequencing conducted at CDC will screen for any other pathogens that might be present. Together with patient data, it should provide a more detailed picture of exactly what’s out there.

Together, these efforts are helping to change the way people and government agencies think about ticks as a public health threat.

“Responsibility for tick control has always fallen to individuals and homeowners,” says Beard. “It’s not been seen as an official civic duty, but we think it’s time whole communities got engaged. And getting better tick surveillance data will help us define risk for these communities in areas where people aren’t used to looking for tick-borne diseases.”

The trouble is that scientists also know very little about which interventions actually reduce those risks.

“There’s no shortage of products to control ticks,” says Ostfeld. “But it’s never been demonstrated that they do a good enough job, deployed in the right places, to prevent any cases of tick-borne disease.”

In a double-blind trial published in 2016, CDC researchers treated some yards with insecticides and others with a placebo. The treated yards knocked back tick numbers by 63 percent, but families living in the treated homes were still just as likely to be diagnosed with Lyme.

Ostfeld and his wife and research partner Felicia Keesing are in the middle of a four-year study to evaluate the efficacy of two tick-control methods in their home territory of Dutchess County, an area with one of the country’s highest rates of Lyme disease. It’s a private-public partnership between their academic institutions, the CDC, and the Steven and Alexandra Cohen Foundation, which provided a $5 million grant.

Ostfeld and Keesing are blanketing entire neighborhoods in either a natural fungus-based spray or tick boxes, or both. The tick boxes attract small mammal hosts, which get a splash of tick-killing chemicals when they venture inside. They check with all the human participants every two weeks for 10 months of the year to see if anyone’s gotten sick. By the end of 2020 the study should be able to tell them how well these methods, used together or separately on a neighborhood-wide scale, can reduce the risk of Lyme.

“If we get a definitive answer that these work the next task would be to figure out how to make such a program more broadly available. Who’s going to pay for it, who’s going to coordinate it?” says Ostfeld. “If it doesn’t work then perhaps the conclusion is maybe environmental control just can’t be done.”

In that case, people would be stuck with pretty much the same options they have today: protective clothing, repellants, and daily partner tick-checks. It’s better than nothing. But with more and more people getting sick, the US will need better solutions soon.



Great article pointing out the scary fact that only 6 pathogens transmitted by ticks are being reported on.  There are currently 18 pathogens and counting… the numbers are woefully inadequate.

Here’s the list so far:

Borrelia miyamotoi
Bourbon Virus
Colorado Tick Fever
Crimean-Congo hemorrhagic Fever
Heartland Virus
Meat Allergy/Alpha Gal
Pacific Coast Tick Fever: Richettsia philipii
Powassan Encephalitis
Q Fever
Rickettsia parkeri Richettsiosis
Rocky Mountain Spotted Fever
STARI: Southern Tick-Associated Rash Illness
Tickborne meningoencephalitis
Tick Paralysis

And the number keeps growing…..but nobody’s keeping score.

Splenic Rupture From Babesiosis, An Emerging Concern? A Systematic Review of Current Literature

Splenic rupture from babesiosis, an emerging concern? A systematic review of current literature

Shuo Li, Bobby Goyal, Joseph D.Cooper, Ahmed Abdelbaki, Nishant Gupta, Yogesh Kumara

Babesiosis is a relatively common tick-borne parasitic infection of erythrocytes primarily affecting the northeastern United States. Babesiosis’ prevalence and presentation have earned it the monikers “malaria of the northeast” and “Nantucket fever”. Clinical presentation ranges from asymptomatic infection to severe infection including acute respiratory distress syndrome (ARDS) and disseminated intravascular coagulopathy (DIC) or death. Since 2008, there have been a number of reports of splenic rupture in patients with the disease. We seek to provide a further understanding of this process, with the report of a case of splenic rupture followed by a systematic review of the current literature. We found that 87% of splenic rupture secondary to babesiosis occurred in male patients who are otherwise healthy, with an average of 56 years. Computed tomography is a reliable mode of diagnosis, and hemoperitoneum is the most common imaging finding. Patients with splenic rupture due to human babesiosis were successfully treated by various management strategies, such as conservative non-operative approach, splenic artery embolization, and splenectomy. The modality of treatment depends on patient’s clinical course and hemodynamic stability, although spleen conserving strategy should be considered first whenever possible.


For more:

The Science Isn’t Settled on Chronic Lyme

The Science Isn’t Settled on Chronic Lyme

A close look at the evidence suggests the controversial diagnosis should be taken more seriously, and that decades of sexism may be to blame for our collective dismissal.

JUNE 27, 2018

Porochista Khakpour’s new memoir, Sick, describes her experience of decades of severe illness from chronic Lyme disease. The thought-provoking book has spurred a conversation about the nature of illness narratives, the impact of sexism on women’s health, and the ills of modern life, along with recommendations from Oprah Magazine and Cheryl Strayed.

It has also received criticism due to the debate around whether chronic Lyme disease is a “real” condition. The Infectious Disease Society of America, or IDSA, has repeatedly and flatly claimed that the whole notion of chronic Lyme is “not based on scientific fact.” Slate’s own coverage of the disease has proposed that it’s a “phantom diagnosis“ that likely indicates a mental health problem, and has likened belief in the disease to being a creationist or anti-vaxxer. Casey Johnston, an editor at the Outline, tweeted earlier this month, “making chronic lyme, a fake disease, about believing women is as helpful to the cause as the rolling stone rape victim’s fabricated story.” These interpretations suggest Khakpour’s memoir is a dangerous tale of delusion.

As journalists who have studied other contested diseases, the disdain and scientific drumbeating of the critics of chronic Lyme raised our suspicions. One of us (Julie Rehmeyer) has written extensively about bad research practices in myalgic encephalomyelitis/chronic fatigue syndrome, aka ME/CFS, and published a memoir about navigating a poorly understood illness, Through the Shadowlands: A Science Writer’s Odyssey Into an Illness Science Doesn’t Understand. And one of us (Maya Dusenbery) has written a book about gender bias in medicine, Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick. We’ve dug into the science and politics of Lyme, and we’ve found that this dismissive position doesn’t have a scientific leg to stand on—and further, that the dynamics around the illness are significantly driven by sexism.

At this point, we simply don’t have an easy way to definitely know if someone has previously been exposed to B. burgdorferi—let alone if they are actively infected.
First, there’s no debate that early Lyme disease—an infection of B. burgdorferi bacterium, contracted via a tick—is a real thing. The CDC estimates that 300,000 people a year get it. In its early stage, patients commonly experience flu-like symptoms and a hallmark bulls-eye–shaped rash. There’s also no debate that, if untreated, it can disseminate throughout the body and advance to late Lyme disease, which is marked by far more debilitating symptoms including arthritis, fatigue, pain, heart complications, neurological problems, and more.

For most Lyme patients, a two-to-four-week course of antibiotics is enough to resolve their symptoms for good. But not everyone: Widely accepted studies have found that about 10–20 percent of those treated for Lyme are left with lingering symptoms. The question is what happens then. If a patient has received a Lyme diagnosis, been treated, and continues to experience symptoms, they are said to be suffering from post-treatment Lyme disease syndrome, or PTLDS, which the CDC recognizes. Some patients, though, have symptoms and a medical history that suggest PTLDS but they don’t qualify for the condition, usually because they lack a positive blood test or other objective evidence of infection with B. burgdorferi. A group of self-described Lyme-literate doctors may diagnose them with “chronic Lyme.”

Khakpour has tested positive on the CDC-approved blood tests for Lyme. And she’s well aware that affords her somewhat more legitimacy than many other Lyme patients; she notes that she’s learned to inform medical professionals that hers is a “CDC-recognized case” to try to stave off suspicions. Yet she has still been subject to countless interactions with health care providers “who could barely stifle their rolled eyes” at hearing she has Lyme. Indeed, despite the CDC’s stamp of approval and the fact that even conservative estimates suggest that at least 30,000 people every year develop PTLDS, it isn’t treated with all that much more respect than chronic Lyme. Skeptics argue that the array of symptoms PTLDS patients experience—muscle and joint pain, fatigue, cognitive problems—are so subjective and nonspecific that they may have nothing to do with Lyme disease. Sufferers’ true problem might be psychiatric—depression or “maladaptive belief systems“ or “a tendency to somatization.” Or patients may be overselling how bad it is: In its 2006 guidelines, IDSA stated, “In many patients, posttreatment symptoms appear to be more related to the aches and pains of daily living rather than to either Lyme disease or a tick-borne coinfection.”

There’s actually ample evidence against the theories that PTLDS is all in one’s head. In 2012, researchers from the Johns Hopkins Lyme Disease Research Center tracked a group of patients treated for Lyme disease to see which of them had ongoing symptoms six months later, and it found no psychological differences between those patients who did and didn’t. A 2017 study by the same research team debunked the claim that such symptoms are no worse than the background complaints of the general population. Compared to healthy controls, PTLDS patients reported significantly greater levels of 25 different symptoms—especially fatigue, muscle and joint pain, sleep disturbances, and cognitive problems—and had much worse quality of life. In 2001, a study in the New England Journal of Medicine found that PTLDS patients were as impaired as those in congestive heart failure.

Researchers are also beginning to find the physiological footprints of the illness. A 2011 study from Columbia found unique proteins in the spinal fluid of cognitively impaired patients treated for Lyme disease that distinguished them both from healthy controls and patients with ME/CFS (another illness that has been treated with disdain and that showed its own unique, identifying proteins). Two different groups found immune markers that remained elevated in early Lyme patients who went on to develop chronic symptoms after their initial treatment, but not in those who recovered. A group at Cornell found autoantibodies directed against neurons in PTLDS patients but not in healthy recovered Lyme patients. And a brain-imaging study found abnormalities in cognitively impaired patients with treated Lyme disease, compared to healthy controls.

So even PTLDS patients, with a diagnosis that is officially accepted, have to cope with a skepticism that isn’t scientifically grounded. Chronic Lyme patients have even less evidence to stand on (all the research is conducted on PTLDS patients), and conversations around their plight can go beyond skepticism to downright dismissal. As Brian Palmer wrote for Slate in 2013, “This form of chronic Lyme is controversial in the same sense that rhinoceros horn therapy is controversial: There’s no reliable data to support it.”

The problem with that perspective is that we’ve also known for a long time that blood tests for Lyme—the primary form of “objective evidence”—are lousy. They give high rates of both false negatives and false positives. The CDC-approved tests don’t detect the bacterium itself—they look for antibodies the body produces to fight the infection. But the immune system generally needs six weeks to generate those antibodies, so in the earliest stage, when detection is most important, the test will be negative in 60 percent of patients. And even after six weeks, the test doesn’t turn positive for everyone exposed. A lasting negative result is particularly likely if a patient happens to take antibiotics during that period, which would greatly reduce the need for an antibody response. Also, the B. burgdorferi bacterium may be able to permanently suppress some people’s immune systems, leaving them both unable to generate the strong antibody response that will create a positive test result and more susceptible to all manner of infection for years to come. A 2015 review of 78 studies of the available Lyme-disease tests concluded by throwing up its hands: “The data in this review do not provide sufficient evidence to make inferences about the value of the tests for clinical practice.”

And unfortunately, the other indicators doctors look for—a known tick bite or a bulls-eye rash—are no better. Up to 30 percent of patients never get a rash, and most patients never saw the tick that bit them, which can be as small as the head of a pin. The result is that misdiagnosis is shockingly common: According to a 2009 study, more than half of patients who didn’t get the classic bulls-eye rash were initially misdiagnosed, along with nearly one-quarter of those who did.

So patients without a positive test may not have reliable data to support their belief that they have Lyme disease—but they also don’t have reliable data suggesting they don’t. At this point, we simply don’t have an easy way to definitely know if someone has previously been exposed to B. burgdorferi—let alone if they are actively infected. That means that some patients with a diagnosis of chronic Lyme probably do have something else entirely unrelated to Lyme. But the problem of misdiagnosis surely goes in both directions; we don’t know how many patients with other poorly understood syndromes or “medically unexplained symptoms” are actually suffering from the aftereffects of a Lyme infection.

Our inability to reliably detect infection is an enormous problem when it comes to trying to determine just what is keeping some Lyme patients chronically sick. And further, the mainstream position has been that a short course of antibiotics is enough to kill off the Lyme bacteria nearly every time; even long-standing late Lyme should respond to a month of intravenous antibiotics, perhaps with one retreatment. But that’s an extraordinary claim for two reasons. First, how often is any treatment effective for virtually every patient, particularly with a devastating, multisystem illness? And second, without an accurate routine test that can determine whether someone is currently infected, we also can’t test to see if they’ve been cured. As Mary Beth Pfeiffer, author of the powerful new book Lyme: The First Epidemic of Climate Change, puts it, “If we can’t even tell if they’re actively infected, how can we say that they’re not?”

And indeed, recent research is demonstrating that B. burgdorferi can survive antibiotic treatment. For one thing, B. burgdorferi bacteria have been doused with high quantities of very potent antibiotics in test tubes, and some have still survived. Dogs, mice, and rhesus monkeys have undergone antibiotic treatment and still harbored live B. burgdorferi bacteria. Humans are harder to study: B. burgdorferi is known to hide in bodily tissues even when it can’t be found in the blood, and we can hardly sacrifice humans to look for bacteria in their brains. But one small study found a way around this: Ticks can pull out the bacteria even when humans can’t find it in the blood. So researchers allowed laboratory-raised, pathogen-free ticks to feed on 26 patients with past Lyme infection and continuing symptoms. They then looked for B. burgdorferi bacteria in the bellies of the ticks, and in two cases, they found it. That’s not enough to prove that PTLDS patients are in fact being made ill by persistent infection, but it does suggest that they’re not crazy to at least consider the hypothesis.

On top of that, Lyme disease is not the only tick-borne illness. Often, patients who remain sick after treatment for Lyme disease are also battling other tick-borne infections including Babesia, Borrelia miyamotoi, and Anaplasma.* Until recently, these were nearly unheard of, so in many cases, doctors still don’t know to look for them. But they can be as bad as, or worse than, Lyme disease itself—a 2016 article in the New England Journal of Medicine reported that .38 percent of blood-donation samples were contaminated with Babesia, causing at least four deaths between 2010 and 2014. Many of these bugs are not killed off by the standard antibiotic treatment for Lyme, so even if B. burgdorferi has been eradicated, patients may be suffering from infection with something else.

Treatment is perhaps the most contentious issue of all. Self-described “Lyme-literate” doctors who will diagnose patients with chronic Lyme often treat them with repeated—or even long-term—courses of antibiotics. The mainstream position is that this is not a reasonable course of action, as four clinical trials of long-term, intravenous antibiotic treatment for PTLDS have proven that they don’t work. But a researcher who ran one of those trials says that they’ve been badly misinterpreted. Brian Fallon, a Columbia scientist who just published Conquering Lyme Disease: Science Bridges the Great Divide, reviewed all of these trials and concluded that “approximately 60 percent of patients with persistent post-treatment Lyme fatigue may experience meaningful but partial clinical improvement in fatigue with antibiotic retreatment.” The trials did conclude that there wasn’t enough evidence for a clinical recommendation for antibiotic treatment, but that was only because they studied intravenous antibiotics, and delivering drugs intravenously introduces all kinds of additional risks to the patient, which complicates the calculation around overall benefit. The next step should be to study the effectiveness of less-risky antibiotics, but because the existing studies have been interpreted as flat failures, there’s no money available for that work.

What is most frustrating about the public conversation around chronic Lyme is that it often fails to recognize that science is an iterative, imperfect process. Skeptics are quick to claim the mantle of “evidence-based medicine” without acknowledging that the evidence is ever-shifting and subject to interpretation. Above all, they often neglect to own up to how much is still not understood about Lyme—let alone recognize that this lack of knowledge is, in large part, a consequence of medicine choosing not to invest in research on this disease. The humility that is central to good scientific thinking gets replaced with scorn.

So how did Lyme disease get to be the object of such disdain? The reasons are many, as Pamela Weintraub describes in Cure Unknown: Inside the Lyme Epidemic. She points to the quirk of history that rheumatologists, rather than infectious-disease specialists, first studied the disease; the fact that many of the sickest patients turn out to fall outside of restrictive definitions even when they have substantial evidence that they have Lyme disease; and the desire for a simple story when the situation is truly complex. But there’s one additional powerful dynamic undermining attitudes toward this condition: sexism.

None of this is settled science, of course. But that’s rather the point: The skeptics act as though the science is already settled, when in actuality, patients are suffering desperately for lack of science.
Take, for example, the fact that women’s overrepresentation among chronic Lyme patients has long been used to suggest there’s no real disease to see here. In 1991, a satirical column in Annals of Internal Medicine ridiculed sufferers of “Lime disease,” which, the author wrote, shows a “very strong association with recent exposure to media stories on Lyme disease.” Rates were “highest in adults of upper middle to upper socio-economic class, with a female-to-male sex ratio of 3:1 (in contrast to the more balanced age and sex distribution of Lyme disease).” In a 2005 article, two experts worried that media coverage might “exacerbate the anxiety and misattribution that are probably at the root of much of the [PTLDS/chronic Lyme] predominantly limited to females in the Northeast.”

More recently, some skeptics have pointed to the gender imbalance among chronic Lyme patients to bolster their argument that, while PTLDS may be a real thing, most “chronic Lyme” is just the result of misdiagnosis. A 2009 article by two prominent mainstream Lyme experts noted that men and women are represented roughly equally among CDC-reported cases of Lyme disease but that patients with a chronic Lyme diagnosis are disproportionately female. They concluded, therefore, that chronic Lyme must be “unrelated to infection with B. burgdorferi” and instead consists of misdiagnoses of “illnesses with a female preponderance, such as fibromyalgia, chronic fatigue syndrome, or depression”—or simply “medically unexplained symptoms” since, they pointed out, “there is also usually a female preponderance in patients with unexplained symptoms.”

The researchers failed to imagine the possibility that there may be a biological explanation for that predominance of women among chronic Lyme patients. Others have started pursuing this only recently. (To be fair, the Lyme community is hardly alone here; sex and gender differences have long been neglected in most areas of biomedical research, perhaps particularly in infectious-disease research.) Yet we know that women’s immune systems are substantially different than men’s, which may be rooted in the fact that women have to allow another creature, a baby, to grow inside them without immune attack. This is thought to be part of the reason that women are prone to autoimmune disease and may well be relevant to the disparity in their experiences with Lyme disease. What’s more, many drugs work differently on men and women, so it’s possible that current antibiotic treatment recommendations are less effective for women, leaving them more vulnerable to long-term effects.

Women might also make up the majority of patients with a diagnosis of chronic Lyme simply because their Lyme may be less likely to meet the official diagnostic criteria for more accepted forms of the disease. Recent research suggests that the current antibody tests may be even less accurate for women. A 2010 study found that among patients with confirmed early Lyme disease, just one-third of the women, compared to half of the men, had a positive result on the CDC-approved tests. This explanation is reinforced by the fact that men are overrepresented (by as much as 2-to-1) in studies of patients with late Lyme, a diagnosis that is even stricter than PTLDS, requiring not only a positive test result but an objective clinical sign like arthritis. If women are both more likely to have chronic symptoms after being treated for early Lyme and less likely to have their late Lyme symptoms recognized because the blood tests systemically underdiagnosed them, then their overrepresentation among chronic Lyme patients isn’t a mystery—or an argument against its existence. Instead, it’s an indictment of diagnostic criteria and a treatment paradigm that appears to be letting many Lyme patients, the majority of them women, fall through the cracks.

None of this is settled science, of course. But that’s rather the point: The skeptics act as though the science is already settled, when in actuality, patients are suffering desperately for lack of science. We need better tests. We need to know if some patients are suffering from persistent infections. We need to know how the B. burgdorferi bacterium alters human immune systems. We need to understand other tick-borne infections. We need to know which antibiotics work with lowest risk. We need other treatments. We need to understand the differences in how men and women are affected by the disease.

The main reason we don’t have answers to those questions yet is that we’ve barely tried to find them. “If the same number of researchers were working on HIV as Lyme disease, we’d still have no treatment for HIV,” says John Aucott of Johns Hopkins. In 2017, the NIH spent $22 million on Lyme disease research; by contrast, Congress appropriated $1.1 billion to study and fight the Zika virus just a year after it first emerged. This lack of investment is likely to cost us dearly as climate change continues to cause ticks and their pathogens to spread: a disease that first drew attention only in a small area of Connecticut is now spreading worldwide and becoming an epidemic. And the attitude of ridicule for chronic Lyme is part of why we don’t bother to research it.

That means that ironically, those who howl that chronic Lyme is “fake” BECAUSE SCIENCE aren’t just being unscientific, they’re also impeding science. On top of that, they are attacking extremely vulnerable patients and feeding sexist stereotypes. So cut the contempt. Let’s do the science and figure this disease out.

Correction, June 27, 2018: This post originally misstated that Bartonella is another tick-borne infection that might cause Lyme-like symptoms. Recent studies suggest that disease is not transmitted via tick, and since the data seems inconclusive, it has been removed from the original list.



Many great things about this article.  Many great points.






Two Cases of Babesia

Severe Babesia microti infection presenting as multiorgan failure in an immunocompetent host.

Ripoll JG, Rizvi MS, King RL, Daniels CE.
BMJ Case Reports, online first 2018 May 30.


A previously healthy 67-year-old farmer presented to an outside hospital after a 2-week history of non-specific respiratory symptoms. A certain diagnosis was not initially apparent, and the patient was discharged home on a regimen for presumed chronic obstructive pulmonary disease exacerbation.

He re-presented to the emergency department with shock and hypoxaemic respiratory failure requiring prompt intubation and fluid resuscitation. He was then transferred to our institution due to multiorgan failure.

On arrival, the patient demonstrated refractory shock and worsening acute kidney injury, severe anaemia and thrombocytopaenia. The peripheral smear revealed absence of microangiopathic haemolytic anaemia. A closer review of the smear displayed red blood cell inclusion bodies consistent with babesiosis.

The patient was started on clindamycin and loaded with intravenous quinidine, and subsequently transitioned to oral quinine. A red cell exchange transfusion was pursued with improvement of the parasite load.

The patient was discharged home on clindamycin/quinine and scheduled for outpatient intermittent haemodialysis.


A Walk in the Park: A Case of Babesiosis in the South Bronx

Hajicharalambous C, Rattu M, Leuchten S.
Clinical Practice and Cases in Emergency Medicine. 2018 Jan 11;2(1):61-63. eCollection 2018 Feb.


Babesiosis, mainly endemic within the Northeastern and upper Midwestern regions of the United States, is a zoonotic disease that invades and lyses red blood cells, which can result in hemolytic anemia. Its decreased incidence in comparison to Lyme disease is often attributed to the greater asymptomatic infection proportion and insufficient physician awareness or suspicion of this disease. Here we describe a case of undifferentiated febrile illness with hemolytic anemia that yielded the diagnosis of babesiosis.



What mainstream medicine as YET to acknowledge and learn is that Lyme patients are typically coinfected with a plethora of pathogens that all demand attention and treatment.  I find the statement in the second abstract telling:  “Its decreased incidence in comparison to Lyme disease is often attributed to the greater asymptomatic infection proportion and insufficient physician awareness or suspicion of the disease.”

What happens in treatment is symptoms disappear one by one only to be replaced by new ones that the patient never noticed before.  My husband and I both had Babesia but didn’t really know it until some of the Lyme symptoms began to abate with treatment.  I was told, and it certainly is true, that treating for tick borne illness is like peeling an onion layer by layer.  This was our exact experience.

Physicians desperately need education on all things TBI as throwing all the doxy in the world at this isn’t going to help many people.  Babesia is a cousin to malaria and requires anti-malarial drugs.  Babesia is also extremely persistent and Dr. Horowitz recommends 9 months to a year of solid treatment.  We treated with Mepron, Arthemisinin (Allergy Research Brand), and an intracellular for a year.  All Babesia symptoms are gone. Dr. Krause published in the New England Journal of Medicine that when a patient has Lyme and Babesia, Lyme is found three-times more frequently in the blood, proving Babesia suppresses the immune system.  It also means you are sicker than a dog.

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