Archive for the ‘Babesia’ Category

All His Symptoms Pointed Toward the Flu. But the Test Was Negative. RMSF in Connecticut

https://www.nytimes.com/2018/10/17/magazine/flu-symptoms-diagnosis-infection.html

All His Symptoms Pointed Toward the Flu. But the Test Was Negative.

CreditCreditIllustration by Andreas Samuelsson

 

“I think I’m losing this battle,” the 58-year-old man told his wife one Saturday night nearly a year ago.

While she was at the theater — they’d bought the tickets months earlier — he had to crawl up the stairs on his hands and knees to get to bed. Terrible bone-shaking chills racked him, despite the thick layer of blankets. The chills were followed by sudden blasts of internal heat and drenching sweats that made him kick off the covers — only to haul them back up as the cycle repeated itself.

“I need to go to the E.R.,” he told his wife. He’d been there three times already. They’d give him intravenous fluids and send him home with the diagnosis of a viral syndrome. He would start to feel better soon, he was told. But he didn’t.

This all began nine days before. That first day he called in sick to his job as a physical therapist. He felt feverish and achy, as if he had the flu. He decided to drink plenty of fluids, take it easy and go back to work the next day. But the next day he felt even worse. That’s when the fever and chills really kicked in. He was alternating between acetaminophen and ibuprofen, but the fever never let up. He’d started sleeping in the guest room because his sweat was soaking the sheets, and his chills shook the bed, waking his wife.

After three days of this, he made his first visit to the Yale New Haven Hospital emergency room. He was already taking antibiotics. Several weekends earlier, he developed a red, swollen elbow and went to an urgent-care center, where he was started on one antibiotic for a presumed infection. He took it for 10 days, but his elbow was still killing him. He went back to urgent care, where he was started on a broader-spectrum drug, which he had nearly finished. Now his elbow was fine. It was the rest of his body that ached as if he had the flu.

But at the hospital, his flu swab was negative. So was his chest X-ray. It was probably just a virus, he was told. He should take it easy until it passed. And come back if he got any worse.

The next day his fever spiked above 105. He went again to the E.R. It was a mob scene — crowded with people who, like him, appeared to have the flu. It would be hours before he could be seen, he was told, because they already knew he didn’t have it. Discouraged, he went home to bed. He went back the next morning after a nurse called to say the E.R. was more manageable.

He might not have the flu, he thought, but he was sure he had something. But the E.R. doctor didn’t know what. He didn’t have chest pain or shortness of breath. No cough, no headache, no rash, no abdominal pain, no urinary symptoms. He felt weak but no longer achy. His heart was beating hard and fast, but otherwise his exam was fine. His white count was low — which was a little strange. White blood cells are expected to increase with an acute infection. Still, a virus can cause white counts to drop. His platelets — the tiny blood fragments that form clots — were also low. That can also be seen in viral infections, but it was less common.

The E.R. staff sent the abnormal blood results to the patient’s primary-care provider and told the patient to follow up with him. He’d been trying get in to see him for days, but the doctor’s schedule was full. When he called again, he was told that the soonest he could be seen was the following week.

The patient asked the doctor to order blood tests to look for an infection in his blood. And could they also test him for tick-borne infections? This was Connecticut, after all. He dragged himself to the lab and then waited for his doctor to call with the results. The call never came. In his mind, he fired his doctor. He’d been sick for over a week, and the doctor’s office couldn’t arrange an appointment, and they couldn’t even call him with the lab results for the test he had to ask for in the first place.

That Sunday morning after the man’s wife had been to the theater, he went once more to the emergency room. It was brought to the attention of the physician assistant on duty that the man had been there several times before and had lab abnormalities. She ordered a bunch of blood tests — looking for everything from H.I.V. to mono. She ordered another chest X-ray and started him on broad-spectrum antibiotics, as well as doxycycline, an antibiotic often used for tick-borne infections. He was given Tylenol for his fever and admitted to the hospital. As he was preparing to leave the emergency department, a new flu test came back positive. He was pretty sure he didn’t have it; he’d never heard of a flu being this bad for this long. But if he could stay in the hospital, where someone could monitor him, he was happy to take Tamiflu.

The lab called again the next day to say that the test had been read incorrectly; he did not have the flu. By then other results started to come in. It wasn’t an infection in his elbow. He didn’t have H.I.V.; he didn’t have mono or Lyme; he didn’t have any of the other respiratory viruses that, along with the worse influenza outbreak in years, had filled up so much of the hospital.

CreditIllustration by Andreas Samuelsson

Yet after a couple of days, the patient began to feel better. His fever came down. The shaking chills disappeared. His white count and platelets edged up. It was clear he was recovering, but from what? More blood tests were ordered, and an infectious-disease specialist consulted.

Gabriel Vilchez, the infectious-disease specialist in training, reviewed the chart and examined the patient. He thought that the patient most likely had a tick-borne infection. The hospital had sent off blood to test for the usual suspects in the Northeast: Lyme, babesiosis, ehrlichiosis and anaplasmosis. Except for the Lyme test, which was negative, none of the results had come back yet. Vilchez considered that given the patient’s symptoms — and his response to the doxycycline — it would turn out that he’d have one of them.

And yet, the results for tick-borne infections were negative. Vilchez thought about other tick-borne diseases that are not on the usual panel. The most likely was Rocky Mountain spotted fever (R.M.S.F.). The name is a misnomer: R.M.S.F. is much more common in the Smoky Mountains than the Rocky Mountains, and the spotted-fever part, the rash, is not seen in all cases. It’s unusual to acquire the infection in Connecticut but not unheard-of. Vilchez sent off blood to be tested for R.M.S.F. The following day, the patient felt well enough to go home. A couple of days later, he got a call. He had Rocky Mountain spotted fever.

Why did the diagnosis take so long? The patient had an unusual infection. But perhaps the bigger issue was that he was one of many patients in the emergency room with flulike symptoms in the midst of a flu epidemic. Under those circumstances, the question for the staff simply becomes: Does he have the flu? When the answer is no, doctors tend to move on to the next very sick patient in line. It’s hard to get back to the question of what the nonflu patient does have.

For the patient, recovery has been tough. Though the antibiotic helped with the acute symptoms, it took months before he had the stamina to resume his usual patient load at work. He feels that the illness brought him as close to dying as he had ever been. Indeed, Rocky Mountain spotted fever is one of the most dangerous of all the tick-borne infections, with a mortality rate as high as 5 percent even with current antibiotics.

One thing he was certain about, however: He needed a new primary-care doctor. And he got one.

Lisa Sanders, M.D., is a contributing writer for the magazine and the author of “Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis.” If you have a solved case to share with Dr. Sanders, write her at Lisa.Sandersmd@gmail.com.

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**Comment**

This is playing out all over the world.  He was one of the lucky ones to finally get an accurate diagnosis.

It is interesting; however, that they are quick to state he doesn’t have the other tick-borne infections when the testing for all of them misses over half of all cases.  Once they gave him doxy, they should have retested him.  This is called a “provocation test” and is used by many LLMD’s (Lyme literate doctors) as they’ve learned this often finally shows an active infection(s) due to the ability of the body to NOW see the pathogens in the blood stream allowing antibodies to be made and picked up by the tests.

RMSF is a nasty beast on it’s own; however, this man should be monitored over time.  If symptoms come back or new ones show up, TBI’s should be suspected.

It’s also a mind boggler how in Connecticut of all places, TBI’s wouldn’t be the FIRST thing medical practitioners think of.  It’s literally ground zero.  

Please know RMSF IS IN WISCONSIN and is on the move:   https://madisonarealymesupportgroup.com/2018/07/10/first-rmsf-death-in-wisconsin/

More on RMSF:  https://madisonarealymesupportgroup.com/2018/09/14/rocky-mountain-spotted-fever-rmsf/

It’s also been found to be spread by the common brown dog tick:

https://madisonarealymesupportgroup.com/2018/08/16/new-tick-causes-epidemic-of-rmsf/  It’s usually spread by the American dog tick and the closely related Rocky Mountain wood tick. But in recent years the bacterial infection has also been spread by the brown dog tick — a completely different species…The researchers were investigating an epidemic of the infection that broke out in the border town of Mexicali starting in 2008. It’s already sickened at least 4,000 people, according to Mexican government estimates. Several hundred have died, and at least four people have died in the U.S. after crossing the border, according to this report and others.

“I was absolutely startled,” Foley said in an interview.

The people who had been sickened in Mexicali had a heavy load of the infectious agent in their blood — something that had not been seen in past outbreaks.
The epidemic is worrisome because the brown dog tick is more likely to bite people and it adapts easily to living in a house, as opposed to living on wild animals, the researchers said.

“The Rocky Mountain spotted fever epidemic in Mexicali has not been contained and may be spreading to other parts of Baja California and into the United States,” the team wrote.

And now it’s possible that for some reason, the infection the brown dog tick transmits is more virulent, Foley said.

https://madisonarealymesupportgroup.com/2017/06/10/two-deaths-from-rmsf-indiana-has-tbis/

https://madisonarealymesupportgroup.com/2015/08/13/severe-case-of-rmsf-had-to-remove-patients-arms-and-legs/

https://madisonarealymesupportgroup.com/2017/10/21/mom-got-rocky-mountain-spotted-fever-while-picking-pumpkins/  “When you go to these pumpkin patches and petting zoos and all those fun fall activities, wear pants, long socks and shoes!”
“Make sure you check for tics! This was me 2 years ago after being bit by a tick and contracting Rocky Mountain spotted fever at a pumpkin patch,” she continued. “I couldn’t walk, my whole body was in pain, my hair fell out, and I almost died.”

https://madisonarealymesupportgroup.com/2018/06/12/georgia-mom-warns-others-after-son-contracts-rocky-mountain-spotted-fever-after-tick-bite/  “This has been a horribly scary experience for our family. I’m thankful that I did my own research and brought it to my doctors attention. So don’t EVER be afraid to be an advocate for your child or yourself when it comes to things like this!” McNair continued, adding that “doctors are humans and have to figure out the puzzle just like the rest of us do!”

Wiser words were never spoken.

P.s. Regarding the red, swollen elbow…..

My journey was similar with the same issue in both my elbow and knee in the middle of January in Wisconsin.  I was told, and I promise I didn’t make this up, that I had “Washer Woman’s Knee,” and “Barstool elbow.”  

I kid you not.

Now, first, I use a mop and rarely get on my knees.  Second, I assure you, I’m not sitting at the bar and have NO reason to have a red, swollen, excruciatingly painful elbow.

Effective tick borne illness treatment completely ameliorated both conditions once I was finally diagnosed with Lyme/MSIDS.  For that exciting journey, that continues to this day, go here:  https://madisonarealymesupportgroup.com/2017/02/24/pcos-lyme-my-story/

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

Please remember, Lyme is the rock star we all know by name.  There are many, many other players involved and people are often coinfected.  Mainstream medicine has yet to accept and deal with this very real fact.

 

 

 

 

 

Babesia Found in Patient With Persistent Symptoms Following Lyme Treatment

https://www.ncbi.nlm.nih.gov/m/pubmed/30262525/

Diagnosis of a tick-borne coinfection in a patient with persistent symptoms following treatment for Lyme disease.

Hoversten K, et al. BMJ Case Rep. 2018.

Abstract

A 67-year-old woman presented with 5 days of myalgias and fevers on completion of a 21-day course of amoxicillin for Lyme disease (Borrelia burgdorferi infection). She was found to have profound thrombocytopenia, as well as new anaemia and leucopenia. Workup revealed Babesia microti as the causative agent of her symptoms. The patient quickly improved after appropriate antimicrobial therapy directed against babesiosis was started. This case illustrates the importance of basic microbiology, including epidemiology and common vectors, when creating a differential diagnosis. Because the Ixodes scapularis tick can harbour and transmit multiple parasites simultaneously, the possibility of coinfection should be considered in any patient not responding to appropriate initial medical therapy.

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**Comment**

Expect a lot more articles like this.  

Word is finally getting out that Lyme is just the Rock Star we all know by name but there are a lot of wanna be’s right behind him that haven’t made the news.  Research still hasn’t been done showing the synergistic effects of all of this together on the human body.  

To date, ticks can transmit 18 and counting pathogens – ALL as devastating as Lyme:  https://madisonarealymesupportgroup.com/2017/07/01/one-tick-bite-could-put-you-at-risk-for-at-least-6-different-diseases/

Lyme alone is a formidable foe that shape shifts to avoid treatment and the immune system that persists for many despite treatment.

Throw in Babesia, Bartonella, Mycoplasma, viruses, Nematodes (parasitic worms), and stuff not even named yet and a scary but telling picture begins to emerge.

More on Babesia:  https://madisonarealymesupportgroup.com/2016/01/16/babesia-treatment/

Please note that Dr. Horowitiz, a prominent Lyme literate doctor (LLMD) recommends 9 months to a year of solid treatment for Babesia.  He’s finding it to be particularly tenacious.

https://madisonarealymesupportgroup.com/2018/06/08/two-cases-of-babesia/  (They typically blame “severe” cases on a compromised immune system like a missing spleen but here we see someone as healthy as a horse all of a sudden develop shock and near respiratory failure).  If you have Lyme & Babesia &/or any other coinfection, your immune system is severely compromised.

https://madisonarealymesupportgroup.com/2018/07/02/splenic-rupture-from-babesiosis-an-emerging-concern-a-systematic-review-of-current-literature/

https://madisonarealymesupportgroup.com/2018/02/20/babesia-and-heart-issues/

https://madisonarealymesupportgroup.com/2018/10/06/case-of-recurrent-fever-multiple-splenic-infarcts-why-short-treatment-duration-often-doesnt-work-for-babesia/

https://madisonarealymesupportgroup.com/2018/06/03/heart-problems-tick-borne-disease/

https://madisonarealymesupportgroup.com/2018/05/31/widespread-babesiosis-in-canada/

https://madisonarealymesupportgroup.com/2018/03/22/what-is-air-hunger-anyway/

Transfusion-transmitted Babesiosis: One State’s Experience

https://onlinelibrary.wiley.com/doi/abs/10.1111/trf.14943

BACKGROUND

The risk for tickborne exposure to Babesia microti infection exists statewide in Massachusetts. Broad exposure complicates investigations of transfusion‐transmitted babesiosis (TTB). We summarize 8 years of the epidemiology of TTB and highlight the role of public health in prevention and control.

STUDY DESIGN AND METHODS

Cases of babesiosis are routinely reported to the Massachusetts Department of Public Health. These are investigated to determine whether they meet the surveillance case definition and to identify whether they were potentially transfusion transmitted. Frequencies from 2009 to 2016 are described and incidence rates calculated using population denominators from the US census. Changes over time were analyzed using simple linear regression.

RESULTS

From 2009 to 2016, there were 2578 cases of babesiosis reported; of these, 45 (1.7%) were transfusion transmitted. Of the 45 cases of TTB, 15 (33%) received blood products from two or more suppliers. In 11 TTB cases, the Department of Public Health was notified first, who in turn notified the appropriate blood provider. In 2009, the crude rate of reported babesiosis was 1.2 per 100,000 population and increased significantly through 2016 to 7.8 per 100,000 population (p = 0.006). The number of blood donors reported with laboratory evidence of B. microti infection increased from 19 in 2012 to 78 in 2016; at the same time, the number of TTB cases decreased from six to three.

CONCLUSION

TTB remains a major challenge, and blood donor screening strategies are currently in the process of implementation. While population and environmental changes facilitate increases in babesiosis, donor screening has the potential to eliminate TTB.

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**Comment**

One problem with blood is ……Asymptomatic individuals with Babesia infection are able to donate blood in the United States because of the lack of specific blood donation testing. Blood products collected in Babesia-endemic areas are distributed nationally; thus, clinicians in nonendemic states may fail to include babesiosis in the differential diagnosis of a patient who had a recent transfusion history and a fever of unknown origin.  https://madisonarealymesupportgroup.com/2017/08/08/transfusion-transmitted-babesiosis-in-nonendemic-areas/

And Babesia can rock your world:  https://madisonarealymesupportgroup.com/2016/01/16/babesia-treatment/

https://madisonarealymesupportgroup.com/2018/10/06/case-of-recurrent-fever-multiple-splenic-infarcts-why-short-treatment-duration-often-doesnt-work-for-babesia/

https://madisonarealymesupportgroup.com/2018/10/05/variable-clinical-presentations-of-babesiosis/  (Please read my comments after the references as this article misses many important points)

 

Lyme Carditis Presenting With Atrial Fibrillation

https://www.hindawi.com/journals/cric/2018/5265298/

Case Reports in Cardiology

Volume 2018, Article ID 5265298, 5 pages
https://doi.org/10.1155/2018/5265298

A Case of Lyme Carditis Presenting with Atrial Fibrillation

Peter J. Kennel,1 Melvin Parasram,2 Daniel Lu,3 Diane Zisa,1 Samuel Chung,1 Samuel Freedman,1 Katherine Knorr,1 Timothy Donahoe,1 Steven M. Markowitz,3 and Hadi Halazun3

Published 2 September 2018

Academic Editor: Kjell Nikus

Abstract

We report a case of a 20-year-old man who presented to our institution with a new arrhythmia on a routine EKG. Serial EKG tracings revealed various abnormal rhythms such as episodes of atrial fibrillation, profound first degree AV block, and type I second degree AV block. He was found to have positive serologies for Borrelia burgdorferi. After initiation of antibiotic therapy, the atrial arrhythmias and AV block resolved. Here, we present a case of Lyme carditis presenting with atrial fibrillation, a highly unusual presentation of Lyme carditis.

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**Comment**

Sigh….there it is again – “highly unusual presentation of Lyme carditis……”

Nothing about Lyme is rare.  It’s just not reported.  Please remember, most of these patients for the past 40 years have been told they are imagining their symptoms and, “it’s all in their head.”  Autopsies have rarely been done on these people and they have faced denial the entire time.

For more on heart-related symptoms with tick borne infections:  https://madisonarealymesupportgroup.com/2018/09/17/lyme-carditis-heart-block-other-complications-of-ld/

https://madisonarealymesupportgroup.com/2018/08/14/vermont-resident-dies-of-rare-lyme-disease-complication-that-isnt-rare/  Trust me, folks have been dying from this for a long time.  It’s just now beginning to make the radar.  If you have Lyme/MSIDS and heart issues, speak loudly about it.

https://madisonarealymesupportgroup.com/2018/07/09/with-unexpected-death-autopsies-should-look-for-lyme-carditis/

Microbiologist Tom Greer has a fantastic article about how post-mortem work is one of the only ways we are going to get to the bottom of the Lyme Wars: https://madisonarealymesupportgroup.com/2018/04/13/chronic-lyme-post-mortem-study-needed-to-end-the-lyme-wars/
For information on preparing for brain and tissue donations upon death for Lyme research, please see: http://whatislyme.com/guidelines-for-brain-and-tissue-donations-for-lyme-patients/

Lyme, BTW, is NOT the only tick borne illness that can cause heart issues:  https://madisonarealymesupportgroup.com/2018/02/20/babesia-and-heart-issues/

https://madisonarealymesupportgroup.com/2018/06/03/heart-problems-tick-borne-disease/  (cases listed here)

Most common parasites causing carditis:

  • Borrelia burgdorferi
  • Ehrlichia species
  • Babesia species
  • Trypanosoma cruzi (Chagas Disease)
  • Bartonella (My addition due to the following…..)
    (RESEARCH NEEDED. TONS OF PARASITES INVOLVED WITH TBD)

 

Updates and News From Russell Labs – Wisconsin

http://labs.russell.wisc.edu/wisconsin-ticks/

Updates

August, 2018: Nymphal deer ticks are less abundant but still active in Wisconsin right now. About 20-25% of nymphs are infected with the Lyme spirochete. Overall, 2018 has been normal in terms of tick numbers.

Live in Wisconsin and want your tick identified?

 

Take a picture of ticks on your phone and go here:  https://uwmadison.co1.qualtrics.com/jfe/form/SV_3s1wBopYCcW0lzT

Wisconsin ticks:  http://labs.russell.wisc.edu/wisconsin-ticks/

Go to link for pictures and information on each.  There are 4 ticks listed including the Lone Star Tick, which was until recently considered a Southern tick but is here as well.  Wisconsin had its first RMSF death, transmitted by the Lone Star Tick, recently:  https://madisonarealymesupportgroup.com/2018/07/10/first-rmsf-death-in-wisconsin/

There is also a tab titled “Tick-Borne Diseases.”  Go to link to read about them.  They give WI stats as well.  Please remember ALL the numbers are low as many go unreported:

  • Lyme (Bb or Bm)
  • Borrelia miyamotoi (relapsing fever)
  • Anasplasmosis
  • Ehrlichia muris eauclairensis (EML)
  • Babesiosis
  • Powassan virus/deertick virus
  • Ehrlichia chaffeensis
  • Rocky Mountain Spotted Fever

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A few points stick out to me:

  1. Please take pictures of these ticks & send them in so we finally have an accurate record.  They are asking us for help so let’s give it.  It will only help us in the end.  Flood them with ticks!
  2. Baronella didn’t make the list, yet nearly everyone I work with has it.  WHY?  Because while Bart has been found in ticks, it hasn’t been proven conclusively they transmit.  Bart is a nasty, nasty bug and alone can kill you.  Coupled with Lyme it can make you want to die.
  3. For viruses, they only list Powassan when many more are on record including Heartland and Bourbon (unfortunately they aren’t mandatory to report).  They know Heartland is transmitted by the Lone Star tick but I couldn’t even find the tick supposedly responsible for Bourbon, although it’s a killer:  https://madisonarealymesupportgroup.com/2017/07/01/one-tick-bite-could-put-you-at-risk-for-at-least-6-different-diseases/
  4. The lack of data is glaring.  Seriously.  Glaring.  Zika makes front page news here and our mosquitoes can’t even carry it.  https://madisonarealymesupportgroup.com/2018/03/13/wed-nite-the-lab-talk-on-mosquitoes-ticks-disease/  There were only 46 cases of Zika in the U.S. in 2018 – ALL due to travelers returning from affected areas.The CDC “estimates” that there are 300,000 NEW Lyme Disease cases annually in the U.S.  Anyone see a disparity here between Zika and Lyme?  (Other tick-borne diseases aren’t even on the radar yet)

 

 

 

 

 

 

 

 

Increase of Infected Ticks Means Higher Risk of Tick Bites

https://www.lymedisease.org/lymesci-tick-bites/  (Please see comment at end of article)

LYMESCI: Increase of infected ticks means higher risk of tick bites

by Lonnie Marcum

More ticks in more places means more tick bites.
More tick bites resulting in more sick people.

That’s the result the Entomological Society of America (ESA) was trying to avoid, when in 2015, it published a “Position Statement on Tick-Borne Diseases.”

The article describes a multitude of factors that have created a near “perfect storm,” leading to more infected ticks in more places throughout the United States.

Along with other steps, the ESA recommended engaging the help of citizen-scientists. In 2016, the Bay Area Lyme Foundation (BALF) decided to do just that. The results of this groundbreaking nationwide project have recently been published—and the news is NOT GOOD!

Among many disturbing facts, the new study found blacklegged ticks —carriers of 7 of 18 US tick-borne diseases—in 83 counties where they had never previously been recorded.

More tick bites = more sick people

Ticks have undergone a population explosion over the past two decades, with Ixodes ticks, the primary source of Lyme disease, now found in nearly 50% more U.S. counties than in 1996.

“Since the late 1990s, the number of counties in the northeastern United States that are considered high-risk for Lyme disease has increased by more than 320%,” says Rebecca Eisen from the Division of Vector-Borne Diseases at the CDC. “The tick is now established in areas where it was absent 20 years ago,” she adds.

The reasons for the explosion of tick populations involves complex human and environmental factors and varies by geographic region. Experts feel the major contributing factors are:

  • Warming winter temperatures
  • Migratory bird patterns
  • Changes in landscape, land use and fragmented forests
  • Abundance of vertebrate hosts (mice, deer, squirrels, etc)
  • Reduction in natural predators (foxes, bobcats, etc.)
  • Invasive and non-native plant species
  • Accidental transport by humans (pets, livestock)

With the increase in ticks, we’ve seen a sharp rise in tick bites and tick-borne diseases, with reports of Lyme disease now coming from all 50 states, costing upwards of $75 billion per year.

What’s being done?

While the CDC lists Lyme disease as a nationally notifiable disease, the responsibility for reporting falls to each state’s health departments. The fact is, many states do not (or can’t) enforce these reporting requirements.

In addition to Lyme disease, the CDC lists six other tick-borne diseases as reportable—anaplasmosis, babesiosis, ehrlichiosis, spotted fever rickettsiosis (including Rocky Mountain spotted fever), and tularemia. Again, many states don’t put resources in tracking these illnesses.

The lack of accurate disease reporting leads to a reduction in public health awareness and medical education in areas where it’s needed. This then hinders a patient’s access to timely and accurate diagnosis and early treatment—which are absolutely critical to a good prognosis.

Citizen scientists collect ticks

BALF’s recently published tick study invited citizens from all over the US to send ticks to Northern Arizona University (NAU) for free testing, with the goal of mapping ticks and the diseases they carry.

Many Lyme advocacy groups helped spread the word. For instance, there were more than 16,000 website hits on LymeDisease.org’s announcement about the project.

Researchers had expected that maybe 2,400 ticks would be sent in. To their astonishment, they received over 16,000 ticks collected from 49 states and Puerto Rico. No ticks were received from Alaska.

As lead author Nate Nieto, PhD, associate professor in NAU’s Department of Biological Sciences, explains,

“This study offers a unique and valuable perspective because it looks at risk to humans that goes beyond the physician-reported infection rates and involves ticks that were found on or near people.”

This represents the first nationwide tick study with the goal of mapping the prevalence of disease-carrying ticks throughout the United States. During the period from January 2016 through August 2017, people could send ticks to NAU, free of charge, for testing of the most common tick-borne infections:

  • Borrelia burgdorferi, the cause of Lyme disease,
  • Borrelia miyamotoi, which causes tick-borne relapsing fever (TBRF), a Lyme-like illness,
  • Anaplasma phagocytophilum, the cause of granulocytic anaplasmosis, and
  • Babesia microti, the protozoan parasite that causes Babesiosis.
The Findings
  • Over 70% of submissions were the result of human tick bites.
  • Blacklegged ticks were found in 83 counties (in 24 states) where they had not previously been recorded.
  • All four pathogens tested for (Anaplasma, Babesia, Borrelia burgdorferi and Borrelia miyamotoi) were found in all three of the most commonly encountered hard-ticks species collected (deer tick, American dog tick, lone star tick).
  • Some ticks tested positive for up to three pathogens (no ticks contained all four).
  • All life stages of these three hard-tick species, including some larvae, were found to be infected with both Borrelia burgdorferi and Borrelia miyamotoi.
  • On the East Coast, B. burgdorferi, the cause of Lyme disease, was predominantly detected in adult Ixodes scapularis (deer tick).
  • On the West Coast, B. burgdorferi was highest in larval Ixodes pacificus (western blacklegged tick).
  • The highest prevalence of Borrelia miyamotoi (a relapsing fever species Borrelia that causes Lyme-like illness) was found in larval ticks in the western US.
  • Babesia was found in lone star ticks in 26 counties (in 10 states) where public health departments do not require reporting.
  • Several Amblyomma americanum, commonly known as the lone star tick and capable of carrying bacteria that cause disease in humans, were found in Northern California, the first known report of this tick in the state.

tick-bite-map

Tick bite map of US

Limits of the Study

While the study was hugely successful, it did have some limits. For one, the sample of ticks was limited to only those areas where citizens were participating, therefore the maps may not show all areas with ticks.

In addition, the researchers only tested for four of the many pathogens known to cause illness in humans.

Pathogens not tested for include: Multiple species of Borrelia including Mayonii, and Bisettii, which also cause Lyme-like illness; Ehrlichia chaffeensis, the cause of human monocytic erhlichiosis; Francisella tularensis, the cause of tularemia; Rickettsia rickettsii, the bacterial agent of Rocky Mountain spotted fever; multiple species of the protozoan pathogen Babesia, including duncani and divergens; and several viruses known to be transmitted by ticks including Bourbon virus, Colorado tick fever virus, Heartland virus, and Powassan virus.

Lack of funding for more studies

Lack of funding poses the biggest challenge to fully understanding the risks that ticks pose to the US population.

When asked, the CDC’s Ben Beard stated

“We’ve got national maps, but we don’t have detailed local information about where the worst areas for ticks are located.…The reason for that is there has never been public funding to support systematic tick surveillance efforts.”

It’s no secret that within weeks of the first Zika infection in 2016, Congress authorized $1.7 billion in funding, of which $397 million was made immediately available to rapidly develop an accurate test and begin work on a vaccine.

That same year, the federal budget allotted only $28 million for Lyme disease—the most common vector-borne disease in the US. (Note: while the CDC can study and report on diseases, it is not allowed to lobby Congress for funding.)

What did we learn?

The big take-away from the NAU study is that ticks are everywhere, and they are full of dangerous pathogens—not just Lyme disease. This study demonstrates that ticks are spreading in range, and they are carrying more pathogens than ever before.

Until we find better ways for the CDC to report illnesses, these type of risk maps, that are generated from the pathogens the ticks are carrying, will be the best predictor of disease.

Finally, we all need to get out there and tell our representatives the dangers that lurk in our backyards. Call them. Ask to meet with them. Bring them a copy of this report. Let them know we need an dramatic increase in funding for Lyme and tick-borne diseases.

Click here for more information about ticks:  https://www.lymedisease.org/lyme-basics/ticks/about-ticks/

LymeSci is written by Lonnie Marcum, a Licensed Physical Therapist and mother of a daughter with Lyme. Follow her on Twitter: @LonnieRhea Email her at: lmarcum@lymedisease.org .

References:

  1. Using citizen science to describe the prevalence and distribution of tick bite and exposure to tick-borne diseases in the United States, PLOSone, July 2018,  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0199644
  2. County-Scale Distribution of Ixodes scapularis and Ixodes pacificus (Acari: Ixodidae) in the Continental United States , Journal of Medical Entomology, Volume 53, Issue 2, 1 March 2016, Pages 349–386,  https://academic.oup.com/jme/article/53/2/349/2459744
  3. Entomological Society of America Position Statement on Tick-Borne Diseases Approved on July 29, 2015, Valid through July 29, 2019  http://www.entsoc.org/PDF/2015/ESA-PolicyStatement-TickBorneDiseases.pdf
  4. Report of the Disease Vectors, Surveillance, and Prevention Subcommittee to the Tick-Borne Disease Working Group  https://www.hhs.gov/ash/advisory-committees/tickbornedisease/reports/disease-vectors-2018-5-9/index.html

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**Comment**

Canadian independent tick researcher, John Scott, stands in opposition to the climate change model affecting tick movement:  https://madisonarealymesupportgroup.com/2018/08/13/study-shows-lyme-not-propelled-by-climate-change/  A recent study shows that warm winters are lethal to I. scapularis (black-legged) ticks. In fact, overwinter survival dropped to 33% when the snow melted. This has been substantiated by other researchers as well. Scott & Scott, 2018, ticks and climate change, JVSM

Also, illogically, people on one hand admit that ticks are now “everywhere” but keep pushing the importance of geographical maps.  Why?  These maps are worthless & constantly changing.  Migratory birds are transiting ticks worldwide along with the fox, coyote, lizard, mouse, and 1,000 other carriers including humans traveling everywhere.

Why do we continue to push and believe in maps that have kept people from diagnosis and treatment for decades?

I’ll tell you why – it’s lining pockets with money.

Authorities look at the inaccurate and constantly changing maps and announce,
“You can’t have ______________, it doesn’t exist here.”

More data that actually hurts patients.

This tick border thing is a man-made constructed paradigm that has never been accurate, but it fits the CDC/NIH/IDSA narrative. http://steveclarknd.com/wp-content/uploads/2013/11/The-Confounding-Debate-Over-Lyme-Disease-in-the-South-DiscoverMagazine.com_.pdf (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)

Dr. Masters fought this tooth and nail for his suffering patients in the South:  https://madisonarealymesupportgroup.com/2017/10/06/remembering-dr-masters-the-rebel-for-lyme-patients-who-took-on-the-cdc-single-handedly/  Even though Fier found borrelia in 2% of sampled lone star ticks and subsequently supported Masters’ Missouri Lyme, the CDC insisted that the EM rash was NOT diagnostic for LD for Missouri patients due to the fact that neither Ixodes dammini nor Ixodes pacificus were found there.  

Maps are continually used against patients and have ALWAYS been faulty:  https://madisonarealymesupportgroup.com/2017/08/24/canine-maps-better-than-the-cdcs-in-predicting-lyme-disease/ (nothing’s changed)

TIME TO PULL THE BLINDERS OFF AND LOOK AT THIS THING AS THE PANDEMIC IT TRULY IS, AND TIME TO FOCUS ON ISSUES THAT ACTUALLY RELIEVE PATIENT SUFFERING.

 

 

 

 

 

 

Case of Recurrent Fever & Multiple Splenic Infarcts (& Why Short Treatment Duration Often Doesn’t Work for Babesia)

https://journals.lww.com/infectdis/fulltext/2018/09000/An_85_Year_Old_Man_With_Recurrent_Fever_and.13.aspx  (See comment at end of article)

An 85-Year-Old Man With Recurrent Fever and Multiple Splenic Infarcts

Shuker, Orel, MSc; Subran, Mala, MBBS; Hardie, Rochelle, MBBS; Ghitan, Monica, MD; Chapnick, Edward K., MD; Lin, Yu Shia, MD

Infectious Diseases in Clinical Practice: September 2018 – Volume 26 – Issue 5 – p 300–302
doi: 10.1097/IPC.0000000000000643

An 85-year-old man with a history of benign prostatic hyperplasia, hyperlipidemia, and Guillain-Barré syndrome in 1989 presented in September 2017 for the third time in 2 months with intermittent fever, chills, and night sweats. In July, he presented with a 5-day history of intermittent fever, with a temperature of 103°F and chills. The urinalysis and chest x-ray were normal, and 2 sets of blood cultures showed no growth. A computed tomography (CT) scan of the abdomen and pelvis was performed (Fig. 1A). The leukocyte count was 4200/μL (69% neutrophils), hemoglobin (Hb) 11.0 g/dL, and platelet count 63,000/μL. Patient received 3 days of azithromycin and was discharged with 2 days of oral cefpodoxime and azithromycin to complete a 5-day course of treatment.

The patient was readmitted to the hospital 4 days later with fever of 104°F associated with chills and sweating. Intravenous vancomycin, cefepime, and metronidazole were given. The leukocyte count was 7800/μL, Hb 11.0 g/dL, and platelet count 386,000/μL. Blood cultures and CT of the abdomen and pelvis were negative. The patient was discharged from the hospital on day 4 without antibiotics when fever subsided.

In mid-September, 2 months after the initial presentation, the patient was readmitted to the hospital for recurrent fever for 10 days, with worsening fatigue, malaise, and anorexia. The leukocyte count was 6100/μL, Hb 7.6 g/dL, and platelet count 130,000/μL, with lactate dehydrogenase 849 U/L, alanine aminotransferase 53 U/L, aspartate aminotransferase 70 U/L, and alkaline phosphatase 41 U/L. The erythrocyte sedimentation rate was 115 mm/h, and C- reactive protein was 10 mg/dL. Blood cultures and echocardiogram were normal. Repeat CT scan of the abdomen and pelvis is shown in Figure 1B. The patient denied travel outside New York. He is originally from Greece and has lived in Brooklyn, NY, for 50 years. He did not recall any insect or tick bites, and no other family members had a similar illness. The patient denied any dental procedures in the past year. Patient’s home medications were finasteride and pravastatin. What is your diagnosis?

Part 2

Diagnosis: Babesia Infection Caused by Babesia microti

Our patient presented with intermittent fever of unknown origin, and tick-borne disease was not included in the differential diagnosis initially. Thus, peripheral smears for parasites were not done in his previous 2 admissions. The initial CT scan showed a normal liver and spleen size (Fig. 2A). A subsequent CT scan 2 months later revealed numerous new splenic infarcts with hepatosplenomegaly (Fig. 2B). As mentioned, blood cultures and echocardiogram were nondiagnostic. On further questioning, the patient recalled that he had visited family in Greenport, Long Island, for the fourth of July weekend, 5 days prior to the onset of his febrile illness. Peripheral blood smear showed intraerythrocytic and extraerythrocytic ring inclusions consistent with babesiosis (Fig. 3) with 0.3% parasitemia. Polymerase chain reaction for Babesia microti was positive. Our patient was immediately started on azithromycin plus atovaquone, and the temperature normalized within 48 hours. He was discharged home on hospital day 7.

Splenic infarction is a rare complication of Babesia infection. To date, only 2 cases of splenic infarction in association with Babesia infection in humans have been published in the literature.1 Interestingly, azithromycin as monotherapy at a higher dose resulted in a significant reduction in Babesia parasitemia and prolongation of survival when compared with controls in hamster models.2 Our patient’s initial improvement in fever and thrombocytopenia after his first hospitalization was likely due to azithromycin therapy. There has been evidence of drug resistance to azithromycin-atovaquone with relapse of Babesia infection in immunocompromised patients after initial exposure to azithromycin as monotherapy.3 However, our patient remained afebrile and has been doing well 3 months after completion of a 10-day course of azithromycin plus atovaquone therapy.

Babesiosis is a tick-borne infection caused by intraerythrocytic protozoa of the genus Babesia, transmitted by the Ixodes tick. Babesia microti is the most predominant strain in the Northeastern and upper Midwestern region of the United States.4 The most common route of transmission is via direct inoculation from Ixodes scapularis ticks. Blood transfusion and rarely transplacental transmission have also been documented.4 The peak acquisition of disease occurs between May and September. Although tick activity and tick-borne diseases are common in warmer months, I. scapularis is active throughout the year, when ambient-air temperature is greater than 4°C (40°F).5 Thus, babesiosis should be considered and investigated appropriately even during the months not typical for increased tick activity.

Clinical manifestations of Babesia infections are variable, depending on the Babesia species and the immune status of the host. Clinical presentation of babesiosis includes febrile hemolytic anemia due to parasite-mediated lysis of red blood cells in the circulation.6 Babesia infections may induce cycles of disease by varying antigen expression and by displaying new outer-surface proteins during the disease course. The antigenic variants are referred to as serotypes and prevent the elimination of the protozoa by the immune system. This may contribute to the recurring nature of relapsing fever.7

Immunocompetent individuals typically have subclinical illness, associated with low-level parasitemia (<4%) and may present with a gradual onset of nonspecific flulike symptoms. Babesiosis in immunocompromised patients is often severe, with a complication rate of 40% to 60%, including acute respiratory failure, congestive heart failure, renal failure, and disseminated intravascular coagulation.8,9 Patients may present with splenic infarction as in our patient. Proposed mechanisms of splenic infarction in human babesiosis include microthrombus formation and local release of vasoactive factors caused by red blood cell lysis leading to infarcted necrosis of splenic tissue.10 Moreover, during infection, proinflammatory cytokines are released, specifically tumor necrosis factor, interleukin 1, interleukin 6, and interferon, leading to increased expression of adhesion molecules on the surface of the vascular endothelium. This in turn results in cytoadherence of the infected erythrocytes to the vascular endothelium.10 The parasitized erythrocytes also lack the deformability needed to transit the splenic sinusoids, causing their sequestration by resident macrophages and obstruction of the vascular flow within the spleen.1

Our patient presented with fever of unknown origin and new splenic infarcts secondary to Babesia infection. Our case reinforces the importance of taking a detailed history including travel history when evaluating a patient with fever of unclear etiology. Our patient did not think that it was relevant to mention during his earlier admissions to the hospital that he traveled to Greenport, Long Island (Suffolk County), for a weekend. Furthermore, babesiosis should be included in the differential diagnosis in a patient who presents with nonspecific flulike symptoms, hematological manifestations, and new splenic infarcts on radiographic imaging. Physicians should ensure timely diagnostic testing and appropriate initiation of treatment in a patient with babesiosisand splenomegaly to prevent further progression to splenic infarct or rupture, which may lead to a fatal outcome.

ACKNOWLEDGMENTS

The authors thank Myrna Dyer from the Department of Microbiology for providing the blood smear figure and Keith Arbeeny from the Department of Radiology of Maimonides Medical Center in Brooklyn, NY, for providing the radiological imaging figures.

REFERENCES

1. Florescu D, Sordillo PP, Glyptis A, et al. Splenic infarction in human babesiosis: two cases and discussion. Clin Infect Dis. 2008;46(1):e8–e11.

2. Weiss LM, Wittner M, Wasserman S, et al. Efficacy of azithromycin for treating Babesia microti infection in the hamster model. J Infect Dis. 1993;168(5):1289–1292.

3. Krause PJ, Lepore T, Sikand VK, et al. Atovaquone and azithromycin for the treatment of babesiosis. N Engl J Med. 2000;343(20):1454–1458.

4. Vannier E, Krause PJ. Human babesiosis. N Engl J Med. 2012;366:2397–2407.

5. Duffy DC, Campbell SR. Ambient air temperature as a predictor of activity of adult Ixodes scapularis (Acari: Ixodidae). J Med Entomol. 1994;31(1):178–180.

6. Kavanaugh MJ, Decker CF. Babesiosis. Dis Mon. 2012;58:355–360.

7. Deitsch KW, Lukehart SA, Stringer JR. Common strategies for antigenic variation by bacterial, fungal and protozoan pathogens. Nat Rev Microbiol. 2009;7(7):493–503.

8. Hatcher JC, Greenberg PD, Antique J, et al. Severe babesiosis in long island: review of 34 cases and their complications. Clin Infect Dis. 2001;32(8):1117–1125.

9. Krause PJ, Gewurz BE, Hill D, et al. Persistent and relapsing babesiosis in immunocompromised patients. Clin Infect Dis. 2008;46(3):370–376.

10. Wozniak EJ, Lowenstine LJ, Hemmer R, et al. Comparative pathogenesis of human WA1 and Babesia microti isolates in a Syrian hamster model. Lab Anim Sci. 1996;46(5):507–515.

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More on Babesia:  https://madisonarealymesupportgroup.com/2016/01/16/babesia-treatment/

https://madisonarealymesupportgroup.com/2018/05/31/widespread-babesiosis-in-canada/

https://madisonarealymesupportgroup.com/2018/04/08/zoonotic-babesia-microti-in-the-nw-u-s-evidence-for-the-expansion-of-a-specific-parasite-lineage/

https://madisonarealymesupportgroup.com/2018/03/22/what-is-air-hunger-anyway/

https://madisonarealymesupportgroup.com/2018/02/20/babesia-and-heart-issues/

https://madisonarealymesupportgroup.com/2018/10/05/variable-clinical-presentations-of-babesiosis/  This article put out by The Nurse Practitioner demonstrates clearly how their short treatment duration doesn’t work for immunocompromised patients, which is pretty much everyone with Lyme/MSIDS as we are typically infected with more than one thing, and even if it’s just Lyme with Babesia http://www.wildcondor.com/dr-horowitz-on-babesiosis.html 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. https://madisonarealymesupportgroup.com/2017/06/28/concurrent-babesiosis-and-lyme-in-patient/  Despite the lack of acknowledgment, there’s a lot of us with Lyme and Babesia and even more pathogens.  

The one drug, one disease paradigm does not work with Lyme/MSIDS.
**Complex Babesiosis is associated with severe anemia and high parasitaemia levels**
**Chronic Babesiosis can trigger cardiovascular, kidney, and liver problems**

Personally, I can attest to the importance of the anti-malarial medications my husband and I were both put on. We both had chest pressure and dizziness but the headaches I had were out of this world. My heart would also flop like a fish out of water and wake me up from a dead sleep – racing. Neither of us had night sweats and we presented differently. My husband developed hyper coagulation and anemia while I did not. Heparin helped him tremendously.

If you are having heart involvement and antibiotics typically used for Lyme are not touching it, please discuss Babesia with your health care provider (and Bartonella as well!). 

Also, go to the Babesia Treatment link above and print and fill out the Babesia checklist by Dr. Schaller.  These checklists are more helpful than testing.  Testing often misses cases.  

For us, treating for Babesia made a huge difference. I’m happy to report ALL of those symptoms are completely gone after a full year hitting it hard with anti-malarials. The best treatments overlap. Again, see Babesia Treatment link for ideas on what this looks like.