Archive for the ‘Babesia’ Category

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

https://www.sciencedirect.com/science/article/pii/S1877959X17303333?via%3Dihub

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

Abstract
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.

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For more:  https://madisonarealymesupportgroup.com/2016/01/16/babesia-treatment/

https://madisonarealymesupportgroup.com/2018/01/24/phase-ii-malaria-meds-100-cured-good-for-babesia/

https://madisonarealymesupportgroup.com/2016/12/05/babesia-cure-update/

https://madisonarealymesupportgroup.com/2018/06/08/two-cases-of-babesia/

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

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

https://madisonarealymesupportgroup.com/2018/03/07/babesia-tests-approved-by-fda-for-screening-purposes/

https://madisonarealymesupportgroup.com/2017/08/08/transfusion-transmitted-babesiosis-in-nonendemic-areas/

Category:

Babesia, Uncategorized

The Science Isn’t Settled on Chronic Lyme

https://slate.com/technology/2018/06/the-science-isnt-settled-on-chronic-lyme.html

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.

By MAYA DUSENBERY and JULIE REHMEYER
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.

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**Comment**

Many great things about this article.  Many great points.

 

 

 

 

 

Category:

Activism, Babesia, Lyme, Psychological Aspects

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.

https://doi.org/10.1136/bcr-2018-224647https://doi.org/10.1136/bcr-2018-224647

Abstract

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.

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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.

https://doi.org/10.5811/cpcem.2017.8.35924

Abstract

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.

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**Comment**

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.

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/.  It also means you are sicker than a dog.

For more:  https://madisonarealymesupportgroup.com/2016/01/16/babesia-treatment/

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

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

 

Category:

Babesia, Lyme, research, Testing, Treatment

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

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

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

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**Comment**

The word is finally getting out.  TICKS ARE EVERYWHERE!

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

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

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

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

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

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

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

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

And everywhere else…..

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

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

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

 

 

 

 

Category:

Activism, Anaplasmosis, Babesia, Bartonella, Borrelia Miyamotoi (Relapsing Fever Group), Ehrlichiosis, Lyme, Mycoplasma, research, Rickettsia, Rocky Mountain Spotted Fever, Ticks, Transmission, Tularemia, Viruses

NYC Issues Tick-borne Disease Advisory

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

NEW YORK CITY DEPARTMENT OF HEALTH AND MENTAL HYGIENE

Mary T. Bassett, MD, MPH

Commissioner

2018 DOHMH Advisory #8: Tickborne Disease Advisory

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

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

    May 30, 2018 Dear Colleagues,

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

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

Disease

Organism

Vector

Endemic US States

Ticks in NYC

Lyme disease

Borrelia burgdorferi

Ixodes scapularis

(blacklegged or deer tick)

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

Blacklegged tick found in Staten Island and northern Bronx.

Babesiosis

Babesia microti

Northeast & MN, WI

Anaplasmosis

Anaplasma phagocytophilum

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

Ehrlichiosis

Ehrlichia chaffeensis

Amblyomma americanum

(lone star tick)

Southeast and south-central

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

Rocky Mountain spotted fever

Rickettsia rickettsii

Dermacentor variabilis

(American dog tick)

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

Dog tick found in all 5 boroughs

Powassan disease

Powassan or deer tick virus

Ixodes cookei (groundhog tick) or Ixodes scapularis

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

Groundhog tick not identified in NYC; blacklegged tick see above
NYC Tickborne Disease Epidemiology

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

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

NYC Tick Surveillance Data

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

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

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

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

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

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

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

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

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

Includes links to:

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

CDC – http://www.cdc.gov/ticks/index.html

Includes links to:

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

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

  •  Tick removal video
Reporting Cases

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

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

 

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

 

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

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**Comment**

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

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

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

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

Category:

Activism, Anaplasmosis, Babesia, Ehrlichiosis, Lyme, Rocky Mountain Spotted Fever, Ticks, Viruses