Archive for the ‘Borrelia Miyamotoi (Relapsing Fever Group)’ Category

Review: Borrelia Miyamotoi

https://danielcameronmd.com/review-borrelia-miyamotoi/

REVIEW: BORRELIA MIYAMOTOI

borrelia-miyamotoi

Borrelia miyamotoi is an emerging tick-borne illness that is transmitted by the deer tick. The most common symptoms of a B. miyamotoi infection include fever, fatigue, headache, chills, myalgia, arthralgia, and nausea.

By 

In their article, “Human Borrelia miyamotoi Infection in North America,” Burde and colleagues discuss the frequency and location of infection in ticks and people, clinical presentation and complications, diagnosis, treatment, and prevention.

Prevalence of B. miyamotoi

B. miyamotoi-infected ticks have been reported throughout the northeastern, northern Midwestern, and western United States. They’ve also been detected in all Canadian provinces except Newfoundland and Labrador.

The prevalence of Borrelia miyamotoi infections is difficult to determine, since the illness is not nationally reportable in the U.S. but reportable in only a few states including Connecticut, Maine, Massachusetts, Minnesota, New Jersey, Vermont, and Wisconsin. And, confirmation of the diagnosis depends upon laboratory testing, which is not always available.

Furthermore, diagnosis can be challenging. “The discrepancy between diagnosed and undiagnosed infection is probably even greater for B. miyamotoi, a tick-borne disease that lacks an easily identifiable clinical marker, such as the erythema migrans rash, and is less well known by health care workers and the general public,” the authors write.

Transmission

B. miyamotoi can be transmitted to humans through the bite of an infected black-legged (deer) tick. Several studies have found that it may be transmitted through blood transfusions, as well.

The B. miyamotoi pathogen can be transmitted from an infected female tick to her eggs, which may result in some larval ticks harboring the infection and transmitting it to a host. “Other larvae become infected after taking a blood meal on an infected mouse reservoir host, molt to the nymphal stage, and then transmit infection to another mouse or human,” they write.

Symptoms & Treatment

B. miyamotoi symptoms can be non-specific and an individual may appear to have a viral-like illness with fever, chills, headache, myalgia, fatigue, arthralgia, and gastrointestinal complaints, according to the authors.

“The most striking clinical feature of B. miyamotoi is relapsing fever with an initial febrile episode followed by a period of wellness and then one or more additional febrile episodes,” the authors write.

Some studies have found that the “average time between relapses was 9 days with a range of 2 days to 2 weeks.”

However, not all individuals develop relapsing fever. “In the largest case series of B. miyamotoi cases in the US, only 2 of 51 cases (4%) developed relapsing fever.”

READ: Don’t Rely on Relapsing Fever to Diagnose B. miyamotoi 

Treatment of B. miyamotoi disease typically involves using the same antibiotics to treat Lyme disease: doxycycline, tetracycline, erythromycin, penicillin, and ceftriaxone. However, there have been no trials to evaluate the effectiveness of these treatments.

Co-infections worsen disease

Co-infections can worsen the illness. There have been reported cases of B. miyamotoi co-infection with B. burgdorferi and/or Babesia microti.

“Previous studies have found that coinfection of B. burgdorferi with either Babesia microti or with Anaplasma phagocytophilum are often associated with more severe disease compared with that caused by B. burgdorferi infection alone,” the authors write.

Testing for the infection can include blood smear, polymerase chain reaction (PCR), and/or antibody detection.

Authors’ Conclude:

“The possibility of B. miyamotoi infection should be considered in any patient with a febrile illness who resides in or has recently traveled to a region where Lyme disease is endemic, especially during the late spring, summer, or early fall.”

Related Articles:

B. miyamotoi can be transmitted from mother ticks to offspring

Could B. miyamotoi infections explain persistent Lyme disease symptoms?

References:
  1. Burde J, Bloch EM, Kelly JR, Krause PJ. Human Borrelia miyamotoi Infection in North America. Pathogens. 2023 Apr 3;12(4):553. doi: 10.3390/pathogens12040553. PMID: 37111439; PMCID: PMC10145171.

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For more:

Since Borrelia miyamotoi is not a reportable illness to the CDC, no one has any clue about prevalence but reports are coming in continually that it’s highly likely to be a much bigger problem than ‘authorities’ believe.
It was recently discovered that:

Also, Borrelia miyamotoi has been in California ticks for a long time:

https://madisonarealymesupportgroup.com/2018/02/15/b-miyamotoi-in-ca-ticks-for-a-long-time/

The following case shows how you can become infected while traveling:  https://madisonarealymesupportgroup.com/2020/10/24/a-case-of-borrelia-miyamotoi/

Category:

Activism, Borrelia Miyamotoi (Relapsing Fever Group), research, Testing, Ticks, Transmission, Treatment, Uncategorized

CDC’s New Online Tool Gives Useful, If Slightly Flawed, Information

https://www.lymedisease.org/cdc-tick-bite-data-tracker/

CDC’s new online tool gives useful, if slightly flawed, information

May 16, 2023

By Lonnie Marcum

The CDC has recently updated its website regarding ticks and their diseases.

The changes include a new online tool called the Tick Bite Data Tracker.  It allows users to track and visualize tick-borne disease data in the United States, advancing our ability to raise awareness.

The new tool provides information on diseases transmitted by ticks such as Lyme disease, anaplasmosis, Rocky Mountain spotted fever, and ehrlichiosis.

The CDC webpage also gives information on the most common North American types of ticks and 16 known diseases transmitted by ticks such as babesiosis, Borrelia miyamotoi, Powassan virus, STARI, Colorado tick fever and more.

In addition, the CDC offers an updated page on Alpha-gal syndrome, an allergy to red meat and products derived from mammals. The condition is triggered by the bite of a tick.

National collaboration

The Tick Bite Data Tracker is part of the National Syndromic Surveillance Program (NSSP) which is a collaboration among the CDC, local health agencies, state health departments and private sector partners. The NSSP allows these partners to collect, share and analyze electronic healthcare data in near real-time as it is processed.

Because there is no medical diagnostic ICD code for “tick bite,” the emergency department visits for tick bites are identified by specific words used in the medical record. For example, “tick” or “tick” and “bite.”

The Tick Bite Data Tracker includes interactive maps, graphs and tables that allow users to explore the data in different ways. Users can view data on a national or state level, as well as by county or even zip code in some areas.

One of the most interesting aspects of this new site is the ability to track emergency department visits for tick bites by week and month. This eliminates the strict reporting criteria that adversely affects statistics in lower incidence states like Florida, Texas and California.

What we see on the Tick Bite Data Tracker is simply the number of persons per 100,000 with reported tick bites who sought care in an emergency room. The new data can indicate when tick bites are most common in a region, and unlike other CDC surveillance data, it is updated weekly, rather than annually.

Tick bites peak in Spring

You can clearly see in the graph below how tick bites peak in the spring in almost all regions of the United States.

Unfortunately, the CDC lumps every state west of Nebraska as the “West.” Therefore, areas with higher incidence of tick bites, like California, are averaged with areas of lower incidence like Wyoming—giving an inaccurate picture.

In my opinion, at the very least, the CDC should have divided this huge region into the southwest and northwest to offer better representation of what is happening in those zones—but that’s another topic.

The site also points out several limitations of the tracker tool: “Results might not be generalizable to emergency departments that are not contributing data to the BioSense Platform. The keywords used to identify tick bite visits may under- or overestimate emergency department visits related to tick bites because of differences in coding, reporting, and availability of chief complaint text data between jurisdictions or over time. Finally, aggregated data by region might be less useful than state or local data.”

So essentially, you have to take this data for what it is: a slightly flawed tool that gives us a glimpse into what is happening in the tick-borne disease world.

Lyme Awareness Month is an opportunity to educate the public about the risks of Lyme disease and promote strategies for prevention and early detection. I hope you’ll use the Tick Bite Data Tracker, as well as additional information spread throughout the pages of our website to spread awareness.

LymeSci is written by Lonnie Marcum, a Licensed Physical Therapist and mother of a daughter with Lyme. She served two terms on a subcommittee of the federal Tick-Borne Disease Working Group. Follow her on Twitter: @LonnieRhea  Email her at: lmarcum@lymedisease.org.

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**Comment**

A flawed tool that will  continued to be used against patients like the Iron Curtain.

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Category:

Activism, Alpha Gal Meat Allergy, Anaplasmosis, Babesia, Borrelia Miyamotoi (Relapsing Fever Group), Ehrlichiosis, Lyme, Rocky Mountain Spotted Fever, Ticks, Viruses

California’s First CDC-Confirmed Case of Borrelia Miyamotoi

https://www.lymedisease.org/californias-first-cdc-confirmed-case-of-borrelia-miyamotoi/

California’s first CDC-confirmed case of Borrelia miyamotoi

By Lonnie Marcum

May 4, 2023

A recent case reminds us that Lyme disease isn’t the only tick-borne disease we need to worry about.

Last year, the CDC confirmed California’s first known case of Borrelia miyamotoi—a tick-borne pathogen that causes a relapsing-fever illness in humans.

This discovery highlights the need for increased awareness and surveillance of emerging tick-borne illnesses across the United States.

In this case, a man from Marin County, California, sought care at a neurology clinic in San Francisco. His symptoms included recurring fever, night sweats, mild vision changes and nausea. The fevers typically lasted one day and would recur every 10-14 days. At the time, he was also undergoing monoclonal antibody therapy for multiple sclerosis.

His standard blood work was negative for fungi, Lyme disease, brucellosis and leptospirosis. Chest x-rays and abdominal CT scans were negative as well.

The only notable blood findings were a positive antigen for Epstein-Barr virus, a low platelet count (thrombocytopenia), an elevated C-reactive protein (an inflammatory marker), and an elevated procalcitonin—a biomarker that is released in response to bacterial infections.

Specialty lab testing

Considering the patient’s immunocompromised status and continued relapsing fevers, his blood was sent to a specialty lab for next-generation DNA sequencing. The specialty lab, Karius,  says it can identify over 1000 clinically relevant pathogens including bacteria, DNA viruses, fungi, and parasites from a single blood sample.

The DNA test results came back positive for Borrelia miyamotoi and were sent to the CDC for confirmation. The CDC confirmed the patient’s blood was positive for Borrelia miyamotoi and 100% identical to an isolate that had been previously collected from an Ixodes pacificus tick in Marin County. This indicates the patient acquired the infection in California.

Borrelia miyamotoi, first identified in Japan in 1995, is considered an emerging infectious disease in Asia, Europe and the United States.

A recent study found widespread evidence of Borrelia miyamotoi in human blood samples of people living in the northeastern United States. An earlier study found evidence of tick-borne relapsing fever (TBRF) Borrelia, including Borrelia miyamotoi in the blood of 26 out of 101 samples of residents of Mendocino County, California in the 1980s.

Another study found multiple species of relapsing fever Borrelia in blood samples drawn from patients in 16 out of 24 California counties. And a 13-year-long study found Borrelia miyamotoi in ticks found in 24 out of 48 counties in California (see map below).

Borrelia miyamotoi is transmitted to humans through the bite of infected blacklegged ticks. These are the same  hardbodied ticks (Ixodes scapularis, Ixodes pacificus) that transmit Lyme disease to humans and animals. Other types of North American tick-borne relapsing fever Borrelia (B. hermsii, B. turicatae, B. parkeri), are transmitted by soft-bodied ticks.

The symptoms of Borrelia miyamotoi disease are similar to those of other tick-borne illnesses, such as Lyme disease. But standard Lyme tests will be negative, making the diagnosis challenging.

TBRF

According to the CDC, the main symptoms of TBRF are high fever, headache, muscle and joint pain. Fewer than 1 in 10 patients will develop a rash. Left untreated, the symptoms typically repeat, producing a telltale pattern of relapsing fever lasting 1-3 days, followed by 7-10 days without a fever, followed by another 1-3 days of fever.

The CDC website says: “Confirmation of a diagnosis relies on 1) the use of polymerase chain reaction (PCR) tests that detect DNA from the organism or 2) antibody-based tests. Both types of tests are under development and not widely commercially available but can be ordered from a limited number of CLIA-approved laboratories.”

Treatment for TBRF involves the use of antibiotics, such as doxycycline, amoxicillin or cefuroxime . In this case the man was given a 4-week course of doxycycline and achieved complete resolution of his symptoms. One month after completing antibiotics ,follow-up laboratory testing showed complete resolution of thrombocytopenia and normalization of inflammatory markers.

All tick-borne diseases are a significant health concern worldwide, particularly in areas where ticks are prevalent. These illnesses can present with a range of symptoms, some of which can be mysterious and difficult to diagnose.

While relapsing fever Borrelia has been detected in California before, this is the first CDC-confirmed case of Borrelia miyamotoi in California.  This case highlights the need for continued education and awareness of tick-borne diseases.

As with all tick-borne illnesses, prevention is key. To reduce the risk of tick bites, take precautions when spending time outdoors, such as pre-treating shoes and clothing with permethrin, using insect repellant on yourself, your children and your pets, and performing thorough tick checks after being outdoors.

LymeSci is written by Lonnie Marcum, a Licensed Physical Therapist and mother of a daughter with Lyme. She served two terms on a subcommittee of the federal Tick-Borne Disease Working Group. Follow her on Twitter: @LonnieRhea  Email her at: lmarcum@lymedisease.org.

Reference

Rubio LA, Kjemtrup AM, Marx GE, Cronan S, Kilonzo C, Saunders MEM, et al. Borrelia miyamotoi infection in immunocompromised man, California, USA, 2021. Emerg Infect Dis. 2023 May https://doi.org/10.3201/eid2905.221638 DOI: 10.3201/eid2905.221638

Padgett K, Bonilla D, Kjemtrup A, Vilcins I-M, Yoshimizu MH, Hui L, et al. (2014) Large Scale Spatial Risk and Comparative Prevalence of Borrelia miyamotoi and Borrelia burgdorferi Sensu Lato in Ixodes pacificus. PLoS ONE 9(10): e110853. https://doi.org/10.1371/journal.pone.0110853

Additional Resources

Stanford: Tick-borne disease risk high in SF Bay Area

Yale: Tick-borne Borrelia miyamotoi widespread in northeastern US

LYME SCI: Infected ticks in California? It’s complicated.

LYME SCI: B. miyamotoi has been in California ticks for a long time

LYME SCI: Lyme-carrying ticks in West differ from their Eastern cousins

LYME SCI: How many “negative” Lyme tests are due to B. miyamotoi?

LYME SCI: Tick infection rates as high as 31% in some coastal areas of California

BALF: New interactive maps show where citizen scientists found infected ticks

For more:

And the question begging to be asked is: how many people with B. miyamotoi are falling through the cracks?  It isn’t even reportable to the CDC yet (which notoriously undercounts all things tick-borne-related).

For more:  https://igenex.com/tick-talk/what-you-need-to-know-about-borrelia-miyamotoi/

This article points out the confusion with B. miyamotoi: 

  • many separate it from other tick-borne relapsing fevers
  • while it can cause relapsing fevers, it sometimes doesn’t
  • it appears to be the only TBRF transmitted from a hard bodied tick, unlike TBRF which is mainly transmitted from a soft bodied tick (I remain skeptical of this as ticks have repeatedly been found to transmit things they shouldn’t – just like they are found in places they shouldn’t be.)
  • symptoms often resemble Lyme disease
  • you can be infected with BOTH B. miyamotoi AND Lyme disease (as well as numerous other coinfections) which will complicate symptom presentation
  • testing for B. miyamotoi is just as abysmal as it is for Lyme/MSIDS:  https://madisonarealymesupportgroup.com/2020/03/01/study-cdcs-2-tier-lyme-testing-inaccurate-in-more-than-70-of-cases/

Category:

Borrelia Miyamotoi (Relapsing Fever Group), research, Testing, Ticks, Treatment

Borrelia Miyamotoi Can Be Transmitted From Mother Ticks To Offspring

https://danielcameronmd.com/borrelia-miyamotoi-can-be-transmitted-from-mother-ticks-to-offspring/

BORRELIA MIYAMOTOI CAN BE TRANSMITTED FROM MOTHER TICKS TO OFFSPRING

borrelia-miyamotoi-ticks

Lyme disease and Borrelia miyamotoi can be transmitted from a tick to a host and vice versa (horizontal transmission). B. miyamotoi can also be transmitted from the mother to their offspring (vertical transmission).

By 

In their article “Borrelia miyamotoi: A Comprehensive Review. Pathogens,” Cleveland and colleagues discuss Borrelia miyamotoi as an emerging tick-borne pathogen and and how it can be transmitted from a mother tick to their offspring.

Cleveland et al. reviewed the proposed vertical transmission of B. miyamotoi.¹

  • An adult female tick infected with B. miyamotoi lays eggs.
  • The larva hatch from these eggs infected with B. miyamotoi.
  • The larva, nymph and adult ticks remain infected.

Ticks can acquire B. miyamotoi after feeding on an infected tick – called horizontal transmission.

Cleveland et al. reviewed the proposed horizontal transmission of B. miyamoti.¹

  • The larva, nymph and adult ticks acquire B. miyamoti from feeding on an infected host.
  • The larva, nymph and adult ticks remain infected.

“B. miyamotoi can be transmitted from infected ticks to naïve mice during the first 24 hours of feeding,” the authors wrote.

B. miyamotoi can be transmitted to mice initially through the salivary glands and subsequently transmitted through the midgut.

Concerns surrounding Borrelia miyamotoi

Shapiro and Wormser summarized the challenges associated with B. miyamotoi in the Journal of the American Medical Association.²

  • “This bacterium can be transmitted within the first 24 hours of tick attachment.”
  • “The probability of transmission increases with every day an infected tick is allowed to remain attached.”
  • While some patients with Lyme disease may exhibit a rash, “patients infected with B. miyamotoi in the United States typically do not have a rash.” But they may present with “a fever in conjunction with headache (96%), myalgia (84%), arthralgia (76%), and malaise/fatigue (82%).”
  • There are no diagnostic tests for B. miyamotoi infection that have been approved by the US Food and Drug Administration.
  • The fever may be relapsing.
  • “Laboratory abnormalities include leukopenia (51%) and thrombocytopenia (60%), which are rarely seen in Lyme disease.” [Editor’s note: These are also seen in Ehrlichia and Anaplasmosis.]
  • “Severely immunocompromised patients may develop chronic meningitis.”

Fortunately, doxycycline and amoxicillin have been shown to effectively treat B. miyamotoi infection in patients, including those who are immunocompromised.

Editor’s notes: Fevers are infrequent and often do not relapse. The laboratory abnormalities seen in B. miyamotoi are also seen in Ehrlichia and Anaplasmosis. Long-term outcome studies are needed.

References:
  1. Cleveland DW, Anderson CC, Brissette CA. Borrelia miyamotoi: A Comprehensive Review. Pathogens. Feb 7 2023;12(2)doi:10.3390/pathogens12020267
  2. Shapiro ED, Wormser GP. Lyme Disease in 2018: What Is New (and What Is Not). JAMA. Aug 21 2018;320(7):635-636. doi:10.1001/jama.2018.10974

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Category:

Borrelia Miyamotoi (Relapsing Fever Group), research, Testing, Ticks, Transmission

CA Ticks Spread Lyme But That’s Not the Whole Story

https://www.globallymealliance.org/blog/california-ticks-can-spread-lyme-disease-but-thats-not-the-whole-story

California Ticks Can Spread Lyme Disease…But That’s Not the Whole Story

by Paul Killinger on February 24, 2023

<span id="hs_cos_wrapper_name" class="hs_cos_wrapper hs_cos_wrapper_meta_field hs_cos_wrapper_type_text" style="" data-hs-cos-general-type="meta_field" data-hs-cos-type="text" >California Ticks Can Spread Lyme Disease…But That’s Not the Whole Story</span>
If you find a tick bite from an Ixodes tick in California, it’s important to consider possible exposure to pathogens that cause more than Lyme disease

Originally published on Medzulabs.org 

The risk of contracting Lyme disease from a tick bite in California has been well-documented, though there is still a long way to go in educating health providers and the broader community in the exposure risk from a tick bite. TickReport’s surveillance of ticks from California (and Oregon and Washington) goes back as far as 2006 and has expanded in recent years.

What ticks are endemic (commonly and consistently found in wild populations) to California and other West Coast states?

That’s a big question, and there are a few dozen species from different genera or families. Many of those species are specialist feeders and—if everything goes “right” in their life cycle—they will only feed on certain wild mammals, birds, or lizards and will bite humans very rarely. That’s doesn’t mean that finding one of these “specialists” attached to ourselves or a family member is impossible: it’s just much less common (and a topic we’ll try to visit soon in another post).

Our surveillance shows that the majority (91.5%) of human or human-adjacent (dogs, cats, horses, etc) tick bites are caused by the following ticks:

  • Ixodes pacificus (“Western black-legged tick,” a close relative of the Deer tick in the Eastern U.S.)
  • Dermacentor variabilis (“American dog tick”)
  • Dermacentor occidentalis (“Pacific Coast tick”)
  • Dermacentor andersoni (“Rocky Mountain Wood tick”)
  • Ixodes spinipalpis
  • Ixodes angustus
What pathogens can these ticks transmit to humans?

Vector competence (the ability of a vector like a tick to transmit a given disease-causing pathogen) tends to run along genus lines, so species within the Ixodes genus tend to be able to transmit pathogens X and Y but not Z, while Dermacentor species tend to transmit Z but not X and Y.

The most common pathogen found in California ticks is Borrelia burgdorferi, which causes Lyme disease in humans and pets. But there’s more than Lyme in those hills! If you find a tick bite from an Ixodes tick in California, it’s also important to consider possible exposure to these pathogens:

  • Borrelia miyamotoi: a bacterium that can cause hard tick relapsing fever—sometimes called Borrelia miyamotoi disease.
  • Anaplasma phagocytophilum: a bacterium that can cause Human granulocyctic Anaplasmosis.
*For every two ticks we find infected with Borrelia burgdorferi (Lyme disease bacteria), we detect one (or more) of these other pathogens

It’s vital that both tick surveillance and diagnostic approaches keep these non-Lyme pathogens in mind. For every two ticks we find infected with Borrelia burgdorferi (Lyme disease bacteria), we detect one (or more) of these other pathogens, so be sure to resist Lyme Tunnel Vision when responding to a tick bite! Common diagnostic tests for Lyme disease have a specific focus on Lyme disease and will not detect infection by these other pathogens if present. Make sure you and your doctor are considering the whole story of a tick bite.

To learn more about the pathogens we find in West Coast ticks, browse our real-time testing data at TickReport.com/stats. If you find and remove a tick, arrange for fast and accurate identification and testing at TickReport.com.
The above material is provided for information purposes only. The material (a) is not nor should be considered, or used as a substitute for, medical advice, diagnosis, or treatment, nor (b) does it necessarily represent endorsement by or an official position of Global Lyme Alliance, Inc. or any of its directors, officers, advisors or volunteers. Advice on the testing, treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history. 

Paul Killinger oversees tick surveillance and pathogen testing at the TickReport testing lab in Amherst, Massachusetts. He has led the lab's public health education and outreach since 2018.

Category:

Activism, Anaplasmosis, Borrelia Miyamotoi (Relapsing Fever Group), Lyme, research, Testing, Ticks, Transmission