Archive for the ‘Ehrlichiosis’ Category

2018 Review of Previous Pathogen Transmission Time Studies in Deer Ticks

https://www.ncbi.nlm.nih.gov/pubmed/29398603

2018 Mar;9(3):535-542. doi: 10.1016/j.ttbdis.2018.01.002. Epub 2018 Jan 31.

Pathogen transmission in relation to duration of attachment by Ixodes scapularis ticks.

Eisen L1.

Abstract

The blacklegged tick, Ixodes scapularis, is the primary vector to humans in the eastern United States of the deer tick virus lineage of Powassan virus (Powassan virus disease); the protozoan parasite Babesia microti (babesiosis); and multiple bacterial disease agents including Anaplasma phagocytophilum (anaplasmosis), Borrelia burgdorferi and Borrelia mayonii (Lyme disease), Borrelia miyamotoi (relapsing fever-like illness, named Borrelia miyamotoi disease), and Ehrlichia muris eauclairensis (a minor causative agent of ehrlichiosis).

With the notable exception of Powassan virus, which can be transmitted within minutes after attachment by an infected tick, there is no doubt that the risk of transmission of other I. scapularis-borne pathogens, including Lyme disease spirochetes, increases with the length of time (number of days) infected ticks are allowed to remain attached. This review summarizes data from experimental transmission studies to reinforce the important disease-prevention message that regular (at least daily) tick checks and prompt tick removal has strong potential to reduce the risk of transmission of I. scapularis-borne bacterial and parasitic pathogens from infected attached ticks.

The most likely scenario for human exposure to an I. scapularis-borne pathogen is the bite by a single infected tick. However, recent reviews have failed to make a clear distinction between data based on transmission studies where experimental hosts were fed upon by a single versus multiple infected ticks. A summary of data from experimental studies on transmission of Lyme disease spirochetes (Bo. burgdorferi and Bo. mayonii) by I. scapularis nymphs indicates that the probability of transmission resulting in host infection, at time points from 24 to 72 h after nymphal attachment, is higher when multiple infected ticks feed together as compared to feeding by a single infected tick.

In the specific context of risk for human infection, the most relevant experimental studies therefore are those where the probability of pathogen transmission at a given point in time after attachment was determined using a single infected tick. The minimum duration of attachment by single infected I. scapularis nymphs required for transmission to result in host infection is poorly defined for most pathogens, but experimental studies have shown that Powassan virus can be transmitted within 15 min of tick attachment and both A. phagocytophilum and Bo. miyamotoi within the first 24 h of attachment. There is no experimental evidence for transmission of Lyme disease spirochetes by single infected I. scapularis nymphs to result in host infection when ticks are attached for only 24 h (despite exposure of nearly 90 experimental rodent hosts across multiple studies) but the probability of transmission resulting in host infection appears to increase to approximately 10% by 48 h and reach 70% by 72 h for Bo. burgdorferi. Caveats to the results from experimental transmission studies, including specific circumstances (such as re-attachment of previously partially fed infected ticks) that may lead to more rapid transmission are discussed.

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**Comment**

There are a number of problematic issues with this study:

  1. This is a review of previous studies.  There is nothing NEW here.  
  2. It’s important to note that ticks typically carry more than just borrelia and transmission times have not taken this fact into account: https://madisonarealymesupportgroup.com/2017/05/01/co-infection-of-ticks-the-rule-rather-than-the-exception/ and https://www.lymedisease.org/lyme-basics/co-infections/about-co-infections/  Infection with more than one pathogen is associated with more severe illness.https://madisonarealymesupportgroup.com/2018/10/30/study-shows-lyme-msids-patients-infected-with-many-pathogens-and-explains-why-we-are-so-sick/  For the first time, Garg et al. show a 85% probability for multiple infections including not only tick-borne pathogens but also opportunistic microbes such as EBV and other viruses.  This is a BIG DEAL.  Finally, a study showing what we face as patients in the real world.  They also never take into account nematodes (worms), mycoplasma, tularemia, and/or Bartonella.  These are infections many if not most patients have to contend with.  Some have been bioweaponized.
  3. They assume that the most likely scenario is for a person to be bitten by one tick.  Assuming makes an ass out of u and me.  When you take into account the latest information on the Asian tick, you quickly realize the probability of coming into contact with hundreds if not thousands of ticks at one time:  https://madisonarealymesupportgroup.com/2018/09/12/three-surprising-things-i-learned-about-asian-longhorned-ticks-the-tick-guy-tom-mather/  While human infection has yet to be found in the U.S., this tick is responsible for plenty of misery in Asia:  https://madisonarealymesupportgroup.com/2018/06/12/first-longhorned-tick-confirmed-in-arkansas/  It spreads SFTS (sever fever with thrombocytopenia syndrome), “an emerging hemorrhagic fever,” but the potential impact of this tick on tickborne illness is not yet known. In other parts of the world, it has been associated with several tickborne diseases, such as spotted fever rickettsioses, Anaplasma, Ehrlichia, and Borrelia, the causative agent of Lyme Disease.
  4. While they discuss the probability of multiple tick attachment, they never discuss the issue of partially fed ticks, where spirochetes would be in the salivary glands – leading to quicker transmission: http://iai.asm.org/content/61/6/2396.full.pdf  Ticks can spontaneously detach – and the authors of this study found that they did so 15% of the time in mice.  They also state that about a tenth of questing nymphs appear distended with partially fed sub-adult ticks being common.
  5. While the current review states, “There is no experimental evidence for transmission of Lyme disease spirochetes by single infected I. scapularis nymphs to result in host infection when ticks are attached for only 24 h (despite exposure of nearly 90 experimental rodent hosts across multiple studies), this study shows transmission can occur in under 16 hours:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4278789/
  6. https://madisonarealymesupportgroup.com/2017/04/14/transmission-time-for-lymemsids-infection/  Within this video, microbiologist Holly Ahern discusses the numerous problems with animal Bb transmission studies.  Transmission Time:  Only one study done on Mice. At 24 hours every tick had transmitted borrelia to the mice; however, animal studies have proven that transmission can occur in under 16 hours and it occurs frequently in under 24 hours.  No human studies have been done and https://www.dovepress.com/lyme-borreliosis-a-review-of-data-on-transmission-time-after-tick-atta-peer-reviewed-article-IJGM  no studies have determined the minimum time it takes for transmission.  And, never forget the case of the little girl who couldn’t walk or talk after a tick bite attachment of 4-6 hours:  https://madisonarealymesupportgroup.com/2016/12/07/igenex-presentation/
  7. They continue to blame Lyme/MSIDS on the black legged tick as the sole perp when experience and studies show there’s more potential transmitters at play:  https://madisonarealymesupportgroup.com/2018/11/07/are-mosquitoes-transmitting-lyme-disease/, https://madisonarealymesupportgroup.com/2016/07/23/german-study-finds-borrelia-in-mosquitos/, https://madisonarealymesupportgroup.com/2019/01/17/remember-deer-keds-study-shows-bartonella-causing-deer-ked-dermatitis-in-humans/
Please, quit doing reviews of previous data and do something new using better laboratory techniques!  We don’t need MORE of the same thing.

Category:

Anaplasmosis, Babesia, Borrelia Miyamotoi (Relapsing Fever Group), Ehrlichiosis, Lyme, research, Ticks, Transmission, Viruses

Multistate Infestation with the Exotic Disease Vector Tick Haemaphysalis Longhornis – U.S., Aug. 2017- Sept. 2018

https://www.cdc.gov/mmwr/volumes/67/wr/mm6747a3.htm

Multistate Infestation with the Exotic Disease–Vector Tick Haemaphysalis longicornis — United States, August 2017–September 2018

Weekly / November 30, 2018 / 67(47);1310–1313

C. Ben Beard, PhD1; James Occi, MA, MS2; Denise L. Bonilla, MS3; Andrea M. Egizi, PhD4; Dina M. Fonseca, PhD2; James W. Mertins, PhD3; Bryon P. Backenson, MS5; Waheed I. Bajwa, PhD6; Alexis M. Barbarin, PhD7; Matthew A. Bertone, PhD8; Justin Brown, DVM, PhD9; Neeta P. Connally, PhD10; Nancy D. Connell, PhD11; Rebecca J. Eisen, PhD1; Richard C. Falco, PhD5; Angela M. James, PhD3; Rayda K. Krell, PhD10; Kevin Lahmers, DVM, PhD12; Nicole Lewis, DVM13; Susan E. Little, DVM, PhD14; Michael Neault, DVM15; Adalberto A. Pérez de León, DVM, PhD16; Adam R. Randall, PhD17; Mark G. Ruder, DVM, PhD18; Meriam N. Saleh, PhD14; Brittany L. Schappach10; Betsy A. Schroeder, DVM19; Leslie L. Seraphin, DVM3; Morgan Wehtje, PhD3; Gary P. Wormser, MD20; Michael J. Yabsley, PhD21; William Halperin, MD, DrPH22 (View author affiliations)

Summary

What is already known about this topic?

Haemaphysalis longicornis is a tick indigenous to Asia, where it is an important vector of human and animal disease agents, which can result in human hemorrhagic fever and substantive reduction in dairy production.

What is added by this report?

During 2017–2018, H. longicornis has been detected in Arkansas, Connecticut, Maryland, New Jersey, New York, North Carolina, Pennsylvania, Virginia, and West Virginia on various species of domestic animals and wildlife, and from two humans.

What are the implications for public health practice?

The presence of H. longicornis in the United States represents a new and emerging disease threat. Characterization of the tick’s biology and ecology are needed, and surveillance efforts should include testing for potential indigenous and exotic pathogens.

Haemaphysalis longicornis is a tick indigenous to eastern Asia and an important vector of human and animal disease agents, resulting in such outcomes as human hemorrhagic fever and reduction of production in dairy cattle by 25%. H. longicornis was discovered on a sheep in New Jersey in August 2017 (1). This was the first detection in the United States outside of quarantine. In the spring of 2018, the tick was again detected at the index site, and later, in other counties in New Jersey, in seven other states in the eastern United States, and in Arkansas. The hosts included six species of domestic animals, six species of wildlife, and humans. To forestall adverse consequences in humans, pets, livestock, and wildlife, several critical actions are indicated, including expanded surveillance to determine the evolving distribution of H. longicornis, detection of pathogens that H. longicornis currently harbors, determination of the capacity of H. longicornis to serve as a vector for a range of potential pathogens, and evaluation of effective agents and methods for the control of H. longicornis.

H. longicornis is native to eastern China, Japan, the Russian Far East, and Korea. It is an introduced, and now established, exotic species in Australia, New Zealand, and several island nations in the western Pacific Region. Where this tick exists, it is an important vector of human and animal disease agents. In China and Japan, it transmits the severe fever with thrombocytopenia syndrome virus (SFTSV), which causes a human hemorrhagic fever (2), and Rickettsia japonica, which causes Japanese spotted fever (3). Studies in Asia identified ticks infected with various species of Anaplasma, Babesia, Borrelia, Ehrlichia, and Rickettsia, and all of these pathogen groups circulate zoonotically in the United States (4,5). In addition, parthenogenetic reproduction, a biologic characteristic of this species, allows a single introduced female tick to generate progeny without mating, thus resulting in massive host infestations. In some regions of New Zealand and Australia, this tick can reduce production in dairy cattle by 25% (6). Before 2017, H. longicornis ticks were intercepted at U.S. ports of entry at least 15 times on imported animals and materials (James W. Mertins, U.S. Department of Agriculture [USDA], personal communication).

The USDA Animal and Plant Inspection Service coordinated cooperative efforts through telephone conference calls with various local, state, and federal agricultural and public health agencies. Through these efforts, enhanced vector and animal surveillance were implemented to detect additional tick infestations. Suspect archival specimens that were available among previously collected ticks were also examined. Ticks were identified definitively by morphology at the USDA National Veterinary Services Laboratories or by DNA sequence analysis (molecular barcoding) at Rutgers University Center for Vector Biology, Monmouth County (New Jersey) Mosquito Control Division; College of Veterinary Medicine, University of Georgia; and Center for Veterinary Health Sciences, Oklahoma State University. By definition, a “report” is any new morphologic or molecular identification of H. longicornis ticks with a new county or host species from that county, identified from August 2017 through September 2018. Subsequent repeat collections are not reported here.

From August 2017 through September 2018, vector and animal surveillance efforts resulted in 53 reports of H. longicornis in the United States, including 38 (72%) from animal species (23 [61%] from domestic animals, 13 [34%] from wildlife, and two [5%] from humans), and 15 (28%) from environmental sampling of grass or other vegetation using cloth drags or flags* or carbon dioxide–baited tick traps.† With the exception of one report from Arkansas, the remaining reports of positively identified ticks are from eight eastern states: New Jersey (16; 30%), Virginia (15; 28%), West Virginia (11; 21%), New York (three; 6%), North Carolina (three; 6%), Pennsylvania (two; 4%), Connecticut (one; 2%), and Maryland (one; 2%) (Figure). Among the 546 counties or county equivalents in the nine states, ticks were reported from 45 (8%) counties (1.4% of all 3,109 U.S. counties and county equivalents) (Table 1). Excluding 15 reports of positive environmental sampling using flagging, dragging, or carbon dioxide traps, the remaining 38 reports reflect collection of ticks from infested host species (Table 2). Surveillance efforts did not include testing the ticks or hosts for pathogens. No cases of illness in humans or other species were reported. Concurrent reexamination of archived historical samples showed that invasion occurred years earlier. Most importantly, ticks collected from a deer in West Virginia in 2010 and a dog in New Jersey in 2013 were retrospectively identified as H. longicornis.

Discussion

Cooperative efforts among federal, state, and local experts from agricultural, public health, and academic institutions during the last year have documented that a tick indigenous to Asia is currently resident in several U.S. states. The public health and agricultural impacts of the multistate introduction and subsequent domestic establishment of H. longicornis are not known. At present, there is no evidence that H. longicornis has transmitted pathogens to humans, domestic animals, or wildlife in the United States. This species, however, is a potential vector of a number of important agents of human and animal diseases in the United States, including Rickettsia, Borrelia, Ehrlichia, Anaplasma, Theileria, and several important viral agents such as Heartland and Powassan viruses. Consequently, increased tick surveillance is warranted, using standardized animal and environmental sampling methods.

The findings in this report are subject to at least two limitations. First, the findings are limited by the variable surveillance methods used to identify the geographic and host distribution of H. longicornis. These methods included both passive and active surveillance. Conclusions about the geographic and host distribution might reflect the biases in the collection and submission of samples to states and USDA and the paucity of available information. Second, the data in this report reflect the collection of specimens that were positively identified by morphology or molecular barcoding. These represent sentinels that H. longicornis is present in different U.S. states and regions, and not a comprehensive assessment of the distribution of H. longicornis in the United States. The absence of positive samples from many states and counties might reflect the absence of infestation, absence of sampling, or failure to recover the tick. Even in states where H. longicornis has been found, the available data do not describe the actual extent or intensity of infestation.

The biology and ecology of H. longicornis as an exotic species in the United States should be characterized in terms of its vector competence (ability to transmit a pathogen) and vectorial capacity (feeding habits, host preference, climatic sensitivity, population density, and other factors that can affect the risk for pathogen transmission to humans) for tickborne pathogens known to be present in the United States (5). Surveillance for H. longicornis should include adequate sampling of companion animals, commercial animals, wildlife, and the environment. Where H. longicornis is detected, there should be testing for a range of indigenous and exotic viral, bacterial, and protozoan tickborne pathogens potentially transmitted by H. longicornis. Given the similarity between SFTSV and Heartland virus, a tickborne phlebovirus (https://www.cdc.gov/heartland-virus/index.html), further evaluation of the potential role of H. longicornis in transmission of this disease agent among animal reservoirs and possibly to humans is warranted. A broad range of interventions should be evaluated, including insecticide and acaricide sensitivity testing. Many state and federal agencies are developing and disseminating information for stakeholders, including development of hotlines, and some states are identifying ticks submitted by the public. The recently documented occurrence of H. longicornis in the United States presents an opportunity for collaboration among governmental, agricultural, public health agencies and partners in academic public health, veterinary sciences, and agricultural sciences to prevent diseases of potential national importance before onset in humans and other animal species.

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Acknowledgments

Wes Watson, Andrew D. Haddow, Naomi Drexler, Gleeson Murphy, Harry Savage, Howard Ginsberg, Kim Cervantes, field and laboratory personnel.

Corresponding author: C. Ben Beard, cbeard@cdc.gov, 970-221-6418.

* Drags consist of white cloth (usually 1 m2) that have a wooden leading frame and are dragged by a cord through grass or a leafy forest floor. Flags are similar but are used to brush uneven surfaces such as small bushes in wooded areas. Drags and flags are used to sample the environment for ticks trying to locate a host.

† Carbon dioxide traps consist of dry ice–filled small boxes with holes that allow the CO2 to escape which are placed on a white cloth or mat in a grassy area or forest floor. Ticks, attracted by the CO2, crawl on to the cloth or mat surface, which is inspected for ticks after a period of time.

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References

  1. Rainey T, Occi JL, Robbins RG, Egizi A. Discovery of Haemaphysalis longicornis (Ixodida: Ixodidae) parasitizing a sheep in New Jersey, United States. J Med Entomol 2018;55:757–9. CrossRef PubMed
  2. Luo L-M, Zhao L, Wen H-L, et al. Haemaphysalis longicornis ticks as reservoir and vector of severe fever with thrombocytopenia syndrome virus in China. Emerg Infect Dis 2015;21:1770–6. CrossRef PubMed
  3. Mahara F. Japanese spotted fever: report of 31 cases and review of the literature. Emerg Infect Dis 1997;3:105–11. CrossRef PubMed
  4. Kang J-G, Ko S, Smith WB, Kim H-C, Lee I-Y, Chae J-S. Prevalence of Anaplasma, Bartonella and Borrelia species in Haemaphysalis longicornis collected from goats in North Korea. J Vet Sci 2016;17:207–16. CrossRef PubMed
  5. Rosenberg R, Lindsey NP, Fischer M, et al. Vital signs: trends in reported vectorborne disease cases—United States and territories, 2004–2016. MMWR Morb Mortal Wkly Rep 2018;67:496–501. CrossRef PubMed
  6. Heath A. Biology, ecology and distribution of the tick, Haemaphysalis longicornis Neumann (Acari: Ixodidae) in New Zealand. N Z Vet J 2016;64:10–20. CrossRef PubMed
Return to your place in the textFIGURE. Counties and county equivalents* where Haemaphysalis longicornis has been reported (N = 45) — United States, August 2017–September 2018

The figure is a map showing the counties and county equivalents where Haemaphysalis longicornis has been reported (N = 45), in the United States, during August 2017–September 2018.* Benton County, Arkansas; Fairfield County, Connecticut; Washington County, Maryland; Bergen, Hunterdon, Mercer, Middlesex, Monmouth, Somerset, and Union Counties, New Jersey; Davidson, Polk, and Rutherford Counties, North Carolina; Richmond, Rockland, and Westchester Counties, New York; Bucks and Centre Counties, Pennsylvania; Albemarle, Augusta, Carroll, Fairfax, Giles, Grayson, Louisa, Page, Pulaski, Rockbridge, Russell, Scott, Smyth, Staunton City, Warren, and Wythe Counties, Virginia; Cabell, Hardy, Lincoln, Mason, Marion, Monroe, Putnam, Ritchie, Taylor, Tyler, Upshur Counties, West Virginia.

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TABLE 1. Percentage of Haemaphysalis longicornis–infested counties or county equivalents in infested states — nine states, August 2017–September 2018Return to your place in the text
State No. of counties* per state No. (%) of counties* with H. longicornis on host or in environment
Arkansas 75 1 (1)
Connecticut 8 1 (13)
Maryland 24 1 (4)
New Jersey 21 7 (33)
New York 62 3 (5)
North Carolina 100 3 (3)
Pennsylvania 67 2 (3)
Virginia 134 16 (12)
West Virginia 55 11 (20)
Total 546 45 (8)

* Counties or county equivalents

TABLE 2. Distribution of Haemaphysalis longicornis, by host and species — nine states, August 2017–September 2018Return to your place in the text
Host category, no. (% of total)/Species No. (% of host category)
Domestic animal, 23 (61)
Cat 1 (4)
Cow 4 (17)
Dog 12 (52)
Goat 2 (9)
Horse 2 (9)
Sheep 2 (9)
Total 23 (100)
Wildlife, 13 (34)
Coyote 1 (8)
White-tailed deer 7 (54)
Gray fox 1 (8)
Groundhog 1 (8)
Virginia opossum 2 (15)
Raccoon 1 (8)
Total 13 (100)
Human, 2 (5) 2 (100)
Total 38 (100)

Beard CB, Occi J, Bonilla DL, et al. Multistate Infestation with the Exotic Disease–Vector Tick Haemaphysalis longicornis — United States, August 2017–September 2018. MMWR Morb Mortal Wkly Rep 2018;67:1310–1313. DOI: http://dx.doi.org/10.15585/mmwr.mm6747a3.

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**Comment**

In the section discussing the species and the other pathogens it’s been known to transmit, Theileria was mentioned. Theileria is a malarial-like pathogen similar to Babesia:

https://en.wikipedia.org/wiki/Theileria_microti

Babesia IS also spread by ticks and is a frequent coinfection with Lyme.

An important difference from malaria is that T. microti does not infect liver cells. Additionally, the piroplasm is spread by tick bites (Ixodes scapularis, the same tick that spreads Lyme disease), while the malaria protozoans are spread via mosquito. Finally, under the microscope, the merozoite form of the T. microti life cycle in red blood cells forms a cross-shaped structure, often referred to as a “Maltese cross“, whereas malaria forms more of a diamond ring structure in red blood cells.[3]

Much is yet to be discovered about the Asian tick that clones itself and can drain cattle of its blood.  For more:  https://madisonarealymesupportgroup.com/2018/09/12/three-surprising-things-i-learned-about-asian-longhorned-ticks-the-tick-guy-tom-mather/

One of the biggest discoveries by Mather was how the ticks line up on stalks of grass resembling grains of wheat.  When anything touches this, it’s like a tick cluster bomb and ticks go everywhere.  Not just one or two, mind you, but hundreds at one time.  See link for pictures.

https://madisonarealymesupportgroup.com/2018/03/01/asian-ticks-mysteriously-turn-up-in-new-jersey/

https://madisonarealymesupportgroup.com/2018/10/03/1st-person-bitten-by-east-asian-longhorned-tick/

https://madisonarealymesupportgroup.com/2018/11/05/hawk-found-carrying-asian-long-horned-tick-the-one-that-drains-cattle-of-all-their-blood/

 

 

 

Category:

Anaplasmosis, Babesia, Ehrlichiosis, Lyme, research, Rickettsia, Testing, Ticks, Transmission, Viruses

Ehrlichiosis Presenting as Severe Sepsis & Meningoencephalitis in an Immunocompetent Adult

https://www.ncbi.nlm.nih.gov/m/pubmed/30425837/

Ehrlichiosis presenting as severe sepsis and meningoencephalitis in an immunocompetent adult.

Buzzard SL, et al. JMM Case Rep. 2018.

Abstract

Introduction: Ehrlichia are obligate intracellular pathogens transmitted to vertebrates by ticks.

Case presentation: We report the case of a 59-year-old man who presented to the University of Kentucky Albert B. Chandler Medical Center (Lexington, KY, USA) after being found fallen down in the woods. A lumbar puncture revealed what appeared to be bacterial meningitis, yet cerebrospinal fluid cultures, Gram stains and a meningitis/encephalitis panel were inconclusive. However, an Ehrlichia DNA PCR of the blood resulted as being positive for Ehrlichia chaffeensis antibodies. The patient received a 14 day course of doxycycline, and recovered from his multiple organ failure. The aetiology of the ehrlichial meningoencephalitis was likely transmission through a tick-bite, due to the patient’s outdoor exposure.

Conclusion: While it is rare to see Ehrlichia as a cause of meningitis, this illness can progress to severe multisystem disease with septic shock, meningoencephalitis or acute respiratory distress syndrome (ARDS). Those with compromised immunity are at a higher risk of developing the more severe form of the disease and have higher case fatality rates.

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**Comment**

Nothing about this monster is rare – it’s just not in the literature yet.  Again, researchers would be wise to remember that just because something isn’t found in the literature, doesn’t mean it doesn’t happen, particularly in a disease complex that testing misses half the cases and much goes unreported because it’s undiagnosed or misdiagnosed.

Notice this poor man was found flat on his face in the woods – that’s how serious this stuff can be.  Please notice his immune system was fine.

Meningeal involvement (brain swelling) is NOT rare.  Why would it be?  When these pathogens can cross the blood/brain barrier, it makes complete, logical sense that people would deal with swelling.  They deal with swelling in their elbows, knees, fingers, wrists, and about every other place in the body.  Dr. Phillips talks about Balanitus, a painful swelling of the foreskin, or head of the penis in males here:  https://madisonarealymesupportgroup.com/2018/12/22/s-e-x-lyme-msids/

I had swelling in my head so great that I wondered if I’d ever go a day without excruciating headaches that honestly felt like I’d been kicked by a horse, but the pain was completely all over in the lining of my head (meningeal).  I had an MRI, which came back normal, but I’ve met numerous folks with a Lyme and Chiari diagnosis:  https://madisonarealymesupportgroup.com/2016/04/02/chiari/

Warning – some with Lyme/MSIDS go through with the Chiari surgery but continue to have symptoms because until the pathogens are dealt with, symptoms will not resolve.  

Now, I’m just a crazy gray-hair, but doesn’t it seem quite logical to have swelling in the brain with Lyme/MSIDS?

For more:  https://madisonarealymesupportgroup.com/2018/12/02/everything-thats-known-about-ehrlichiosis/

https://madisonarealymesupportgroup.com/2018/10/15/ehrlichiosis-masquerading-as-thrombotic-thrombocytopenia-purpura/

https://madisonarealymesupportgroup.com/2018/10/02/north-carolina-ehrlichia-often-overlooked-when-tick-borne-illness-suspected/

https://madisonarealymesupportgroup.com/2018/07/24/oklahoma-ehrlichiosis-central/

https://madisonarealymesupportgroup.com/2018/11/11/gestational-lyme-other-tick-borne-diseases-dr-jones/

https://madisonarealymesupportgroup.com/2018/03/09/dogs-ehrlichiosis/

Category:

Ehrlichiosis, Inflammation, research, Testing, Ticks, Treatment

Five Genera of Pathogens Found in Ticks On Russian Dogs

https://www.ncbi.nlm.nih.gov/m/pubmed/30428925/

Dog survey in Russian veterinary hospitals: tick identification and molecular detection of tick-borne pathogens.

Livanova NN, et al. Parasit Vectors. 2018.

Abstract

BACKGROUND: Species of Canidae in Russia can be infested with up to 24 different tick species; however, the frequency of different tick species infesting domestic dogs across Russia is not known. In addition, tick-borne disease risks for domestic dogs in Russia are not well quantified. The goal of this study was to conduct a nationwide survey of ticks collected from infested dogs admitted to veterinary clinics in Russian cities and to identify pathogens found in these ticks.

METHODS: Ticks feeding on dogs admitted to 32 veterinary clinics in 27 major cities across Russia were preserved in ethanol and submitted to a central facility for examination. After identification, each tick was evaluated for infection with known tick-borne pathogens using PCR.

RESULTS: There were 990 individual ticks collected from 636 dogs. All collected ticks belonged to the Ixodidae (hard ticks) and represented 11 species of four genera, Dermacentor, Ixodes, Rhipicephalus and Haemaphysalis. Four most common tick species were D. reticulatus, followed by I. persulcatus, I. ricinus and R. sanguineus. Ixodes persulcatus ticks were found to be infected with 10 different pathogens, and ticks of this species were more frequently infected than either D. reticulatus or I. ricinus. Ixodes persulcatus females were also more frequently co-infected with two or more pathogens than any other tick.

Pathogenic species of five genera were detected in ticks:

  • Anaplasma centrale, A. phagocytophilum & A. marginale (Anaplasma)
  • Babesia canis, B. microti, B. venatorum, B. divergens, B. crassa & B. vogeli (Babesia)
  • Borrelia miyamotoi, B. afzelii and B. garinii (Borrelia)
  • Ehrlichia muris, E. canis and E. ruminantu (Ehrlichia)
  • Theileria cervi (Theileria – a parasitic protozoan)
Anaplasma marginale, E. canis, B. crassa, B. vogeli and T. cervi were detected in I. persulcatus, and Babesia canis in D. marginatum, for the first time in Russia.

CONCLUSIONS: Multiple ticks from four genera and 11 species of the family Ixodidae were collected from domestic dogs across Russia. These ticks commonly carry pathogens and act as disease vectors. Ixodes persulcatus ticks present the greatest risk for transmission of multiple arthropod-borne pathogens.

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**Comment**

It’s getting harder and harder for The Cabal to hide the polymicrobial nature of Lyme/MSIDS.  The data just keeps pouring in:  https://madisonarealymesupportgroup.com/2018/10/30/study-shows-lyme-msids-patients-infected-with-many-pathogens-and-explains-why-we-are-so-sick/

For the first time, Garg et al. show a 85% probability for multiple infections including not only tick-borne pathogens but also opportunistic microbes such as EBV and other viruses.

I’m thankful they included Bartonella as that one is often omitted but definitely a player. I’m also thankful for the mention of viruses as they too are in the mix. The mention of the persister form must be recognized as well as many out there deny its existence.

Key Quote: “Our findings recognize that microbial infections in patients suffering from TBDs do not follow the one microbe, one disease Germ Theory as 65% of the TBD patients produce immune responses to various microbes.”

But there is another important point.

According to this review, 83% of all commercial tests focus only on Lyme (borrelia), despite the fact we are infected with more than one microbe.

And those tests miss half of all cases:  

https://madisonarealymesupportgroup.com/2018/09/12/lyme-testing-problems-solutions/  ...with the C6 Elisa its around 50% sensitive (in the context of the two tiered testing system on its own it has a sensitivity of 75%) because it misses about half of true positive cases….The Western Blot also has many problems with sensitivity at all stages but especially within the first month and again later on the more chronic it becomes.If you take the terrible sensitivity of both tests in the two tiered system you will start to see how testing positive consecutively on both is very unlikely, mathematically improbable and biologically almost impossible unless you are in the HLA autoimmune group which is comparatively rare.

https://madisonarealymesupportgroup.com/2018/01/16/2-tier-lyme-testing-missed-85-7-of-patients-milford-hospital/  Dr. Sin Lee identifying faulty serology tests for Lyme disease in 85.7% of the walk-in patients in the Emergency Room of Milford Hospital.

Please note that all the studies showing the polymicrobial nature of tick borne illness  are foreign.

The Cabal has everyone in the U.S. in a head-lock.

Will the real researchers please stand up and be counted?

 

 

 

 

 

 

 

 

 

Category:

Anaplasmosis, Babesia, Borrelia Miyamotoi (Relapsing Fever Group), Ehrlichiosis, research, Testing, Ticks

Everything That’s Known About Ehrlichiosis

https://www.news-medical.net/health/Epidemiology-of-Ehrlichiosis.aspx

Epidemiology of Ehrlichiosis

By Tomislav Meštrović, MD, PhDReviewed by Liji Thomas, MD

 

Ehrlichiosis is a disease caused by several Gram-negative obligate intracellular bacteria that are transmitted by a tick vector. The frequency of ehrlichiosis is increasing, which is ascribed to the increased awareness and diagnostic availability, as well as the expansion of regions populated with the most common tick vector – Amblyomma americanum (also known as the Lone Star tick).

Lone Star Tick (Amblyomma americanum). Image Credit: Melinda Fawver / Shutterstock

Symptoms of the disease usually include fever, anorexia, headache and myalgia, with a relatively low incidence of rash (present only in 20% of affected individuals). The knowledge of disease epidemiology is vital, as early recognition may prevent a large number of cases (and thus avoid rare fatal outcomes).

Generally, the median age for acquiring ehrlichiosis is 51-53 years, while Caucasian males are the most commonly affected group. Even though cases of the disease are found year-round, the greatest number is observed between May and August, which coincides with periods of abundant populations of ticks and human open air recreation.

Epidemiology of Human Monocytic Ehrlichiosis

Human monocytic ehrlichiosis (caused by the species Ehrlichia chaffeensis and Ehrlichia canis) was initially described in 1986, and almost three thousand cases have been reported to the U.S. Centers for Disease Control and Prevention (CDC) in the last three decades. Even though the average incidence of this disease in the United States is 0.7 cases per million inhabitants, this estimation is based on passive surveillance and probably represents substantial underestimation of the actual incidence.

For example, in one seroprevalence study conducted on children it was demonstrated that 20% of infected individuals from endemic areas had detectable antibodies to Ehrlichia chaffeensis, without any previous history of apparent clinical disease. This is in line with the finding that more than two-thirds of all infections with causative agents of human monocytic ehrlichiosis are either without any symptoms or minimally symptomatic.

Akin to other tick-borne illnesses, the distribution of arthropod vectors and reservoirs in vertebrates highly correlates with the disease occurrence in humans. The predominant zoonotic cycle of Ehrlichia chaffeensis is comprised of infected white-tailed deer as the reservoir and Amblyomma americanum as the tick vector, both prevalent across southcentral and southeast United States.

This tick also has three feeding stages (known as larval, nymph and adult stages), and each developmental representative feeds only once. Transstadial transmission of Ehrlichia can be seen during nymph and adult feeding, because larvae are uninfected. Unlike some other species (most notably Rickettsia), Ehrlichia cannot be maintained via trans-ovarial transmission pathway.

Epidemiology of Human Granulocytic Anaplasmosis

In the 1990s certain patients from Wisconsin and Michigan with a history of tick bite presented with a febrile illness similar quite similar to human monocytic ehrlichiosis. These cases were characterized by inclusion bodies in granulocytes rather than agranulocytes (monocytes), which is why this syndrome was initially named human granulocytic ehrlichiosis. After recent reclassification of Ehrlichia phagocytophilum to the genus Anaplasma, the disease has been renamed to human granulocytic anaplasmosis.

The annual number of human granulocytic anaplasmosis cases exceeds those of human monocytic ehrlichiosis, with an incidence case rate of 1.6 per million inhabitants in the U.S. As with Ehrlichia chaffeensis, different serosurveillence studies evince that asymptomatic disease is quite common. The disease is primarily caused by Anaplasma phagocytophilum.

This disease is seen in Europe as well, where the majority of cases is found in central Europe (e.g. Slovenia) and Scandinavian countries (e.g. Sweden), though individual reports have come from other countries as well. Nonetheless, there is limited knowledge as to the exact epidemiological features and implicated animal reservoirs in Europe.

Different ticks transmit human granulocytic anaplasmosis in different continents; Ixodes scapularis and Ixodes pacificus are the predominant tick species in the United States, Ixodes ricinus in Europe, while Ixodes persulcatus transfers the infectious agent in Asia. Small mammals (such as White-footed mouse and Dusky-footed wood rat) are primary reservoirs of the disease.

Epidemiology of Ehrlichia ewingii

The epidemiology of Ehrlichia ewingii is usually addressed separately as there are certain problems with this species, such as the absence of specific serological tests and the lack of adequate reporting systems. What we do know is that most infections have been observed in immunosuppressed patients (after organ transplantation) and in those infected with human immunodeficiency virus (HIV).

The primary vector for Ehrlichia ewingii is the Lone Star tick, as for Ehrlichia chaffeensis. Most human cases of the disease have been documented in Missouri, Oklahoma and Tennessee in the United States, although infection has been described in dogs and deer throughout the range of the tick that transmits the disease, suggesting that the infection with this specific species might be even more widespread.

Pathophysiology of the Disease

Infection with bacterial species causing ehrlichiosis occurs when the extracellular infectious form of the organism is taken up by the host cell. These infectious forms are either the elementary body or the dense core, and are taken up by the cell via a process known as endocytosis. Once inside the cell, the infecting organism divides and matures until it forms a reticulate body/reticulate core, and then a morula; these are then redifferentiated again into an elementary body/dense core so it can leave the infected host cell and spread further.

During this process, Ehrlichia and Anaplasma utilize a range of immune evasion mechanisms, such as suppression of apoptosis in host cells, down-regulation of recognition receptors in the host that could enable clearance of the infection, as well as modulation of cytokine and chemokine responses. Some species have a preference for granulocytic cells (Anaplasma phagocytophilum and Ehrlichia ewingii), while others target mononuclear phagocytes (Ehrlichia chaffeensis and Ehrlichia canis)

Furthermore, multisystem involvement is also a potential consequence, as microorganisms are found in the spleen, bone marrow, lymph nodes and peripheral blood. In fact, all the clinical manifestations are thought to be a result of a host inflammatory response to disseminated infection, rather than because of direct bacteria-induced damage.

Clinical Presentation

Patients with ehrlichiosis (regardless of the putative organism) clinically present with fever, chills, severe headache, confusion, malaise, nausea, vomiting, and generalized body aches. Respiratory symptoms such as cough may also be observed, but they are more common in adults than in  children.

Symptoms are typically seen one to two weeks following a tick bite, with a median of nine days. The problem with tick bites is that they are usually painless, and therefore many people do not even remember being bitten. Due to immune suppression, secondary infections (usually caused by cytomegalovirus or fungi) are also frequent in severely diseased patients.

In approximately one-third of individuals with ehrlichiosis there is a visible rash that is maculopapular or petechial. The rash is more commonly observed in children and typically develops five days after fever ensues. If present, the rash typically spares the palms, soles and the face.

Akin to rickettsial infections, central nervous system involvement may occur in up to 20% of affected individuals, including dangerous manifestations like meningoencephalitis. Moreover, in some patients the disease may advance to acute respiratory distress syndrome or a shock-like presentation coupled with bleeding disorders and cardiovascular instability.

However, the overall death rate is substantially lower in ehrlichiosis when compared to rickettsial diseases. According to the data published by U.S. Centers for Disease Control and Prevention (CDC), the mortality rates in patients who are seen by a healthcare professional due to ehrlichiosis range from 1% to 3%.

On the other hand, a large number of patients may be infected with Ehrlichia and Anaplasma, but do not come for medical evaluation; therefore, these percentages may be overestimations of mortality. Naturally, immunocompromised individuals, elderly and those previously treated with sulfonamide antibiotics are at higher risk of more severe disease.

Differential Diagnosis

Since ehrlichiosis is a multisystem disease characterized by protean manifestations (i.e. without pathognomonic and highly characteristic clinical features), the differentials are often quite broad. Initial symptoms are often generalized and somewhat vague, which is why the illness may first be diagnosed as a possible “viral syndrome” in the context of upper respiratory infection, gastroenteritis and/or meningoencephalitis.

A history of tick exposure or tick bite in the recent past can be elicited from a majority of patients, but it is important to emphasize that this feature may be absent in up to 30% of all cases. Therefore, pursuing other appropriate diagnostic procedures to confirm this disease is of the utmost importance.

Pancytopenia (i.e. an abnormally low count for all three types of blood cells) is a hallmark laboratory finding of human ehrlichiosis during the early days of the disease.

  • leukopenia (mild or moderate) in 70% of patients (with the most significant decline being in the lymphocyte population) during the first week.
  • Anemia in 50% of acute patients
  • Low platelet count
  • elevated liver transaminases

The next step towards accurate diagnosis is making blood smears from peripheral blood, cerebrospinal fluid or bone marrow, which are stained with Giemsa or Wright’s stains to detect specific bacterial structures known as morulae.

Albeit this technique is rapid, it is rather insensitive in comparison to other confirmatory tests, and particularly in immunocompetent patients who have extremely low bacterial loads in blood and body organs.

The Use of Serology

The most sensitive method of infection confirmation is a seroconversion or a 4-fold change in antibody titers during the convalescent phase of the disease.

Specific serologic testing of IgM and IgG antibodies to Ehrlichia chaffeensis or Anaplasma phagocytophilum by means of indirect immunofluorescence assay is considered the “gold standard” and thus the most frequently employed confirmatory test.

Nonetheless, serology has its limitations, and these include a negative IgG test and uninformative levels of IgM titers in 80% of affected individuals during the first week of the disease, a high false positive rate, seroconversion failures due to weak immune function, as well as alteration of antibody response because of early antibiotic treatment.

Molecular Diagnostic Procedures

Due to high specificity and sensitivity values, as well as a very rapid turnaround time, polymerase chain reaction (PCR) became the preferred test for confirming serology findings indicative of human monocytic ehrlichiosis and human granulocytic anaplasmosis.

The use of PCR is especially important in the detection of early stages of infection, when antibody levels are low or undetectable.

A large number of kits are commercially available for whole blood PCR testing, which enables rapid diagnosis in up to 85% of infected individuals. Recent advances in molecular research even allow multiplex testing that can identify several agents of ehrlichiosis from one test.

Laboratory Culture

Although the possibility of culturing Ehrlichia and Anaplasma species is also available to clinicians and researchers, the isolation of these organisms requires cell lines and typically takes 2-6 weeks of incubation.

The sensitivity of this approach for the isolation of Ehrlichia chaffeensis is very low when compared to PCR, but higher (and almost comparable to PCR) for Anaplasma phagocytophilum.

The major pitfall of the laboratory culture approach is the paucity of competent laboratories, since this technique necessitates unique and antibiotic-free cell culture methods that are not usually available in clinical microbiology laboratories.

In addition, prior treatment with doxycycline or some other antimicrobial drugs lowers the sensitivity of culture to a greater degree when compared with blood smear analysis or PCR.

Immunohistochemistry

This is another confirmatory technique and is especially valuable when the diagnosis is to be made before antibiotic treatment is begun, or at least within 48 hours of its initiation. It can also be applied to bone marrow and autopsy specimens.

All those factors have to be taken into account when assessing patients with suspected ehrlichiosis, which is the reason why some propose combining different diagnostic methods to increase the likelihood of early diagnosis. Naturally, clinicians always have to consider other diseases that have similar clinical and laboratory findings to ehrlichiosis.

Treatment Options for Ehrlichiosis

Ehrlichia chaffeensis and Ehrlichia canis, the causative agents of human monocytic ehrlichiosis, are susceptible to all tetracycline antibiotics and their derivatives. These drugs exhibit broad spectrum activity by binding to bacterial ribosomes and inhibiting protein synthesis by interrupting peptide chain formation. A plethora of other human pathogens (such as rickettsiae, borreliae, chlamydiae, as well as some mycobacterial and protozoal species) are susceptible to tetracyclines as well.

Treatment considerations for human granulocytic anaplasmosis are similar to those for human monocytic ehrlichiosis, with tetracyclines being very effective against Anaplasma phagocytophilum and Ehrlichia ewingii. The possibility of Babesia co-infection often has to be considered, which means monotherapy is sometimes not sufficient.

In both groups of diseases treatment response is usually rapid. Therefore, an alternative diagnosis should be considered if fever persists for more than 72 hours after the initiation of appropriate antibiotics. Even though research studies did not specifically address recommended treatment duration, many experts advocate continued antibiotics for 3-5 days after fever abates, and perhaps even longer (up to 14 days) if there were signs of central nervous system involvement.  (Please see my comment at end of article)

A particular challenge for clinicians is ehrlichiosis in pregnancy, as tetracyclines are contraindicated in this population. Antibiotic sensitivity studies show that certain anti-tuberculous drugs have bactericidal activity in vitro against Ehrlichia and Anaplasma. This is also a viable and appropriate alternative approach in pregnant women.

Since clinical experience with other drugs that show activity in vitro is lacking, there are no fixed treatment recommendations for children younger than eight years of age, as well as for individuals who are hypersensitive to tetracycline drugs. Furthermore, there is no clinical data on the potential usefulness of adjunctive corticosteroid application to suppress the inflammatory manifestations of the disease.

Pertinent Prevention Strategies

Avoiding tick bites and removing any adherent tick immediately are the first steps in disease prevention. Individuals who reside in endemic areas are advised to wear long sleeves and light colored clothing during outdoor activities, since the latter permits easier visualization of crawling ticks. Adults at high risk of tick bites should apply repellents such as N,N-diethyl-meta-toluamide (commonly known as DEET) or permethrin to prevent this.

After visiting tick-infested regions, a careful inspection of body, hair and clothes should always be done with immediate removal of attached ticks. Research studies have demonstrated that a period lasting from 4 to 24 hours after infected ticks attach to the host is possibly essential for the  successful transmission of Ehrlichia and Anaplasma. Hence, swift and thorough removal of attached ticks is of the utmost importance for preventing transmission and subsequent disease.

At the moment there are no commercially available or experimental vaccines for prevention of either human or veterinary ehrlichiosis. In conclusion, it has to be emphasized that the diagnosis of ehrlichiosis necessitates a high level of suspicion, which is why it is often made retrospectively, with potentially dire consequences for the affected individuals in rare cases.

Sources

  1. https://www.cdc.gov/ehrlichiosis/index.html
  2. https://www.ncbi.nlm.nih.gov/pubmed/28457353
  3. https://www.ncbi.nlm.nih.gov/pubmed/17582569
  4. https://www.ncbi.nlm.nih.gov/books/NBK441966/
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC145301/
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2882064/
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4710445/
  8. Vanderhoof-Forschner K. Everything You Need to Know About Lyme Disease and Other Tick-Borne Disorders. John Wiley & Sons, 2004; pp. 104-132.

Sources for treatment and prevention

  1. http://www.antimicrobe.org/r01.asp
  2. https://www.ncbi.nlm.nih.gov/pubmed/28457353
  3. https://www.ncbi.nlm.nih.gov/books/NBK441966/
  4. https://academic.oup.com/cid/article/45/5/589/274600
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC145301/
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4744069/
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2882064/
  8. https://www.cdc.gov/ehrlichiosis/treatment/index.html

_________________

**Comment**

Lyme/MSIDS patients are often coinfected with numerous pathogens making them immunocompromised.  Cortico-steroids are not recommended for this population.  Also, as a rule, ILADS (International Lyme and Associated Diseases Society) recommends longer treatment and numerous antimicrobials due to the polymicrobial nature of tick-borne illness as well as the fact many of these pathogens are persistent.

For another great read:  https://www.lymedisease.org/ehrlichiosis-tick-borne-disease-no-one-heard/  The author brings up a valid point about the potential of there being undiagnosed Ehrlichia behind a ME/CFS diagnosis in a subset of patients since it infects white blood cells and the mitochondria.  The article also gives helpful percentages of symptoms and the following information:

Other symptoms of ehrlichiosis can include:

  • Fever/chills and headache (majority of cases)
  • Fatigue/malaise (over two-thirds of cases)
  • Muscle/joint pain (25% – 50%)
  • Nausea, vomiting and/or diarrhea (25% – 50%)
  • Cough (25% – 50%)
  • Confusion or brain fog (50% of children, less common in adults)
  • Lymphadenopathy (47% – 56% of children, less common in adults)
  • Red eyes (occasionally)
  • Rash (approximately 60% of children and 30% of adults)

Other modes of transmission

Ehrlichia chaffeensis has been shown to survive for over a week in refrigerated blood. Therefore these bacteria may present a risk for transmission through blood transfusion and organ donation. It has also been suggested that ehrlichiosis can be transmitted from mother to child, and through direct contact with slaughtered deer. (14, 15)

Summary of Ehrlichiosis

As you can see from this nifty table, much is UNKNOWN.  This right here is another example of research begging to be done.  The results would be practical, effectual, and essential in treating patients – unlike climate data which will only line the pockets of research institutions.  Remember Zika?  It caused a media blitz with research being done everywhere.  As you can see from this article, Ehrlichia can be deadly and is spreading.  Why no news and research?

For more:  https://madisonarealymesupportgroup.com/2018/10/15/ehrlichiosis-masquerading-as-thrombotic-thrombocytopenia-purpura/

https://madisonarealymesupportgroup.com/2018/10/02/north-carolina-ehrlichia-often-overlooked-when-tick-borne-illness-suspected/

https://madisonarealymesupportgroup.com/2018/07/24/oklahoma-ehrlichiosis-central/

https://madisonarealymesupportgroup.com/2018/03/09/dogs-ehrlichiosis/

https://madisonarealymesupportgroup.com/2018/11/11/gestational-lyme-other-tick-borne-diseases-dr-jones/

Category:

Ehrlichiosis, Ehrlichiosis Treatment, Treatment