Archive for the ‘Ehrlichiosis’ Category

Ehrlichiosis Masquerading as Thrombotic Thrombocytopenia Purpura

https://www.ncbi.nlm.nih.gov/m/pubmed/30279260/

Ehrlichiosis masquerading as thrombotic thrombocytopenic purpura.

Chen D, et al. BMJ Case Rep. 2018.

Abstract

Ehrlichiosis is a rare tickborne illness that can manifest from an asymptomatic, self-limiting disease to a severe presentation with encephalopathy and renal failure. Ehrlichiosis is diagnosed largely based on patient history with confirmatory tests including peripheral blood smear, serology and PCR. Empiric treatment is warranted in patients with suspected tick bites as a delay in treatment can result in multiorgan failure. We discuss a case of ehrlichiosis that presented with the classic pentad of thrombotic thrombocytopenic purpura (TTP). A history of a tick bite was elicited and intravenous doxycycline 100 mg two times a day was initiated. Tick panel results revealed a positive Ehrlichia chaffeensis IgG and IgM titres, consistent with human monocytic ehrlichiosis. Autoimmune workup and antibodies to Borrelia burgdorferi were negative, and ADAMTS13 activity assay results were inconsistent with TTP. The patient completed 14 days of intravenous doxycycline and had an uneventful recovery.

PMID

30279260 [ – in process]

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**Comment**
Thrombotic Thrombocytopenic Purpura (TTP) causes tiny blood clots throughout your body.  This can block blood vessels and impede blood flow.  The clots can use up too many platelets which in turn can inhibit clot formation when you need it.
Symptoms include:
  • Purplish bruises (purpura) from no obvious cause
  • tiny red or purple spots that look like a rash
  • skin may turn yellowish (jaundice)
  • skin may look pale
  • fever
  • fatigue
  • confusion
  • weakness
  • headache
  • In very serious cases, a stroke, major internal bleeding, or a coma can occur
Warning!
In May 2017, an article in the CDC “Emerging Infectious Diseases” Journal, warns that ehrlichiosis infections are being “grossly underreported” in the U.S. with as many as 97-99% of infections going unrecognized. They are projecting that the actual number of annual cases could go as high as 1/2 the number of Lyme disease cases—which would mean we may already have over 150,000 cases of ehrlichiosis annually. (3)
Rickettsiae and Ehrlichia belong to a broad group of bacteria that can be spread by a tick bite. These infections can be transmitted alone or at the same time as Lyme disease and are commonly known as co-infections.

 

The Ehrlichia (E) group includes: (5, 6, 7, 8,)

  • chaffeensis: the cause of human monocytic ehrlichiosis (HME)
  • ewingii
  • muris-like (EML)

Symptoms
While some cases of ehrlichiosis are mild, the disease can be severe or fatal if not treated correctly, even in previously healthy people. Severe symptoms of ehrlichiosis may include difficulty breathing, respiratory failure, bleeding disorders, kidney or heart failure.

Because Ehrlichia infect white blood cells (the cells that fight infection), and mitochondria (the powerhouse of the human cell) the consequences of untreated infection may have long-lasting effects.(9) I often wonder if undiagnosed Ehrlichiosis isn’t responsible for some portion of the millions of people with the mysterious illness known as “Myalgic Encephalomyelitis” or “Chronic Fatigue Syndrome”.

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)

Diagnosis And Treatment
Like other tick-borne diseases, diagnostic blood tests will frequently be false-negative during the first weeks of illness. And like other tick-borne diseases, treatment is most effective if started early. For this reason, healthcare providers must use their best clinical judgement and treat patients based upon early symptoms alone.

According to the CDC website: “The diagnosis of ehrlichiosis must be made based on clinical signs and symptoms, and can later be confirmed using specialized confirmatory laboratory tests. Treatment should never be delayed pending the receipt of laboratory test results, or be withheld on the basis of an initial negative laboratory result.”

The CDC goes on to say: “Doxycycline is the first line treatment for adults and children of all ages and should be initiated immediately whenever ehrlichiosis is suspected.” (10)

Patients who are treated early may recover quickly on outpatient medication, while those who experience a more severe illness may require intravenous antibiotics, prolonged hospitalization or intensive care.

Category:

Ehrlichiosis, research, Treatment

Lyme Carditis Presenting With Atrial Fibrillation

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

Case Reports in Cardiology

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

A Case of Lyme Carditis Presenting with Atrial Fibrillation

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

Published 2 September 2018

Academic Editor: Kjell Nikus

Abstract

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

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**Comment**

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

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

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

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

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

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

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

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

Most common parasites causing carditis:

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

 

Category:

Babesia, Bartonella, Ehrlichiosis, Heart Issues, Lyme, research

Updates and News From Russell Labs – Wisconsin

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

Updates

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

Live in Wisconsin and want your tick identified?

NEW for 2018: Page over to check out the Tick App,  http://labs.russell.wisc.edu/wisconsin-ticks/the-tickapp/ our new tool for studying tick exposure and providing mobile information about ticks and tick-borne disease. More than 600 Wisconsinites have already participated in 2018.

NEW for 2018: We are starting a tick identification service. Identifying the stage and species of a tick are crucial to deciding whether to seek medical attention or not. Tick-borne diseases are only carried by certain ticks in specific regions. We can help you identify the tick you’ve found based on your images and geographical location. Use the following link to submit your photos and information:

 

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

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

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

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

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

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A few points stick out to me:

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

 

 

 

 

 

 

 

 

Category:

Activism, Anaplasmosis, Babesia, Borrelia Miyamotoi (Relapsing Fever Group), Ehrlichiosis, Lyme, research, Rocky Mountain Spotted Fever, Testing, Tickborne Relapsing Fever, Ticks, Viruses

Colorado Tick-Borne Disease Prevalence in Dogs

https://coloradoticks.org/for-physicians-and-patients/colorado-tick-borne-disease-prevalence-dogs/

Colorado Tick-Borne Disease Prevalence in Dogs

Colorado Tick-Borne Disease Awareness Association

PO Box 53
Poncha Springs, CO 81242

Email: info@coloradoticks.org
Facebook: Facebook.com/ColoradoTicks/

Help Support the COTBDAA with your tax deductible donation.

Category:

Activism, Anaplasmosis, Ehrlichiosis, Lyme, Prevention, Ticks

North Carolina: Ehrlichia Often Overlooked When Tick-borne Illness Suspected

http://outbreaknewstoday.com/north-carolina-ehrlichia-often-overlooked-tick-borne-illness-suspected-24872/

North Carolina: Ehrlichia often overlooked when tick-borne illness suspected

by Press Release
October 1, 2018

When a patient presents with signs and symptoms suspicious for a tick-borne illness, medical providers in central North Carolina regularly test for Lyme disease and Rocky Mountain Spotted Fever, but often don’t think about Ehrlichia, according to researchers at the University of North Carolina at Chapel Hill.

North Carolina map/ National Atlas of the United States
North Carolina map/ National Atlas of the United States

The failure to test for Ehrlichia, even as more and more evidence suggests that the infection may be just as common as other endemic tick-borne diseases, appears to impact patient care with antibiotics prescribed less frequently when testing is not ordered. This study’s results and recommendation for increased provider education were recently published in the Center for Disease Control and Prevention’s journal Emerging Infectious Diseases.

“Providers order Ehrlichia testing much less frequently than Rocky Mountain Spotted Fever or even Lyme disease, despite the low-incidence of Lyme disease in the state,” said Ross Boyce, M.D., M.Sc., the study’s lead author and a clinical instructor in the Division of Infectious Diseases at the UNC School of Medicine. “This disparity may be attributable to unfamiliarity with local vector epidemiology, as well as the greater attention given to Rocky Mountain Spotted Fever and Lyme disease in the popular media.”

Ehrlichia is an illness caused by the Lone Star Tick, which is found throughout the mid-Atlantic United States. Symptoms typically include fever, headache and muscle aches. Boyce and colleagues performed a retrospective chart review on 194 patients who underwent testing for tick-borne illness at UNC hospitals and associated clinics between June and September 2016.

They found that nearly 80 percent of patients were tested for Rocky Mountain Spotted Fever and two-thirds were tested for Lyme disease. Yet providers ordered testing for Ehrlichia in only one-third of patients. Among the initial results

37 patients tested positive for Rocky Mountain Spotted Fever, nine tested positive for Ehrlichia, one tested positive for Lyme disease and,

Using leftover serum, Boyce and colleagues tested the 124 patient samples that were not initially tested for Ehrlichia. Twenty-five of those samples ultimately tested positive for Ehrlichia,

putting the total number of positive results nearly equal with the number of Rocky Mountain Spotted Fever cases.

“Our results demonstrate that Ehrlichia accounted for a large proportion of reactive antibodies among a cohort of individuals with suspected tick-borne illness in Central North Carolina,” Boyce said. “These finding provide strong, albeit circumstantial evidence that Ehrlichia infection is as prevalent as Rocky Mountain Spotted Fever even as providers appear to consider this diagnosis much less frequently than other tick-borne diseases.”

While the CDC guidelines recommend empirical antibiotic treatment when there is suspicion for tick-borne illness, Boyce and colleagues work suggests that providers are less likely to provide antibiotics if testing is not ordered. While it is difficult to distinguish an acute infection from a past exposure with a single test, the study estimates that failure to test for Ehrlichia may have resulted in a missed diagnosis in more than 10 percent of individuals.

Boyce said educating front-line providers in primary care clinics and emergency departments about the prevalence of this tick-borne illness is urgently needed.

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**Comment**

Great example of the importance of medical practitioners understanding clearly that ticks are infected with many pathogens that can and do infect humans causing disease.  They need to ditch the one pathogen, one drug paradigm completely or patients are not going to improve.

Please see:  https://madisonarealymesupportgroup.com/2017/07/01/one-tick-bite-could-put-you-at-risk-for-at-least-6-different-diseases/

More on Ehrlichiosis:

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

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

https://www.lymedisease.org/ehrlichiosis-tick-borne-disease-no-one-heard/

 

 

Category:

Activism, Ehrlichiosis, Lyme, research, Rocky Mountain Spotted Fever, Testing, Ticks