https://www.bmj.com/content/370/bmj.m3029/rr-3
BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3029 (Published 13 August 2020)Cite this as: BMJ 2020;370:m3029
https://igenex.com/tick-talk/symptom-checker (Go here for Symptom Checker)
If you’ve been sick and aren’t getting better, use this IGeneX symptom checker to determine your likelihood of having Lyme disease or other associated tick-borne illnesses.
The Lyme and Tick-Borne Disease Symptom Checker is for informational purposes only and should not be considered, or used as a substitute for, medical advice, diagnosis, or treatment. By using this website and the Symptom Checker, you agree that this website and the Symptom Checker is not intended to and does not replace the advice of your own physician or other medical professional and that this website does not constitute the practice of any medical or other professional healthcare advice, diagnosis, or treatment. You are solely responsible for your own health care decisions regarding the use of this website and the Lyme and Tick-Borne Disease Symptom Checker and your use is entirely at your own risk. You should consult a medical professional for all questions or concerns you may have relating to your health. If this is an emergency in the United States, call 911.
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**Comment**
A very helpful online quiz. You can also read about common symptoms for Lyme disease, Babesia, Tick-borne Relapsing Fever, Bartonella, Ehrlichiosis, Anaplasmosis, and Rickettsiosis.
My only caution is that there are other symptoms omitted from this quiz. My own case is a perfect example.
All my initial symptoms were gynecological and I believe strongly were my first signs of Lyme/MSIDS infection, obtained from my husband who is also infected. You can read about that here: https://madisonarealymesupportgroup.com/2017/02/24/pcos-lyme-my-story/
It is quite common to have an initial 90 minute appointment with these ILADS trained doctors as you fill out medical history forms going back to infancy. The doctor then discusses these with you to further ascertain the potential of early infection (perhaps in utero). Often, many health issues can be traced back to infancy if you were infected congenitally. For more: https://madisonarealymesupportgroup.com/2018/06/19/33-years-of-documentation-of-maternal-child-transmission-of-lyme-disease-and-congenital-lyme-borreliosis-a-review/
While sexual transmission of Lyme/MSIDS has not been admitted to by ‘authorities,’ congenital transmission recently has been: https://madisonarealymesupportgroup.com/2020/02/01/cdc-website-updated-today-possibility-of-mother-to-fetus-transmission-of-lyme-disease/
It is also quite common for ‘authorities’ to first admit something is ‘rare’ only to have to admit later it’s more common than first thought. This is their modus operandi. For years I’ve watched them state Lyme doesn’t exist in certain geographical locations because the ticks that transmit it aren’t there, only to have to update that information later on. This has happened repeatedly. But before the information gets updated, infected patients are told “it’s all in their heads,” left to rot, and are denied treatment. These patients only go on to worsen, making their cases far more difficult to treat: https://madisonarealymesupportgroup.com/2017/09/21/its-all-in-your-head-until-finally-a-lyme-diagnosis/
This must end. Using entomology maps to diagnose has hurt patients. While maps are interesting, they should never keep patients from getting diagnosed.
For the Horowitz symptom questionnaire, which has been validated: https://madisonarealymesupportgroup.com/wp-content/uploads/2016/01/symptomlist.pdf Print, fill out, and tally up the points.
Just remember that while these checklists are helpful, and in fact probably far better than current testing, they are not perfect. Lyme/MSIDS is wiley – with waxing and waning symptoms. Your best hope of correct diagnosis and treatment remain in the hands of an experienced Lyme literate doctor, although nothing replaces learning all you can to be a helpful partner in your own healing.
https://vineyardgazette.com/news/2020/10/07/lone-star-ticks-swarm-aquinnah
Tick biologist Richard Johnson said the best way to reduce the tick population is to reduce the deer population. Credit: Tim Johnson
Lone star ticks – and thousands of their larvae — have overrun the town of Aquinnah, biologist and tick expert Richard Johnson told Aquinnah selectmen at their meeting Wednesday, following reports that showed a high incidence of tick-borne disease in the town this year.
In a letter that went out last week, the town board of health reported 13 new cases of tick-borne illnesses since April of this year, including cases of Lyme disease, ehrlichiosis, babeosis and Rocky Mountain spotted fever. At the meeting, Mr. Johnson said he was in Aquinnah on Tuesday surveying yards for ticks and found lone star larvae in every location he visited.
(See link for article)
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**Comment**
OK – this here should alarm us – an entomologist getting a daily call from folks discovering clusters of lone star ticks.
Although not known to carry Lyme, they can cause ehrlichiosis, Rocky Mountain spotted fever, as well as a red meat and or dairy allergy.
“I hope this isn’t the new normal but I fear that they’re exploding in numbers.” Richard Johnson
Johnson also points out that unlike deer ticks, lone star larvae stay in groups of 2,000-8,000 until they are nymphs which means those who brush up against a cluster could have hundreds to thousands attaching simultaneously.
The article mentions controlled burns for changing the habitat which could eradicate the ticks. Please see: https://madisonarealymesupportgroup.com/2019/07/18/frequent-prescribed-fires-can-reduce-risk-of-tick-borne-diseases Burning works but it must be done repeatedly.
The article mentions using various birds to eat them, but the ticks also travel and feed on birds.
Johnson stated that the number one thing they can do is reduce the deer population.
Sep 29, 2020
Local authorities in Rhode Island announced that two new tick species were identified on Block Island. The tick species were traced back to Eurasia and Asia origins.
Dr. Danielle Tufts from Columbia University identified the two species Haemaphysalis longicornis (Asian long-horned tick) and Haemaphysalis punctata (red sheep tick), reported the state’s Department of Environmental Management (DEM). (See link for article)
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**Comment**
Both ticks are considered live-stock pests but they can and do bite humans, transmitting diseases. Farmers, hunters, and hikes are at greater risk.
Sheep: Babesia motasi, Theileria ovis
Red sheep tick, Adult female dorsal view
https://medicalxpress.com/news/2020-09-jersey-1.html
SEPTEMBER 9, 2020
A tick species associated with bats has been reported for the first time in New Jersey and could pose health risks to people, pets and livestock, according to a Rutgers-led study in the Journal of Medical Entomology.
This species (Carios kelleyi) is a “soft” tick. Deer ticks, which carry Lyme disease, are an example of “hard” ticks.
“All ticks feed on blood and may transmit pathogens (disease-causing microbes) during feeding,” said lead author James L. Occi, a doctoral student in the Rutgers Center for Vector Biology at Rutgers University-New Brunswick. “We need to be aware that if you remove bats from your belfry, attic or elsewhere indoors, ticks that fed on those bats may stay behind and come looking for a new source of blood. There are records of C. kelleyi biting humans.” (See link for article)
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**Comment**
A few important points:
https://www.newsbreak.com/news/2058858379813/first-case-of-parasitic-soft-ticks-reported-in-new-jersey The current pandemic has been accompanied by cases of other illnesses and diseases such as African Swine Flu, Ebola, Bubonic Plague, West Nile Virus, Dengue outbreaks around the world.
https://pubmed.ncbi.nlm.nih.gov/32723635/
doi: 10.1016/j.ttbdis.2020.101489.Epub 2020 Jun 8.
In mountain areas of northwestern Italy, ticks were rarely collected in the past. In recent years, a marked increase in tick abundance has been observed in several Alpine valleys, together with more frequent reports of Lyme borreliosis. We then carried out a four-year study to assess the distribution and abundance of ticks and transmitted pathogens and determine their altitudinal limit in a natural park area in Piedmont region.
Our study provides new insights into the population dynamics of ticks in the Alps and confirms a further expansion of ticks to higher altitudes in Europe. We underline the importance of adopting a multidisciplinary approach in order to develop effective strategies for the surveillance of tick-borne diseases, and inform the public about the hazard posed by ticks, especially in recently invaded areas.
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**Comment**
Not that ticks can’t climb mountains – but migrating birds probably dropped them there: https://madisonarealymesupportgroup.com/2018/11/07/ticks-on-the-move-due-to-migrating-birds-and-photoperiod-not-climate-change/
Regarding R. slovaca:
We also identified a case of R. slovaca infection in southern Rhineland-Palatinate. The patient reported a tick bite; the tick was identified as Dermacentor spp. Fever, lymphadenopathy of submandibular lymph nodes, and exanthema at the site of the tick bite developed 7 days later. Serologic examinations by using an immunofluorescent test (Focus Diagnostics, Cypress, CA, USA) showed antibody titers of 64 for immunoglobulin (Ig) M and 1,024 for IgG against rickettsiae of the spotted fever group. These results indicated an acute rickettsial infection. Because of strong cross-reactivity among all species in the spotted fever group, we cannot differentiate between antibodies against R. slovaca and other species in this group. https://wwwnc.cdc.gov/eid/article/15/12/09-0843_article
Madison Area Lyme Support Group 
Rapid Response:
Re: Tick bite
Dear Editor
Razai et al, in their consultation on tick bite, missed an important message to learners (1).
The most common infectious agents transmitted by Ixodes species ticks in North America that have the potential for co-infection with B burgdorferi are Anaplasma phagocytophilum, Babesia species, deer tick (Powassan) virus, Borrelia miyamotoi, and the Ehrlichia muris–like agent (2).
A phagocytophilum is transmitted by the same Ixodes ticks as B burgdorferi in the United States and causes fever, chills, headache, myalgia, and fatigue arising 1 to 3 weeks following tick exposure. Most cases are mild and self-limited. However, severe manifestations may include respiratory failure, adult respiratory distress syndrome, peripheral neuropathy, rhabdomyolysis, acute renal failure, pancreatitis, and coagulopathies.
It has been found that in Wisconsin, approximately 3% of I scapularis ticks examined were co-infected with B burgdorferi and A phagocytophilum (3). A similar study in 11,000 ticks in public parks of New York State’s Hudson Valley Region found that co-infection rates of nymphs and adults were 0.5% and 6.3%, respectively (4).
The frequency of humans with Lyme disease simultaneously co-infected with A phagocytophilum from various studies ranges from 2% to 10% (5,6). Similirly, Babesiosis is transmitted through the bite of infected I scapularis and I pacificus ticks. Most patients are asymptomatic or have mild, self-limited disease but may be complicated by renal failure, acute respiratory distress, and shock.
In a study of patients with Lyme disease from southern New England, approximately 10% were co-infected with babesiosis (7).
Unlike Lyme disease and Anaplasmosis, doxycycline is not an effective treatment of babesiosis and requires atovaquone and azithromycin or combination of clindamycin with quinine, making it imperitive to consider this diagnosis in mind in patients with tick bite.
Of the 3 species of Ehrlichia in United States, only E muris–like (EML) agent is transmitted by I scapularis is the vector of this emerging pathogen(8).
Possible co-infections should be considered in any patients who are diagnosed with tick bite or Lyme disease, especially those who have unexplained leukopenia, thrombocytopenia, or anemia, or who fail to respond to treatment for Lyme’s disease.
References:
1- Razai MS, Doerholt K, Galiza E, Oakeshott P. Tick bite. BMJ 2020;370:m3029
2- Caulfield AJ, Pritt BS. Lyme disease Coinfections in the United States. Clin Lab Med 2015;35:827–846.
3- Lee, X, Coyle DR, Johnson DK, et al. Prevalence of Borrelia burgdorferi and Anaplasma phagocytophilum in Ixodes scapularis (Acari: Ixodidae) nymphs collected in managed red pine forests in Wisconsin. J Med Entomol 2014;51:694-701.
4- Prusinski MA, Kokas JE, Hukey KT, et al. Prevalence of Borrelia burgdorferi (Spoirochets: Spirochaetaceae), Anaplasma phagocytophilum (Rickettsiales: Anaplasmataceae), and Babesia microti (Piroplasmida: Babesiidae) in Ixodes scapularis (Acari: Ixodidae) collected from recreational lands in the Hudson Valley Region, New York State. J Med Entomol 2014;51:226-36.
5- Horowitz HW, Aguero-Rosenfeld ME, Holmgren D, et al. Lyme disease and human granulocytic anaplasmosis coinfection: impact of case definition on coinfection rates and illness severity. Clin Infect Dis 2013;56;93-9.
6- Steere AC, McHugh G, Suarez C, et al. Prospective study of coinfection in patients with erythema migrans. Clin Infect Dis 2003;36:1078-81.
7- Krause PJ, Telford SR, Spielman A, et al. Concurrent Lyme disease and babesiosis – evidence for increased severity and duration of illness. JAMA 1996;275:1657-60.
8- Pritt BS, McFadden JD, Stromdah E, et al. Emergence of a novel Ehrlichia sp. agent
pathogenic for humans in the Midwestern United States. 6th International Meeting
on Rickettsiae and Rickettsial Diseases. Heraklion (Greece), June 5–7, 2011.
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**Comment**
This important letter to the editor highlights many contentious issues Lyme/MSIDS patients have to muddle through. From where I sit, I disagree with the author’s statements that these infections are ‘mild and self-limited’, but I deal with sick people – not healthy. If there’s one thing I DO know, it’s that these infections have been downplayed for far too long, and it’s been a real problem. Patients haven’t been taken seriously for over 40 years!
The consideration of coinfections; unfortunately, is not common in mainstream medicine regarding Lyme/MSIDS. They still treat this as a one germ disease with doxycycline curing it, when nothing could be further from the truth: https://madisonarealymesupportgroup.com/2018/10/30/study-shows-lyme-msids-patients-infected-with-many-pathogens-and-explains-why-we-are-so-sick/