Archive for the ‘Heart Issues’ Category

When Lyme Kills

https://elemental.medium.com/when-lyme-kills

Illustration by Anuj Shrestha

When Lyme Kills

The extremely rare complication you should know about

This story is part of “Tickpocalypse,” a multi-part special report.

Joseph Elone just felt tired at first, like he wasn’t sleeping well. A 17-year-old high-school student from upstate Poughkeepsie, New York, Joseph was a quiet but popular science whiz and electric-guitar lover who had just finished a summer environmental fellowship at Brown University. He’d spent two weeks studying on campus and hiking in the Rhode Island woods and was still riding high from the experience. It was late July, and life had a carefree feeling to it. “He was really happy that he had this chance to really open himself up,” says Joseph’s brother, Emmanuel. “He knew that as soon as senior year started he was going to apply early to Brown.”

Soon, however, Joseph developed cold symptoms — a cough, a sore throat, head and body aches, digestive problems, and a low-grade fever.

Poughkeepsie is located in New York’s Hudson Valley region, an area known for high rates of Lyme disease. Joseph had seen no signs of a tick, a tick bite, or the bull’s-eye rash that is often the telltale marker of Lyme, but he and his parents decided he should see his pediatrician in any case.

The doctor saw little reason for concern. Joseph likely had the flu, he said. He prescribed the standard regimen — rest, fluids, and the like — and suggested they give it time.

But a few days later, Joseph’s symptoms worsened. He was feeling light-headed and said he was sensitive to bright light. He returned to the same doctor, who ordered blood tests for strep throat, Lyme disease, and another tick-borne illness called anaplasmosis. The results were all negative.

Joseph and his family were aware that the antibodies indicating the presence of Lyme disease can take weeks to show up in tests, but even if Joseph were to develop the disease, they weren’t worried. Joseph was young and otherwise healthy, and Lyme is usually curable in a matter of weeks with antibiotics.

“It just seemed like he had a cold or something, or a little fever, but nothing crazy,” Emmanuel says. “It wasn’t something that you would take seriously in the moment.”

August 4, 2013, was a hot and hazy Sunday in Poughkeepsie. Diane’s 49th birthday was the next day, and the family had planned a barbecue that night. Late in the afternoon, Benedict and Emmanuel were getting the backyard ready while Joseph and Diane drove to the drugstore for cough drops. They had just come back, Diane walking toward the house ahead of Joseph, when she heard her son collapse behind her.

Joseph lay on the lawn, a few steps from the family’s front door, unconscious. Diane began screaming. The others came and started screaming, too — calling to Joseph and hugging him, but he didn’t respond.

EMTs rushed Joseph to a local hospital, where doctors spent several hours working to revive him. His breathing was shallow, his heartbeat erratic. Later that evening, he was transported 50 miles south to Westchester Medical Center. Not long after he arrived, in the early hours of August 5, just three weeks since he had started feeling sick, Joseph was pronounced dead.

It would take at least four months and several incorrect diagnoses to determine the cause of Joseph’s death, but ultimately, examinations revealed the presence of Lyme bacteria in several of his organs, including his heart.

The Elone family, devastated by Joseph’s loss, was shocked all over again. They had never heard of anyone dying from Lyme disease.


According to the Centers for Disease Control and Prevention, the number of confirmed cases of Lyme Disease in the U.S. rose 131% in the two decades leading up to 2017 and 17% from 2016 to 2017 alone. More than 300,000 new cases are now diagnosed annually, and as climate change and other factors trigger a dramatic increase in the tick population, experts expect the disease to become more common still.

If Lyme is detected early, the standard two-week course of antibiotics usually works well, and most people recover quickly. But about 20% of those who contract the disease continue living with its effects for months after treatment. The corresponding diagnosis, Post-Treatment Lyme Disease Syndrome (PTLDS), stands to affect more than two million people in the U.S. by 2020.

There is also a very small subset of Lyme cases in which the disease proves to be fatal. Although such instances are extremely rare, they are uniquely devastating. They may also be underreported — and preventable.

Joseph Elone’s death in 2013 occurred the same year the CDC released a report of three other deaths related to Lyme. The discovery of the four cases, a small but nevertheless unusual number, led to further inquiries that uncovered numerous additional instances in New York state that had previously gone largely unnoticed, leading experts to wonder if Lyme deaths might actually be more common than previously thought. The new focus on Lyme deaths also shined a light on a cause of the fatalities called Lyme carditis, raising questions about doctors’ awareness of that condition, and the screening procedures used to detect it. Advocates say those questions have yet to be resolved.

“One preventable death is one too many.”

Timothy Sellati, a veteran Lyme researcher and the chief scientific officer of the Global Lyme Alliance, which funds research and awareness programs, says the number of deaths associated with Lyme carditis are underreported. His group and others have begun calling for revised methods of diagnosis to detect the condition earlier. While the overall number of deaths from Lyme disease remains small, “One preventable death is one too many,” he says.


Given the absence of swift and reliable testing to detect Lyme disease, confirming its role in any death is a slow process. At first, all experts could say was that something had weakened Joseph Elone’s heart, compromising its function. The cause of death initially recorded was myocarditis (an inflammation of the heart muscle) and meningitis (a bacterial infection). Another tick-borne illness, Powassan encephalitis, was also suspected at one point.

It was only in December when reports surfaced that tests had found Lyme spirochetes, or bacterial residue, in Joseph’s heart tissue. Sure enough, in March 2015, a prominent medical journal confirmed that Joseph’s liver, heart, lung, and brain tissues all contained evidence of Lyme. The official cause of Joseph’s death was Lyme carditis.

Lyme carditis occurs when Lyme disease bacteria invade the tissues of the heart, disrupting electrical signals between the organ’s upper and lower chambers. That, in turn, causes an abnormal heart rhythm and a problem known as “heart block.” Heart block can be mild, but it can also become serious very quickly. Patients typically experience many of the symptoms characteristic of Lyme disease — fatigue, coughing, headaches, and the like — plus cardiovascular or pulmonary symptoms like light-headedness, fainting, shortness of breath, heart palpitations, or chest pain. Like Lyme itself, the condition is generally treatable if detected early. (Depending on the severity of the case, people are given oral or intravenous antibiotics; in some instances, they may need a temporary pacemaker.) But if Lyme carditis is not treated in time, it can be fatal.

According to the CDC, Lyme carditis occurs in approximately 1% of Lyme cases reported to the agency; in one 2008 epidemiological study, the condition was named as the main cause of death among patients who die from Lyme disease. A 2009 study of 207 pediatric patients with Lyme disease found that 16% had Lyme carditis. All three of the additional deaths cited in the CDC report issued the year Joseph died were linked to the condition.

The other three victims were two men and one woman, the youngest 26, the oldest 38. In November 2012, one of them, a Massachusetts man, complained of malaise and muscle and joint pain in the weeks before being found behind the wheel of a car after it veered off the road. In July 2013, a New York state corrections officer who had also worked as a landscaper was hanging laundry on his front lawn when he clutched his chest in pain, staggered, and dropped to the ground. He had experienced chest pain on and off for at least several days, his wife later said, but had not seen a doctor. That same month, just a few days before Joseph’s death, a Connecticut resident collapsed after more than a week of complaining of occasional shortness of breath and anxiety. In all three cases, Lyme carditiswas found posthumously.

When Joseph Elone became known as the fourth case of death from Lyme disease in the space of a year, reporters from the Poughkeepsie Journal combed through 1.2 million death certificates from non-New York City counties in New York state searching for more fatalities that might be linked to Lyme. They found nine Lyme-related deaths over 13 years. Not all of those cases involved Lyme carditis, and the details of each weren’t analyzed.

The CDC has officially identified just nine cases of fatal Lyme carditis in the United States between 1985 and 2018, but if one newspaper can find nine Lyme deaths in one state in a shorter period of time, some experts believe the real number may be higher.

“I think they are underreported,” says Renu Virmani, a cardiac pathologist who has studied Lyme carditis deaths and runs a cardiac research organization in Maryland called CVPath Institute. Her suspicion, she says, is based on the fact that Lyme carditis occurs in one out of every hundred Lyme cases, but medical examiners rarely consider testing people who die from sudden heart failure for Lyme.

“Nobody thinks of doing that until after you made the diagnosis,” she says. The only deceased patients who are tested for Lyme posthumously are people who tested for Lyme while they were still living, she says. And since it is well-established that many Lyme cases go undiagnosed while the person is still living, it stands to reason that at least some fatalities may happen with no one knowing.

“It’s very unusual for a medical examiner to make the diagnosis of Lyme disease,” Virmani says. “Very unusual. And I’m sure there are people who die of Lyme disease.”


Lyme carditis isn’t the only source of Lyme-related deaths. People with underlying health conditions can be overcome by Lyme disease, and suicide is a risk for PTLDS patients who become severely debilitated or depressed. But those risks are relatively well-known.

Lyme carditis, on the other hand, often goes overlooked. The condition is so rare that most people and doctors are barely aware of it, if they’ve even heard of it at all.

After Joseph Elone’s death and the report of the three other Lyme carditis deaths in the same year, officials in Duchess County, New York changed their public health advisory to doctors weighing Lyme as a cause of illness. Now physicians are told to ask about cardiac symptoms in possible Lyme cases and to check cardiac cases for possible exposure to ticks and symptoms of the disease. (Forty-two percent of the pediatric Lyme carditis patients identified in the 2009 CDC study had advanced heart-function problems.)

Lyme prevention advocates want standards like those adopted universally. Doctors in the United States currently follow guidelines for Lyme diagnosis set forth by the Infectious Disease Society of America, but a newly formed group of physicians called the International Lyme and Associated Diseases Society has developed a more aggressive screening approach. It involves more than one blood test, and faster treatments for patients seen to be more at risk, and above all a set of criteria that encourages doctors to move more quickly based on their own professional judgment, even when tests come back negative. Under the older IFDS guidelines, advocates say, some doctors felt penned in by the criteria, concerned about professional blowback for treating cases in which there is no confirmation by a blood test or no classic bull’s-eye rash.

“I think the problem with the IDSA guidelines is they operate from the notion that all patients are going to respond to antibiotics the same way and a relatively short course of antibiotics will cure all patients,” says Sellati of the Global Lyme Alliance. Such a rigid, uniform approach may not permit doctors to be more aggressive when they believe the circumstances warrant it. The new recommendations issued by ILADS, Sellati says, are more nimble. “They want to provide more deference to the physician’s experience, especially if they see a lot of Lyme disease patients. Using a combination of their experience, seeing large numbers of patients, and the broader symptoms that could be associated with Lyme disease, they’re allowed to sort of think outside the box.

He suggests parents not be alarmed about Lyme carditis, but to be aware of it, “especially if a patient has other heart abnormalities, like congenital heart disease or other things that could impair their heart’s function.”


After his son’s death, Benedict Elone called for increased awareness of Lyme’s fatal potential and for more to be done to prevent Lyme deaths.

“Be it Lyme or be it Powassan — people need to know that it can kill a strong, physical guy,” he told reporters. “There is something in our environment that can kill somebody that fast. We really need to know about it, study it, and find some solutions.”

In front of the TV cameras, he spoke lovingly about his son. “He’s a kid who knew who he was,” Benedict said. “He had all kinds of ambition. Teachers couldn’t stop speaking well of him.”

And then he dissolved into tears, repeating the same phrase again and again. “I just miss my son,” he said. “I just miss my son. I just miss my son. I just miss my son.”


This story is part of “Tickpocalypse,” a multi-part special report.

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**Comment**

Well, if this isn’t heartbreaking, I don’t know what is.

There are numerous points that should be mentioned:

  1. The media, researchers, and doctors need to refrain from the word “RARE” on pretty much anything regarding tick-borne illness. Notice out of one side of his mouth, the author states the same year Elone died, the CDC released a report of three other deaths related to Lyme, “which led to further inquiries that uncovered numerous additional instances in New York state…leading experts to wonder if Lyme deaths might actually be more common than previously thought.”  Then, out of the other side of his mouth he announces with certainty that it’s rare. This is illogical and undermines the seriousness of this. All I can say is Zika was handled very differently.
  2. Please take note that spirochetes riddled his body. They were all over. How many dead bodies have to pile up before the CDC/IDSA/NIH believe Lyme is serious and that those with persistent symptoms just might be chronically infected, with spirochetes riddling our bodies? Instead, we have bone-heads saying we have MUS (medically unexplained symptoms), which essentially means he believes we are psychosomatic:  https://madisonarealymesupportgroup.com/2019/06/11/dr-eugene-shapiro-medically-unexplained-symptoms/  Video of Shapiro stating he believes our symptoms are completely unrelated to Lyme, i.e. – MUS. He also states the parents weren’t happy with his findings….gee, I wonder why?
  3. Again, regarding only 20% of patients being in the PTLDS group: https://madisonarealymesupportgroup.com/2019/02/25/medical-stalemate-what-causes-continuing-symptoms-after-lyme-treatment/, microbiologist Holly Ahern states that number is incorrect and only includes those patients diagnosed and treated early. When you add the 10-20% in this category with the 30-40% NOT diagnosed and treated, you get a whopping potential 60% of ALL patients who go on to develop chronic/persistent symptoms.  This is HUGE and downplayed. Little to no research exists on this patient group and yet they are in the majority.
  4. If you want to take a peek at the number of people DYING from Lyme: http://whatislyme.com/rip-lyme-friends-memorial/  Collected by Lyme patient and advocate Lisa Hilton, she’s also made a chart and listing of Lyme deaths: http://whatislyme.com/is-lyme-disease-fatal/, based upon 219 Lyme deaths.  
Is that still considered rare?

 

 

How Vector-Borne Diseases Impact Heart Health

https://www.galaxydx.com/bartonella-lyme-impact-heart-health/

How Vector-Borne Diseases Impact Heart Health

LET’S SUFFICE IT TO SAY, HEART ISSUES WITH TICK BORNE ILLNESS IS NOT RARE.

 

Lyme Carditis Presenting as Atrial Fibrillation

https://casereports.bmj.com/content/12/4/e228975

Lyme carditis presenting as atrial fibrillation

Zainal A, Hanafi A, Nadkarni N, et al.
Online issue publication 
April 29, 2019

Abstract

The incidence of Lyme disease in the USA is 8 per 100 000 cases and 95% of those occur in the Northeastern region. Cardiac involvement occurs in only 1% of untreated patients. We describe the case of a 46-year-old man who presented with chest pressure, dyspnoea, palpitations and syncope. He presented initially with atrial fibrillation with rapid ventricular response, a rare manifestation of Lyme carditis. In another hospital presentation, he had varying degrees of atrioventricular block including Mobitz I second-degree heart block. After appropriate antibiotic treatment, he made a full recovery and his ECG normalised. The authors aim to urge physicians treating patients in endemic areas to consider Lyme carditis in the workup for patients with atrial fibrillation and unexplained heart block, as the associated atrioventricular nodal complications may be fatal.

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**Comment**

A better statistic would be that in 2017, the CDC estimated the number of NEW cases of Lyme disease to be approximately 430,000 – which is 6 times the prevalence of HIV/AIDS and nearly twice as prevalent as breast cancer.  The numbers have only increased since that time.

As to cardiac involvement only occurring in 1% of untreated patients & atrial fibrillation with rapid ventricular response being rare, I highly doubt it.  Testing misses over half of all cases with research ignoring chronically infected patients since inception and nobody’s keeping score because cases aren’t being diagnosed, treated, researched, and recorded.

Heart involvement with Lyme is not new:  https://madisonarealymesupportgroup.com/2019/03/10/when-lyme-hurts-your-heart-warning-signs-solutions/

https://madisonarealymesupportgroup.com/2018/09/17/lyme-carditis-heart-block-other-complications-of-ld/

https://madisonarealymesupportgroup.com/2019/02/13/mitral-valve-endocarditis-a-supposed-rare-manifestation-of-lyme-disease/

https://madisonarealymesupportgroup.com/2018/06/03/heart-problems-tick-borne-disease/

https://madisonarealymesupportgroup.com/2019/02/14/impact-of-pre-operative-antimicrobial-treatment-on-microbiological-findings-from-endocardial-specimens-in-infective-endocarditis/

https://madisonarealymesupportgroup.com/2017/06/07/early-onset-lyme-carditis-concurrent-disseminated-erythema-migrans/

https://madisonarealymesupportgroup.com/2019/02/21/diagnosis-treatment-of-lyme-carditis/

 

 

What Does Lyme Disease Do To Your Body?

 Approx. 5 Min.

What Does Lyme Disease Do To Your Body?

Published on Apr 23, 2019
What exactly is the connection between a tick bite and lyme disease? While we’re not sure exactly where and when the disease originated, we do know a lot about how it works, its signs, its symptoms in humans and dogs, how it’s spread and its treatment.
SICK is a new series that looks at how diseases actually work inside our body. We’ll be visiting medical centers and talking to top researchers and doctors to uncover the mysteries of viruses, bacteria, fungi and our own immune system. Come back every Tuesday for a new episode and let us know in the comments which diseases you think we should cover next.
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What this video didn’t touch upon is the very real probability that Lyme/MSIDS is spread by more than the sole perp of the deer tick:  https://madisonarealymesupportgroup.com/2019/04/02/transmission-of-lyme-disease-lida-mattman-phd/  From 2005, Dr. Lida Mattman isolated Lyme (borrelia) from:

mosquitoes, fleas, mites, semen, urine, blood, plasma and Cerebral Spinal Fluid. She discovered that this bacteria is dangerous because it can survive and spread without cell wall (L shape). Because L-forms do not possess cell wall, they are resistant to antibiotics that act upon the cell wall.

Others have found other various ways Bb is transmitted as well:

Nobody seems to want to talk about this, yet it’s important.

 

 

 

 

Case of Endocarditis Caused By Bartonella After Mitral Valve Repair

https://www.ncbi.nlm.nih.gov/pubmed/30981216

2019 Apr 13. doi: 10.1111/jocs.14047. [Epub ahead of print]

Bartonella haenselae infective endocarditis following transcatheter edge-to-edge mitral valve repair: A case report.

Abstract

Infective endocarditis following a Mitraclip procedure might be an under-recognized complication. We describe the case of infective endocarditis by Bartonella henselae as a late complication in a patient with a previously implanted MitraClip system for mitral valve repair. Due to the severity of infection, surgical treatment was performed despite the high preoperative surgical risk, but recurrence of endocarditis of the biological valve implanted occurred. Although infection with Bartonella is known as a possible source of endocarditis, it has never been described before in relation to failed MitraClip therapy.

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**Comment**

A great article came out recently about Bartonella being an under appreciated public health problem:  https://madisonarealymesupportgroup.com/2019/04/24/human-bartonellosis-an-underappreciated-public-health-problem/

And, frankly, that’s an understatement!

Heart issues with Bartonella abound:  https://madisonarealymesupportgroup.com/2017/05/11/bartonella-henselae-in-children-with-congenital-heart-disease/

https://madisonarealymesupportgroup.com/2017/01/04/endocarditis-consider-bartonella/

https://madisonarealymesupportgroup.com/2018/09/28/bartonella-infective-endocarditis-with-dissemination-a-case-report-literature-review/

https://madisonarealymesupportgroup.com/2018/09/07/bartonella-infectious-endocarditis-associated-with-cryoglobulinemia-multifocal-proliferative-glomerulonephritis/

https://madisonarealymesupportgroup.com/2018/07/10/infective-endocarditis-associated-with-bartonella-henselae-a-case-series/

But many other issues abound as well:  https://madisonarealymesupportgroup.com/2019/04/09/abstract-bartonella-in-boy-with-pans/

https://madisonarealymesupportgroup.com/2019/03/21/bartonella-sudden-onset-adolescent-schizophrenia-a-case-study/

https://madisonarealymesupportgroup.com/2019/04/08/case-series-bartonella-ocular-manifestations/

https://madisonarealymesupportgroup.com/2019/03/02/skin-inflammation-nodules-letting-the-cat-out-of-the-bag/

 

Tick Talk: A Conversation About Lyme – Dr. Neil Spector

Tick Talk: A Conversation About Lyme

Published on Apr 14, 2019

PA still holds the crown for highest number of CDC reported cases of Lyme Disease making our state home to thousands of sick people. @drneilspector, Duke University Oncologist, chats with @Chick2Chick about his own Lyme story and how cancer research is providing hope for Lyme diagnostics and therapies! You can also listen to this as a podcast at your convenience through your favorite online podcast directory – iTunes, Stitcher, Spotify, TuneIn, Podbean or Google Play.
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For more:
Dr. Spector suffered from misdiagnosed Lyme disease for many years, and during that time, his heart was affected. He was near death and only a heart transplant could save his life. He chronicled the experience in his riveting memoir, Gone in A Heartbeat: A Physician’s Search for True Healing.  Since then, Dr. Spector has become a unique advocate for Lyme patients. He thoroughly understands the patient’s viewpoint, including what it’s like to know that something is seriously wrong with your body and yet have doctors dismiss your symptoms.

 

 

 

Human Bartonellosis: An Underappreciated Public Health Problem?

https://www.mdpi.com/2414-6366/4/2/69

Trop. Med. Infect. Dis. 2019, 4(2), 69; https://doi.org/10.3390/tropicalmed4020069

Human Bartonellosis: An Underappreciated Public Health Problem?

Published: 19 April 2019
(This article belongs to the Special Issue Recent Advancements on Arthropod-Borne Infectious Diseases)

Abstract

Bartonella spp. bacteria can be found around the globe and are the causative agents of multiple human diseases. The most well-known infection is called cat-scratch disease, which causes mild lymphadenopathy and fever. As our knowledge of these bacteria grows, new presentations of the disease have been recognized, with serious manifestations. Not only has more severe disease been associated with these bacteria but also Bartonella species have been discovered in a wide range of mammals, and the pathogens’ DNA can be found in multiple vectors. This review will focus on some common mammalian reservoirs as well as the suspected vectors in relation to the disease transmission and prevalence. Understanding the complex interactions between these bacteria, their vectors, and their reservoirs, as well as the breadth of infection by Bartonella around the world will help to assess the impact of Bartonellosis on public health. View Full-Text

tropicalmed-04-00069-g001
Figure 1  The Clinical Manifestations of Bartonellosis
Excerpt from full-text
Known diseases caused by Bartonella infections include:
  • Carrion’s disease
  • cat-scratch disease
  • chronic lymphadenopathy
  • trench fever
  • chronic bacteraemia
  • culture-negative endocarditis
  • bacilliary angiomatosis
  • bacilliary peliosis
  • vasculitis
  • uveitis [1,2,4,6,7,9,10,11].
Recently, Bartonella infections have been linked to more diverse manifestations such as:
  • hallucinations
  • weight loss
  • muscle fatigue
  • partial paralysis
  • pediatric acute-onset neuropsychiatric syndrome (PANS)
  • other neurological manifestations [6,8,10].

A few case studies have also documented Bartonella in tumors, particularly vasoproliferative and those of mammary tissue [12,13,14]. The potential involvement of this pathogen in breast tumorigenesis is both disconcerting and warrants significantly more research.

Bartonella spp. are zoonotic pathogens transmitted from mammals to humans through a variety of insect vectors including the sand fly, cat fleas, and human body louse [4,5]. New evidence suggests that ticks, red ants, and spiders can also transmit Bartonella [15,16,17,18]. Bed bugs have been implicated in the transmission cycle of B. quintana and have been artificially infected [19]. B. quintana was found in bed bug feces for up to 18 days postinfection [19]. The diversity of newly discovered Bartonella species, the large number and ecologically diverse animal reservoir hosts, and the large spectrum of arthropod vectors that can transmit these bacteria among animals and humans are major causes for public health concern.

Regarding ticks….

3.2. Arachnids (Spiders and Ticks)

Over the last 10 years, the topic of ticks transmitting Bartonella species has been widely debated. Evidence exists to support the transmission of Bartonella through many different species of ticks.

Ixodid ticks, also known as hard ticks, appear to be the main type of tick associated with these bacteria. Tick cell lines have been used to show that Bartonella can replicate and survive within:

  • Amblyoma americanum (Lone Star Tick)
  • Rhipicephalus sanguineus (Brown Dog Tick)
  • Ixodes scapularis cells [77] (Deer Tick)

In California, questing ticks of

  • Ixodes pacificus (Western Black legged Tick)
  • Dermacentor occidentalis (Pacific Coast Tick)
  • Dermacentor variabilis (American Dog Tick)

were collected when in the adult and nymphal stages and tested for Bartonella by PCR for the citrate synthase gene. [78]. All types of ticks were found to contain Bartonella DNA, although in varying percentages and locations. These data alone do not prove that ticks can transmit Bartonella spp. Bacteria; however, the results do show Bartonella DNA occurring naturally in these wild ticks.

In Palestine,

  • Hyalomma spp. (Genus of hard-bodied tick) found in Asia, Europe, & North and South Africa.
  • Haemphysalis spp. (The Asian Long-horned tick is an example)
  • Rhipicephalusspp. (Hard-bodied tick native to tropical Africa)

ticks were collected from domestic animals and tested by PCR for the Bartonella intergenic transcribed spacer (ITS) region [38]. These ticks were infected with 4 strains of Bartonella: B. rochalimae, B. chomelii, B. bovis, and B. koehlerae [38]. While this study tested a collection of ticks found on domestic animals, the results suggest that individuals in close contact with these animals should be aware of the potential for transmission through tick bites.

In a sampling of ticks (Ixodes scapularis and Dermacentor variabilis) and rodents (Peromyscus leucopus) from southern Indiana, the midgut contents of the tick species and rodent blood were analyzed by 16S sequencing. Bartonella was present in a moderate percentage (26% in D. variabilis and 13.3% in I. scapularis) of larvae and nymphs of both tick species, even those scored as unengorged, but was present in the majority (97.8%) of the rodents tested [79].
A survey of ticks from 16 states in the U.S. revealed that the overall prevalence of Bartonella henselae in Ixodes ticks was 2.5% [80].
Interestingly, the highest rate of both Borrelia spp. (63.2%) and B. henselae (10.3%) was found in Ixodes affinis ticks collected from North Carolina.
Ixodes ricinus has been the focus of studies that support tick transmission of Bartonella spp. in Europe. This is because I. ricinus is an important vector for tick-borne diseases in Europe [81]. I. ricinus have been collected in the larval, nymphal, and adult stages in Austria [82]. The analyses revealed that 2.1% of all ticks were infected with Bartonella spp., with the highest rate in ticks derived from Vienna (with a 7.5% infection rate), and that adult ticks had a higher prevalence than other stages [82].
B. henselae, B. doshiae, and B. grahamii DNA were amplified, and this was the first study to find Bartonella-infected ticks in Austria [82].
A recent One Health perspective review on Bartonella indicated that the overall presence of Bartonella in ticks (combining evidence from multiple surveillance studies) was approx. 15% [83].
B. henselae DNA has also been isolated from I. ricinus removed from an infected cat. However, whether the cat gave the tick Bartonella or vice versa cannot be established, so the vector competence of these ticks for transmission cannot be determined [30].
A lab in France has studied the relationship between I. ricinus and Bartonella transmission. One study focused on the ability of ticks to maintain infection from one life stage to the next and tested a vertical transmission from adults to eggs. The authors used B. henselae and found that a transstadial transmission was possible and that a transovarial transmission was not likely [84]. The researchers also supplied evidence to support the vector competency of I. ricinus by amplifying B. henselae DNA from the salivary glands of infected ticks and by amplifying DNA from blood 72 h after infected ticks fed through an artificial system [84]. Although the evidence strongly suggests the ability of ticks to transmit these bacteria, the system employed artificial means for feeding; therefore, one major critique has been that it is not representative of a natural blood meal from a host.
To address this issue, another experiment was performed to the assess vector competency of I. ricinus to transmit Bartonella birtlesii [85]. Mice were infected with B. birtlesii through an intravenous injection via a tail vein, and once mice were infected, naïve ticks were fed on the mice and kept for 3 months to molt. Nymphal ticks were shown to transmit B. birtlesii to naïve mice, and adult ticks were shown to infect blood through a feeder method [85]. B. birtlesii was identified in the blood of the recipient mice through PCR and immunofluorescence [85]. This evidence strongly supports the transmission of these bacteria by ticks. However, the limitation is that this only supports I. ricinus’ ability to transmit a very specific strain of Bartonella, B. birtlesii, which is not linked to human disease.
Concerns such as these related to vector competence and transmission can only be quelled by repeated studies utilizing multiple strains of Bartonella and differing tick species.
An interesting case study provided evidence of spiders transmitting Bartonella. A mother and two sons suffered from neurological symptoms following bites suspected from woodlouse hunter spiders [18]. Bartonella henselae DNA was amplified from the blood of the family as well as from a woodlouse and a woodlouse hunter spider near the family’s home [18]. It cannot be determined if the family contracted the bacteria from the woodlouse or the woodlouse hunter spider or if the lice and spiders contracted the bacteria from the family. This case study points to the importance for diagnosticians to test for bacterial infections after suspected arachnid bites. It also emphasizes the lack of knowledge on the possible vectors that transmit Bartonella as well as the range of manifestations by infection with Bartonella.

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**Comment**

I think we can safely state that Bartonella IS an under appreciated health problem.