Published on Feb 14, 2018
Suncoast News Network – Living with Lyme – A 4-year search for 1 diagnosis
Published on Feb 15, 2018
SNN: Living with Lyme – What is Lyme?
Published on Feb 14, 2018
Suncoast News Network – Living with Lyme – A 4-year search for 1 diagnosis
Published on Feb 15, 2018
SNN: Living with Lyme – What is Lyme?
INFECTIOUS DISEASE Feb. 16 2018
PROMISING TO REVOLUTIONIZE DIAGNOSIS, A SINGLE BLOOD TEST CAN NOW ACCURATELY DETECT IF SOMEONE HAS LYME DISEASE AND/OR ONE OF SEVEN OTHER TICK-BORNE DISEASES
A new blood test called the Tick-Borne Disease Serochip (TBD Serochip) promises to revolutionize the diagnosis of tick-borne disease by offering a single test to identify and distinguish between Borrelia burgdorferi, the pathogen responsible for Lyme disease, and seven other tick-borne pathogens. Led by scientists at the Center for Infection and Immunity (CII) at Columbia University’s Mailman School of Public Health, the research team reports details on the new test in the journal Nature Scientific Reports.
The researchers—who also include scientists from the Centers for Disease Control and Prevention, National Institute of Allergy and Infectious Diseases, Roche Sequencing Solutions, Farmingdale State College, and Stony Brook University—sought to improve on existing tests for tick-borne diseases (TBDs), which have limited diagnostic accuracy and cannot test for more than one infection simultaneously. Currently, diagnosis of Lyme disease, the most common TBD, requires two separate tests. This cumbersome approach also relies on subjective criteria for the interpretation of results, and accurately identifies fewer than 40 percent of patients with early disease and results in false positives 28 percent of the time. The accuracy of the method used to diagnose TBDs Babesia, Anaplasma, Ehrlichia, and Rickettsia varies widely among testing laboratories. And for other tick-borne agents, specific blood tests are not yet available, or in the case of the potentially deadly Powassan virus or Heartland virus, are only performed in specialized laboratories.
“The number of Americans diagnosed with tick-borne disease is steadily increasing as tick populations have expanded geographically,” says Rafal Tokarz, PhD. “Each year, approximately 3 million clinical specimens are tested for TBDs in the U.S. Nonetheless, the true incidence of TBDs is likely greatly underestimated, as patients with presumed TBDs are rarely tested for the full range of tick-borne agents, and only a fraction of positive cases are properly reported,” adds Nischay Mishra, PhD. Co-lead authors Tokarz and Mishra are associate research scientists in the Center for Infection and Immunity.
The TBD Serochip can simultaneously test for the presence of antibodies in blood to more than 170,000 individual protein fragments. Version 1.0 can identify exposure to eight tick-borne pathogens present in the U.S., including Anaplasma phagocytophilum (agent of human granulocytic anaplasmosis), Babesia microti (babesiosis), Borrelia burgdorferi (Lyme disease), Borrelia miyamotoi, Ehrlichia chaffeensis (human monocytic ehrlichiosis), Rickettsia rickettsii (Rocky Mountain spotted fever), Heartland virus and Powassan virus. The researchers also included Long Island tick rhabdovirus, a novel virus they recently discovered in Amblyomma americanum ticks. As new tick-borne infectious agents are discovered, the TBD-Serochip will be modified to target them—a process the researchers say can be done in less than four weeks.
The TBD Serochip is also able to identify whether an individual is infected with more than one tick-borne pathogen. Individual ticks are frequently infected with more than one agent; Ixodes scapularis ticks alone can transmit at least five human pathogens. Evidence of exposure to other tick-borne pathogens in patients with Lyme disease has been well documented. In the new paper, the researchers report finding antibodies to another agent in 26 percent of blood specimens from patients with TBD.
In addition to its utility as a diagnostic platform, the TBD Serochip also provides a powerful research tool for studies of TBDs. The technology can be employed to discriminate individual antibody responses in patients with TBD and thus examine the interplay of TBD agents on disease manifestation and progression. It can also be used to assess the impact of genetic diversity of tick-borne pathogens on the host immune response.
“Diagnosing tick-borne illness is a difficult journey for patients, delaying effecting treatment,” says senior author W. Ian Lipkin, MD, director of CII and John Snow Professor of Epidemiology at Columbia University’s Mailman School of Public Health. “The TBD Serochip promises to make diagnosis far easier, offering a single, accurate test for eight different TBDs. Early detection of infection enables rapid and appropriate treatment.”
Co-authors include Thomas Briese, Teresa Tagliafierro, Stephen Sameroff, Adrian Caciula, Lokendrasingh Chauhan, of CII; Jigar Patel and Eric Sullivan of Roche Sequencing Solutions, Madison, WI; Azad Gucwa of Farmingdale State College, Farmingdale, NY; Brian Fallon of Columbia University; Marc Golightly of Stony Brook University; Claudia Molins and Martin Schriefer of Centers for Disease Control and Prevention; and Adriana Marques of National Institute of Allergy and Infectious Diseases.
This study was funded through grants from the Steven & Alexandra Cohen Foundation and the National Institutes of Allergy and Infectious Diseases (AI109761). The content of study does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. government. CII has filed an invention report and provisional patent application for the technology.
The following article explains that Borrelia Miyamotoi is not new to California. First considered nonpathogenic, it wasn’t even reported until 2011 in Russia. http://www.nejm.org/doi/full/10.1056/NEJMc1215469 Diagnosis relies on PCR testing during acute infection and two-tiered testing for Lyme will not pick it up. It is not a reportable illness so prevalence is pure conjecture. Dr. Horowitz states clinicians should be vigilant for clinical pictures that look like viral infections such as high fever, headache, and muscle and joint pain. In publications, only 16% of patients presenting with BMD were seropositive for IgG and/or IgM antibody to B. miyamotoi rGlpQ, so PCR should also be considered in patients with a history of tick bites and appropriate clinical manifestations.
This is also an important reminder that new strains and species are being discovered continually, so nothing about Tick Borne Illness should be set in stone and open minds are a must.
Like forensic detectives, using a bank of frozen blood serum from the 1980s, tick researchers from both the west and east coasts set out to determine how prevalent Borrelia miyamotoi infection is in California. What they discovered should set off more than a few alarms.
B. miyamotoi is a spiral-shaped bacterium in the same genus as Borrelia burgdorferi, the agent of Lyme disease. But it is most closely related to the group of relapsing fever Borrelia spirochetes. It has recently been recognized as causing a form of borreliosis that is similar to Lyme disease—Borrelia miyamotoi disease (BMD).
B. miyamotoi is transmitted by the same hard-bodied ticks that carry Lyme disease—the blacklegged or deer tick (Ixodes scapularis) and the western blacklegged tick (Ixodes pacificus).
The symptoms of BMD are similar to Lyme disease but generally more severe, with the addition of a relapsing fever, and the absence of a typical bull’s-eye rash. Because BMD is not a reportable disease in the US, there is very little information about its symptoms or prevalence.
For this study, the researchers were given access to a biobank of 101 blood samples collected from a rural community in Mendocino County, California, after an outbreak of Lyme disease in the late 1980s. The area has since been the focus of many tick studies and is known for high prevalence of ticks that carry both BMD and Lyme disease.
Three quarters of the people in the study reported frequent tick bites in the one to two years prior to the blood draw. Later, a confirmatory blood test showed that 79% had antibodies to tick saliva—a rate nearly three times that of residents of Block Island, Rhode Island (29%), where Lyme disease is highly endemic.
For the BMD screening, researchers used two different methods to look for evidence of prior exposure to B. miyamotoi—a two-step glycerophosphodiester phosphodiesterase enzyme-linked immunosorbent (rGlpQ) assay and a whole-cell lysate (WCL) assay.
Twenty-six of the 101 samples were reactive for BMD. [Note: the B. miyamotoi GlpQ assay is not affected by Lyme disease infection because B. burgdorferi does not produce GlpQ antigen.]
The samples were also tested for Borrelia hermsii and Borrelia burgdorferi, to examine the possibility of cross-reactivity and/or dual infection.
The researchers feel there is probable cause of BMD infection for several reasons:
Studies showing 0.5% to 15% of Ixodes pacificus ticks carry B. miyamotoi infection in Northern California, B. miyamotoi is passed from parent to offspring (transovarial transmission), increasing risk of infection from nymphal ticks, and mild climates allow for nearly year-round activity of ticks in California.
“No human cases of B. miyamotoi previously have been reported from the western United States even though I. pacificus ticks in northern California have a spirochete-infection prevalence similar to or exceeding that of I. scapularis ticks in the Northeast and upper Midwest,” according to the authors.
The authors go on to warn, “Healthcare professionals in the far-western United States should be aware that B. miyamotoi disease may occur throughout the geographic distribution of I. pacificus and that improved relapsing fever group spirochete antibody assays are urgently needed.”
In summary, while B. miyamotoi is considered an “emerging” infectious disease, it is not new to California. The fact that there are no previously reported cases is because 1) until recently there have been no commercially available tests and 2) since BMD is not a reportable disease, nobody collects such information.
This study highlights the pressing need to develop better diagnostic tests capable of detecting all tick-borne diseases–and to collect the results of those tests in a way that’s accessible to the public.
Interestingly, the CDC states that PCR and antibody-based testing for Bm are under development and not widely available but can be ordered from a few CLIA-approved labs.
Now that’s sweet isn’t it? Up until now the CDC has vilified all CLIA approved labs – especially for Lyme testing.
Dr. Cameron points out the hypocrisy marvelously here: http://danielcameronmd.com/fda-test-borrelia-miyamotoi/ Researchers have had to diagnose B. miyamotoi based on blood smear, direct detection of spirochetes in cerebrospinal fluid and follow-up polymerase chain reaction (PCR) and molecular detection of B. miyamotoi DNA in acute whole blood from patients. These are all non FDA-approved tests. So, where would these patients be if the FDA insisted on only its tests being utilized?
You gotta love fate.
February 14, 2018, 8:00AM. By Gordon Gibb
The plaintiff suffering from Lyme disease pursued benefits from her LTD insurance provider. Unum even approved short-term, and long-term benefits, before doing an about-face and denying her benefits.
San Diego, CA – A medical professional who could no longer fulfill the functions of her occupation due to a diagnosis of Lyme disease, had her long term disability benefits claim denied by her LTD provider. Plaintiff Laura Wakil holds that Unum unfairly denied her LTD benefits that were rightfully hers according to the terms of her policy, and she is taking the insurer to court after filing an Unum lawsuit in an attempt to achieve benefits resulting from her disability.
Wakil had been practicing as a Board Certified Psychiatrist when she began experiencing debilitating pain, together with other symptoms that combined to make it increasingly difficult to carry out her professional duties. According to her Unum insurance lawsuit, Wakil was ultimately diagnosed with Lyme disease in March, 2016.
Under the terms of her Unum LTD policy, a diagnosis of Lyme disease translated to a total disability under the terms of her Unum long term disability policy, or so Wakil’s Unum disability insurance lawsuit claims.
According to Court documents, Wakil submitted her disability claim with Unum together with a statement of support and corroboration of her diagnosis, and her struggles with Lyme disease, provided by her physician. The plaintiff, according to her Unum disability insurance lawsuit, was approved for short term disability benefits for Lyme disease in July of that year and a month later, was also approved for long term disability benefits.
But then, the bottom fell out. Her benefits were later denied by Unum. An appeal of her denial was also lost.
In the meantime, Wakil continued suffering from pain and other symptoms associated with Lyme disease, and was continuing to struggle without the capacity to earn income by way of her profession.
Wakil filed her Unum disability insurance lawsuit against Unum Life Insurance Company of America and others in December of last year, having exhausted all other administrative means at her disposal to do so outside of litigation.
Wakil asserts that Unum’s denial of her legitimate claims for benefits, was unfair and improper.
The case is Wakil v. Unum Life Insurance Company of America et al, Case No. 3:2017-cv-02564, filed December 26, 2017, in the US District Court for the Southern District of California, County of San Diego.
Show Description: Killer Green follows the lives of two pivotal couples in different stages of life as the two lead female character battle a widely ignored chronic illness. Based on biographical accounts, this musical attempts to uncover the dark truth behind how Lyme Disease affects its victims, educate viewers on the reality of these stories, and expose the widespread ignorance of the medical community.
This show was graciously funded by The Wisconsin Lyme Network, a nonprofit organization dedicated to raising awareness for this cause. https://wisconsinlymenetwork.org/
Warning: Killer Green depicts suicide, depression, and topics that viewers might find disturbing but Lyme patients struggle with daily.
Buchholz MJ, Davis C, Rowland NS, Dick CW.
Parasitology Research, online first 2018 Feb 7.
The incidence of tick-borne zoonoses such as Lyme disease has steadily increased in the southeastern United States. Southeastern states accounted for 1500 of over 28,000 confirmed cases of Lyme disease reported in the United States during 2015. Borrelia burgdorferi, the etiologic agent of Lyme disease, is maintained in small mammal reservoirs and vectored to new hosts by ixodid ticks.
This study examined ecological relationships of the B. burgdorferi/vector/reservoir system in order to understand the dynamics of Lyme disease risk in Kentucky. Small mammals were captured using live traps from November 2014 to October 2015. Ticks were removed and blood and tissue collected from small mammals were screened for B. burgdorferi DNA by PCR with primers specific to the OspA gene.
Prevalence of B. burgdorferi (21.8%) in Kentucky small mammals was comparable to the lowest recorded prevalence in regions where Lyme disease is endemic. Moreover, infestation of small mammals by Ixodes scapularis, the primary vector of B. burgdorferi, was rare, while Dermacentor variabilis comprised the majority of ticks collected.
These findings provide ecological insight into the relative paucity of Lyme disease in Kentucky.
The conclusion of this study is all wrong. Bb was found Kentucky mammals. That in itself is important. Also, the fact the preponderance of ticks were dermacentor variabilis (wood tick or American dog tick) which supposedly has not been proven to be a competent vector of Bb as supposedly it doesn’t efficiently pass Bb from inside the tick to humans or other hosts), it does transmit Tularemia and Rocky Mountain Spotted Fever.
BTW: these transmission studies given as references for this fact were done from 1997-2006. It’s now 2018. http://labs.russell.wisc.edu/wisconsin-ticks/wisconsin-ticks/dermacentor-variabilis/ Notice it states, “It doesn’t efficiently pass Bb.” What if it passes it inefficiently? It still passes!
Regardless of whether the wood tick can transmit Bb or not, they do transmit pathogens. The fact that nearly 22% of small Kentucky mammals have Bb due to the black legged deer tick and most of the ticks they picked up were wood ticks, those deer ticks were particularly infected.
Hear ye, hear ye, the South has Lyme.
https://madisonarealymesupportgroup.com/2016/09/24/arkansas-kids-denied-lyme-treatment/ According to Dr. Naveen Patil, Director of the Infectious Disease Program, ADH,
“We don’t have Lyme Disease in Arkansas, we have the ticks that transmit Lyme Disease but we don’t have any recorded cases of Lyme Disease.”
https://madisonarealymesupportgroup.com/2017/03/02/hold-the-press-arkansas-has-lyme/ A news report emphasizing the CDC’s belief Arkansas is a “low incident” state in regards to Lyme Disease, is countered by the Arkansas Lyme Foundation that claims at least 150 cases, and they just started counting. http://www.thv11.com/news/local/arkansas-lyme-foundation-claims-over-150-lyme-disease-cases-in-state/414489522 (Video here)
“People are dying and I’m not exaggerating, people are calling us every week in desperate situations,” said Sikes.
https://madisonarealymesupportgroup.com/2017/10/24/no-lyme-in-oklahoma-yeah-right/ Last summer, a friend who lives in Oklahoma found a classic bullseye rash on her seven-year-old daughter.
“That’s a spider bite,” a local pediatrician told her. “We don’t have Lyme in Oklahoma.”
The doctor was wrong. Had my friend taken his advice, her daughter would not have been diagnosed in a timely fashion and she would likely have developed symptoms over the next few months or years. She probably would have become severely debilitated, and the infections might have crossed the blood-brain barrier and become chronic.
Get the picture yet? Lyme/MSIDS is everywhere.
Quit saying it’s rare!
Krause PJ, Carroll M, Fedorova N, Brancato J, Dumouchel C, Akosa F, Narasimhan S, Fikrig E, Lane RS.
PLoS One. 2018 Feb 8;13(2):e0191725. eCollection 2018.
To determine whether human Borrelia miyamotoi infection occurs in the far-western United States, we tested archived sera from northwestern California residents for antibodies to this emerging relapsing fever spirochete. These residents frequently were exposed to I. pacificus ticks in a region where B. miyamotoi tick infection has been reported.
We used a two-step B. miyamotoi rGlpQ assay and a B. miyamotoi whole-cell lysate (WCL) assay to detect B. miyamotoi antibody. We also employed Borrelia hermsii and Borrelia burgdorferi WCL assays to examine if these Borrelia induce cross reacting antibody to B. miyamotoi. Sera were collected from 101 residents in each of two consecutive years.
The sera of 12 and 14 residents in years one and two, respectively, were B. miyamotoirGlpQ seroreactive. Sufficient sera were available to test 15 of the 26 seropositive samples using B. miyamotoi and B. hermsii WCL assays. Two residents in year one and seven residents in year two were seroreactive to both Borrelia antigens.
Although discernible differences in seroreactivity were evident between the B. miyamotoi and B. hermsii WCL assays, infection with one or the other could not be determined with certainty. Sera from two Borrelia burgdorferi /B. miyamotoi seropositive subjects reacted strongly against B. miyamotoi and B. hermsii WCL antigens. Ecological, epidemiological, and clinical data implicated B. miyamotoi as the probable cause of infection among those whose sera reacted against both antigens.
Our findings suggest that human B. miyamotoi infection occurs in northern California and that B. hermsii and B. burgdorferi infections produce antibodies that cross-react with B. miyamotoi antigens. Health care professionals in the far-western United States should be aware that B. miyamotoi disease may occur throughout the geographic distribution of I.pacificus and that improved relapsing fever group spirochete antibody assays are urgently needed.
This study points out one the biggest reasons we are in this quagmire: poor testing and cross reactivity of antigens. Remember, testing for miyamotoi is new so folks could have been infected with this pathogen for a long time and it flew under the radar. They got tested for borrelia burgdorferi (Lyme) with a test that misses over half of all cases, and are sent home and told, “Go home and be well.”
There very probably are other strains and pathogens we don’t have testing for yet.
It also demonstrates Tick borne illness is everywhere, despite Speilman’s maps: https://madisonarealymesupportgroup.com/2018/01/19/how-ticks-find-you/ (Scroll down to comment section after article)