Archive for the ‘Lyme’ Category

Management of Tick Bites & Lyme Disease During Pregnancy

https://pubmed.ncbi.nlm.nih.gov/32414479/

Practice Guideline
J Obstet Gynaecol Can

. 2020 May;42(5):644-653.

doi: 10.1016/j.jogc.2020.01.001.

Committee Opinion No. 399: Management of Tick Bites and Lyme Disease During Pregnancy

Graeme N Smith 1, Kieran M Moore 1, Todd F Hatchette 2, Jennifer Nicholson 3, William Bowie 4, Joanne M Langley 2

Abstract

Objective: Lyme disease is an emerging infection in Canada caused by the bacterium belonging to the Borrelia burgdorferi sensu lato species complex, which is transmitted via the bite of an infected blacklegged tick. Populations of blacklegged ticks continue to expand and are now established in different regions in Canada. It usually takes more than 24 hours of tick attachment to transfer B. burgdorferi to a human. The diagnosis of early localized Lyme disease is made by clinical assessment, as laboratory tests are not reliable at this stage. Most patients with early localized Lyme disease will present with a skin lesion (i.e., erythema migrans) expanding from the tick bite site and/or non-specific “influenza-like” symptoms (e.g., arthralgia, myalgia, and fever). Signs and symptoms may occur from between 3 and 30 days following the tick bite. The care of pregnant patients with a tick bite or suspected Lyme disease should be managed similarly to non-pregnant adults, including the consideration of antibiotics for prophylaxis and treatment. The primary objective of this committee opinion is to inform practitioners about Lyme disease and provide an approach to managing the care of pregnant women who may have been infected via a blacklegged tick bite.

_____________________

**Comment**

Payment is required to see the full article.

A few points:

  • I’m glad they acknowledge that ticks are expanding everywhere – and that goes for ALL ticks.
  • In my opinion, as these ticks expand, biting animals/people outside of their typical range, more transmission studies need to be done to determine if they are also picking up new pathogens not common to them previously.  This would help explain the expansion of pathogens as well as ticks. Unfortunately, researchers are content with 35+ year old studies with an inch of dust on them.
  • It DOES NOT take 24 hours to become infected and a minimum time has never been established:  https://madisonarealymesupportgroup.com/2017/04/14/transmission-time-for-lymemsids-infection/
  • I’m glad they acknowledge that Lyme/MSIDS is a clinical assessment.  Unfortunately, due to top down education from the CDC/IDSA, doctors are woefully unprepared to make this assessment.  There needs to be an overhaul on this aspect of medical training and they should listen to Lyme literate doctors with decades of experience rather than vilify them:  https://madisonarealymesupportgroup.com/2020/11/25/what-makes-a-doctor-lyme-literate/
  • Most patients will NOT present with a skin lesion:  https://madisonarealymesupportgroup.com/2019/02/22/why-mainstream-lyme-msids-research-remains-in-the-dark-ages/
  • I’m extremely grateful they recommend considering prophylactic treatment.  Unfortunately, again due to top down education from the CDC/IDSA, doctors are scared to death to use antibiotics for this, further revealing the need for education on the severe nature of this disease(s) and the potential for congenital transmission affecting the life of the newborn forever. This detail makes it clear any risk is worth the benefit, but only if you are knowledgable about the severity of the disease(s).
  • No mention of coinfections is given, and this is another important issue mainstream medicine is clueless about. Patients that are coinfected are sicker for longer and require far more than the typical mono treatment.

For more:  

Category:

Lyme, Pregnancy, research, Treatment

Diagnosing and Treating Lyme: Podcast

https://canlyme.com/2020/09/02/new-podcast-dr-ralph-hawkins-shares-his-medical-expertise-and-hands-on-experience-diagnosing-and-treating-lyme-disease/

New Podcast: Dr. Ralph Hawkins shares his medical expertise and hands on experience diagnosing and treating Lyme disease

https://www.lookingatlyme.ca/2020/09/dr-ralph-hawkins-explains-the-challenges-of-detecting-lyme-disease-through-testing/  Podcast here

September 1st, 2020

In this episode of Looking at Lyme, Sarah speaks with Internal Medicine Specialist and Canadian Lyme expert, Dr. Ralph Hawkins. Dr. Hawkins has been treating Lyme patients in Canada for many years, gaining a wealth of knowledge about the disease. He recounts his introduction to the shortcomings of Lyme disease testing in Canada while treating a patient with a history of multiple previous tick bites, many common symptoms of Lyme disease, but a negative Canadian Lyme test. Dr. Hawkins had the patient’s blood tested at a University Lab in New York, revealing test band patterns consistent with Lyme disease. He referred this patient to Infectious Diseases colleagues for treatment, but quickly found out that the diagnosis of late stage Lyme disease is not generally recognized by the Infectious Diseases community. He was advised to not only drop this case, but to avoid other similar cases. The recommendation to avoid such patients sparked Dr. Hawkins’ curiosity and interest, inspiring him to dive deeply into the research and history of Lyme disease.

Dr. Hawkins walks us through the current testing protocols for Lyme disease in Canada, explaining why some patients with Lyme disease receive a negative test result. He explains the difference between current testing in Canada and tests done in other parts of the world, highlighting a test done in Germany that he often relies on when diagnosing patients, and touching on the approval process for such tests by Health Canada. Without better testing, Canadians with Lyme disease continue to fall through the cracks of the healthcare system. Dr. Hawkins refers to a recent analysis of Lyme diagnosis in Canada in which researchers speculate that in some areas, two thirds of Lyme cases go unreported. With this in mind he points out that, in light of the severity of untreated Lyme disease, a trial period of treatment for Lyme disease would be valid for certain patients with negative Canadian serology. Thank you Dr. Hawkins for walking with us down the bumpy road of Lyme disease testing and treatment in Canada!

Resources and notes

For more:  

Category:

Activism, Lyme, Ticks, Treatment

Could Borrelia Miyamotoi Infections Explain Persistent Lyme Symptoms?

https://danielcameronmd.com/borrelia-miyamotoi-persistent-symptoms-lyme-disease/

COULD BORRELIA MIYAMOTOI INFECTIONS EXPLAIN PERSISTENT SYMPTOMS IN LYME DISEASE PATIENTS?

borrelia miyamotoi and lyme disease

 

“This is the first study to investigate the presence of B. miyamotoi antibodies in a clinical population experiencing persistent symptoms and suspected tick-borne illness,” writes Delaney and colleagues from Columbia University Irving Medical Center. [1] According to the findings, Lyme disease patients testing positive for Borrelia miyamotoi were more likely to present with sleepiness and pain.

By

Borrelia miyamotoi (BM) is another tick-borne pathogen and “unlike Lyme disease, erythema migrans rash, and arthralgias are uncommon,” the authors write in the journal Frontiers in Medicine. The infection is diagnosed with polymerase chain reaction (PCR) called glycerophosphodiester phosphodiesterase (GlpQ) enzyme immunoassay.

Investigators looked at the incidence of BM in 82 patients who were seeking a second opinion regarding persistent symptoms which included fatigue, pain, neurocognitive, and psychiatric problems.

In their study, 1 out of 4 Lyme disease patients tested positive for Borrelia miyamotoi,using a GlpQ test. The BM positive group were significantly more likely to suffer from sleepiness (according to the Epworth Sleepiness Scale) and from pain, as measured by the McGill VAS Pain Scale, and Zung Anxiety Scale.

Eight patients with Lyme disease and Borrelia miyamotoi were hospitalized.  “Eight of 21 (38%) reported hospitalization (seven medical and one psychiatric) since symptom onset, three for cardiac and two for neurologic abnormalities,” according to the authors.

All of the patients, except for one, with Lyme disease (LD) and Borrelia miyamotoi were treated with antibiotics.  “All 21 received prior antibiotic treatment, of whom 20 received at least 2 weeks of doxycycline or amoxicillin.”

Five of the 21 patients with LD and BM lived outside of the with Northeast/Mid-Atlantic states. “Two lived in California, two lived in Florida, and one lived in Illinois.”

Study insights

The study found that clinicians are not testing for Borrelia miyamotoi, as only 1 out of the 82 study participants were tested for the infection.

Furthermore, clinicians were often dismissive of a tick-borne illness.  “Many patients reported that their clinicians dismissed the possibility of tick-borne illness both at the onset and during the course of their illness and attributed symptoms to psychological stress,” writes Delaney.

The authors raise a public health concern:

“In Lyme disease, delayed diagnosis and treatment is associated with prolonged symptoms. The same may prove true for B. miyamotoi disease.”

Editor’s note: A co-infection with Borrelia miyamotoi may explain why some Lyme disease patients are sicker than others. Unfortunately, there are still problems with the reliability of  testing for Borrelia miyamotoi.  There is also uncertainty over the best treatment approach for the infection.

Related Articles:

The best antibiotics to treat Borrelia miyamotoi?

Doctors face challenges in diagnosing Borrelia miyamotoi

Don’t count on a relapsing fever to diagnose Borrelia miyamotoi

References:
  1. Delaney SL, Murray LA, Aasen CE, Bennett CE, Brown E, Fallon BA. Borrelia miyamotoi Serology in a Clinical Population With Persistent Symptoms and Suspected Tick-Borne Illness. Front Med (Lausanne). 2020;7:567350.
________________________
 
**Comment**
 
 
Many great points:
 
  • Could Bm explain some with persistent symptoms (highly likely)
  • Many of the patients here don’t live in what are considered Lyme-endemic areas, blowing further holes into the whole – “you have to live in the North or Eastern U.S. to be infected” paradigm.  Drop those maps like a bad habit!
  • These people had SEVERE symptoms.  Nearly 40% were hospitalized!
  • Clinicians need to WAKE UP AND SMELL THE COFFEE.  Lyme/ MSIDS patients quickly learn that those who are coinfected are sicker for longer.  Mainstream medicine is in the Stone-Ages on this fact.  There’s a real pandemic but it ain’t COVID.
  • This letter to the editor highlights the problem with coinfections & abysmal testing:  https://madisonarealymesupportgroup.com/2020/12/23/tick-bite-letter-to-the-editor/

Category:

Borrelia Miyamotoi (Relapsing Fever Group), Lyme

Tick Bite – Letter to the Editor

https://www.bmj.com/content/370/bmj.m3029/rr-3

Tick bite

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3029 (Published 13 August 2020)Cite this as: BMJ 2020;370:m3029

21 August 2020
Habib ur Rehman
Physician
Saskatchewan Health Authority
Suite 100, 2550 12th Ave, Regina, SK, S4P 3X1, Canada

Rapid Response:

Re: Tick bite

Dear Editor

Razai et al, in their consultation on tick bite, missed an important message to learners (1).

  • As the incidence of Lyme disease increases, there is also greater likelihood of co-transmission of other pathogens carried by I scapularis and I pacificus ticks.
  • Since symptoms of these co infections are non-specific and may overlap with Lyme’s disease, accurate diagnosis becomes more difficult. It is therefore important that a high level of suspicion is maintained for these co-infections so patients receive accurate diagnosis and adequate treatment.

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.

_______________________

**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/

Category:

Activism, Anaplasmosis, Babesia, Ehrlichiosis, Lyme, Testing, Ticks

Evaluation of Disulfiram Drug Combinations & Identification of Other More Effective Combinations against Stationary Phase Borrelia burgdorferi

https://www.mdpi.com/2079-6382/9/9/542

Evaluation of Disulfiram Drug Combinations and Identification of Other More Effective Combinations against Stationary Phase Borrelia burgdorferi

by Hector S. Alvarez-Manzo, Yumin Zhang, Wanliang Shi and Ying Zhang 

Antibiotics2020, 9(9), 542; https://doi.org/10.3390/antibiotics9090542 (registering DOI)Received: 7 August 2020 / Revised: 21 August 2020 / Accepted: 25 August 2020 / Published: 26 August 2020View Full-TextDownload PDFBrowse Figures

Abstract

Lyme disease, caused by Borrelia burgdorferi, is the most common vector-borne disease in USA, and 10–20% of patients will develop persistent symptoms despite treatment (“post-treatment Lyme disease syndrome”). B. burgdorferi persisters, which are not killed by the current antibiotics for Lyme disease, are considered one possible cause. Disulfiram has shown to be active against B. burgdorferi, but its activity against persistent forms is not well characterized. We assessed disulfiram as single drug and in combinations against stationary-phase B. burgdorferi culture enriched with persisters.

  • Disulfiram was not very effective in the drug exposure experiment (survival rate (SR) 46.3%) or in combinations.
  • Clarithromycin (SR 41.1%) and nitroxoline (SR 37.5%) were equally effective when compared to the current Lyme antibiotic cefuroxime (SR 36.8%) and more active than disulfiram.
  • Cefuroxime + clarithromycin (SR 25.9%) and cefuroxime + nitroxoline (SR 27.5%) were significantly more active than cefuroxime + disulfiram (SR 41.7%).
  • When replacing disulfiram with clarithromycin or nitroxoline in three-drug combinations, bacterial viability decreased significantly and subculture studies showed that combinations with these two drugs (cefuroxime + clarithromycin/nitroxoline + furazolidone/nitazoxanide) inhibited the regrowth, while disulfiram combinations did not (cefuroxime + disulfiram + furazolidone/nitazoxanide).

Thus, clarithromycin and nitroxoline should be further assessed to determine their role as potential treatment alternatives in the future.View Full-Text

_______________________

For more:

https://madisonarealymesupportgroup.com/2020/12/07/repurposing-disulfiram-in-the-treatment-of-lyme-disease-and-babesiosis-retrospective-review-of-first-3-years-experience-in-one-medical-practice/

https://madisonarealymesupportgroup.com/2020/11/30/patients-can-respond-very-differently-to-disulfiram-be-cautious/

https://madisonarealymesupportgroup.com/2020/10/01/study-shows-dsm-works-for-lyme-reduces-inflammatory-markers-antibody-titers/

https://madisonarealymesupportgroup.com/2019/11/19/if-disulfiram-is-the-cure-for-lyme-disease-should-it-be-prescribed-to-all-lyme-disease-patients/

https://madisonarealymesupportgroup.com/2020/06/26/new-treatments-for-lyme-disease-on-the-horizon/

https://madisonarealymesupportgroup.com/2016/02/13/lyme-disease-treatment/

Category:

Lyme, research, Treatment