Archive for the ‘Lyme’ Category

Lyme Found in Asian Long-horned Ticks Again

https://wwwnc.cdc.gov/eid/article/27/2/20-1552_article

Disclaimer: Early release articles are not considered as final versions. Any changes will be reflected in the online version in the month the article is officially released.

Volume 27, Number 2—February 2021

Borrelia burgdorferi Sensu Stricto DNA in Field-Collected Haemaphysalis longicornis Ticks, Pennsylvania, United States

Keith J. PriceComments to Author , Christine B. Graham, Bryn J. Witmier, Holly A. Chapman, Brooke L. Coder, Christian N. Boyer, Erik Foster, Sarah E. Maes, Ying Bai, Rebecca J. Eisen, and Andrew D. Kyle
Author affiliations: Pennsylvania Department of Environmental Protection, Harrisburg, Pennsylvania, USA (K.J. Price, B.J. Witmier, H.A. Chapman, B.L. Coder, C.N. Boyer, A.D. Kyle); Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (C.B. Graham, E. Foster, S.E. Maes, Y. Bai, R.J. Eisen)

Abstract

We collected questing Haemaphysalis longicornis ticks from southeastern counties of Pennsylvania, USA. Of 263 ticks tested by PCR for pathogens, 1 adult female was positive for Borrelia burgdorferi sensu stricto, yielding a 0.4% infection rate. Continued monitoring of this invasive tick is essential to determine its public health role.

Borrelia burgdorferi sensu stricto is the causative agent of Lyme disease, the most commonly reported vectorborne disease in North America (1). In Pennsylvania, which is first in the United States in the number of reported Lyme disease cases, the spirochete has been identified in nearly 50% of adult Ixodes scapularis ticks, the primary vector (2). In 2018, Pennsylvania initiated a statewide active surveillance program to monitor tick distribution and density, by county, and tickborne pathogen prevalence. Although focused primarily on collecting and testing Ixodes scapularis ticks, initial surveillance efforts recovered, among other species, Haemaphysalis longicornis (Asian longhorned tick), an exotic species recently detected in North America (3), providing quantitative records of their presence in Pennsylvania public lands (4).

Since its US discovery in New Jersey during 2017, the number of states that have detected H. longicornis ticks has increased rapidly. In its native range, H. longicornis ticks have been found to carry a variety of pathogens endemic to Pennsylvania, including B. burgdorferi (5). However, because the ecologic characteristics and the pathogen diversity and prevalence of H. longicornis ticks in the United States are understudied, potential epidemiologic risks there remain unknown. We report surveillance program data on the presence of pathogen-infected H. longicornis in public areas in Pennsylvania.

The Study

We performed surveillance activities weekly in 38 Pennsylvania counties during May 1–September 6, 2019, capturing peak nymphal I. scapularis ticks, in addition to adult and nymphal H. longicornis tick densities (6). Sampling sites, primarily high-use public areas in deciduous forests, were selected for high risk of recreational and occupational tick encounters and suitable I. scapularis and reported H. longicornis tick habitat (6).

Collection processes were standardized to minimize spatial and temporal bias. We collected questing ticks by dragging a 1 m2 white felt cloth over vegetation and leaf litter for 100–600 m. We examined cloths every 10 m and transferred recovered ticks into vials containing 80% ethanol, which we shipped to a central laboratory where they were stored at −80°C until being identified using morphological keys.

We tested the majority (84%) of collected H. longicornis nymphs and adults for pathogens, then retained the rest as voucher specimens. We prepared DNA extracts from individual H. longicornis tick homogenates on the KingFisher Flex Purification System with the MagMAX CORE Nucleic Acid Purification Kit (ThermoFisher Scientific, External Link). We tested each extract for B. burgdorferi sensu stricto, B. mayonii, B. miyamotoi, and Babesia microti using probe-based real-time PCR assays comprising multiple targets for each pathogen (Table). We amplified a segment of the Borrelia dipeptidyl aminopeptidase (PepX) gene using seminested PCR and sequenced it to confirm B. burgdorferi sensu stricto–positive specimens. We followed real-time PCR and PepX amplification protocols published elsewhere (9). We amplified and sequenced a 667-nt fragment of the cytochrome oxidase subunit I (COI) gene using primers LCO1490 and HCO2198 (11) to confirm the tick species of positive specimens. The PCR mixture (25 µL) contained forward and reverse primers at a final concentration of 0.4 µmol and 5 µL of DNA template. Thermocycling conditions followed protocols published elsewhere (11). COI and PepX amplicons were sequenced as described elsewhere (9).

Results
County map of Pennsylvania, USA, and the southeastern region (inset) showing locations of active tick surveillance, where Haemaphysalis longicornis ticks were recovered, and where Borrelia burgdorferi sensu stricto–positive H. longicornis ticks were found, May 1–September 6, 2019. Pennsylvania county map shows 38 counties sampled weekly and an additional 14 counties sampled opportunistically that yielded low tick recovery (Ixodes scapularis ticks only).

 

Figure. County map of Pennsylvania, USA, and the southeastern region (inset) showing locations of active tick surveillance, where Haemaphysalis longicornis ticks were recovered, and where Borrelia burgdorferisensu…

A total of 668 H. longicornis ticks (356 larvae, 166 nymphs, 146 adults) were collected from 4 counties in southeastern Pennsylvania (Figure). During the same period, 265 I. scapularis ticks (174 larvae, 78 nymphs, 13 adults) were collected from the same 4 counties. Of the subset of H. longicornis ticks tested by using real-time PCR (n = 263), 1 (0.4%) adult female collected from a county park in Bucks County on June 14, 2019 was positive for B. burgdorferi sensu stricto. A 570-nt segment of the PepX gene from this specimen was identical to B. burgdorferi sensu stricto reference sequences (GenBank accession nos. CP002312.1:657467–658036). The COI gene fragment from this tick showed 99.8% identity to an H. longicornis tick sequence in the GenBank database (accession no. JQ737090). No H. longicornis ticks were positive for B. miyamotoi, B. mayonii, or B. microti.

Conclusions

We document detection of the Lyme disease spirochete, B. burgdorferi sensu stricto, in invasive H. longicornis ticks. The overall infection rate of 0.4% was low. In comparison, B. burgdorferi sensu lato infection rates in I. scapularis ticks collected during the same surveillance period and in the same counties ranged from 16.7% to 57.1% (M.P. Price et al., unpub. data). This finding is consistent with recent findings that H. longicornis ticks are relatively averse to feeding on white-footed mice (Peromyscus leucopus), the primary reservoir of B. burgdorferi sensu stricto (12). Our findings support laboratory studies demonstrating that H. longicornis ticks can acquire B. burgdorferi sensu stricto while feeding on experimentally infected mice; however, those studies suggested that H. longicornis ticks are unlikely to contribute to transmission of B. burgdorferi sensu stricto because infection is lost during molting (13). However, refeeding and transmission of Lyme spirochetes by partially-fed ixodid ticks has been documented (14).

Based on microscopy, we estimated that ≈10% of the host-seeking H. longicornis ticks that we recovered were partially fed, suggesting the possibility that transmission could occur before the ticks molt. Of note, however, although we detected B. burgdorferi sensu stricto DNA in the tick, we have no evidence to suggest the spirochetes were viable. Unique ecologic traits of H. longicornis ticks (e.g., cold hardiness, parthenogenetic reproduction, host generality), which may enable the species’ rapid establishment and high density (4), could confound efforts to determine the extent to which the tick may be involved in maintenance of B. burgdorferi sensu stricto in nature.

Continued monitoring to identify infested areas is essential, especially in densely populated regions (e.g., southeastern Pennsylvania). Despite limited documentation of H. longicornis ticks biting humans in the United States (15), findings presented here support continued use of personal protective measures. H. longicornis ticks are a vector of human pathogens in its native range; further investigation is needed to determine its potential public health significance in the United States.

Dr. Price is a microbiologist at the Pennsylvania Department of Environmental Protection, Division of Vector Management, Harrisburg, PA. His research interests include vector ecology and vector-borne disease epidemiology.

Acknowledgments

We thank field personnel for collection efforts, Rebecca Eckert for helpful comments, and Pennsylvania Department of Health, especially Leah Lind, for cooperation and support.

Funding for this study was provided, in part, by an epidemiology subgrant (#4100082142) from the Pennsylvania Department of Health.

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**Comment**

While the article is quick to point out the low borrelia infection rate, this is the tick that clones itself multiplying like wild-fire and spreading geographically.  I think we should be concerned.  A study last year found the following:

At least 30 human pathogens were associated with H longicornis, including seven species of spotted fever group rickettsiae, seven species in the family of Anaplasmataceae, four genospecies in the complex Borrelia burgdorferi sensu lato, two Babesia species, six species of virus, and Francisella, Bartonella, Coxiella, and Toxoplasma, which were mainly reported in eastern Asia. The predictive modelling revealed that H longicornis might affect more extensive regions, including Europe, South America, and Africa, where the tick has never been recorded before.  https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(20)30145-5/fulltext

For more:  

The very important issue of interrupted/partial feeding in ticks is not very well understood but would explain quicker transmission times:

https://madisonarealymesupportgroup.com/2020/07/05/interrupted-blood-feeding-in-ticks-causes-and-consequences/

Lyme Disease Mimics Cellulitis Skin Infection

https://danielcameronmd.com/lyme-disease-mimics-cellulitis-skin-infection/

LYME DISEASE MIMICS CELLULITIS SKIN INFECTION

patient with lyme disease being examined for cellulitis

Lyme disease can mimic acute and chronic illness. In their article “Lyme Disease Mimics Postoperative Cellulitis,” the authors describe a patient who developed an abdominal rash, which was initially diagnosed as cellulitis, six days after a laparoscopic left salpingo-oophorectomy surgery. [1]

The 40-year-old woman, who developed redness, swelling, pain, and a rash at the excision site, was treated with cephalexin and later switched to trimethoprim/sulfamethoxazole (TMP/SMX).

“Over the next 24 hours, there was a rapid expansion of abdominal redness and patchy areas of redness on her left groin and her right forearm,” the authors write. The patient had complained of muscle and joint stiffness but attributed it to recent outdoor camping and exercise.

The woman was “admitted for postoperative cellulitis remote from surgery.” She was treated with doxycycline for possible Lyme disease, due to her recent camping trip and exposure to ticks.

Within hours of starting doxycycline, the patient’s “abdominal erythema [rash] significantly receded, the forearm and leg rashes resolved, and the joint pain and stiffness improved markedly.”

The Lyme disease diagnosis was confirmed with an IgM Western blot test.

“Initial suppression of the worsening rash could have been due to a low level of TMP/SMX activity on Borrelia burgdorferi stationary phase cells,” the authors explain.

The woman’s IgG Western blot test was negative.

Although Lyme disease can present with erythema migran rashes, early rashes can be confused with cellulitis. The authors suggest, “Lyme disease should be considered in patients with cellulitis in areas of endemic Lyme.”

Lyme disease rashes have been misidentified

Lyme disease rashes were misidentified in a case series involving 88 patients who presented with an erythema migrans (EM).  In 13 of these patients, the rash had been incorrectly identified or treated.

“Rashes were often misidentified by clinicians and patients as a spider bite, cellulitis, or shingles,” wrote Aucott and colleagues. [2]

The authors concluded, “Until more accurate tests are developed for early Lyme disease, cases without a diagnostic EM rash will need to be managed carefully.

In patients with cutaneous lesions where the differential diagnosis of cellulitis is not certain, empiric antibiotics should be chosen that will have activity against both Lyme disease and common agents of cellulitis.”

Editor’s note: I have prescribed cefuroxime or amoxicillin/clavulanic acid if Lyme disease is a consideration. Neither cephalexin nor TMP/SMX are effective against Lyme disease. If I believe Lyme disease is involved, I will treat patients longer than 7 to 10 days.  You can look at the rash yourself as the journal is open access.

References:
  1. Miles S, Mansuria S. Lyme Disease Mimics Postoperative Cellulitis. J Minim Invasive Gynecol. Nov 15 2020;doi:10.1016/j.jmig.2020.11.002
  2. Aucott J, Morrison C, Munoz B, Rowe PC, Schwarzwalder A, West SK. Diagnostic challenges of early Lyme disease: lessons from a community case series. BMC Infect Dis. Jun 1 2009;9:79. doi:10.1186/1471-2334-9-79

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For more:  

Lyme on the Brain Podcast

https://www.lookingatlyme.ca/2020/09/discussing-the-effects-of-lyme-disease-on-the-brain-with-dr-leo-shea/

Looking at Lyme, episode 10 with Dr. Leo Shea.

Discussing the effects of Lyme disease on the brain with Dr. Leo Shea III

Podcast here:  https://cdn.transistor.fm/file/transistor/m/shows/17123/4e5cfc06b6c30614524aece0c20d9371.mp3

In this episode Sarah talks about the effects of Lyme disease on the brain with Dr. Shea, a senior staff psychologist, professor and President of Neuropsychological Evaluation and Treatment Services in New York City and Boston. Dr. Shea starts off by explaining many of the effects that Lyme disease has on the brain including the ability to process information, changes in memory, multitasking and high level reasoning. He also explains the importance of understanding the effects on the brain and mental health in terms of what is going on physically to cause these changes. He uses neuropsychological evaluation to measure changes in a person’s cognitive, emotional and behavioural function as a result of Lyme disease. Dr. Shea also notes that results of imaging tools such as a SPECT scan often reflect findings in neuropsychological testing in patients.

“When it does get to the brain…it reduces the person’s ability to function, not only in their general daily life, but certainly in their professional or academic life.”

Dr. Leo Shea

We are introduced to the concept of psychoeducation: educating families, teachers, and employers to better support Lyme patients at home, in school and in returning back to work. Dr. Shea gives a few examples of how students can be supported in their learning. He talks about the added social burden that pediatric and adolescent patients experience within their peer groups, and the implications for those patients. Dr. Shea also touches on the challenge that people with dark skin have in getting a diagnosis of Lyme disease in part due to the different appearance of bites and rashes on darker skin tones.

“Psychoeducation is important so that everybody has an understanding of what this patient is going through and what their role is in supporting the patient”

Dr. Leo Shea

Dr. Shea describes the preceptorship program for physicians through ILADEF, where they are mentored by physicians with many years of experience treating patients with Lyme disease. These physicians (who have treated many Lyme disease patients) have gained a wealth of knowledge and clinical experience that they are able to share. He leaves us with a reminder that much more research is needed in the area of Lyme disease and other tick-borne illnesses.

Related resources

“There’s a need for an enormous amount of research into this so that we get a better understanding of not only Lyme, but all the other tick-borne illnesses”

Dr. Leo Shea

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Living With Lyme Brain

https://globallymealliance.org/living-lyme-brain/

by Jennifer Crystal

SHORT-TERM MEMORY LOSS, CONFUSION, BRAIN FOG, AND WORD REPETITION ARE JUST A FEW SYMPTOMS OF LYME BRAIN EXPERIENCED BY MANY LYME PATIENTS. HOW HAS LYME BRAIN AFFECTED YOU?

Listen to the audio version of this blog here:

I was recently talking on the phone with a friend who is expecting a baby. “I’m so sorry I didn’t call you back earlier,” she said. “I can’t remember anything these days. It must be ‘pregnancy brain’!”

I knew what she meant. I’ve experienced “Lyme brain,” and the symptoms are similar. Throughout my 20-year battle with Lyme and other tick-borne illnesses—eight of which were undiagnosed and untreated—I have wrestled with short–term memory loss, confusion, brain fog, word repetition, difficulty retrieving vocabulary, and a tendency to mix up words. Other neurological symptoms have included insomnia, hallucinogenic nightmares, migraines, burning extremities and mini seizures.

It’s hard to explain the neurological component of Lyme disease to people who haven’t experienced it. Most people know Lyme causes joint pain, and it does. But when it goes undiagnosed for too long, the bacteria can replicate and cross the blood-brain barrier, invading the central nervous system. A scan of my brain showed that the tick–borne parasite babesia was preventing me from getting oxygen to the left side of my brain. The scan also showed lesions caused by Lyme.

But that scan was done years after my initial tick bite, years after I’d first noticed that my hands trembled when I tried to apply eyeliner, years after doctors had written off my migraines as “altitude sickness” or “stress.”

blog_JC_lyme brain_1

Unfortunately, my story is all too common. The neurological symptoms of Lyme disease are some of the most confused with other illnesses. Besides the brush-off diagnoses I received, patients are often misdiagnosed with multiple sclerosis, Parkinson’s, and/or mental illness. Without proper diagnosis, neurological Lyme disease can lead to paralysis, schizophrenia and even death.

I was one of the lucky ones. My sleep disturbances were unbearable at times, but my day time neurological troubles never got worse than brain fog and word loss. So what did that actually feel like? Imagine molasses seeping through your brain, pouring into all the crevices until your brain feels so full that you wonder if it will explode right out of your skull. Imagine that thick substance sticking to the synapses of your brain, dulling your thoughts, slowing your ability to put those thoughts into words.

It became impossible to read or watch TV. Just skimming the opening paragraph of an article left me confused and frustrated. Sometimes I’d be telling a story to my family—something as simple as, “I ran into an old friend at the pharmacy today”—and I’d stop mid-sentence and ask, “What was I talking about?” I had no memory of what I’d just said or what point I was trying to make. I also sometimes mixed up the syntax such as, “I ran into a friend old at the pharmacy today.”

Other times, I couldn’t come up with basic words. While telling my family that story I might say, “I ran into an old friend at the…at the…at the blank today.” I knew that “today” came after the word I was trying to say, but I couldn’t fill in the blank. Usually whomever I was speaking with could fill it in for me, but I was nervous about that happening in public. I’d be at the pharmacy and suddenly not be able to come up with my zip code when prompted by the pharmacist. Sometimes the word or number would come eventually, as if my brain had done a Google search. Other times I would just try to laugh it off, saying something like, “Wow, I must be really tired today!” I wished I had the more obvious excuse of “pregnancy brain.”

As a writer, I have always been exacting in my vocabulary. Losing the ability to come up with precisely the right word was humiliating. Words are my currency, and I was broke.

Luckily, the antibiotics started beating out the spirochetes in my brain, and slowly things improved. Soon I could read an entire magazine, as long as I stopped in between articles to sit quietly and let my brain rest. Eventually, I could type multi-paragraph emails. The word repetition fortunately decreased. I worked my way up to attending graduate school, writing papers and essays —thinking again at a high level.

blog_JC_lyme brain_2

These days, I still wrestle with some neurological symptoms especially when I’m tired. Recently I was writing a chapter of my next book and called my mom to say, “I’m thinking of a word that sounds like ‘synonymously’ and means two things happening at the same time.”

“Simultaneously,” she quickly said. I smiled, filled in the blank, and continued writing.

While working on my book, I’ve been doing some prompts with a writing group to help generate material. Recently we wrote about things we’ve lost and found. “I’m writing about losing my mind,” I told my mother.

“How do you know you’ve found it?” she joked.

I know because I can write about my experiences with some distance, using exactly the words I want. I know because I can teach. I know because I can read student essays and newspaper articles. I know because I can read entire books—albeit slowly—and I’ve even written one, too. And in the rare event that  I can’t think of a word, I know I can always call my mother.


jennifer-crystalOpinions expressed by contributors are their own.

Jennifer Crystal is a writer and educator in Boston. She is working on a memoir about her journey with chronic tick borne illness. Contact her at jennifercrystalwriter@gmail.com

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For more:

FREE Webinar: In For the Long Haul: Lyme & COVID-19

https://www.eventbrite.com/e/in-for-the-long-haul-lyme-covid-19-tickets

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Date And Time

Thu, Jan 21, 2021, 4:30 PM CST

Project Lyme will host Dr. Daniel Cameron, M.D., MPH and Dr. Bill Rawls, M.D. to address issues facing the Lyme community during COVID-19.

About this Event

Project Lyme will host Lyme disease expert Dr. Daniel Cameron, M.D., MPH and integrative health innovator Dr. Bill Rawls, Medical Director of Vital Plan. They will be discussing the challenges that face the Lyme community as we continue to face the pandemic including the similarities between the long-haul patients, and how to stay healthy in these uncertain times.

Noah Johnston, Administrative Director of Project Lyme will moderate the discussion and take live Q&A from the virtual crowd. The event will also feature Jennifer Hoffmann, Program Associate at Project Lyme and Senior Director of the Generation Lyme initiative. Jennifer is a Lyme patient who was dually diagnosed with COVID-19 in March of 2020.

Once you register through Eventbrite you will gain access to the private Zoom link.

Project Lyme is happy to host this educational event for free. We request you donate through https://projectlyme.org/donate/ to help us continue to provide this content.