Archive for the ‘mosquitoes’ Category

We Have No Idea How Bad the US Tick Problem Is

https://www.wired.com/story/we-have-no-idea-how-bad-the-us-tick-problem-is/
AUTHOR: MEGAN MOLTENIMEGAN MOLTENI
SCIENCE
7.04.18

WE HAVE NO IDEA HOW BAD THE US TICK PROBLEM IS

WHEN RICK OSTFELD gets bitten by a tick, he knows right away. After decades studying tick-borne diseases as an ecologist at the Cary Institute of Ecosystem Studies in Millbrook, New York, Ostfeld has been bitten more than 100 times, and his body now reacts to tick saliva with an intense burning sensation. He’s an exception. Most people don’t even notice that they’ve been bitten until after the pest has had time to suck up a blood meal and transfer any infections it has circulating in its spit.

Around the world, diseases spread by ticks are on the rise. Reported cases of Lyme, the most common US tick-borne illness, have quadrupled since the 1990s. Other life-threatening infections like anaplasmosis, babesiosis, and Rocky Mountain spotted fever are increasing in incidence even more quickly than Lyme. Meat allergies caused by tick bites have skyrocketed from a few dozen a decade ago to more than 5,000 in the US alone, according to experts. And new tick-borne pathogens are emerging at a troubling clip; since 2004, seven new viruses and bugs transmitted through tick bite have shown up in humans in the US.

Scientists don’t know exactly which combination of factors—shifting climate patterns, human sprawl, deforestation—is leading to more ticks in more places. But there’s no denying the recent population explosion, especially of the species that carries Lyme disease: the black-legged tick.

“Whole new communities are being engulfed by this tick every year,” says Ostfeld. “And that means more people getting sick.

Tick science, surveillance, and management efforts have so far not kept pace. But the country’s increasingly dire tick-borne disease burden has begun to galvanize a groundswell of research interest and funding.

In 1942, Congress established the CDC specifically to prevent malaria, a public health crisis spreading through mosquitoes. Which is why many US states and counties today still have active surveillance programs for skeeters. The Centers for Disease Control and Prevention uses data from these government entities to regularly update distribution maps, track emerging threats (like Zika), and coordinate control efforts. No such system exists for ticks.

Public health departments are required to report back to the CDC on Lyme and six other tick-borne infections. Those cases combined with county-level surveys and some published academic studies make up the bulk of what the agency knows about national tick distribution. But this data, patchy and stuck in time, doesn’t do a lot to help public health officials on the ground.

“We’ve got national maps, but we don’t have detailed local information about where the worst areas for ticks are located,” says Ben Beard, chief of the CDC’s bacterial diseases branch in the division of vector-borne diseases. “The reason for that is there has never been public funding to support systematic tick surveillance efforts.

That’s something Beard is trying to change. He says the CDC is currently in the process of organizing a nationwide surveillance program, which could launch within the year. It will pull data collected by state health departments and the CDC’s five regional centers about tick prevalence and the pathogens they’re carrying to build a better picture of where outbreaks and hot spots are developing, especially on the expanding edge of tick populations.

The CDC is also a few years into a massive nationwide study it’s conducting with the Mayo Clinic, which will eventually enroll 30,000 people who’ve been bitten by ticks. Each one will be tested for known tick diseases, and next-generation sequencing conducted at CDC will screen for any other pathogens that might be present. Together with patient data, it should provide a more detailed picture of exactly what’s out there.

Together, these efforts are helping to change the way people and government agencies think about ticks as a public health threat.

“Responsibility for tick control has always fallen to individuals and homeowners,” says Beard. “It’s not been seen as an official civic duty, but we think it’s time whole communities got engaged. And getting better tick surveillance data will help us define risk for these communities in areas where people aren’t used to looking for tick-borne diseases.”

The trouble is that scientists also know very little about which interventions actually reduce those risks.

“There’s no shortage of products to control ticks,” says Ostfeld. “But it’s never been demonstrated that they do a good enough job, deployed in the right places, to prevent any cases of tick-borne disease.”

In a double-blind trial published in 2016, CDC researchers treated some yards with insecticides and others with a placebo. The treated yards knocked back tick numbers by 63 percent, but families living in the treated homes were still just as likely to be diagnosed with Lyme.

Ostfeld and his wife and research partner Felicia Keesing are in the middle of a four-year study to evaluate the efficacy of two tick-control methods in their home territory of Dutchess County, an area with one of the country’s highest rates of Lyme disease. It’s a private-public partnership between their academic institutions, the CDC, and the Steven and Alexandra Cohen Foundation, which provided a $5 million grant.

Ostfeld and Keesing are blanketing entire neighborhoods in either a natural fungus-based spray or tick boxes, or both. The tick boxes attract small mammal hosts, which get a splash of tick-killing chemicals when they venture inside. They check with all the human participants every two weeks for 10 months of the year to see if anyone’s gotten sick. By the end of 2020 the study should be able to tell them how well these methods, used together or separately on a neighborhood-wide scale, can reduce the risk of Lyme.

“If we get a definitive answer that these work the next task would be to figure out how to make such a program more broadly available. Who’s going to pay for it, who’s going to coordinate it?” says Ostfeld. “If it doesn’t work then perhaps the conclusion is maybe environmental control just can’t be done.”

In that case, people would be stuck with pretty much the same options they have today: protective clothing, repellants, and daily partner tick-checks. It’s better than nothing. But with more and more people getting sick, the US will need better solutions soon.

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**Comment**

Great article pointing out the scary fact that only 6 pathogens transmitted by ticks are being reported on.  There are currently 18 pathogens and counting…..so the numbers are woefully inadequate.

Here’s the list so far:  https://madisonarealymesupportgroup.com/2017/07/01/one-tick-bite-could-put-you-at-risk-for-at-least-6-different-diseases/

Babesiosis
Bartonellosis
Borrelia miyamotoi
Bourbon Virus
Colorado Tick Fever
Crimean-Congo hemorrhagic Fever
Ehrlichiosis/Anaplasmosis
Heartland Virus
Meat Allergy/Alpha Gal
Pacific Coast Tick Fever: Richettsia philipii
Powassan Encephalitis
Q Fever
Rickettsia parkeri Richettsiosis
Rocky Mountain Spotted Fever
STARI: Southern Tick-Associated Rash Illness
Tickborne meningoencephalitis
Tick Paralysis
Tularemia

And the number keeps growing…..but nobody’s keeping score.

CDC Warns About 7 New Tick Viruses

https://www.today.com/health/7-new-tick-viruses-worry-about-big-epidemic-bugs-much-t128894?cid=sm_npd_td_tw_ma

Is there really a ‘big epidemic’ of tick diseases? CDC warns about 7 new viruses

Experts say we can expect each tick season to be worse than the last.

by Linda Carroll, Updated Source: TODAY

A recent afternoon walk turned into a tick attack for a Massachusetts man.

As community forester Derek Lirange was hiking around the Tower Hill Botanic Gardens in Worcester on May 16, he spotted a few ticks on his pants. Within a few more minutes, there were five or six more ticks, followed by more and more. By the end of the hike, he counted 26 ticks.

I hadn’t taken every precaution, such as spraying with insect repellent, but I was wearing long pants and socks,” the 26-year-old told TODAY. “It was a creepy, ongoing discovery.”
Luckily, none had embedded. But the spike of the tick population in the gardens led to the cancellation of a spring walk around the reservoir.
Welcome to the new tick season. No one knows exactly how many ticks are out there, but the skyrocketing cases of tick-borne diseases recently reported by the Centers for Disease Control and Prevention provides indirect evidence that the little bloodsuckers are becoming more numerous, said Alfaro Toledo, an assistant professor in the department of entomology at Rutgers University.
“It’s a big epidemic affecting the entire East Coast,” said Toledo. “Witness the spread of the deer tick to the north and west.”

WHY MORE TICKS?

One big factor leading to the so-called tick explosion is the overall warming trend. But there are several factors beyond warming weather driving the rise in tick numbers, experts say. One is the booming numbers of deer and rodents. Deer, which are the preferred hosts of adult ticks, are increasing in numbers, “because basically there are no predators anymore,” Toledo says.

More deer means more female adult ticks go on to lay eggs.

High numbers of rodents also drive the numbers of ticks. After hatching from eggs, tick larvae attach to rodents to feed and, unfortunately for us, pick up diseases like Lyme and Rocky Mountain Spotted Fever. Once the larvae get their meal of blood, they move on to the next phase of their cycle, the nymph stage, which is when they’re most likely to latch on to a human.

ticks-today-180511-inline_2823a35a09e91201aaff3eba51c8decc.fit-760w
Ticks in the Northeast Rutgers-New Brunswick Center for Vector Biology

Though both nymphs and adults can transmit disease, the nymphs are more likely to do so because of their small size. Adult ticks are big enough to be easy to spot and get rid of before they can pass on diseases like Lyme. Nymphs are much smaller and often attach long enough to transmit disease without our ever spotting them.

And while deer ticks are most likely to be the ones transmitting Lyme and lone star ticks, Rocky Mountain Spotted Fever, dog ticks and a new invader, the Longhorned tick, can also carry and transmit disease.

Experts used to tell people they’d be safe from tick bites if they kept their lawns mowed and stayed out of wooded areas—and that’s still mostly true for deer ticks. But Lone star ticks and dog ticks, which both can carry diseases and bite humans, are perfectly happy roaming through mowed lawns, said Matt Frye, an entomologist at Cornell University.

Frye says we should just accept that every year now is going to be a bad tick year. That means we should get serious about examining our bodies for ticks. “You should do a tick check every day, like you brush your teeth every day,” he said.

tick-muffin-today-180515-inline2_67fa838155c0613f99366ce0282c0f2a.fit-760w
Can you spot the five ticks in the muffin? The CDC caused a panic when it tweeted that ticks can be as small as a poppyseed. CDC

The situation isn’t entirely hopeless. Though there are no real natural enemies of ticks, researchers are working on some ingenious ways of knocking their numbers back. One method currently being tested in communities with high numbers of ticks is to treat rodents with tick-killing substances, Frye said. Boxes baited for the rodents give them a dose of the same tick poison used to protect dogs.

The idea is that if you can lower the numbers of ticks that make it to the nymph stage, fewer people will be infected. That method is still being tested, so it won’t help any of us right now.

In the meantime, if you do spot a tick and want to know what kind it is and whether it’s carrying a disease, you can send it to a lab for testing, said Laura Goodman, an assistant research professor at Cornell.

She suggests you place your tick in a sealed, escape-proof container and ship it to Cornell or one of the other certified labs around the country. One of the best ways to kill the tick, Goodman says, is to place the container in your freezer. The shock from going directly from warm weather to freezing temperatures will be enough to do in your tick, she said.

TODAY.com writer Meghan Holohan contributed to this report

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**Comment**

Gone are the days of frolicking in the yard in shorts and sandals…..

BTW:  Ticks love wood chips.  They use them like leaf-litter and burrow underneath where it’s moist.  They also love Japanese Barberries as other invasives that harbor moisture at the base where they hang out.

In my yard, there has been a chipmunk invasion in all my landscape beds.  They love the natural rock/boulders that have gaps between them.  They burrow into these gaps and create colonies by tunneling into the dirt.  As they work, they deposit ticks everywhere.  I would avoid using these rocks and wood chips as much as possible and steer toward interlinking stones without gaps, weed barrier, and rock.  (Think Fort Knox)

As much as we love nature, keep it away from your living quarters and spray any suspected areas with an acaracide.  And far more than white-footed mice and deer carry these suckers.  Your neighborhood squirrel, chipmunk, opossum, bird, fox, raccoon, and on and on to infinity are scattering ticks.

I’m thankful they are finally admitting that other ticks are problematic.  I’ve always scratched my head when “experts” keep saying the sole perp is the dastardly black legged tick.  Treat every tick like a land mine.  They all exchange fluids with creatures.  Do the math.

When you do go outside into grass, preferably wear white shoes and socks sprayed with permethrin and tuck your light colored pants that have also been sprayed, into your socks.  Ideally you would have a long sleeved white shirt that has also been sprayed and if you are going underneath any trees, shrubs, overhanging plants, wear a hat that has also been sprayed.

This is war, people!

More ideas:  https://madisonarealymesupportgroup.com/2017/05/11/tick-prevention-and-removal-2017/

And while climate issues might affect mosquitoes, they don’t affect ticks, according to independent tick researcher John Scott:  https://madisonarealymesupportgroup.com/2017/08/14/canadian-tick-expert-climate-change-is-not-behind-lyme-disease/
This is an important issue to acknowledge as there are only so many research dollars and we need those dollars going toward things that help sick patients.  Enough’s, enough.

 

 

Mosquito Spit Alone May Significantly Alter Your Immune System for Days After a Bite

http://www.newsweek.com/mosquito-spit-alone-may-significantly-alter-your-immune-system-days-after-bite-932675?utm_source=engageim  By Aristos Georgiou, 5/18/18

MOSQUITO SPIT ALONE MAY SIGNIFICANTLY ALTER YOUR IMMUNE SYSTEM FOR DAYS AFTER A BITE

GettyImages-619207386File photo: A mosquito is seen on a man legs in Yangon, Myanmar, on October 30, 2016. Mosquito saliva contains proteins which may significantly alter our immune system, according to new research.YE AUNG THU/AFP/GETTY IMAGES

blob:http://www.newsweek.com/2562375e-c0c4-4bc3-9f79-15498c0465ba (News video here)

When mosquitoes bite you, hundreds of different proteins present in their saliva enter your bloodstream, in addition to any pathogens they may be carrying.

Some of these proteins help the mosquito to suck blood from you. But they may also have more wide-ranging effects, increasing the severity of any diseases that the mosquitos are carrying by causing a significant immune response that can last for days after a bite, according to new research.

In a new study, published in the journal PLOS Neglected Tropical Diseases, scientists from Baylor College of Medicine examined the effects of mosquito bites on human immune cells. To do this they bioengineered mice using human stem cells, which effectively gave the rodents some features of a human immune system. These features included a complete set of human white blood cells, including the so-called ‘T cells’ that fight disease.

The mice were bitten by mosquitoes uninfected with any pathogens in a lab environment. Afterwards, the scientists analyzed any change in the functioning of the humanized immune cells.

They found that the mosquito spit alone produced an immune response involving more types of cells and lasting far longer than expected. In fact, the scientists detected immune cells traveling to the site of the bite up to seven days after it occurred. Furthermore, the immune response was observed in various tissue types, including the blood, skin and bone marrow.

“The biological significance of these changes remains to be determined, but it might explain how some pathogens, such as viruses, can spread through the body in these cells, replicate to higher extents, and even remain in some tissues for far longer than detected in blood,” the researchers wrote in the study.

Previous studies have also indicated that some properties of a mosquito bite, including its saliva, may exacerbate diseases that the insects carry.

For example, mouse experiments have shown that infections caused by a mosquito bite are often more severe than those caused by injecting the same parasite with a needle. However, whether or not the results of previous studies looking into this issue would translate to humans is an open question, as the experiments used bioengineered mice that provide a less accurate model of our immune system in comparison to the mice used in the latest study.

Mosquitoes and the pathogens they transmit are a growing public health concern. Around the world, 750,000 people die every year from mosquito-borne diseases—including malaria, dengue, West Nile, Zika and chikungunya.

Treatment options are often limited for these diseases and their incidence is only expected to rise in the next few decades, as the host ranges of multiple mosquito species increase due to climate change.

“Understanding how mosquito saliva interacts with the human immune system not only helps us understand mechanisms of disease pathogenesis but also could provide possibilities for treatments,” the researchers wrote in the study.

“If we know which mosquito saliva components enhance pathogenesis of diseases, we could create a human vaccine to counteract these effects for multiple infections,” they said.

______________

**Comment**

What does this mean for Lyme/MSIDS patients?  According to this study, mosquitoes carry Lyme disease (borrelia):  https://madisonarealymesupportgroup.com/2016/07/23/german-study-finds-borrelia-in-mosquitos/

Here is an excellent read by Dr. Sponaugle on the study:  https://sponauglewellness.com/lyme-study-how-borrelia-bacteria-is-transmitted-from-mosquitoes-to-humans/  He explains that the fact mosquitoes bite quickly makes some question their ability to transmit Bb; however, Sponaugle states, “Mosquitoes might have the equipment after all to enable Borrelia spirochetes the ability to survive for the durations necessary to be viable vectors of Lyme disease.”

Reading this current information on the various proteins & other pathogens present in their saliva altering human immune systems certainly screams for more intense study of the potential not only of spreading Bb but of amplifying all pathogens in the mosquito as well as the human.  The combination of tick and mosquito transmission would certainly help explain the far-ranging (world-wide) transmission rates of Lyme/MSIDS.  And, what about the other coinfections?  Much must be done with clear, unbiased studies starting at ground zero.

We need transmission studies more than we need climate studies.  People are dying out here.

For more:  https://madisonarealymesupportgroup.com/2017/08/14/canadian-tick-expert-climate-change-is-not-behind-lyme-disease/

https://madisonarealymesupportgroup.com/2017/07/08/global-warming-numbers-fudged/

GMO mosquitoes:  https://madisonarealymesupportgroup.com/2015/12/28/frankinbugs/

Wolbachia as a biocontrol:  https://madisonarealymesupportgroup.com/2018/02/12/wolbachia-laced-mosquitoes-being-released-why-lyme-msids-patients-might-be-negatively-affected/  Ticks carry worms and transmit them to humans.  Here’s what’s scary about Wolbachia: “Dogs treated for heart worm (D. immitis) have trouble due to the heart worm medication causing Wolbachia to be released into the blood and tissues causing severe Inflammation in pulmonary artery endothelium which may form thrombi and interstitial inflammation. Wolbachia also activates pro inflammatory cytokines.”  Nobody’s talking about what this could do to humans – particularly humans with worms.

GMO Mice:  https://madisonarealymesupportgroup.com/2016/06/21/first-frankenbugs-now-frankinmice/

Regarding tick eradication, controlled burns are 78-98% effective, yet are not huge money makers and isn’t garnering support.  It’s up to We the People to spread the truth:  https://madisonarealymesupportgroup.com/2018/04/03/fire-good-news-for-tick-reduction/

Palsy of the Gut & Other GI Manifestations of Lyme/MSIDS

This 2008 article is full of nuggets for those of you who suffer with GI issues and Lyme/MSIDS.  It has natural options as well as pharmaceutical options.

http://www.publichealthalert.org/palsy-of-the-gut-and-other-gi-manifestations-of-lyme-and-associated-diseases.html

“Palsy Of The Gut” And Other GI Manifestations Of Lyme And Associated Diseases​

March 1, 2008 in Science/Research by Dr. Virginia T. Sherr, MD

Bell’s palsy signifies paralysis of facial muscles related to inflammation of the associated seventh Cranial Nerve. Physicians may not realize that this syndrome is caused by the spirochetal agent of Lyme disease until proven otherwise. Whether it is a full or hemifacial paralysis, Bell’s palsy is cosmetically disfiguring when fully expressed. Sudden loss of normal facial expression terrifies patients who naturally fear they are having a stroke. When a smile is asked for, normal countenances warp into bizarre grimaces. The amount of tooth area exposed in this attempt to smile helps doctors evaluate the degree of paralysis and its change over time (Figure 1). In every case of Bell’s, doctors need to carefully investigate by history, physical, and laboratory work every shred of evidence that might suggest the presence of cryptic tertiary Lyme, a serious multisystem, gut and neuro-brain infection even though about half of fully diagnosed patients have no evidence whatsoever of having had a tick-bite.

Gastrointestinal Lyme disease may cause gut paralysis and a wide range of diverse GI symptoms with the underlying etiology likewise missed by physicians. Borrelia burgdorferi, the microbial agent often behind unexplained GI symptoms—along with numerous other pathogens also contained in tick saliva—influences health and vitality of the gastrointestinal tract from oral cavity to anus. Disruptions caused by GI borreliosis (Lyme) may include, amongst many others, distortions of taste, failure of other neural functions that supply the entire GI tract—paralysis or partial paralysis of the tongue, gag reflex, esophagus, stomach and nearby organs, small and/or large intestines (“ileus”), bowel pseudo-obstruction, intestinal spasms, excitability of gut muscles, inflammation of lumen lining tissues, spirochetal hepatitis, possibly cholecystitis, dysbiosis, jejunal or ileal incompetence with resultant small intestine bacterial overgrowth (SIBO), megacolon, encopresis and rectal muscle cramping (proctalgia fugax).

In cerebral hypothalamic and pituitary centers, usual sites of borrelial disruptions of the brain’s normal hormonal cascades, there are strong influences on human attitudes, ideation, and behavior relating to gastronomic issues. Newly discovered Lyme endangered cerebral hormones and renegade cytokines regulate brain-gut interactions thus initiating behavioral tendencies such as anorexia or a failure of satiety with resultant obesity.

Ticks and other vectors of Lyme disease attract their own infections from many microbes, some known and some unknown (viruses, amoebas, bacteria, and possibly parasitic filaria), which they then also can pass on to humans. The GI tract is especially vulnerable to machinations of such co-infections as bartonellosis, mycoplasmosis, human anaplasmosis (HA), and human monocytic ehrlichiosis (HME). Syndromes exactly similar to Irritable Bowel Syndrome (IBS), Crohn’s Disease, and cholecystitis, for example, may not have readily suggested a borrelial etiology to the diagnostician but Lyme increasingly is known to be a potential contributor to each.

All known Lyme-gut syndromes are treated by combining several effective antimicrobials (including use of azole medications with specific antibiotics) with agents that boost gut lining repairs and overall immunity enhancement. Azole medications are borreliacidal (against the anti-Bb spirochetal cyst form) medications such as metronidazole (Flagyl). Needed GI healing agents may include gut stimulants or relaxants, Ph agents, bile salts, nutriceuticals, immunity-enhancers, neurotoxin absorbents, and sterilizers of gut-specific microbes.

Parallelism between Lyme borreliosis-caused paresis of facial muscles supplied by Cranial Nerve VII and Lyme-caused gastrointestinal paralyses suggested a pseudonym to the author–Bell’s palsy of the Gut—despite the fact that these syndromes are related to different types of neural fibers and only occasionally occur together. Since similar injury to all sites may be etiologically related, however, otherwise unexplained gastrointestinal symptoms should be considered as possibly related to Lyme borreliosis and/or its co-infections until proven otherwise.

Until proven otherwise, a patient’s unexplained facial paralysis is caused by the tick-borne spirochetes of Lyme disease (LYD) (1). The widely endemic bacteria are easily capable of inducing distal inflammation of the Seventh Cranial (Facial) Nerve (2). “Considering the incidence of Bell’s palsy in Lyme, it is improper to treat it as viral in origin without a work-up for Lyme disease” (3). In an early study with nearly 1000 LYD cases studied, Bell’s palsy occurred in at least 10% of validated cases (4). The frequency of Lyme’s Bell’s palsy etiology is unfamiliar to many physicians. Likewise many physicians are unfamiliar with the spirochetal cause of paralyses of muscles that facilitate normal gastrointestinal transit. Yet, these vital muscles also may be greatly compromised by the same offending neurotropic spirochete, Borrelia burgdorferi (Bb) in patients who are totally unaware of having Lyme disease. Their physicians are often surprised to learn that persistent Lyme disease is outstandingly a disease of the brain as well as involving one or all components and sub-systems of the entire nervous system (5). It is not yet widely understood by clinicians that at least 40% or more of Lyme-infected patients have major, handicapping, neurological manifestations (6,7) with the likelihood that 100% have some brain involvement. It remains to be clarified which Bb neuritides are involved in specific GI sequelae of the infection or if inflamed nerves are, indeed uniformly at fault.

“The vagi (10th Cranial Nerves) are major suppliers of the gut’s external nervous system and being very long and complex, are vulnerable to neuropathies such as Lyme disease or diabetes which can cause them serious damage.” (Personal communication from Neurologist, Richard Rhee, M.D., F.A.A.N., Neptune, NJ)

“Vagus nerve paralyses are more commonly diagnosed when caused by Herpes (varicilla) zoster or Herpes simplex viruses wherein most patients I have seen are nauseated and have no appetite. I have not observed paralytic ileus in these cases. Should vagal paralysis occur in a Lyme patient, I think the patient would complain of hoarseness and dysphagia.” (Personal communication from Dr. Hidecki Nakagawa, Japan) Indeed, both of these problems are common symptoms of neuro-Lyme.

“The autonomic nervous system supplies the gut . . . sympathetic fibers inhibiting peristalsis and secretion and parasympathetic fibers increasing them . . . Functions of the sympathetic nerves include vasomotor, motor to the sphincters, inhibition of peristalsis, and transport of sensory fibers from all of the abdominal viscera. . . . Functions of the parasympathetic nerves comprise motor and secretomotor to the gut and glands” (8).

Borreliosis-caused, gastrointestinal tract paralysis and related abnormalities can occur anywhere along the entire length of the tract (9,10)—involving, for example, functionality of taste buds (11,12), muscular strength of the tongue, gag reflex, ability to swallow, gastroparesis, peristaltic retardation (or excitation) related to small bowel competency, dysbiosis, total arrest of peristalsis (“ileus”), pseudo-obstruction (sometimes associated with Bell’s palsy) (13), colon dysfunctions, encopresis, proctalgia fugax and the final act of defecation. “In 5%–23% of patients with early Lyme borreliosis, there can be gastrointestinal symptoms such as anorexia, nausea, vomiting, severe abdominal pain, hepatitis, hepatomegaly and splenomegaly. Diarrhea occurs but is seen in only 2% of cases” (14). Regardless of the site, spirochetes’ disturbing symptoms may come and go spontaneously, often temporarily resolving in a matter of hours to days, although resolution does not imply cure. As with Bell’s palsy of the face, these gastrointestinal conditions may endure or only partially remit (15).

Similarities between Bb-caused paralyses of muscles supplied by the Facial Nerve and Lyme-caused GI neurogenic paralyses suggested a pseudonym to this writer–Bell’s palsy of the gut—despite the fact that the two manifestations of the infection may not be synchronous. Yet, they are etiologically related, which suggests need for a high index of suspicion regarding presence of borrelial disease in all perplexing gastrointestinal syndromes.

Potent Microbial Co-infections As Related To Geographic Factors

Endemic areas for tick-borne diseases include the entire Eastern and Western coasts of North America with their internally contiguous states as well as Midwestern states that support migratory bird North-South flyways (16). Infected deer ticks (Ixodes scapularis and similar hard-bodied ticks), vectors of many diseases including the ones discussed below, are thus most widely distributed by birds, geographically. There are few places in the United States that are totally safe from the risk of microbes thus ferried. In 2002, the CDC estimated the existence of nearly one-quarter million new cases in USA’s rapidly expanding LYD epidemic.

Very common co-infections from infected Ixodes sp. ticks (Figure 2) include the ehrlichioses—Human Granulocytic Ehrlichiosis, which recently was renamed Human Anaplasmosis (HA) and Human Monocytic Ehrlichiosis (HME). Human babesiosis, a tick-borne, one-celled parasite of erythrocytes, is widely misdiagnosed in its endemic, chronic form (17,18). A Bartonella-like bacteria, mycoplasma spp, and other viral and opportunistic infectors are now known to be tick-borne (19), existing in the full territorial range ofI. and other ticks (20–22). Resultant illnesses include two that have been found to be the most common tick-borne invaders of children’s gastrointestinal tracts—the combination of bartonellosis and Lyme borreliosis gut infections (23).

As with the spirochetes of Lyme, Bartonella is an increasingly common (perhaps the most common) tick infector (21). “PCR analysis of Ixodes scapularis ticks collected in New Jersey identified infections with Borrelia burgdorferi (33.6%), Babesia microti (8.4%), Anaplasma phagocytophila (1.9%), and Bartonella spp. (34.5%). The I. Scapularis tick (Figure 3) is a potential pathogen vector that can cause coinfection and contribute to the variety of clinical responses noted in some tick-borne disease patients” (24). As more experience has been gained with Bartonella henselae and its related species, bartonellosis has been found capable of causing severe gastrointestinal pain and malfunction as well as specific skin eruptions. Both of these sites involve vasculopathy— enteric and dermal as well. Scar-like stripes on the patient’s torso are telltale “stretch marks” or “scratch marks” of the disease, easily notable. This external and visible sign (the seemingly mysterious but diagnostically pathognomonic striae) may make the GI bartonellosis diagnosis less complicated for gastroenterologists and other specialists (25).

Quite surprising to many physicians, bartonellosis can cause major central nervous system damage, similar in some aspects to the aforementioned Lyme neuroborreliosis. Lyme and bartonellosis symptoms may include encephalitis signified by headaches, major memory loss, rages, seizures, and coma, as well as inflammation of the heart, abdominal pain, bone lesions, and loss of vision. Until recent years, Bartonella, at onset of infection an endothelial and subsequent red blood cells infector, was considered to cause a relatively benign and common disease otherwise known as cat scratch disease (26–28). Now that ticks have become significant transmitters of Bartonella infections into humans, this vectoring appears to amplify victims’ general Lyme symptoms (26), and quite likely amplifies GI tract lining symptoms as well.

Often Unsuspected Presentations Of GI Tract Lyme—diagnostic Usefulness Of PCR Tests On Specimens Harvested From Endoscopy/Colonoscopy Biopsies (With Illustrative Cases)

One of the blessings of modern medical investigation is a positive PCR (A direct test—polymerase chain reaction— capable of pinpointing an offending microbe’s DNA). This test can be performed on specimens from the patient’s blood, serum, plasma, CSF, urine, mothers’ milk, and all biopsy tissues. PCRs can play a vital role in diagnosing tick-borne diseases especially those affecting any organs or associated tissues. “Lyme disease is usually diagnosed and treated based on clinical manifestations. However, laboratory testing is useful for patients with confusing presentations and for validation of disease in clinical studies” (29).

DNA tests are especially handy because they can be utilized by way of biopsies harvested from inside the gut during otherwise routine colonoscopies and endoscopies in cases where the diagnosis is uncertain. PCR’s are highly specific although they are less than ideally sensitive so that a positive test is a reliable indicator of Bb infection while a negative test simply does not exclude Lyme and does not indicate a lack of infection (30).

An illustrative case history is that of “Mr. F,” a mature man thought to have been mentally retarded most of his life. His father had ascribed his youth’s sudden headaches, stiff neck, and cognitive losses to the will of God. No further evaluation or treatment was allowed. They lived in endemic tick territory at the time. Decades later the patient realized that his symptoms back then followed a series of bites by minute ticks). Now an adult, the patient’s chronic “ulcerative colitis” and depression kept him from his job as a school janitor. (Antidepressant medication had mostly just helped his anxiety) When a colonoscopy was needed, a generous gastroenterologist biopsied Mr. F’s luminal tissues, which the referring doctor then sent for testing to a reference lab specializing in tick-borne diseases. Specimen analysis returned as PCR positive for etiologies of 3 diseases that infected his colon: Borrelia burgdorferi (Lyme disease), Mycoplasma fermentans (suspected of causing GI injury via proinflammatory cytokines) (25), and B. henselae (bartonel bartonellosis). Each disease required its own unique treatment, all of which were successful and the patient’s GI symptoms resolved. Mr. F’s depression also cleared and in its place there was a kind of chronic good cheer, off and on resembling mild hypomania.

The case of “Mrs. M” illustrates another important method of detecting the presence of an active Lyme infection as well as uncovering a possible contributing cause of cholecystitis. Gall bladder (GB) tissue was tested for Bb spirochetal DNA following a cholecystectomy on this seronegative patient: A middle-aged woman with a known diagnosis of pre-existing, asymptomatic gallstones, experienced episodes of allergies, severe headaches and extreme chronic fatigue. She was treated for 2 tick-borne diseases—- LYD and babesiosis, having had symptoms of both and a positive PCR blood test for babesiosis. The LYD was treated with oral antibiotics and then 3 months of IV ceftriaxone (Rocephin) following which she showed improvement.

About a year later, Mrs. M, again fatigued, developed right shoulder blade pain and afebrile nausea after eating greasy foods. Surgery to remove her diseased gallbladder was scheduled. Treatment (doxycycline) for suspected but unproven persistent Lyme was begun. The family physician asked that biopsy specimens of the removed gall bladder be tested in a reference laboratory specializing in tick-borne diseases (31). The resultant PCR test on her gall bladder tissue was positive for DNA of the causative Bb spirochete of Lyme disease. This PCR biopsy confirmation of a seronegative patient’s Lyme diagnosis illustrates that, while Western Blot and PCR blood sample testing, especially for active late stage LYD, may not show a positive antibody response, a tissue PCR analysis may confirm the diagnosis, even when the patient has previously been treated. PCR’s done on blood are less satisfactory since Bb prefers an in-tissue environment. Treatment of Lyme disease by IV Rocephin can lead to gall bladder sludging. In this case the GB stones were considered to have predated the IV treatment. Of interest, a similar spirochetal disease (leptospirosis) has been reported as simulating symptoms of cholecystitis (32). This may be the first confirmation of a diagnosis of Lyme disease performed on GB tissue to be published—its write-up has been submitted for publication. (Case and personal correspondence from Sabra Bellovin, M.D., Portsmouth, VA)

In another instance, “Mrs. E” was evaluated in a psychiatrist’s office for severe depression, anxiety, and fatigue some months following successful removal of a colonic polyp. She mentioned that she had been experiencing chronic, depleting, diarrhea and severe insomnia. Biopsy tissue was then obtained from a repeat colonoscopy by a cooperating gastroenterologist. The specimen was PCR positive for an unspecified Mycoplasma. M. Pneumoniae is a known gut epithelial lining pathogen (33) and M. fermentanshas been found in inflamed gastro-enteric linings (19). Both potentially pathogenic mycoplasmas have been documented as carried by ticks. In addition, Mrs. E’s blood tests revealed the presence of high antibody titers for ehrlichiosis (Human Anaplasmosis—HA) as well as positive Western Blot (WB) tests for Lyme disease, indicating active cases of both when tested in a related specialty laboratory (34). Interestingly, Mrs. E’s family physician in Pennsylvania was willing to treat the ehrlichiosis but unlike some more southerly PCP’s (35) she thought Lyme was confined to New England and was unwilling to treat her patient’s borreliosis.

Treatment of active Lyme disease is often denied to very sick patients with or without the presence of positive test findings. Serologic testing for Lyme disease as routinely performed by local laboratories is well known for insensitivity. The CDC surveillance case definition excludes, for example, as many as 78% for IgG of known positive cases (36,37). More modern guidelines are currently available for diagnosis and treatment of tick-borne diseases (38,39).

Because the recommended first-use enzyme-linked immunosorbent assay (ELISA) test tends to miss at least 50% of authentically positive Lyme cases, it is less likely to be relied on (29,40). ELISA tests were not performed in any of the cases presented here.

A suddenly spastic or immobile esophagus or similar paralysis of the stomach muscles may represent esophageal and/or gastric paresis or spasm from Lyme neuropathies (5). Infection influencing the vagus nerves has been documented to cause paralysis in other diseases (8). Additional Bb-related symptoms may manifest as gastroesophageal reflux disease (GERD), early or absent satiety, GI bloating, nausea, vomiting, and atypical colitis wherein the pANCA test may be helpful. If Crohn’s and colitis are considerations, a Prometheus first step may help to support this diagnosis; however tissue biopsy is necessary to confirm the diagnosis. (Personal communication from Martin D. Fried, MD, FAAP, Colt’s Neck, NJ)

As noted, neuropathies can result from the immune (cytokine) system over-activation often seen in chronic Lyme cases. This may lead to prolonged inflammation with resultant damage to the enteric nervous system and/or the autonomic nervous system supplying the gut (5). In addition, possible spirochetal paralysis of the vagal nerve(s) may cause temporary or long-lasting disruption of normal small intestinal mobility, and that, in turn, may lead to Small Bowel (or Intestinal) Bacterial Overgrowth (SBBO or SIBO) (41). SIBO can be a serious and difficult-to-eradicate infection. The colon microbes involved usually have migrated backwards to small bowel areas from their original site of benign bacterial growth following loss of competent peristaltic rhythm in a now partially compromised small bowel. This overgrowth of upwardly mobile but misplaced bacteria may greatly interfere with the normal absorption of nutrients from the small intestines causing dysbiosis and various forms of malnutrition among other mischief. Bacterial overgrowth in the small gut can result in remarkable, intermittent, immense, abdominal bloating/distention with or without eructation or flatulence (42). Such disruption may occur despite the fact that small bowel muscles have their own enteric enervation and could function independently to some degree. In many cases, the diagnosis of SIBO is verifiable by the Hydrogen-Lactulose Breath test, which can reveal excess hydrogen production from the relocated colon bacteria. Related test kits are offered to outpatients upon physicians’ requisitions by Genova (aka Great Smokies) (43) and Doctor’s Data (44) Laboratories, thus allowing the unassisted patient to complete the test at home and mail it back to the lab.

Another borrelial cause of massive increases in abdominal girth associated with “gasless” bloating may cause diagnostic confusion. Unrelated to gut symptoms from Lyme’s disruption of the body’s internal “wiring,” Bb-inflicted polyradiculopathies of T7- 12 (nerve root inflammations) may result in paralysis of external abdominal muscles such as the rectus abdominus. This in turn can also lead to the appearance, not the reality, of extensive bloating. No exercise “crunches” will alleviate this distention even for a previously well-toned individual. Antibiotic treatment for borreliosis may resolve this symptom (45, 46).

A diagnostic tip-off to the presence of LYD (and/or bartonellosis) may be a concomitant hypersensitivity of the chest or waist area skin in combination with distended belly from weakened abdominal wall muscles (47). One may hear from a child with unrecognized tick-borne disease, “I can’t stand anything touching the front of me.” Or, “My clothes have to be real tight” or “I will wear only these (very loose) clothes.” Parents of children with Lyme disease are often bewildered by apparent compulsions such children may develop while trying to get dressed in the morning. Catching the school bus on time can result in chaos as the harried parent attempts to ready a child when the child is not known to be Lyme- or bartonellacompromised.

Adynamic or paralytic ileus, a non-obstructive motility failure (suddenly “silent” intestines), may occur as a result of neuroborreliosis on an intermittent basis, with resultant abdominal distention. As mentioned, these functional lapses and pseudo-obstructions from faulty gut motility may be due to direct spirochetal or other microbial invasion with resultant tissue inflammation, or to noxious influences of cytokine (immune system) reactions, or to microbeproduced neurotoxins that can affect Central, Somatic, Autonomic (parasympathetic or sympathetic), and Enteric nervous systems that supply the GI tract.

In children and in adults who unknowingly have been inoculated with Bb spirochetes, etc. from ticks or from bites of other less common Lyme disease vectors such as horseflies, deer flies, or even mosquitoes (48), the resultant altered gastrointestinal motility symptoms may be mild to life-threatening. (Ehrlichiosis has a 5% mortality rate in children.) Students are frequently reported to the office as having persistent stomach pain (“belly aches”) (49), failure to thrive, reluctance to go to school (their behavior often incorrectly labeled psychosomatic, attention-getting or amotivational), or as adults, patients may be fearful of going out to eat or to work due to an apparent “Irritable Bowel Syndrome.” These latter borreliosis symptoms are a result of visceral hypermotility instead of paralysis. In addition, the patient may have bloody diarrhea reminiscent of Crohn’s disease, or of colitis (50). As in the case of H. pylori’s discovery as a cause of gastric ulcers, suspicion amongst researchers is growing in regard to “stress” as the cause of IBS. And, Crohn’s Disease is now considered etiologically related to a pre-existing (unspecified) gastroenteritis (51). Constipation of an unusual type can occur in a LYD patient who is not prone to having sluggish bowel movements. The stool can suddenly become puttylike, unresponsive to usual laxative treatments. Even massive efforts to relieve this obstipation using all vigorous conventional methods may not suffice. In addition, many patients with gastrointestinal Lyme disease develop symptoms reminiscent of Sprue/celiac disease and/or lactose intolerance all of which may improve somewhat when treatment for the underlying infection( s) is successfully concluded.

The Molecular Brain As A Gut-influencing Organ

Another site of Bb spirochete-caused neuron damage that likely affects the GI tract is the human brain—especially its Lyme-injured hypothalamic and brain stem melanocortin circuits. “Melanocortins are small protein molecules that carry messages between nerve cells in the brain. They are involved in regulating a variety of complex behaviors, including social interactions, stress responses and—most importantly in this context—food intake. So it is easy to see how interference with them could cause anorexia and bulimia . . . Anorexia and bulimia may be autoimmune diseases—and so may several other psychiatric illnesses” (52). This passage refers to the work of scientists from the Karolinska Institute in Stockholm, Sweden, who have been looking at possible connections between different gut bacteria and autoantibodies against melanocortins to see if they can determine which bacteria might be responsible for a variety of eating disorders. They are finding that the level of autoantibodies to melanocortins is positively correlated with anorexia, but inversely correlated with bulimia (53). When melanocortins are pathologically over or under-activated, either stimulation of hunger or of food avoidance may result. The former leads to hyperalimentation and obesity (54). The latter leads in some cases to anorexia nervosa and other health problems. Brian Fallon, MD, and other psychiatrists have long noted that when their neuro-Lyme patients are treated with antibiotics for the underlying chronic Bb infection, there is significant improvement in eating disorder symptoms (55). Bell’s 7th and the vagus’ (10th) Cranial Nerve pathologies, brain molecular distortions, gastrointestinal disruptions, and human behavioral idiosyncrasies are all perceived of as interrelated.

Additional Diagnostic Hints

Patients with a Lyme disease-related facial paralysis may not have positive antibody laboratory tests for borreliosis as is often also true of those with gastrointestinal neuroborreliosis. Despite those facts, it is imperative that the multi-organ infecting microbes associated with such dysfunctions be suspected and treated if they are likely to be present—but the prescription of immunity lessening steroids should never be used routinely to decrease symptoms (56). Neuro-Lyme is mid-or-latestage (tertiary) Lyme disease, which may account for the lack of positives on many antibody tests (antibodies having been depleted by Bb, an ace immune system disabler.) Commonly, active tertiary Lyme shows a diagnostic positive IgM response that is conventionally but mistakenly thought to be a marker accurate only in relatively early infection (57). Persistence of a positive IgG WB test is most often seen in those with predominantly arthritic forms of Lyme disease (58).

Although the tests should be run, attempts to check for positive DNA is time consuming with results rarely coming back inside of several weeks. Yet, the patient needs immediate treatment. That same dilemma confronts both the patient with Seventh Cranial Nerve palsy as well as the enterically compromised patient. If paresis or spasm occurs and the esophagus stops functioning, a patient may choke on recently swallowed food or fluid. If it occurs in the stomach, it may cause nausea and gnawing abdominal pain. If even a partial paralysis occurs in the small intestines, SIBO (SBBO) with bloating of immense proportions may ensue. Paresis of the colon may result in mega colon with severe constipation and/or encopresis even in very young children in Lyme-endemic regions. Diarrhea resembling an IBS-like syndrome can occur if there is Bb-sponsored gut hypermotility. Similarly, GI spasms may also result in a plethora of symptoms, including spastic colon and seeming occlusions. A trial on antimicrobials is helpful for those suspected of having tick-borne diseases despite negative tests. The “symptom intensification syndrome” known as a Herxheimer reaction needs to be anticipated by both doctor and patient as potentially distressingly difficult but is to be expected when immune systems over-respond to a spirochetal die-off. This reaction should not be confused with an allergic reaction to the antibiotic.

Most helpful diagnostic tests for Lyme disease are the direct or photographed observations of a “Bulls Eye’s” circular or oval skin rash. Unfortunately, it is only present in roughly 50% of known cases. If the lesion slowly expands (due to spirochetes multiplying in the outer edge, which fact allows easier biopsy and culture) it is perfectly diagnostic of Lyme disease or its associated “STARI” (Master’s disease—a form of Lyme disease.) In endemic areas, patients should be coached to photograph any suspect rashes and to keep the living tick for a doctor’s observation or Bb DNA testing. Western Blots (WBs) are best done in a reference lab specializing in tick-borne diseases with the doctor’s insistence that all antibody bands be counted and reported. The tests should employ the correct strains of Borrelia and also not depend on spirochetes that have lost DNA due to multiple passes through a series of hosts.

Acceptable tests have both high specificity and sensitivity. For example, the C6 Peptide/Lyme test has excellent specificity so that those tests that come back positive are valid and are confirmatory of Lyme’s presence. However, negative results from the C6 test merely show that the test was done—they do not show that Bb was absent. The negative test does not prove that the patient is free of Lyme disease.

Useful tests include a urine Bb antigen test with positive findings backed up by the highly accurate Southern Blot test. As noted, PCR tests on all appropriate tissues/fluids, especially serum, whole blood, urine, tears, mother’s milk and CSF are valuable diagnostically.

Choices of tests for several Bb’s co-infections are enhanced by awareness of the prevalent strain/species of the infection that is extant in the area where the patient was tick-inoculated. Tandem IFA and PCR tests are usually performed for co-infections. In addition, florescent microscopic views of stained slides can show babesiosis ring forms inside RBC and other tests can show cystic forms of Bb under black light. Bartonellosis can be tested for by PCR (blood and tissues) and its positive WBs are considered diagnostic when combined with history and physical evidence. As is true of Bb, however, bartonella patients may be seronegative and without PCR-DNA captured.

A Brief Overview Of Some Approaches To The Treatment Of Tick-borne Diseases Affecting The Gut

Sensations of total, dire, overwhelming, unending, weakness or fatigue in most seriously ill Lyme patients lead many Lyme patients to consider suicide. Treatment begins with educating them about the treatable, underlying diseases and about realistic expectations in order to inspire hopefulness for recovery. The physician’s listening skills and willingness to give anxious patients extra time can be life-saving.

Prescription of skillfully combined oral antibiotics in an attempt to avoid IV treatment for all but those seriously afflicted with advanced neuro-Lyme (patients that manifest MS-like or ALS-type symptoms) is the next challenge (59). In addition to the usual antibiotics advised for Lyme disease, telithromycin (Ketec) used cautiously or azithromycin (Zithromax) may successfully accomplish blood-brain tissue barrier penetration that is needed. Such patients have to be monitored closely for liver, etc. side effects. In recent years, Lyme expertise has included the combining of antibiotic(s) with those in the azole family of drugs (such as metronidazole/Flagyl) that penetrate cell wall-less cyst forms of Bb, forcing spirochetes out of cover as it were to their demise from the antibiotics. Regularly spaced “safety blood work” must be regularly ordered for all patients who require long-term use of any antibiotics. For those with Lyme-sluggishness of the gut with resultant SIBO, non-absorbable, intestinal “antimicrobials” likely will be needed (60). Current usage of rifaximin may include carefully monitored long term prescriptions.

  • Doxycycline has the advantage of being able to arrest both Lyme and the ehrlichioses in those who are multiply infected with each.
  • Bartonella (the tick-borne variant) usually responds, albeit slowly, to aggressive treatment by one of the quinolone family of antibiotics such as levofloxacin (Levaquin) or by rifampin (Rifampicin).
  • Mycoplasmas may respond best to tetracycline, rifampin, and erythromycin.
  • Babesia, the red blood cell parasite, requires different approaches for acute and chronic disease stages. In chronic babesiosis, the form incidentally seen by gastroenterologists, a combination of artemisinin, atovaquone (Mepron) or Malarone, a combination of atovaquone and proguanil hydrochloride, and azithromycin are still drugs of choice (61).
Nutraceuticals And Antimicrobials To Restore The Immune System And The GI Tract

Restoration of gastrointestinal systems damaged by tick-borne diseases can be a formidable task depending on the presentation and severity of symptoms, antimicrobial or other treatments involved, and any side effects thus incurred. The goals are to enhance gut motility or reduce spasticity, remove toxins, improve patients’ general and gut-lining immunity while killing off invaders such as tick-borne microbes, fungi, and other gut opportunists (62,63).

Painful rectal area muscle spasms in Lyme patients usually respond to alprazolam (Xanax) 0.25 mg (1?2 to one tablet) best chewed for quick relief and Natural Calm, a formulary of instant release, water-soluble magnesium. Rectal cramps probably can be prevented most of the time by using the highest tolerated doses of daily magnesium—slow release is the recommended approach but many patients also need the quick-acting powder at bedtime to prevent all kinds of Lyme-caused muscle cramping or spasms.

Dietary intake of all sugars and non-complex carbohydrates should be totally avoided while patients take antibiotics. Probiotics—high quality lactobacillus (2 enteric-coated pearls) once or twice daily or more as needed and bifidus (at least one cap) once daily are essential for gut protection during and following antibiotic treatment. Immunity and energy enhancers such as extract from reishi mushrooms, Cordyceps sinensis (at least one 740 mg capsule daily), Co-Enzyme Q10 (100 mg twice daily), green tea, acetyl L-Carnitine (500 mg at least twice daily), Vitamin B Complex-50 to 100, folate, sublingual B12, magnesium (slow release tablets) taken to tolerance daily, gamma linolenic acid (GLA) as refrigerated Oil of Evening Primrose (1?2 tsp. daily) or borage oil (one 1,000 mg soft gel daily), Omega 3 EFA fish oil (one soft gel 3–4 times per day), selenium (200 mcg one cap daily), alpha lipoic acid (100 mg daily) and a comprehensive multivitamin (59)—all can be of great benefit.

Healing agents will be needed to repair the gut lining and restore functions damaged by Lyme-Bartonella- Mycoplasma infections. That list may include oral preparations of liquid Aloe Vera, Oil of Clove drops, Uncaria spp., anti-fungal tannins, garlic, chewable licorice tabs, betaine, Enteric-coated Oil of Peppermint, Conjugated linoleic acid CLA) (1000 mg twice daily), a-lipoic acid (100 mg one daily), Slippery Elm demulcent capsules (325 mg 1–8 three times daily), and ursodiol bile acid tablets (64). Additionally, in the treatment of SIBO, complete stool analysis with culture and sensitivity of opportunistic bowel pathogens may elucidate the choice of antibiotic. Alternatively, a trial may be undertaken with rifaximin (Xifaxan) 200 mg three times a day until symptoms have cleared (60). Cholestyramine (Questran) may be useful in reducing the recycling neurotoxins produced by tick-borne diseases.

As tick-borne-diseased GI systems and their owners heal, relief will be palpable. Physicians will partner in that gratification as well when previously grimfaced patients move to the healthy side of a bellshaped curve—a graph that would measure the degree to which both gastrointestinal tracts and lives have been restored to functional capacities. These satisfactions satisfactions will be re-experienced when wisely diagnosed and treated Lyme-sick patients will be able to smile broadly at last, knowing in their guts that zesty appetites for life really will be possible again.

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Cone RD. Anatomy and regulation of the central melanocortin system). Nat Neurosci, 2005; 8(5):571-578.
Fallon BA, Nields JA. Lyme disease: a neuropsychiatric illness, Am J Psychiatry, 1994; 151(ll):1571-1583.
Dattwyler RJ, Halperin JJ, Volkman DJ, et al. Treatment of late Lyme borreliosis—randomised comparison of ceftriaxone and penicillin. Lancet, 1988; 1(8596):1191-1194.
Craft JE, Fischer DK, Shimamoto GT, Steere AC. Antigens of Borrelia burgdorferi recognized during Lyme disease. Appearance of a new immunoglobulin M response and expansion of the immunoglobulin G response late in the illness. J Clin Invest, 1986; 78(4):934-939.
Kalish RA, McHugh G, Granquist J, et al. Persistence of immunoglobulin M or immunoglobulin G antibody responses to Borrelia burgdorferi 10–20 years after active Lyme disease. Clin Infect Dis, 2001; 33(6):780-85. rkalish@lifespan.org
Burrascano JJ. Diagnostic hints and treatment guidelines for Lyme and other tick borne illnesses. 2005. http://www.ilads.org [See “Articles and presentations”].
Lauritano EC, Gabrielli M, Lupascu A, et al. Rifaximin dose-finding study for the treatment of small intestinal bacterial overgrowth. Aliment Pharmacol Ther, 2005; 22(1): 31-35.
Sherr VT. Human babesiosis—an unrecorded reality. Absence of formal registry undermines its detection, diagnosis and treatment, suggesting need for immediate mandatory reporting. Med Hypotheses, 2004; 63(4):609-615.
Zaidel O, Lin HC. Uninvited guests: the impact of small intestinal bacterial overgrowth on nutritional status. Practical Gastroenterology, 2003; 27(7):27.
Parrish CR (Ed), Yoshida CM. Nutrition intervention for the patient with gastroparesis: an update. Pract Gastroenterol—Nutrition issues in gastroenterology. 2005; 29(8):29.
Nichols TW, Faass N. Optimal Digestive Health: A Complete Guide. 2005. Healing Arts Press, Rochester, VT.

 

 

 

 

Tick & Mosquito-borne Diseases: Trends in the U.S.

https://www.gideononline.com/2018/05/04/tick-and-mosquito-borne-diseases-trends-in-the-united-states/

May 4th 2018

TICK AND MOSQUITO-BORNE DISEASES: TRENDS IN THE UNITED STATES

The following data are abstracted from Gideon and the Gideon e-book series. [1] Charts were created using an interactive tool driven by over 30,000 base graphs in the program. [2]

Chart 1 contrasts trends for reported incidence of Lyme disease and Rocky Mountain spotted fever (RMSF). Note that while rates of Lyme disease in 2016 are 15-fold those reported in 1987, those of RMSF increased by a factor of seven. The number of fatal cases for both diseases have remained similar in recent years (i.e., the relative case-fatality rate of Lyme disease has decreased)

LymeSF-768x295

Chart 2 summarizes incidence data for a variety of tick-borne and mosquito-borne infections. Note that rates of Ehrlichiosis, Anaplasmosis, Babesiosis, Jamestown Canyon virus infection and Powassan encephalitis have increased since the year 2000. The incidence of LaCrosse encephalitis has decreased, while that of California encephalitis is largely unchanged.

MiscArbo-768x322

Charts 3 and 4 demonstrate that incidence and reported deaths for Western equine encephalitis, Eastern equine encephalitis, St. Louis encephalitis and West Nile fever have changed little in recent years.

Enceph-768x296

References:

Berger S. Infectious Diseases of the United States, 2018. 1,254 pages, 510 graphs, 16,672 references. Gideon e-books, https://www.gideononline.com/ebooks/country/infectious-diseases-of-the-united-states/
Gideon e-Gideon multi-graph tool, https://www.gideononline.com/cases/multi-graphs/

Tick, Mosquito, and Flea Diseases More Than Tripled Since 2004

https://www.washingtonpost.com/news/to-your-health/wp/2018/05/01/diseases-spread-by-ticks-mosquitoes-and-fleas-more-than-tripled-in-the-u-s/?

Diseases spread by ticks, mosquitoes and fleas more than tripled in the U.S. since 2004

By Lena H. Sun, May 1, 2018

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Clockwise from top left: The deer tick, which transmits Lyme disease; the American dog tick, which transmits Rocky Mountain spotted fever and tularemia; the Culex pipiens mosquito, which transmits West Nile virus; and the Aedes aegypti mosquito, which transmits Zika, dengue and chikungunya. (Centers for Disease Control and Prevention)

The warmer weather of spring and summer means the start of tick and mosquito season and the diseases they transmit, including Lyme disease, Rocky Mountain spotted fever, West Nile and Zika.

A new report from the Centers for Disease Control and Prevention has found that illnesses from mosquito, tick and flea bites more than tripled in the United States from 2004 to 2016.

The report, released Tuesday, shows that the number of reported cases of these diseases jumped from 27,388 cases in 2004 to more than 96,000 cases in 2016. The data includes illnesses reported in U.S. states and territories. During that period, more than 640,000 cases of these diseases were reported to the CDC.

Officials say the actual number of people who have become sick is much higher, in part because many infections are not reported or recognized. Some patients may experience mild symptoms and not seek medical attention, and not all diseases were reported for the full 13-year analysis period or from all states and territories. The data “substantially underestimate disease occurrence,” the report said.

For example, recent data from clinical and laboratory diagnoses estimate that Lyme disease infects about 300,000 Americans every year, which is eight to 10 times the number reported in the CDC analysis. In 2016, the number of Lyme disease incidents reported for the United States was 36,429.

As a group, these diseases in the United States are notable for their wide geographical distribution and resistance to control. Only one of the diseases, yellow fever, has a vaccine approved by the Food and Drug Administration.

The increase in disease cases caused by the bite of an infected mosquito, tick or flea in the United States is the result of many factors. Mosquitoes and ticks and the germs they spread are increasing in number and moving into new areas. West Nile virus, for example, was introduced to New York City in 1999 and then spread across the country. As a result of these increases, more people are at risk for infection. Overseas travel and commerce are also increasingly common, and someone infected with a mosquito-borne virus such as Zika in one country can unknowingly transport it home.

Climate change, which experts say can exacerbate many public health threats, also plays an important role, allowing mosquitoes and ticks to thrive in warmer temperatures, said Lyle Petersen, director of the CDC’s Division of Vector-Borne Diseases, which produced the report. Warmer temperatures tend to make mosquitoes get infected faster and also more infectious, he said in an interview. “The amount of virus in the mosquito increases, and when it bites you, more virus gets into you and the chances of you getting infected and becoming sick goes up,” said Petersen, who has gotten sick from West Nile virus.

For ticks, the higher temperatures have allowed them to spread into new areas, allowing them to live farther north, and that puts more people at risk, he said. What’s more, he said, “when the tick season is longer, people are exposed over longer periods.”

But other factors also play a role. The number of Lyme disease cases has increased rapidly because the population of deer — and deer ticks — has skyrocketed. “In New England 100 years ago, there were hardly any trees because they were all cut down for farmland, and the deer had been hunted to extinction,” he said. “All those forests have grown back, the deer population exploded, and the tick populations have also exploded, bringing more disease.”

Most of the pathogens are transmitted to humans from animals, such as rodents or birds, “making them difficult or impossible to eliminate,” the report said.

“The presence of vectors with proven or possible capacity to transmit a wide range of pathogens leaves the United States susceptible to outbreaks of exotic vector-borne diseases,” the report said.

Tick-borne diseases account for more than 75 percent of the reports and occur throughout the continental United States, but they are predominantly in the eastern part of the country and in areas along the Pacific Coast. Diseases spread by mosquitoes, such as dengue fever, chikungunya and Zika, were almost exclusively transmitted in Puerto Rico, American Samoa and the U.S. Virgin Islands. West Nile virus, also spread by mosquitoes, is widespread across the continental United States, where it is the major mosquito-borne disease.

During the time covered in the study, nine new germs spread by the bites from infected mosquitoes and ticks were discovered or introduced in the United States, the report said.

“The pace of emergence of new or obscure vector-borne pathogens through introduction or belated recognition appears to be increasing,” the report said.

They include two previously unknown life-threatening tick-borne viruses — Heartland and Bourbon — that were reported from the Midwest, and the chikungunya and Zika viruses transmitted by mosquitoes that were introduced to Puerto Rico in 2014 and 2015. In the United States, there were also travel-related Zika cases and limited local spread of dengue and Zika viruses in Florida and Texas. The total number of reported Zika cases in the U.S. states and territories in 2016 was 41,680, accounting for the upsurge in disease cases from all vectors for that year.

The responsibility for detecting and responding to diseases spread by vectors such as mosquitoes and ticks is almost all funded locally and operated by local and state health departments. But their resources have been greatly reduced over the years. More than 80 percent of 1,083 local mosquito control organizations in a recent national survey reported some basic deficiencies.

But on a more basic level, Petersen said, more innovative ways are needed to control ticks and mosquitoes. When the first local spread of Zika in the continental United States was reported in Florida in 2016, authorities discovered that the Aedes aegypti mosquitoes that spread the virus there were “resistant to the most common pesticides that we have,” Petersen said.

In some ways, the Zika outbreak allowed state and local authorities to increase their capacity to fight these threats. But much more needs to be done, he said. “This is a long-term problem that’s going to getting worse, and it requires a sustained response over time.”

CDC 2  (Go here for CDC graph)

Lena H. Sun is a national reporter for The Washington Post covering health with a special focus on public health and infectious disease. A longtime reporter at The Post, she has covered the Metro transit system, immigration, education and was the Beijing bureau chief from 1990 to 1994. Follow @bylenasun

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**Comment**

Again, climate change does not affect ticks and Lyme/MSIDS as they are ecoadaptive and can essentially survive just about anywhere:  https://madisonarealymesupportgroup.com/2017/08/14/canadian-tick-expert-climate-change-is-not-behind-lyme-disease/

“Ticks are marvellous eco-adaptors. They will be the last species on the planet. Do you see how silly this theory of climate change is as a way to rationalize what’s happening. It’s all a red herring to divert your attention,” he explains.

https://madisonarealymesupportgroup.com/2018/05/01/cdc-says-tick-mosquito-infections-spreading-rapidly/

But the author, Dr. Lyle R. Petersen, the agency’s director of vector-borne diseases, repeatedly declined to connect the increase to the politically fraught issue of climate change, and the report does not mention either climate change or global warming.
Many other factors are at work, he emphasized, while noting that “the numbers on some of these diseases have gone to astronomical levels.”

CDC Says Tick & Mosquito Infections Spreading Rapidly

https://www.nytimes.com/2018/05/01/health/ticks-mosquitoes-diseases.html

Tick and Mosquito Infections Spreading Rapidly, C.D.C. Finds

More Americans are living in wooded suburbs near deer, which carry the ticks that spread Lyme disease, anaplasmosis, Rocky Mountain spotted fever, babesiosis, rabbit fever and Powassan virus.  Credit Scott Camazine/Science Source

The number of people who get diseases transmitted by mosquito, tick and flea bites has more than tripled in the United States in recent years, federal health officials reported on Tuesday. Since 2004, at least nine such diseases have been newly discovered or introduced into the United States.

Warmer weather is an important cause of the surge in cases reported to the Centers for Disease Control and Prevention, according to the lead author of a study in the agency’s Morbidity and Mortality Weekly Report.

But the author, Dr. Lyle R. Petersen, the agency’s director of vector-borne diseases, repeatedly declined to connect the increase to the politically fraught issue of climate change, and the report does not mention either climate change or global warming.

Many other factors are at work, he emphasized, while noting that “the numbers on some of these diseases have gone to astronomical levels.”

C.D.C. officials called for more support for state and local health departments. Local agencies “are our first line of defense,” said Dr. Robert Redfield, the C.D.C.’s new director. “We must enhance our investment in their ability to fight these diseases.”

 Although state and local health departments get brief infusions of cash during scares like the 2016 Zika epidemic, they are chronically underfunded. A recent survey of mosquito control agencies found that 84 percent needed help with basics like surveillance and pesticide-resistance testing, Dr. Petersen said.

While the C.D.C. did not suggest that Americans drop plans for playing outdoors or lying in hammocks this summer, Dr. Redfield emphasized that everyone — especially children — needed to protect themselves against tick and mosquito bites.

Between 2004 and 2016, about 643,000 cases of 16 insect-borne illnesses were reported to the C.D.C. — 27,000 a year in 2004, rising to 96,000 by 2016. (The year 2004 was chosen as a baseline because the agency began requiring more detailed reporting then.)

The real case numbers were undoubtedly far larger, Dr. Petersen said. For example, the C.D.C. estimates that about 300,000 Americans get Lyme disease each year, but only about 35,000 diagnoses are reported.

The study did not delve into the reasons for the increase, but Dr. Petersen said it was probably caused by many factors, including two related to weather: Ticks thriving in regions previously too cold for them, and hot spells triggering outbreaks of mosquito-borne diseases.

Other factors, he said, include expanded human travel, suburban reforestation and a dearth of new vaccines to stop outbreaks.

In an interview, Dr. Petersen said he was “not under any pressure to say anything or not say anything” about climate change and that he had not been asked to keep mentions of it out of the study.

More jet travel from the tropics means that previously obscure viruses like dengue and Zika are moving long distances rapidly in human blood. (By contrast, malaria and yellow fever are thought to have reached the Americas on slave ships three centuries ago.)

A good example, Dr. Petersen said, was chikungunya, which causes joint pain so severe that it is called “bending-up disease.”

In late 2013, a Southeast Asian strain arrived on the Dutch Caribbean island of St. Maarten, its first appearance in this hemisphere. Within one year, local transmission had occurred everywhere in the Americasexcept Canada, Chile, Peru and Bolivia.

Tickborne diseases, the report found, are rising steadily in the Northeast, the Upper Midwest and California. Ticks spread Lyme disease, anaplasmosisbabesiosis, Rocky Mountain spotted fever, rabbit fever, Powassan virus and other ills, some of them only recently discovered.

Ticks need deer or rodents as their main blood hosts, and those have increased as forests in suburbs have gotten thicker, deer hunting has waned, and rodent predators like foxes have disappeared.

(A century ago, the Northeast had fewer trees than it now does; forests made a comeback as farming shifted west and firewood for heating was replaced by coal, oil and gas.)

Most disease outbreaks related to mosquitoes since 2004 have been in Puerto Rico, the Virgin Islands and American Samoa. But West Nile virus, which arrived in 1999, now appears unpredictably across the country; Dallas, for example, saw a big outbreak in 2012.

For most of these diseases, there are no vaccines and no treatment, so the only way to stop outbreaks is through mosquito control, which is expensive and rarely stops outbreaks. Miami, for instance, was the only city in the Western Hemisphere to halt a Zika outbreak with pesticides.

The only flea-borne disease in the report is plague, the bacterium responsible for the medieval Black Death. It remains rare but persistent: Between two and 17 cases were reported from 2004 to 2016, mostly in the Southwest. The infection can be cured with antibiotics.

Dr. Nicholas Watts, a global health specialist at University College London and co-author of a major 2017 report on climate change and health, said warmer weather is spreading disease in many wealthy countries, not just the United States.

In Britain, he said, tick diseases are expanding as summers lengthen, and malaria is becoming more common in the northern reaches of Australia.

But Paul Reiter, a medical entomologist at the Pasteur Institute, has argued that some environmentalists exaggerate the disease threats posed by climate change.

The 2003-2014 period fell during what he described as “a pause” in global warming, although the notion of a long trend having pauses is disputed.

Also, disease-transmission dynamics are complicated, and driven by more than temperature. For example, transmission of West Nile virus requires that certain birds be present, too.

In the Dust Bowl years of the 1930s, St. Louis encephalitis, a related virus, surged, “and it looked like climate issues were involved,” Dr. Reiter said. But the surge turned out to depend more on varying hot-cold and wet-dry spells and the interplay of two different mosquito species. St. Louis encephalitis virtually disappeared, weather notwithstanding.

“It’s a complicated, multidimensional system,” he said.

A. Marm Kilpatrick, a disease ecologist at the University of California, Santa Cruz, said many factors beside hot weather were at work, including “a hump-shaped relationship between temperature and transmission potential.”

Warm weather helps mosquitoes and ticks breed and transmit disease faster, he explained. But after a certain point, the hotter and drier it gets, the more quickly the pests die. So disease transmission to humans peaks somewhere between mildly warm and hellishly hot weather.

Experts also pointed out that the increase in reports of spreading disease may have resulted partially from more testing.

Lyme disease made family doctors begin to suspect tick bites in patients with fevers. Laboratories began looking for different pathogens, especially in patients who did not have Lyme. That led to the discovery of previously unknown diseases.

**Comment**
I for one appreciate Peterson’s refusal to push the climate change model.  Finally, someone who refuses to fall for the bait.
While mosquitos are more dependent upon weather for survival, ticks are appearing nearly indestructible, but fire does kill them:  https://madisonarealymesupportgroup.com/2018/04/03/fire-good-news-for-tick-reduction/
Excerpt:
Ottmar Edenhofer, lead author of the IPCC’s fourth summary report released in 2007 candidly expressed the priority. Speaking in 2010, he advised, “One has to free oneself from the illusion that international climate policy is environmental policy. Instead, climate change policy is about how we redistribute de facto the world’s wealth.”