Archive for the ‘research’ Category

Lyme & Pregnancy

https://lymediseaseassociation.org/blogs/lda-guest-blogs/sue-faber-rn-bscn-guest-blog-lyme-pregnancy/

Sue Faber, RN, BScN Guest Blog – Lyme & Pregnancy

SueFaberbyStef&Ethan

Sue Faber is a Registered Nurse (BScN) and Co-founder and President of LymeHope, a not-for-profit organization in Canada.  Sue’s specific area of expertise and research is in the compilation and analysis of the literature that exists on maternal-fetal transmission of Lyme and congenital Lyme borreliosis; amplifying, supporting and powering urgent research initiatives to investigate this alternate mode of transmission with the ultimate goal of opening new doors to ensure that children and families affected are able to access appropriate care, treatment, and support.

In 2018, Sue co-authored a nursing resolution for the Registered Nurses Association of Ontario – based on the needs and voiced concerns of Canadians  with Lyme disease coast to coast.  ‘Patient First Treatment for Ontarians with Lyme Disease’– which was passed at the annual 2018 AGM in Toronto.    Sue was awarded the RNAO HUB Fellowship award in 2019.  Sue is honored to be an advisor to the newly formed advocacy group Mothers Against Lyme and has spoken at various conferences on maternal-fetal transmission of Lyme including ILADS (2019), LymeMIND (2019, 2020), NE Ohio Lyme Symposium,  Lyme WNY Symposium and Target Lyme (Ontario).   Sue is honored to collaborate with colleagues from McMaster Midwifery Research Centre in new ground-breaking research on Lyme and Pregnancy.

Sue is firmly committed to transparent and collaborative partnerships with governments, academia, research institutions, healthcare colleagues, and industry stakeholders, to collectively identify challenges, knowledge gaps, and fresh opportunities, to examine and develop transformative health policy, best practice guidelines, and research priorities, which are anchored in patient voice, values, and priorities.

Lyme and Pregnancy:  A Hopeful and Tangible Path Forward

My History  I’ll never forget the day at the end of January 2017 that I received an official letter from my local public health department.  The letter was in response to my requests for a meeting with senior management, to alert them to positive test results for Lyme disease for both myself and one of my daughters and to discuss my concerns that I may have transmitted this infection to her in-utero.   A year earlier I had tested two-tier positive for a European strain of Lyme in Canada – after years of complex multi-system medical symptoms which were fully investigated by multiple medical specialists, without any definitive answers.   I had no recall of a tick bite or an erythema migrans rash and thus tickborne disease had never been considered as a differential diagnosis by my medical team.  As a trained ER nurse, I knew nothing about Lyme disease.

It was a stroke of luck that my primary doctor decided to test me for Lyme after every other possible diagnosis had been ruled out.  The test was positive. My eventual diagnosis of late-stage disseminated Lyme disease by a Canadian infectious disease physician was initially a relief as I now had a name to my illness and what I thought would be a defined path to recovery and healing.  Little did I know that this diagnosis would be the start of a journey into advocacy – one which I have likened to climbing up a steep mountain – without a map or guide – trusting and hoping that one day, I’d make it to the top.

As a Registered Nurse I am extensively trained in evidence-based practice and problem-based learning which has put me in good stead after receiving my Lyme disease diagnosis. I started delving into the published literature on Lyme disease and soon discovered the multi-system complexities of Lyme disease with some researchers identifying striking similarities to syphilis. [i] [ii]  Soon thereafter, I discovered the first published case report that Lyme disease could be transmitted from a mother to her baby in-utero in a paper titled ‘Maternal-fetal transmission of the Lyme disease spirochete, Borrelia burgdorferi’.[iii]  My heart started to race, I was nauseated and tears started to fall down my cheeks – could this mean that my precious daughters were also impacted?   Like most other aspects of Lyme, I would soon learn that the issue of maternal-fetal transmission was very controversial.

The onset of my symptoms was gradual and predated all of my pregnancies including one first trimester pregnancy loss.  All my daughters had struggled with varying complex medical issues from birth which included jaundice, severe colic, high fevers, myocarditis, atypical seizures, severe OCD, night terrors, anxiety, joint pain, learning difficulties, abdominal pain, strange rashes, speech delay, severe headaches, frequent pneumonia and double vision.  Each child had different clinical manifestations with one common theme – there were no definitive answers as to why.  Could tickborne infection transmitted in-utero be contributing to their illnesses?

My infectious disease physician who was treating me at the time never mentioned that Lyme could be transmitted in pregnancy. Later after I asked, they acknowledged that yes, there were case reports.  One of my daughters also tested two-tier positive in Canada for a European strain of Lyme disease – except unlike me who had lived in Asia and travelled throughout Europe where European strains of Lyme are predominant, she hadn’t.  We both had positive tests for a European strain of Lyme disease and this was why I had asked for a meeting with my local public health unit.  I was hoping they would be interested in investigating the possibility of maternal-fetal transmission.

Instead, the letter I received back was disheartening and disconcerting.  I was advised that despite having tested positive in Canada, using two-tier criteria, both our cases would not be counted in Canadian surveillance statistics because our symptoms were ‘non-specific’ and we didn’t have a ‘clear onset’ or ‘reliable travel history.’  Furthermore I was informed that they had completed ‘a significant amount of research and no scientific evidence to support congenital Lyme in the scientific literature was found.’

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Starting a Non-Profit: LymeHope  By this time, I had read more primary research papers reporting transmission of Lyme from mother to baby in-utero [iv] [v] including a report issued by the World Health Organization[vi] and Health and Welfare Canada[vii] clearly documenting the risk of this alternate mode of transmission and possible adverse pregnancy outcomes.  Shortly thereafter, myself and colleague Jennifer Kravis co-founded the Canadian not-for-profit organization LymeHope.[viii]

In February 2017, we started a ‘Ticking Lyme Bomb’ petition[ix] which now has over 86,600 signatures and over 17,000 personal comments from across Canada.  We also arranged meetings with Federal politicians from all parties, organized a bi-partisan round-table in Ottawa on Lyme disease,[x] testified at a Parliamentary Health Committee hearing[xi] and met with senior executives, scientists and officials from the Public Health Agency of Canada and Health Canada.  We were invited to meet with then Federal Minister of Health[xii] and then leader of the Conservative Party of Canada – each time drawing attention to the many complex, serious issues faced by Lyme sufferers across Canada including the documented risk of maternal-fetal transmission.  Each meeting represented another step ‘up the mountain’ with goals of identifying and initiating meaningful, collaborative solutions including innovative research – anchored in meaningful patient engagement and triaged by patient priorities.

In 2018 I co-authored a resolution on Lyme disease which was passed by the Registered Nurses Association of Ontario (RNAO) membership titled: ‘Patient First Treatment for Ontarians with Lyme Disease.’ [xiii]  This resolution highlights the multi-faceted issues faced by Canadian Lyme sufferers and the RNAO would later feature our resolution in an article[xiv] in their Registered Nurse Journal. I am so grateful for the ongoing support of the RNAO and especially the brilliant leadership of Dr. Doris Grinspun who leads the organization.  I’ll never forget her addressing the RNAO membership at the 2018 Annual General Meeting in Toronto – this was the meeting in which our resolution was later being presented for vote.  She shared in general terms that ‘disruption’  may be necessary when confronting obstacles which stand in the way of Canadians accessing appropriate health care.   As she spoke, tears flowed down my cheeks as I recalled the numerous letters, petition comments, personal testimonies and cries for help from my fellow Canadians – adults[xv] and children[xvi] alike – struggling to access appropriate care[xvii] and treatment for Lyme disease within Canada.[xviii]

I personally didn’t want to be labeled as a ‘disruptor’ but rather a bridge-builder and peace-maker.  I so badly wanted meaningful, sustainable change for Canadians with Lyme disease.  However, I have since learned that ‘disruption’ is sometimes necessary if it leads to re-calibration, innovation and opens new opportunities for critical thinking, trust-building, identifying strategic research initiatives and initiates forward momentum.  Many issues around Lyme disease urgently need re-investigation including adequate testing, treatment and alternate modes of transmission.  New research continues to emerge which challenges the status quo, such as the persistence of the Lyme spirochete despite antibiotic treatment.[xix]  [xx]  This is an issue which advocates, clinicians and scientists have identified for decades and is anchored in findings from hundreds of peer-reviewed papers.[xxi]  What is most important is that new research on Lyme disease must be patient relevant.  In a 2016 CMAJ editorial article by Kristen Patrick[xxii], she states, ‘For patient-relevant research to be meaningful, patient and public engagement in research cannot comprise a token lay person on a research ethics review board.  Patients and their caregivers must be involved in decision-making at all steps in the research process, from design, to choice of primary and secondary outcomes, through dissemination and implementation.’

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National Media Coverage  In 2019, CTV National News[xxiii] highlighted our advocacy work regarding maternal-fetal transmission of Lyme disease and the importance of initiating new research collaborations on this important, under-studied issue.  This national media coverage also highlighted a systematic review on gestational Lyme[xxiv] which had been authored by scientists from both the Public Health Agency of Canada and CDC.  This review included a meta-analysis which identified a significant difference in the frequency of adverse outcomes between treated and untreated pregnancies affected by Lyme disease.

In 2020, an advocate shared with me a discovery that three Federal Canadian agencies including: Health Canada[xxv], Public Health Agency of Canada[xxvi] and Occupational Health and Safety Canada,[xxvii] had historically acknowledged the risk of adverse outcomes associated with Lyme and pregnancy and/or maternal fetal transmission of Lyme on their respective websites.  In all three cases, over a period of several years, this precautionary guidance was subsequently removed.   For years,  we had been advocating for acknowledgement of these issues which had already been publicly communicated!

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20 Years of Research Has Not Overturned Published Risks & Adverse Outcomes  As there has been no new research in over 20 years which has negated, questioned or overturned the published findings of earlier investigators, these precautionary statements should be clearly communicated.  This is highlighted by the tenants of the Precautionary Principle and clearly communicated in a Health Canada Framework on Managing Health Risks which states: [xxviii] ‘A key feature of managing health risks is that decisions are often made in the presence of considerable scientific uncertainty. A precautionary approach to decision making emphasizes the need to take timely and appropriately preventative action, even in the absence of a full scientific demonstration of cause and effect.’ Both the public and healthcare practitioners should be made aware of these documented risks of adverse pregnancy outcomes and of in-utero transmission of Lyme itself, even if considered rare.  I have asked Canadian Public Health Agency officials for rationale as to why this guidance was removed and continue to await an evidence-based response.

I trust that the Public Health Agency of Canada and Health Canada will follow the CDC[xxix] and NIH[xxx] in updating their public guidance on Lyme and pregnancy to acknowledge that YES, Lyme can be transmitted in utero.  With this simple, evidence-based acknowledgement as a starting point – new doors WILL open for urgent, multi-disciplinary research to better understand this alternate mode of transmission and open new avenues for families and children impacted to receive the medical care and support they need and deserve.

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So where do we go from here?  There is action, HOPE and meaningful forward momentum!  In Canada, a brand new research project on Lyme and Pregnancy was initiated in the fall of 2020 by McMaster University Midwifery Research Centre[xxxi] and remains open for participants from the US, Canada and globally, I am thankful to part of this research team.  The Canadian Association of Schools of Nursing (CASN) has just released free, open access, online resources including online learning modules for nurses and other professionals working with clients, communities and populations facing climate-driven infectious diseases.[xxxii]  This innovative resource acknowledges both the risk of maternal-fetal transmission of Lyme disease and potential for adverse pregnancy outcomes and also includes a section titled: ‘Living with Climate-Driven Vector-Borne Disease’ which highlights patient advocacy efforts, patient stories and patient centered resources.[xxxiii]  I am so proud that nurses are listening, engaging and paving an inclusive way forward which respects, empowers and includes patients.

In the US, the Cohen Foundation[xxxiv] continues to lead with generous philanthropy for Lyme disease research, innovation and collaboration.  For the last two years I have been honored to represent LymeHope as a panelist in the  LymeMind Conference[xxxv], speaking directly to the issue of maternal-fetal transmission of Lyme[xxxvi] and alongside other experts, bringing this important, understudied alternate mode of transmission back into the forefront of academia and government.  I recently spoke at a webinar hosted by Project Lyme and Mothers Against Lyme Disease [xxxvii] where I shared an overview of the literature on Lyme and Pregnancy[xxxviii]  and also shared several research recommendations for a path forward.

The recent US HHS announcement of LymeX, in partnership with the Steven and Alexandra Cohen Foundation[xxxix] is an extraordinary step forward in bringing together diverse stakeholders including government, non-profits, academia, advocates, patients and industry to ‘accelerate Lyme innovation.’  A recent Notice of Special Interest by the NIH for improving outcomes for maternal health[xl] included ‘development and validation of diagnostics for gestational Lyme disease, which can adversely impact maternal health and pregnancy outcomes.’  All of these things are indicators of positive forward momentum and provide me with renewed Hope that new science, innovation and collaboration will lead the way and open new doors.

Four years after starting Lyme advocacy I believe that we are collectively reaching a Lyme tipping point and patients and advocates are being respected, welcomed and heard.  I admit, there have been times I have been discouraged, exhausted, frustrated and even wanted to step away from leadership.  I’m so thankful for many who encourage me to keep going.  Advocacy in a field as contentious as Lyme disease can be a lonely, misunderstood place.  Pushing for change can be met with skepticism and silence.   If we continue to take one step and another, anchored in evidence, leaning on scientific inquiry and partnered with respectful dialogue and meaningful collaboration – we will make it up to the top of the mountain.

I really look forward to the view from the top of the mountain and one day reaching the pinnacle and planting a flag which represents the hard work and dedication of advocates, patients, scientists, researchers, not-for-profits, clinicians and government officials – all determined to make a lasting difference on behalf of Lyme sufferers . For all the families impacted by Lyme disease and those concerned that in-utero transmission may be a factor in their child’s illness – don’t give up!  I wish I could give you a big Mama-bear hug – we must keep speaking out and sharing our stories, concerns and ideas for solutions.  Our collective voice is being heard and acknowledged and I truly believe that help is on the way.

Footnotes

[i] Hercogova J, Vanousova D. Syphilis and borreliosis during pregnancy. Dermatol Ther. 2008 May-Jun;21(3):205-9. doi: 10.1111/j.1529-8019.2008.00192.x. PMID: 18564251.

[ii] Miklossy, J. (2008). Biology and Neuropathology of Dementia in Syphilis and Lyme Disease. Handbook of Clinical Neurology, 825–844. doi:10.1016/s0072-9752(07)01272-9

[iii] Schlesinger PA, Duray PH, Burke BA, Steere AC, Stillman MT. Maternal-fetal transmission of the Lyme disease spirochete, Borrelia burgdorferi. Ann Intern Med. 1985 Jul;103(1):67-8. doi: 10.7326/0003-4819-103-1-67. PMID: 4003991.

[iv] Weber K, Bratzke HJ, Neubert U, Wilske B, Duray PH. Borrelia burgdorferi in a newborn despite oral penicillin for Lyme borreliosis during pregnancy. Pediatr Infect Dis J. 1988 Apr;7(4):286-9. doi: 10.1097/00006454-198804000-00010. PMID: 3130607.

[v] MacDonald AB. Gestational Lyme borreliosis. Implications for the fetus. Rheum Dis Clin North Am. 1989 Nov;15(4):657-77. PMID: 2685924.

[vi] World Health Organization, Geneva. Weekly Epidemiological Record. No. 39. 26 September 1986. Page 297-304.

[vii] Health and Welfare Canada. Lyme Disease in Canada. Canada Dis Wkly Report, June 4, 1988.

[viii] LymeHope:  https://www.lymehope.ca/

[ix] Ticking Lyme Bomb Petition: https://www.change.org/p/minister-philpott-ticking-lyme-bomb-in-canada-fix-canada-s-lyme-action-plan-now

[x] MP Round Table and MP engagement.  https://www.lymehope.ca/advocacy-updates/update-on-mp-round-table-and-mp-engagement-regarding-lyme-disease-in-canada

[xi] Standing Committee on Health, Tuesday, June 6th, 2017.  Evidence. https://www.ourcommons.ca/DocumentViewer/en/42-1/HESA/meeting-59/evidence

[xii] Kingston, Anne.  How the Impatient Patient is Disrupting Medicine.  Macleans Magazine,  Oct, 2017. https://www.macleans.ca/society/health/how-the-new-impatient-patient-is-disrupting-medicine/

[xiii]https://myrnao.ca/sites/default/files/attached_files/Resolution%202018%20Final%20from%20AGM%20with%20amendments%20for%20website.pdf

[xiv]Registered Nurses Association of Ontario. ‘Ticking Lyme Bomb, May/June 2018. https://rnao.ca/sites/rnao-ca/files/RNJ-MayJune2018_ticking_lyme_bomb.pdf

[xv]Patient Testimonies at 2016 Federal Framework on Lyme Disease. https://www.canada.ca/en/public-health/services/diseases/lyme-disease/federal-framework-lyme-disease-conference/audio-recordings/public-forum-1.html

[xvi] Stimers, Daniel. Lyme Disease MP Roundtable Address, May 2018.  https://www.youtube.com/watch?v=Td-Vw-V7kGU&feature=youtu.be

[xvii] Gaudet EM, Gould ON, Lloyd V.  Parenting When Children Have Lyme Disease:  Fear, Frustration, Advocacy.  Healthcare 2019, 7(3), 95: https://doi.org/10.3390/healthcare7030095

[xviii] Boudreau CR, Lloyd VK, Gould ON. Motivations and Experiences of Canadians Seeking Treatment for Lyme Disease Outside of the Conventional Canadian Health-Care System. J Patient Exp. 2018;5(2):120-126. doi:10.1177/2374373517736385

[xix] Sapi E, Kasliwala RS, Ismail H, Torres JP, Oldakowski M, Markland S, Gaur G, Melillo A, Eisendle K, Liegner KB, Libien J, Goldman JE. The Long-Term Persistence of Borrelia burgdorferi Antigens and DNA in the Tissues of a Patient with Lyme Disease. Antibiotics (Basel). 2019 Oct 11;8(4):183. doi: 10.3390/antibiotics8040183. PMID: 31614557; PMCID: PMC6963883.

[xx] https://news.tulane.edu/pr/study-finds-evidence-persistent-lyme-infection-brain-despite-aggressive-antibiotic-therapy; https://www.frontiersin.org/articles/10.3389/fneur.2021.628045/full

[xxi]Peer-Reviewed Evidence of Persistence of Lyme Disease Spirochete Borrelia burgdorferi and Tick-Borne Diseases https://www.ilads.org/wp-content/uploads/2018/07/CLDList-ILADS.pdf

[xxii] Patrick, K. Realizing the Vision of Patient Relevant Research. CMAJ, Vol 188, Issue 15, Oct 2016. https://www.cmaj.ca/content/188/15/1063.full

[xxiii] CTV National News.  Mothers on a mission to prove Lyme disease can be passed to an unborn child. https://www.ctvnews.ca/health/mothers-on-a-mission-to-prove-lyme-disease-can-be-passed-to-unborn-child-1.4261403

[xxiv] Waddell LA, Greig J, Lindsay LR, Hinckley AF, Ogden NH (2018) A systematic review on the impact of gestational Lyme disease in humans on the fetus and newborn. PLoS ONE 13(11): e0207067. https://doi.org/10.1371/journal.pone.0207067

[xxv] Health Canada. (October 2006) https://web.archive.org/web/20061018070947/http:/www.hc-sc.gc.ca/iyh-vsv/diseases-maladies/lyme_e.html

[xxvi] Public Health Agency of Canada (March 2009)

https://web.archive.org/web/20090307034620/http:/www.phac-aspc.gc.ca/id-mi/lyme-fs-eng.php

[xxvii]Canadian Centre for Occupational Health and Safety (May 1999)

https://web.archive.org/web/19990508215316/http:/www.ccohs.ca/oshanswers/diseases/lyme.html

[xxviii] Health Canada Decision making framework identifying, assessing and managing health risks, August 1, 2000: https://www.canada.ca/en/health-canada/corporate/about-health-canada/reports-publications/health-products-food-branch/health-canada-decision-making-framework-identifying-assessing-managing-health-risks.html#a13

[xxix] CDC. Pregnancy and Lyme Disease: https://www.cdc.gov/lyme/resources/toolkit/factsheets/Pregnancy-and-Lyme-Disease-508.pdf

[xxx] Lyme Disease, the Facts, the Challenge. NIH Publication No. 08-7045.  2008.

https://permanent.fdlp.gov/lps81243/LymeDisease.pdf

[xxxi] McMaster University Midwifery Research Centre.  ‘Health Outcomes of people with Lyme disease during pregnancy.’

English Version:  https://obsgynresearch.mcmaster.ca/surveys/index.php?s=MN9CCXDTW9

French Version: https://obsgynresearch.mcmaster.ca/surveys/?s=KWJT9K9TR9

[xxxii] Canadian Association of Schools of Nursing. Nursing and Climate Driven Vector Borne Disease.  https://vbd.casn.ca/

[xxxiii] Canadian Association of Schools of Nursing. Living with Climate Driven Vector Borne Disease. https://vbd.casn.ca/index.php/resources/living-with-climate-driven-vector-borne-disease/

[xxxiv] Cohen Lyme and Tickborne Disease Initiative:  https://www.steveandalex.org/ticks-suck/

[xxxv] LymeMIND: https://lymemind.org/

[xxxvi] 5th Annual LymeMIND Virtual Conference 2020: Mothers and Children Panel. https://www.youtube.com/watch?v=gevtoKkzS2Y&t=8s

[xxxvii] https://lymediseaseassociation.org/about-lyme/pregnancy-and-lyme/lyme-disease-pregnancy-research-opportunities-webinar/

[xxxviii] https://lymediseaseassociation.org/wp-content/uploads/2021/05/SueFaber_Maternal-Fetal-Transmission-of-Lyme-Research-Gaps-and-Next-Steps_April-29-2021_Webinar.pdf

[xxxix] LymeX initiative: https://www.hhs.gov/cto/initiatives/innovation-and-partnerships/lyme-innovation/lymex/index.html

[xl] Notice of Special Interest (NOSI): Small Business Initiatives for Innovative Diagnostic Technology for Improving Outcomes for Maternal Health

https://grants.nih.gov/grants/guide/notice-files/NOT-EB-21-001.html

Category:

Lyme, Pregnancy, research, Uncategorized

How to Protect Yourself From Ticks With Permethrin-Treated Clothing

https://danielcameronmd.com/permethrin-treated-clothing-causes-hot-foot-effect-ticks/

How to protect yourself from ticks with Permethrin-treated clothing

how-to-protect-yourself-from-ticks

Several studies have found that wearing permethrin-treated clothing can reduce the risk of tick bites. But very few studies have looked at the behavior of a tick when it comes in contact with permethrin-treated clothing. Does it climb onto the insecticide-soaked textile or avoid it entirely? Does permethrin actually kill ticks?

By Dr. Cameron

As more individuals begin to venture outside with warmer weather, there are often concerns over how to protect yourself from ticks. Researchers have examined not only the effectiveness of various repellents and protective clothing but also the behavior of individuals who are more likely to encounter ticks.

Researchers in Indiana looked at the protective measures used by recreational hikers in their state. Surprisingly, they found that only 9.5% of hikers used a tick repellent, even fewer (3.4%) wore protective clothing and only 2 individuals “indicated that they took a shower post-recreation and used that activity to search for tick bites.” [1]

Ultrasonic device

Meanwhile, investigators in Australia recently studied the efficacy of ultrasonic pest repellent devices against the Australian paralysis tick, Ixodes holocyclus. “As more than 80% of the ticks were not repelled within the confined area, this level of repellency is clearly insufficient to provide adequate protection from a potential tick bite,” they conclude. [2]

Permethrin-treated clothing

Several studies have looked at Permethrin-treated clothing in repelling ticks.  Sullivan et al. recruited state and county park employees from North Carolina to wear long-lasting Permethrin-impregnated (LLPI) clothing. The authors found that the clothing “retained Permethrin and bioactivity against ticks after three months of use in real-world conditions.” [3]

A study in Rhode Island aimed to provide insight as to how to protect yourself from ticks by examining Permethrin-treated footwear. The authors found that people wearing sneakers and socks treated with Permethrin were 73.6 times less likely to have a tick bite than those wearing untreated footwear. [4]

Researchers found “people wearing sneakers and socks treated with Permethrin were 73.6 times less likely to have a tick bite than those wearing untreated footwear.”

Meanwhile, another study explored the behavior of ticks when they encounter Permethrin-treated clothing. How do ticks react? Using a model that mimicked a pant leg or the arm of a long-sleeved shirt, scientists studied the behavior and fate of ticks when exposed to Permethrin-treated clothing. [5]

“Ticks approaching a textile impregnated with a strong non-contact spatial repellent (DEET) very rarely made physical contact with the treated textile,” according to Eisen and colleagues from the Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases at the Centers for Disease Control and Prevention. [4]

Tick behavior when exposed to Permethrin

However, Permethrin-treated textiles did not repel ticks without contact, as seen with DEET. In fact, the majority (88%) of nymphal ticks chose to move onto Permethrin-treated textile versus DEET-treated textile.

After coming in contact with the treated clothing, the ticks dislodged through a “hot-foot” effect.

“Ticks readily walked onto a Permethrin-treated textile…. but laboratory-reared ticks became visibly agitated, displaying a hot-foot effect, and escaped contact with the Permethrin-treated textile by tumbling downwards until they dislodged themselves completely from a textile-covered assay card.”

Unfortunately, field-collected ticks were hardier than laboratory-reared ticks and able to sustain longer contact with the treated textile. The authors postulated that field-collected ticks have been exposed to highly variable temperatures and humidity conditions which may result in slower absorption of Permethrin.

“However, by 1 and 24 hours post-exposure very few ticks displayed normal movement, thus presenting minimal risk to bite, regardless of whether they were reared in the laboratory or collected in the field.”

“Contact with Permethrin-treated textiles negatively impacts the vigor and behavior of nymphal ticks for >24 hours,” according to Eisen, “with outcomes ranging from complete lack of movement to impaired movement and unwillingness of ticks displaying normal movement to ascend onto a human finger.”

One day after exposure, a majority of ticks were completely motionless. The remaining ticks were able to recover. “Ticks having recovered normal movement 1 day after exposure in our study most often ascended onto a finger when given the opportunity (and presumably also were capable of biting),” Eisen points out.

“In a real-life scenario, prolonged periods of time where ticks having fallen off a human host after contact with Permethrin-treated textile are unable to move will undoubtedly increase the risk of mortality due to desiccation or predation.”

“A scenario more difficult to address in a bioassay is when a tick makes initial contact with bare skin and subsequently approaches loose-fitting summer-weight Permethrin treated garments, such as shorts or a T-shirt,” states Eisen.

“In this case, the tick may walk underneath the treated textile and be contacted primarily from the dorsal side as the person moves and the clothing comes in and out of contact with the tick and the person’s skin.”

Permethrin is acutely toxic in high doses. The authors did not address the potential toxicity of Permethrin to humans. “Acute signs of toxicity to the central nervous system include incoordination, ataxia, hyperactivity, convulsions, and finally prostration, paralysis, and death,” according to a review by the National Research Council (US) Subcommittee to Review Permethrin Toxicity from Military Uniforms. [6]

Note: Users have been advised not to inhale Permethrin when treating clothes and not to apply Permethrin to the skin.

Article Updated: June 1, 2021

Related Articles:

Only a minority of children with Lyme disease recall a tick bite

Are Lyme disease prevention methods really working?

How concerned are people about tick bites and tick-borne diseases?

References:
  1. Anderson KR, Blekking J, Omodior O. Tick trails: the role of online recreational trail reviews in identifying risk factors and behavioral recommendations associated with tick encounters in Indiana. BMC Public Health. 2021;21(1):908. Published 2021 May 13. doi:10.1186/s12889-021-10940-4
  2. Panthawong A, Doggett SL, Chareonviriyaphap T. The Efficacy of Ultrasonic Pest Repellent Devices against the Australian Paralysis Tick, Ixodes holocyclus (Acari: Ixodidae). Insects. 2021;12(5):400. Published 2021 Apr 30. doi:10.3390/insects12050400
  3. Sullivan KM, Poffley A, Funkhouser S, et al. Bioabsorption and effectiveness of long-lasting permethrin-treated uniforms over three months among North Carolina outdoor workers. Parasit Vectors. 2019;12(1):52. Published 2019 Jan 23. doi:10.1186/s13071-019-3314-1
  4. Tick Encounter. https://www.tickencounter.org/prevention/permethrin
  5. Eisen L, Rose D, Prose R, et al. Bioassays to evaluate non-contact spatial repellency, contact irritancy, and acute toxicity of permethrin-treated clothing against nymphal Ixodes scapularis ticks. Ticks Tick Borne Dis. 2017.
  6. Health Effects of Permethrin-Impregnated Army Battle-Dress Uniforms (1994) by National Research Council. 1994. Washington, DC: The National Academies Press. https://doi.org/10.17226/9274. at https://www.nap.edu/catalog/9274/health-effects-of-permethrin-impregnated-army-battle-dress-uniforms. Last accessed 8/12/17.

For more:

Category:

Prevention, research, Ticks, Treatment

Inflammation From Peripheral Organs to the Brain: How Does Systemic Inflammation Cause Neuroinflammation?

https://www.frontiersin.org/articles/10.3389/fnagi.2022.903455/full

Inflammation From Peripheral Organs to the Brain: How Does Systemic Inflammation Cause Neuroinflammation?

Yuanjie Sun1, Yoshihisa Koyama1,2* and Shoichi Shimada1,2
  • 1Department of Neuroscience and Cell Biology, Osaka University Graduate School of Medicine, Osaka, Japan
  • 2Addiction Research Unit, Osaka Psychiatric Research Center, Osaka Psychiatric Medical Center, Osaka, Japan

As inflammation in the brain contributes to several neurological and psychiatric diseases, the cause of neuroinflammation is being widely studied. The causes of neuroinflammation can be roughly divided into the following domains: viral infection, autoimmune disease, inflammation from peripheral organs, mental stress, metabolic disorders, and lifestyle. In particular, the effects of neuroinflammation caused by inflammation of peripheral organs have yet unclear mechanisms. Many diseases, such as gastrointestinal inflammation, chronic obstructive pulmonary disease, rheumatoid arthritis, dermatitis, chronic fatigue syndrome, or myalgic encephalomyelitis (CFS/ME), trigger neuroinflammation through several pathways. The mechanisms of action for peripheral inflammation-induced neuroinflammation include disruption of the blood-brain barrier, activation of glial cells associated with systemic immune activation, and effects on autonomic nerves via the organ-brain axis. In this review, we consider previous studies on the relationship between systemic inflammation and neuroinflammation, focusing on the brain regions susceptible to inflammation.

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**Comment**

Lyme/MSIDS also causes peripheral nervous system inflammation.  Once borrelia enter the cerebrospinal fluid (CSF), they elicit an inflammatory response.   This study states about 15% of patients with Lyme disease develop peripheral and central nervous system involvement, although I suspect it’s much, much higher.  It also states inflammation plays a causal role in the array of neurologic changes associated with Lyme disease.

Category:

Inflammation, research

UW-Stevens Point Researchers Use DNA to Link Lyme Disease, Infected Ticks

https://www.uwsp.edu/news/uptick-uwsp-researchers-use-dna-to-link-lyme-disease-infected-ticks/

Uptick: UWSP researchers use DNA to link Lyme disease, infected ticks

May 26, 2022
Molecular biology students use white flags to collect deer ticks for research on pathogens they carry.

Diane Caporale has collected thousands of ticks during her career as a biology professor and researcher. Since moving to Wisconsin 1999, she has had help. Nearly 500 students in her molecular biology courses at UW-Stevens Point have collected ticks each year from 2000-2020.

Tick surveillance is useful for predicting human disease risk. What’s especially significant about Caporale’s research is its duration. This is the first continuous surveillance of tick-borne pathogens for two decades in the nation. “It’s been quite an enormous, exciting project,” she said.

“It was started in 2000 — before I was born — so it’s kind of crazy the amount of time this has been going on,” said Cody Korth, a student researcher in her lab.

Caporale first began collecting ticks in the Northeast, where she grew up.

When she was asked to develop a molecular biology course at UW-Stevens Point, it was an opportunity to broaden her research into tick-borne diseases. During the first week of October each year since 2000, her molecular biology students collect blacklegged ticks (Ixodes scapularis). It gives students the opportunity to use DNA as a tool to forecast the incidence of disease.

Blacklegged (or deer) ticks carry three pathogens that can cause human disease. Caporale’s students analyzed all three: Borrelia burgdorferi, the bacterium responsible for Lyme disease; Anaplasma phagocytophilum, a bacterium that causes Anaplasmosis; and Babesia microti, a protozoan that causes Babesiosis. The latter presents with malaria-like symptoms, while the others have flu-like symptoms.

Caporale and her students conducted research in what is known as a microgeographic region that is also convenient to campus: the Schmeeckle Reserve trail around Lake Joanis. They use white flannel flags to collect the ticks – a total of 2,008 in 21 years.

The students extracted DNA and analyzed it for the presence of three pathogens that cause human diseases, then sequenced the DNA to learn what percentage of ticks were infected with one, two or all three pathogens, said McKenzi Fernholz, who took molecular biology in 2019.

Cody Korth and McKenzi Fernholz are student researchers in Biology Professor Diane Caporale’s lab at UW-Stevens Point, analyzing 20 years of data on ticks.
Cody Korth and McKenzi Fernholz are student researchers in Biology Professor Diane Caporale’s lab at UW-Stevens Point, analyzing 20 years of data on ticks.

They found each pathogen became more prevalent over time. In 2000, Borrelia burgdorferi, which causes Lyme disease, was found in just the northwest segment of the trail. Seven years later, it reached detectable levels around the perimeter of the lake. The number of ticks with Borrelia peaked in 2015, which was also a year when a high number of ticks were infected with more than one pathogen.

Anaplasma was first detected in 2004 in the southeast segment. It reached detectable levels all around the lake within four years. Babesia was first detected in 2007 in the southwest region. It took eight years to reach detectable levels around the lake.

The highest number of infected ticks – 56%  — was recorded in 2014.

An increase in the number of infected ticks in one year was related to an increase in tick-borne illness, notably Lyme disease, the following year, Korth said. The students compared their data with human disease statistics from Portage County and state public health units.

“If it’s increasing here, it’s increasing elsewhere,” said Caporale, who has also researched ticks in the Kettle Moraine area, Colfax and Whitewater. Overall, cases of Lyme disease oscillate, she said.

Caporale’s students also monitored rainfall each June, average winter temperature in December through February and snow depth for conditions that favor ticks. More eggs hatched when rainfall was higher the prior year, and more snow increased the chance of winter survival, Caporale said.

Tick numbers around Lake Joanis dropped significantly in 2017. That summer, strong winds downed numerous trees on the north end of the trail. When trees were removed, so was refuge for white-footed mice, the main reservoir for these pathogens. Also, invasive buckthorn – a preferred vegetation for ticks – was removed or treated with herbicide. In fall 2021 no ticks were found along the lake trail where extensive restoration occurred. Students did find ticks around the Schmeeckle Reserve Visitor Center carrying Borrelia and Anaplasma.

As independent study researchers in Caporale’s lab, Fernholz and Korth analyzed all the sequenced DNA data collected over the 21 years and determined trends in tick infection rates. They developed graphs and charts to display the results and presented them at the College of Letters and Science research symposium earlier this month. The results will be submitted for publication this summer.

It’s interesting to observe the correlation between infection rates in ticks and humans, Korth said, which means that tick surveillance may be able to predict Lyme disease trends in the following year. “It’s worth the time to take the samples every year because when we compared our tick infection rates to the cases of Lyme disease in humans in Portage County, we saw a one-year difference consistently with pathogen emergence.”

Korth, a biochemistry major from Marshfield, enjoys doing research independently in the lab and said it’s helped him develop critical thinking and problem-solving skills outside of the classroom. “Research is why I came to UW-Stevens Point. I was pleased with how easy it was to get involved.”

​Doing undergraduate research with Caporale helped Fernholz, of West Salem, realize she wants to pursue a career in research. “It allowed me to get a sense of what a career in molecular biology research would be like.” A biochemistry and Spanish major, she graduated in May.

Helping students learn research techniques and be inspired to pursue research careers is a proud legacy for Caporale, who will retire in August.

For more:

Category:

Anaplasmosis, Babesia, Lyme, research, Ticks

Study: Public Health vs Reality Regarding TBDs

https://www.mdpi.com/2227-9032/10/7/1178

Neurological Pain, Psychological Symptoms, and Diagnostic Struggles among Patients with Tick-Borne Diseases

by Sarah P. Maxwell1,*, Chris Brooks2, Connie L. McNeely3 and Kevin C. Thomas2
1School of Economic, Political & Policy Sciences, University of Texas at Dallas, Richardson, TX 75080, USA
2Laboratory for Human Neurobiology, Boston University School of Medicine, Boston, MA 02118, USA
3Center for Science, Technology, and Innovation Policy, George Mason University, Fairfax, VA 22030, USA
*Author to whom correspondence should be addressed.
Academic Editor: Raphael B. Stricker
Healthcare 2022, 10(7), 1178; https://doi.org/10.3390/healthcare10071178
Received: 3 June 2022 / Revised: 20 June 2022 / Accepted: 21 June 2022 / Published: 23 June 2022
(This article belongs to the Section Preventive Medicine)
Abstract

Public health reports contain limited information regarding the psychological and neurological symptoms of tick-borne diseases (TBDs). Employing a mixed-method approach, this analysis triangulates three sources of symptomology and provides a comparison of official public health information, case reports, medical literature, and the self-reported symptoms of patients with Lyme disease and other TBDs.
  • Out of the fifteen neuropsychiatric symptoms reported in the medical literature for common TBDs, headaches and fatigue and/or malaise are the only two symptoms fully recognized by public health officials.
  • Lyme disease is the least recognized by public health officials for presenting with neuropsychiatric symptoms
  • Only headaches and fatigue are recognized as overlapping symptoms of Lyme disease
  • Comparisons from a patient symptoms survey indicate that self-reports of TBDs and the associated symptoms align with medical and case reports.
    • anxiety
    • depression
    • panic attacks
    • hallucinations
    • delusions
    • pain—ranging from headaches to neck stiffness and arthritis—are common among patients who report a TBD diagnosis.

Given the multitude of non-specific patient symptoms, and the number and range of neuropsychiatric presentations that do not align with public health guidance, this study indicates the need for a revised approach to TBD diagnosis and for improved communication from official public health sources regarding the wide range of associated symptoms. View Full-Text

Category:

Lyme, Psychological Aspects, research