Archive for the ‘research’ Category

STARI & Lyme Disease

https://danielcameronmd.com/southern-tick-associated-rash-illness-stari-and-lyme-disease/

Southern Tick-Associated Rash Illness (STARI) and Lyme disease

Welcome to another Inside Lyme Podcast with your host Dr. Daniel Cameron. In this episode, Dr. Cameron will be discussing the case of a 63-year-old woman who was diagnosed with Southern Tick-Associated Rash Illness (STARI).

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In their article “Southern Tick-Associated Rash Illness: Florida’s Lyme Disease” Abdelmaseih and colleagues describe the woman’s case, highlighting the differences between STARI and Lyme disease.¹

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The patient was bitten by a lone-star tick on her right leg while camping in Gainesville, Florida. She noticed a pruritic target erythematous lesion after removing the tick.

Two weeks later she was evaluated and reported having a persistent fever, headache, and diffuse myalgias for 4 days following the tick bite. On presentation, she had a fever of 100.5 F and a tachycardia of 127 BPM, low white count, anemia, low platelet count and elevated liver function tests.

Fortunately, the patient’s symptoms resolved with a 14-day course of doxycycline.

The authors discuss the differences and similarities of STARI and Lyme disease:

  • “The associated rash is similar if not indistinguishable from Lyme disease erythema migrans, with lymphocytic dermal infiltrate.”
  • Both the diagnosis of STARI and Lyme disease are based on clinical evidence. “At the present time, there is no approved diagnostic modality to identify STARI; thus, the diagnosis must be made on clinical evidence including erythema migrans and tick exposure.”
  • The diagnosis of STARI and Lyme disease often rely on geography. “Diagnosis usually relies on geographic association (STARI from central Texas and Oklahoma eastward across the southern states and along the Atlantic coast as far north as Maine, versus Lyme disease in northeast, mid-Atlantic, and upper mid-west).”

However, the authors did not address reports documenting the presence of lone-star ticks in the Northeast, mid-Atlantic, and upper Midwest and of deer ticks in the South.

It has been assumed that STARI does not have any long-term sequelae.

“A recent study has suggested that STARI is transmitted by the lone-star tick Amblyoma americanum; however, it may take some time before all the necessary data can be collected, since much is still unknown about STARI.”

The treatment of STARI is also uncertain. “STARI is often treated as Lyme disease with doxycycline twice daily for 14 days; however, there is no approved treatment yet.”

The authors conclude, “STARI is an emerging Lyme-like illness that causes the characteristic rash, erythema migrans. The current incidence of STARI remains unknown as it is not nationally reportable.”

The following questions are addressed in this Podcast episode:

  1. What is STARI?
  2. Are there differences between STARI and Lyme disease rashes?
  3. Are there differences in the ticks?
  4. How is STARI diagnosed, compared to Lyme disease?
  5. What clinical evidence does one need to diagnose STARI?
  6. What are the consequences if Lyme disease or co-infections is overlooked?
  7. What do we know about ticks in the South?

Thanks for listening to another Inside Lyme Podcast. Please remember that the advice given is general and not intended as specific advice to any particular patient. If you require specific advice, please seek that advice from an experienced professional.

Inside Lyme Podcast Series

This Inside Lyme case series will be discussed on my Facebook page and made available on podcast and YouTube.  As always, it is your likes, comments, and shares that help spread the word about this series and our work. If you can, please leave a review on iTunes or wherever else you get your podcasts.

References:
  1. Abdelmaseih R, Ashraf B, Abdelmasih R, Dunn S, Nasser H. Southern Tick-Associated Rash Illness: Florida’s Lyme Disease Variant. Cureus. May 28 2021;13(5):e15306. doi:10.7759/cureus.15306

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**Comment**

When I speak with experts they state STARI IS LYME.  Southerners have fought to be heard.  Patients have been turned away undiagnosed and untreated and are told, “You can’t have Lyme because Lyme doesn’t exist here,” which of course is asinine.  Until the birds quit flying, rodents quit crawling, lizards and humans quit moving, and transporting ticks everywhere they go, ticks will continue to travel.

Category:

Lyme, research, Testing, Ticks, Treatment

High Cost of Treating Lyme Arthritis in Children With Surgery

https://danielcameronmd.com/high-cost-lyme-arthritis-children-surgery/

High cost of treating Lyme arthritis in children with surgery

lyme arthritis in children being treated by doctor wrapping knee

A study by Tout and colleagues investigated how operative management impacts the clinical course and health care costs of pediatric patients hospitalized with Lyme arthritis.

“We hypothesized that surgery does not improve clinical outcomes for children with Lyme arthritis but does increase resource utilization and cost,” the authors wrote.

By Dr. Daniel Cameron

In their article “The Impact of Operative Intervention in Pediatric Lyme Arthritis,” Tout et al. described 149 children admitted to a tertiary care children’s hospital in Pennsylvania who had been diagnosed with Lyme arthritis between 2008 and 2018.¹

All of the children met the CDC case definition, had Lyme arthritis, and were culture negative. The average age of the children was 6.7 years with a range of 4.5 to 9.7 years.

Out of the 149 patients, 47 underwent orthopedic intervention.

The study found:

  • 1 in 3 children underwent surgery
  • 2 out of 3 underwent open surgery
  • The remaining children underwent arthroscopic surgery. One child underwent arthroscopic surgery followed by open surgery. And, just over 50% of the children underwent a synovectomy.

Two children were re-admitted for surgical complications — one for wound dehiscence and the other for “persistence of arthritis in the setting of inappropriate initial antibiotic therapy (first-generation cephalosporin).”

“This retrospective cohort study demonstrates that operative intervention for Lyme arthritis does not improve outcomes, though it does increase cost and health care utilization.”

“One child was admitted due to persistent symptoms despite appropriate antibiotic therapy (doxycycline) for therapeutic arthrocentesis,” Tout wrote.

Cost and Outcome for Operative Intervention

The length of stay for children undergoing surgery was longer (3.17 vs. 1.40 days) and the cost was higher ($27,850 vs. $10,716) than children who did not have surgery. However, the outcome was the same for both groups (98% for each).

The two children who did not experience symptom resolution were diagnosed with a rheumatologic condition (e.g., juvenile idiopathic arthritis).

READ MORE: Preventing unnecessary surgery for children with Lyme arthritis

The authors were not able to definitively comment on why each child was admitted and why a subset underwent surgery.  One reason may have been the turnaround time for Lyme disease testing, as this was “typically 3 to 8 days, which is generally considered too long to wait if there was a concern for a septic joint.”

Authors’ Conclusion

“This retrospective cohort study demonstrates that operative intervention for Lyme arthritis does not improve outcomes, though it does increase cost and health care utilization.”

The authors emphasized the need for “rapid Lyme diagnostic testing in Lyme-endemic areas, the importance of increased provider awareness of the expanding distribution of Lyme disease when assessing acute undifferentiated arthritis, and the need for additional research in elucidating factors that can distinguish Lyme arthritis from septic arthritis.”

Editor’s perspective: The authors did not address the long-term cost of surgical intervention after open knee surgery and/or synovectomy.  I always examine children diagnosed with juvenile idiopathic arthritis for evidence of a persistent tick-borne infection.

Successful treatment for Lyme arthritis after knee surgery
Diagnosing Lyme arthritis of the hip in children
Will steroid injections help children with lyme arthritis of the knee?

References:
  1. Tout AR, McClincy M, Anderson A, Nowalk A, Campfield BT. The Impact of Operative Intervention in Pediatric Lyme Arthritis. J Pediatr Orthop. 2021 Nov-Dec 01;41(10):e911-e916. doi: 10.1097/BPO.0000000000001959. PMID: 34483307.

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**Comment**

Of course the obvious issue this study doesn’t address is persistent/chronic infection which often improves or eradicates symptoms with appropriate antimicrobial treatment. Researchers/medical professionals continue to view this through a myopic, simplistic lens and until that changes patients will not obtain help from mainstream and will continue to have to hunt for experienced Lyme literate professionals.

Regarding knee arthritis, please also see: https://madisonarealymesupportgroup.com/2018/05/09/rheumatological-presentation-of-bartonella-koehlerae-henselae-a-case-report-chiropractors-please-read/

I suspect Bartonella plays a major role in my knee/joint popping, which started when I became infected and has persisted to this day. I’ve struggled with a Baker’s cyst in my knee now for 6 months. I’ve tried many things over the years for inflammation/pain including DMSO & MSM, systemic enzymes, Class IV lasers, and biomats utilizing PEMF & red light therapy. The cyst has me pounding the pavement once more for possible treatments and relief. Here’s what I’ve discovered so far:

  • http://www.doctoryourself.com/index.html  This wonderful website by Dr. Saul that is chuck full of conditions and remedies. When you click on the arthritis links on the far right hand side, you will discover that juicing (getting micronutrients already broken down), sprouting (more living micronutrients), and vitamins D, A, C, and niacinamide have miraculously helped those with severe arthritis.  I’ve begun all of these modalities, some of which I was already doing, but now am spreading the niacinamide doses throughout the day which is making a big difference.

It has been found in the treatment of joint dysfunction that the manner in which the daily dosage of niacinamide is divided has an important bearing on the the therapeutic results achieved; e.g., 300 mg niacinamide given three times daily (900 mg/24 hours) is inferior in its therapeutic action to 150 mg niacinamide administered every 3 hours for 6 daily doses (900 mg/24 hours).

I have found this to be the case as well.

I’ve already had noticable results with the juicing, sprouting, and vitamin C/niacinamide supplements.  Pain has diminished by over half and cyst is shrinking, allowing a greater range of movement.

 

 

 

 

 

 

 

 

Category:

Lyme, research

Longitudinal Analysis Reveals High Prevalence of EBV Associated With MS

https://www.science.org/doi/10.1126/science.abj8222?

Longitudinal analysis reveals high prevalence of Epstein-Barr virus associated with multiple sclerosis

Kjetil Bjornevik, Marianna Cortese, Brian C. Healy, Jens Kuhle, Michael J. Mina, Yumei Leng, Stephen J. Elledge, David W. Niebuhr, Ann I. Scher[…], Alberto Ascherio
Science • 13 Jan 2022 • First Release • DOI: 10.1126/science.abj8222
Abstract
Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system of unknown etiology. We tested the hypothesis that MS is caused by Epstein-Barr virus (EBV) in a cohort comprising more than 10 million young adults on active duty in the US military, 955 of whom were diagnosed with MS during their period of service. Risk of MS increased 32-fold after infection with EBV but was not increased after infection with other viruses, including the similarly transmitted cytomegalovirus. Serum levels of neurofilament light chain, a biomarker of neuroaxonal degeneration, increased only after EBV seroconversion. These findings cannot be explained by any known risk factor for MS and suggest EBV as the leading cause of MS.
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http://  Approx. 2 Min
DR. LUCIJA TOMLIJENOVIC: ADVERSE REACTION STUDIES – ONE MORE GIRL EXCERPTS

May, 2013

Independent reports have shown the Gardasil vaccine has been known to cause MS.

For More:

Category:

research, Viruses

AONM Newsletter: Long COVID, Mitochondrial Test, PANS Conference, Book Reviews, Upcoming Events

AONM-Newsletter-January-2022 (1)

Please read in it entirety.  A few teasers:

  • University of Washington reports that almost a third go onto suffer persistent COVID symptoms.  They found that the S1 segment of the spike protein is recoverable from human monocytes in PASC patients up to 15 months after an acute infection compared to controls.
  • The Royal Society’s SET-C group describe a wide range of symptoms that overlap with M.E.
  • Since its introduction in 2006, Seahorse XF technology has been used in over 7,000 peer-reviewed publications and AONM now offers a range of tests of mitochondrial and cellular performance using Seahorse as well as extracellular flux analysis with luciferase assays. AONM will be holding a series of webinars in the first quarter of 2022 explaining the tests.
  • Virtual conference on autoimmune encephalopathy (PANDS/PANDAS) takes place on Feb. 9-11.
  • Early bird tickets if you do not wish to be awarded CPD points are available here hopehealingknowledge.com for $69 for all three days, until January 17th, after which the price rises to $99. For medical professionals (with CPD included), the early bird until Jan. 17th is $325, and $375 afterwards:  https://inevent.com/en/FoundationforTotalRecovery-1625240794/94-FoundationforTotalRecovery-1639074062/purchase.php  You can view the complete agenda and lineup of  incredible speakers by clicking here.
  • The books Toxic Legacy and Chronic are reviewed.
  • A list of upcoming events is at the end of the newsletter.

Category:

Activism, PANS, research, Testing, Viruses

Case Report: Powassan Virus

https://danielcameronmd.com/case-report-powassan-virus-meningoencephalitis/

Case report: Powassan virus meningoencephalitis

death-powassan-virus

Powassan virus (POWV) is a rare tick-borne infection which can lead to encephalitis, meningitis, and meningoencephalitis in humans. In this case report, the authors describe a 62-year-old man who developed “rapid deterioration of mental status including profound expressive aphasia and required intubation and high-dose steroids.” The man later tested positive for the Powassan virus. [1]

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The patient presented to the hospital with fevers, headaches, fatigue, and a history of night sweats, according to the case report, “Powassan Meningoencephalitis: A Case Report Highlighting Diagnosis and Management.”

He had a history of chronic lymphocytic leukemia (CLL), Lyme disease, and reactive arthritis. He was not on any medication for Lyme disease or CLL. And had been treated for a year with methotrexatem, which had been stopped one week before admission.

The patient’s spinal tap was consistent with meningitis or encephalitis. The patient was treated with empiric antibiotics (vancomycin and ceftriaxone) and an antiviral (acyclovir). The diagnosis of CLL was confirmed but there was no evidence of bulky lymphadenopathy. His MRI showed mild generalized cerebral and cerebellar atrophy and a few small nonspecific hyperintensities.

Symptoms quickly worsen

“The patient’s mental status deteriorated over the hospital day 1-2 and he developed profound expressive aphasia and ataxia,” wrote the authors. “He was transferred to the ICU and intubated for airway protection on hospital day 6.”

CSF serologies returned positive for Powassan virus (POWV), which supported a diagnosis of Powassan meningoencephalitis.

“He was given a five-day course of IV methylprednisolone with gradual improvement in neurologic status,” wrote the authors. “The infectious diseases service was consulted and recommended no further treatment in the in-patient setting.”

The man was discharged to a skilled nursing facility after being hospitalized for 34 days.

On follow-up, he demonstrated significant left-sided ataxia, expressive aphasia, spasticity of both upper extremities and occasional pain in the left upper extremity.

He underwent physical and occupational therapy and was treated with gabapentin, baclofen 10 mg TID, botulinum toxin (Botox) injections, and received a baclofen pump.

“Neurologic symptoms seen in POWV include altered mental status, seizures, headache, memory impairment, blurry vision, diplopia, nystagmus, upward gaze palsy, dizziness, spastic and flaccid paralysis, and positive Babinski sign,” according to the authors.

Other findings have included upper and lower motor neuron involvement, focal deficits, such as hemiplegia and hemiparesis in the setting of intracranial bleeding, and neuropsychiatric symptoms such as anhedonia [the inability to feel pleasure] and depression.

The authors also highlighted the potential for long-term sequelae. “Long-term sequelae are variable, ranging from severe, disabling residual deficits to a return to near baseline function with a normal neurologic exam.”

“While rare, infections with POWV carry a 10-15% fatality rate, with some reports exceeding 20%,” the authors wrote.

No treatment for Powassan virus

There is no vaccine or treatment for POWV.

“Physicians should be prepared to recognize the common presenting symptoms of POWV, including fever, headache, confusion, encephalopathy, and neurological symptoms, and to provide both aggressive supportive care in the initial phases and appropriate management of long-term neurologic sequelae,” wrote the authors.

“It is important to have a broad differential diagnosis when evaluating patients presenting with symptoms of neuroinvasive infection. While rare, as demonstrated by our patient’s case, infection with POWV may lead to rapid clinical deterioration and long-term neurologic deficits.”

Editor’s perspective: I have not seen a case of Powassan virus meningoencephalitis at my practice. These cases would typically be evaluated in the ER or hospital. I refer my patients with significant neurologic findings to an ER, hospital, infectious disease specialist or neurologist.

I am concerned when doctors overlook other tick-borne infections during a POWV evaluation. An 18-year-old man believed to have the Powassan virus later died from Lyme disease.² Since Lyme disease tests were negative, the young man did not receive antibiotic treatment. An autopsy confirmed the presence of spirochetes in multiple body organs.

Related Articles:

What is Powassan virus?
Can Powassan virus cause encephalitis or other neurologic damage?
Maine woman dies from deer tick virus

References:
  1. Pach JJ, Zubair AS, Traner C, Falcone GJ, Dewey JJ. Powassan Meningoencephalitis: A Case Report Highlighting Diagnosis and Management. Cureus. Jul 2021;13(7):e16592. doi:10.7759/cureus.16592
  2. Young man dies from Lyme carditis. https://danielcameronmd.com/lyme-disease-podcast-17-year-old-young-man-dies-from-lyme-carditis/ Last accessed 10/10/21.

For more:

According to this study by Coppe Labs, right here in Wisconsin, 85% of Powassan infected ticks come from Northern Wisconsin. Another study by Coppe showed that when 95 patients were tested for suspected tick-borne disease, 66% showed evidence of current or prior Lyme infection.  Of those patients, 17% had serologic evidence of acute POWV infection, demonstrating that POWV may affect more patients than we know.

Category:

research, Treatment, Viruses