Archive for the ‘research’ Category

Anaplasmosis Found for the First Time in Asian Long-horned Tick and Anaplasmosis in the Brain

https://onlinelibrary.wiley.com/doi/10.1111/zph.12901

First detection of human pathogenic variant of Anaplasma phagocytophilum in field-collected Haemaphysalis longicornis, Pennsylvania, USA

First published: 27 December 2021
https://doi.org/10.1111/zph.12901

Abstract

The Asian longhorned tick, Haemaphysalis longicornis, an invasive species associated with human pathogens, has spread rapidly across the eastern USA. Questing H. longicornis ticks recovered from active surveillance conducted from 1 May to 6 September, 2019 throughout Pennsylvania were tested for rickettsial pathogens. Of 265 ticks tested by PCR for pathogens, 4 (1.5%) were positive for Anaplasma phagocytophilum. Sequence analysis of the 16S rRNA gene confirmed two positives as A. phagocytophilum–human agent variant. This is the first reported detection of A. phagocytophilum–human pathogenic strain DNA in exotic H. longicornis collected in the USA.

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Please remember that the Asian Long-horned tick reproduces by cloning and can cause severe infestations.  It is spreading across the U.S.

https://danielcameronmd.com/anaplasmosis-in-the-brain/  Podcast Here

Anaplasmosis in the brain

anaplasmosis-brain

Welcome to another Inside Lyme Podcast with your host Dr. Daniel Cameron. In this episode, Dr. Cameron will be discussing the case of a 64-year-old woman with central nervous system involvement of the brain.

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The case was first described by Mullholand and colleagues in the British Medical Journal in a paper entitled “Central nervous system involvement of anaplasmosis.” 1

A 64-year-old woman was hospitalized with a 24-hour history of confusion and lethargy. The following morning, her lethargy had worsened and she developed subjective fever, mild headache, nausea, vomiting and increased confusion, according to the authors.

The physical exam showed “aphasia and memory lapse of the past 24 hours and an engorged tick behind the knee.”

Her tests revealed leptomeningeal enhancement and bilateral frontal lobe subarachnoid hemorrhage (SAH).

Note: Leptomeninges are the two innermost layers of tissue that cover the brain and spinal cord. The causes of leptomeningeal enhancement can include infectious meningitis of bacterial, fungal, and viral etiology; autoimmune and inflammatory diseases such as encephalitis, vasculitis, and sarcoidosis; trauma; and metastatic disease.1

Anaplasmosis testing is positive

The Anaplasmosis PCR test of the serum was positive. A spinal tap was not performed.

The authors point out that the time from transmission to symptom onset in anaplasmosis can be within 24 hours. And typically, neurologic involvement is seen more often in Lyme disease and Ehrlichia.

Tests for Lyme disease or other co-infections were negative. However, the authors acknowledged that these tests might not be positive in early disease.

Treatment for Anaplasmosis

The woman was treated with doxycycline and discharged home.

“However, the patient was again hospitalised 6 weeks later due to persistent headache, word finding difficulties, memory loss and generalised fatigue,” wrote the authors.

“Repeat MRI and MRA of the brain showed significant increase in the FLAIR hyperintensity and hypointensity involving bilateral frontal, parietal occipital lobes, consistent with SAH with persistent left MCA anterior division vasospasm.”

She was discharged without retreatment and speech therapy was arranged.

“The patient has had marked improvement and returned to her cognitive baseline 3 months later,” wrote the authors.

The following questions are addressed in this Podcast episode:

  1. What is Anaplasmosis?
  2. What is leptomeningeal enhancement?
  3. What is subarachnoid haemorrhage (SAH)?
  4. How quickly can tick-borne infections be transmitted?
  5. How long does it take for Anaplasmosis symptoms to appear?
  6. What other treatments are there for Anaplasmosis?

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. Mullholand JB, Tolman N, De Obaldia A, et al. Central nervous system involvement of anaplasmosis. BMJ Case Reports CP 2021;14:e243665.

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For more:

Category:

Anaplasmosis, Inflammation, research, Treatment

Forty Years of Evidence on the Efficacy & Safety of Oral & Injectable Antibiotics for Treating Lyme Disease in Adults & Children: A Network Meta-Analysis

https://journals.asm.org/doi/10.1128/Spectrum.00761-21

Forty Years of Evidence on the Efficacy and Safety of Oral and Injectable Antibiotics for Treating Lyme Disease of Adults and Children: A Network Meta-Analysis

Authors: Jiaru Yang, Shiyuan Wen, Jing Kong, Peng Yue, Wenjing Cao, Xin Xu, Yu Zhang, Jingjing Chen, Meixiao Liu, Yuxin Fan, Lisha Luo, Taigui Chen, Lianbao Li, Bingxue Li, Yan Dong, Suyi Luo, Guozhong Zhou, Aihua Liu liuaihua@kmmu.edu.cn, Fukai Bao https://orcid.org/0000-0003-2652-6660 baofukai@kmmu.edu.cnAuthors Info & Affiliations
DOI: https://doi.org/10.1128/Spectrum.00761-21
Volume 9, Number 3
22 December 2021
ABSTRACT
Lyme disease (LD) is a heavy public health burden. The most common manifestations of LD include erythema migrans (EM), Lyme neuroborreliosis (LNB), and Lyme arthritis (LA). The efficacy and safety of antibiotics for treating LD is still controversial. Thus, we performed a network meta-analysis (NMA) to obtain more data and tried to solve this problem. We searched studies in the databases of Embase and PubMed from the date of their establishments until 22 April 2021. Odds ratios (ORs) were used to assess dichotomous outcomes. A total of 31 randomized controlled trials (RCTs) involving 2,748 patients and 11 antibiotics were included.
  • Oral amoxicillin (1.5 g/day)
  • oral azithromycin (0.5 g/day)
  • injectable ceftriaxone
  • injectable cefotaxime were effective for treating LD (range of ORs, 1.02 to 1,610.43)
  • Cefuroxime and penicillin were safe for treating LD (range of ORs, 0.027 to 0.98)
  • Amoxicillin was effective for treating EM (range of ORs, 1.18 to 25.66)
  • Based on the results, we thought oral amoxicillin (1.5 g/day), oral azithromycin (0.5 g/day), injectable ceftriaxone, and injectable cefotaxime were effective for treating LD
  • Cefuroxime and penicillin were safe for treating LD.
  • Amoxicillin was effective for treating EM.
  • We did not observe evidence proving the advantage of doxycycline in efficacy and safety for treating LD, LA, LNB, and EM of children or adults.
  • We did not have sufficient data to prove the significant difference of efficacy for treating LA and LNB in adults and LD in children, the significant difference of safety of oral drugs for treating LD, and the significant difference of safety of drugs for treating EM.

Category:

Lyme, research, Treatment

On Disulfiram for Lyme? Good News: It May Also Protect Against Severe COVID Study Says

https://insight.jci.org/articles/view/157342

Disulfiram inhibits neutrophil extracellular trap formation protecting rodents from acute lung injury and SARS-CoV-2 infection

Published February 8, 2022 –

 

Abstract

Severe acute lung injury has few treatment options and a high mortality rate. Upon injury, neutrophils infiltrate the lungs and form neutrophil extracellular traps (NETs), damaging the lungs and driving an exacerbated immune response. Unfortunately, no drug preventing NET formation has completed clinical development. Here, we report that disulfiram —an FDA-approved drug for alcohol use disorder— dramatically reduced NETs, increased survival, improved blood oxygenation, and reduced lung edema in a transfusion-related acute lung injury (TRALI) mouse model. We then tested whether disulfiram could confer protection in the context of SARS-CoV-2 infection, as NETs are elevated in patients with severe COVID-19. In SARS-CoV-2-infected golden hamsters, disulfiram reduced NETs and perivascular fibrosis in the lungs, and downregulated innate immune and complement/coagulation pathways, suggesting that it could be beneficial for COVID-19 patients.

In conclusion, an existing FDA-approved drug can block NET formation and improve disease course in two rodent models of lung injury for which treatment options are limited.

Disulfiram has previously been associated in observational studies with lowering the risk of infection from SARS-CoV-2, and one study of the drug in human patients with moderate COVID-19 was completed in 2021, but results haven’t yet been posted. A separate trial testing the drug against COVID-19 in humans has not yet been completed.

For more:

Other drugs approved for different uses have shown some success against COVID-19, including ivermectin, hydroxychloroquine, and fluvoxamine, though U.S. health officials primarily recommend ones such as paxlovid that are specifically approved.

Category:

Lyme, research, Treatment, Viruses

Lumbar Puncture Helpful for Diagnosing Lyme Neuroborreliosis?

https://danielcameronmd.com/lumbar-puncture-helpful-for-diagnosing-lyme-neuroborreliosis/

Lumbar puncture helpful for diagnosing Lyme neuroborreliosis?

patient getting lumbar puncture to diagnose lyme neuroborreliosis

Welcome to another Inside Lyme Podcast with your host Dr. Daniel Cameron. In this episode, Dr. Cameron will be discussing a case which examines the diagnostic value of a lumbar puncture in Lyme neuroborreliosis.

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The case was first described by Portales-Castillo and colleagues in the journal Cureus in a paper entitled “To Lumbar Puncture or Not to Lumbar Puncture.” The authors presented a case of “early disseminated Lyme neuroborreliosis with manifestations of facial palsy and painful radiculoneuritis as determined by clinical and serological criteria.”¹

A 61-year-old woman was admitted to the hospital with an inability to close her left eye and an odd sensation on part of her face. She presented with erythematous raised circled rash and swelling on the base of the index finger of her right hand.

She thought she might have been bitten by a spider two days prior and was therefore treated with cephalexin for a presumed cellulitis.

Three weeks later, she started to develop posterior dull neck pain, along with bilateral arm pain and arm weakness. Her symptoms progressed to the point where she could no longer comb her hair.

CLICK BELOW TO WATCH VIDEO DISCUSSION OF THE CASE

“The pain later became associated with progressive arm weakness, which continued to progress over the following three weeks up to the point where she could not comb her hair,” the authors wrote.

The woman then developed Bell’s palsy. A Lyme disease IgM Western blot test was positive, consistent with acute Lyme disease.

“Our case aimed to highlight the controversy on the diagnostic utility of cerebrospinal fluid (CSF) analysis in certain presentations of [Lyme neuroborreliosis].”

A spinal tap was recommended but not performed. “She politely declined as she wondered if the treatment decision would be altered by the results of an invasive procedure,” wrote the authors.

Instead, she was treated empirically for Lyme disease.

“After discussion with the neurology and infectious disease consultants, the diagnosis of early disseminated Lyme neuroborreliosis manifesting as painful radiculoneuritis, motor weakness, and facial nerve palsy (so-called Bannwarth syndrome) was considered a strong possibility based on her clinical presentation and serologic criteria,” wrote the authors.

The woman’s Bell’s palsy and pain resolved after 4 weeks of treatment with doxycycline, prednisone (60 mg for 5 days) and eye drops. In addition, there was marked improvement in her weakness.

At her two-week follow-up appointment, the woman reported having a “complete resolution of her facial weakness and pain along with marked improvement in her weakness, which did not recur after successful course completion,” the authors wrote.

Spinal tap controversy

“[Lyme neuroborreliosis] remains a challenging diagnosis and often warrants spinal fluid analysis, particularly in the context of acute meningitis,” wrote the authors. “However, the ultimate decision to obtain a lumbar puncture (LP) in such patients with facial palsy and peripheral neurological symptoms remains controversial.”

Guidelines are divided over whether to take an individualized approach for spinal fluid analysis or relying on spinal fluid analysis for the diagnosis.

Cerebral spinal fluid (CSF) tests are not reliable, given that the increase in the number of white cells in the CSF (called pleocytosis) can be raised from other illnesses.

A finding of an elevated B. burgdorferi antibody in the spinal fluid has been helpful. However, the ration of CSF: serum antibodies should be 1.3 or higher. In other words, the CSF antibodies must be 30% higher than the serum antibodies. In some cases, the CSF B. burgdorferi polymerase chain reaction (PCR) may be positive.

The sensitivity of the spinal tests can be low. Only 1 in 27 patients with neurologic Lyme disease had a pleocytosis and that was only 7 cells. One other patient with neurologic Lyme had CSF antibodies but the ratio was only 1. Other studies have shown higher sensitivities. Other CSF tests have been examined including the CXCL13 chemokine biomarker in CSF.

“To Lumbar Puncture or Not to Lumbar Puncture”

A spinal tap may be important to rule out alternative diagnoses. “The need for an LP in suspected cases of LNB remains a clinical decision that needs to be tailored to the specific clinical situation, favored when diagnostic uncertainty is present, and potentially spared when the clinical suspicion for LNB is high,” wrote the authors.

The following questions are addressed in this Podcast episode:

1. What is neurologic Lyme disease?
2. What were the neurologic findings for this patient?
3. What is Bannwarth syndrome?
4. What is a spinal tap?
5. Why is a spinal tap useful and what is the accuracy?
6. What are the findings in a spinal tap of someone with neurologic Lyme disease?
7. What are problems with reliability of the test?
8. Do you discuss “To Lumbar Puncture or Not to Lumbar Puncture” with your patients?

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. Portales-Castillo C A, Said M (September 14, 2021) To Lumbar Puncture or Not to Lumbar Puncture: A Case of Lyme Neuroborreliosis. Cureus 13(9): e17970. doi:10.7759/cureus.17970

Category:

Lyme, research, Testing, Treatment

Babesia & Lyme: Missed Diagnosis Can Have “Dire Consequences”

https://danielcameronmd.com/co-infections-babesiosis-lyme-disease-dire-consequences/

Co-infections Babesiosis and Lyme disease, missed diagnosis can have “dire consequences”

Woman being examined for co-infections with Babesiosis and Lyme disease

In a recently published article, “A Case of Tick Bite Induced Babesiosis With Lyme Disease,” Bhesania and colleagues [1] describe a 72-year-old woman with atypical symptoms, who was found to have co-infections with Lyme disease and Babesiosis.

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The woman had a three-week history of a fever (maximum temperature, 104 F], chills, nausea, and productive cough of yellow sputum.

Six weeks prior to her onset of symptoms, the woman had been vacationing in Connecticut, an area endemic for Lyme disease. She reported having 2 tick bites during the previous year.

Her examination and tests were normal, except for pancytopenia and manual peripheral blood smear showed Babesia microti in her red blood cells. Initially, 1.7% red blood cells were infected with Babesia microti.

“The unique feature of our case was the atypical presentation with no rash and no joint pain, but the patient had only constitutional symptoms like weakness and occasional fever…”

“The patient was started on azithromycin, atovaquone for Babesiosis, and doxycycline to treat Lyme disease with initial suspicion of co-infection and a plan to deescalate once the Lyme disease was ruled out,” the authors state.

She was discharged home with the combination of the three oral treatments.

Dire consequences with delayed treatment

“Cases with severe hemolytic anemia, disseminated intravascular coagulation, respiratory failure, renal failure erythrocyte apheresis should be considered,” they suggest.

And, “Clinicians should consider co-infection when suspecting tick-borne disease which can lead to fatal consequences if not addressed promptly.”

“If there is delayed initiation of therapy in these kinds of patients, there may be dire consequences that may require aggressive therapy.”

The authors cited another case report to highlight the importance of a timely diagnosis.

A 67-year-old woman was treated for Lyme disease. But her fever, rash, and myalgias persisted despite a 21-day course of amoxicillin. The patient was also found to have pancytopenia and evidence of Babesia. Once she began treatment for Babesia, her symptoms improved.

Related Articles:

Case series shows wide range of Babesia symptoms and presentations
The case of an untreated Babesia infection
Babesia symptoms can be deadly: A family’s story

References:
  1. Bhesania S, Arora KS, Tokarski M, et al. A Case of Tick Bite Induced Babesiosis With Lyme Disease. Cureus. Aug 2021;13(8):e17401. doi:10.7759/cureus.17401

For more:

Category:

Babesia, Lyme, research