Archive for the ‘research’ Category

Focus on COVID-19 Leads to Delayed Diagnosis of Lyme Disease

https://danielcameronmd.com/covid-19-delayed-diagnosis-lyme-disease/

FOCUS ON COVID-19 LEADS TO DELAYED DIAGNOSIS OF LYME DISEASE

covid lyme disease

Hello, and welcome to another Inside Lyme Podcast. I am your host Dr. Daniel Cameron. In this episode, I’ll be discussing a unique case involving a 67-year-old man whose diagnosis of Lyme disease was delayed because clinicians suspected his symptoms were due to COVID-19.

By

The case report, by Novak and colleagues, entitled “Lyme Disease in the Era of COVID-19: A Delayed Diagnosis and Risk for Complications” was published recently in the journal Case Reports in Infectious Diseases.1

The authors report that this case “illustrates the overlap of symptoms among disparate infectious diseases and the risk of a narrow approach and focus on COVID-19 in patients with undifferentiated febrile illnesses, such as Lyme disease.”

In July 2020, the man presented with symptoms consistent with COVID-19. He had chills, body aches, fever, headache, and neck ache.

Doctors concluded he suffered from a viral-like illness and instructed him to quarantine until results from his COVID-19 test were obtained. His COVID tests were negative.

The patient’s symptoms slowly resolved without treatment.

6 weeks after symptom onset

Six weeks later, however, he developed a rash on his arm. A dermatologist diagnosed the rash as an insect bite reaction rather than Lyme disease.

However, test results for early Lyme disease were positive with 3 of 3 IgM Western blot bands. In addition, 4 of 10 IgG Western blot bands were positive.

The patient was treated with one week of doxycycline.

After 7 days of doxycycline, the man developed double vision due to sixth nerve palsy. He also suffered from headaches, neck stiffness, and new onset fatigue.

At this point, the patient was referred to a Lyme disease telemedicine referral clinic, where a diagnosis of Lyme disease was confirmed.

“This delayed diagnosis of Lyme disease in the patient we describe resulted in disseminated infection and sixth nerve palsy,” the authors write.

The patient’s spinal tap was negative. He was treated with 200 mg of doxycycline twice a day.

After 4 weeks of treatment, his sixth nerve palsy had resolved. However, he still had minimal double vision with extreme right gaze, along with difficulty initiating sleep, mild anxiety, mild daytime fatigue, and subtle, difficulty with his short-term memory.

Diagnostic issues during a pandemic

In this case, doctors focused on screening the patient for COVID-19 and recommending he quarantine. However, the man never developed COVID-19.

“They [clinicians] did not suggest further testing or give input on what could have been the cause of the chills, muscle aches, etc., ” the patient wrote. As a result, his diagnosis of Lyme disease was delayed for 6 weeks.

Novak and et al. proposed that the diagnostic delay was due to clinicians focusing solely on COVID-19 rather than examining other possible causes. Lyme disease was not considered until the patient developed an erythema migrans (EM) rash, 6 weeks after his onset of symptoms.

The man’s diagnosis was confirmed by a Lyme disease telemedicine referral clinic and he improved with treatment.

The man wrote about his frustrations with diagnostic delays even before the COVID-19 pandemic.

“I have spoken to several former business colleagues about my experience with Lyme disease. Their comments were similar; friends/family members who had Lyme disease in past years expressed the same complaint: Lyme disease was not tested for in the first stages of the illness because of the lack of a rash. Their stories were remarkably similar to mine. They experienced health problems before Lyme testing was finally considered and done.”

Editor’s perspective

The patient was left with chronic manifestations of Lyme disease. The authors did not address whether a persistent infection might be the cause of these chronic manifestations.

The following questions are addressed in this podcast episode:

  1. Was this man’s case of Lyme disease typical?
  2. Why is the author’s inclusion of “July” important?
  3. What is a 6th nerve palsy?
  4. The patient developed an EM rash 6 weeks after symptom onset. Is this unsual?
  5. The dermatologist unfortunately attributed the rash to an insect bite reaction?
  6. What is the significance of Western blot test results?
  7. Why was the spinal tap normal?
  8. Is it unusual to develop new symptoms (in this case, double vision) AFTER a week of antibiotic treatment? What would cause this?
  9. Have you seen diagnostic delays for Lyme disease patients during the COVID-19 pandemic?
  10. What are some of the causes of diagnostic delays?
  11. What are the consequences of diagnostic delays?
  12. The patient still had several symptoms following 1 month of treatment. What are your concerns regarding the remaining chronic manifestations?
  13. How has the use of telemedicine helped you in caring for your Lyme disease patients?
    • Thanks for listening to another Inside Lyme Podcast. You can read more about these cases in my show notes and on my website @DanielCameronMD.com. As always, it is your likes, comments, reviews, and shares that help spread the word about Lyme disease. Until next time on Inside Lyme.

Please remember that the advice given is general and not intended as specific advice as to any particular patient. If you require specific advice, then please seek that advice from an experienced professional.

Inside Lyme Podcast Series

This Inside Lyme case series will be discussed on my Facebook 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. Novak CB, Scheeler VM, Aucott JN. Lyme Disease in the Era of COVID-19: A Delayed Diagnosis and Risk for Complications. Case Rep Infect Dis. 2021;2021:6699536. doi:10.1155/2021/6699536
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**Comment**
I’m too angry to write anything productive.

Category:

Lyme, research, Viruses

The EMA COVID-19 Data Leak, and What it Tells Us About mRNA Instability

https://www.bmj.com/content/372/bmj.n627

The EMA covid-19 data leak, and what it tells us about mRNA instability

BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n627 (Published 10 March 2021)Cite this as: BMJ 2021;372:n627
 
 
  1. Serena Tinari, journalist
Author affiliations
  1. serena.tinari@re-check.ch
Leaked documents show that some early commercial batches of Pfizer-BioNTech’s covid-19 vaccine had lower than expected levels of intact mRNA, prompting wider questions about how to assess this novel vaccine platform, writes Serena Tinari

As it conducted its analysis of the Pfizer-BioNTech covid-19 vaccine in December, the European Medicines Agency (EMA) was the victim of a cyberattack.1 More than 40 megabytes of classified information from the agency’s review were published on the dark web, and several journalists—including from The BMJ—and academics worldwide were sent copies of the leaks. They came from anonymous email accounts and most efforts to interact with the senders were unsuccessful. None of the senders revealed their identity, and the EMA says it is pursuing a criminal investigation.

The BMJ has reviewed the documents, which show that regulators had major concerns over unexpectedly low quantities of intact mRNA in batches of the vaccine developed for commercial production.

EMA scientists tasked with ensuring manufacturing quality—the chemistry, manufacturing, and control aspects of Pfizer’s submission to the EMA—worried about “truncated and modified mRNA species present in the finished product.” Among the many files leaked to The BMJ, an email dated 23 November by a high ranking EMA official outlined a raft of issues. In short, commercial manufacturing was not producing vaccines to the specifications expected, and regulators were unsure of the implications. EMA responded by filing two “major objections” with Pfizer, along with a host of other questions it wanted addressed.

The email identified “a significant difference in % RNA integrity/truncated species” between the clinical batches and proposed commercial batches—from around 78% to 55%. The root cause was unknown and the impact of this loss of RNA integrity on safety and efficacy of the vaccine was “yet to be defined,” the email said.

Ultimately, on 21 December, EMA authorised Pfizer-BioNTech’s vaccine. The agency’s public assessment report, a technical document published on its website, noted, “the quality of this medicinal product, submitted in the emergency context of the current (covid-19) pandemic, is considered to be sufficiently consistent and acceptable.”2

It’s unclear how the agency’s concerns were satisfied. According to one of the leaked emails dated 25 November, positive news had come from an undisclosed source in the US: “The latest lots indicate that % intact RNA are back at around 70-75%, which leaves us cautiously optimistic that additional data could address the issue,” the email said.

A near miss?

It’s also unclear whether the events in November constitute a near miss in the commercial manufacturing of mRNA vaccines.

EMA says the leaked information was partially doctored, explaining in a statement that “whilst individual emails are authentic, data from different users were selected and aggregated, screenshots from multiple folders and mailboxes have been created, and additional titles were added by the perpetrators.”3

But the documents offer the broader medical community a chance to reflect on the complexities of quality assurance for novel mRNA vaccines, which include everything from the quantification and integrity of mRNA and carrier lipids to measuring the distribution of particle sizes and encapsulation efficiency. Of particular concern is RNA instability, one of the most important variables relevant to all mRNA vaccines that has thus far received scant attention in the clinical community. It is an issue relevant not just to Pfizer-BioNTech’s vaccine but also to those produced by Moderna, CureVac, and others,4 as well as a “second generation” mRNA vaccine being pursued by Imperial College London.5

RNA instability is one of the biggest hurdles for researchers developing nucleic acid based vaccines. It is the primary reason for the technology’s stringent cold chain requirements and has been addressed by encapsulating the mRNA in lipid nanoparticles (box).

“The complete, intact mRNA molecule is essential to its potency as a vaccine,” professor of biopharmaceutics Daan J.A. Crommelin and colleagues wrote in a review article in The Journal of Pharmaceutical Sciences late last year. “Even a minor degradation reaction, anywhere along a mRNA strand, can severely slow or stop proper translation performance of that strand and thus result in the incomplete expression of the target antigen.”6

Crommelin and colleagues note that specific regulatory guidance for mRNA based vaccines has yet to be developed, and The BMJ’s attempts to clarify current standards were unsuccessful.
Transparency and confidentiality

The BMJ asked Pfizer, Moderna, and CureVac, as well as several regulators, what percentage mRNA integrity they consider acceptable for vaccines against covid-19. None offered any specifics.

The Medicines and Healthcare products Regulatory Agency, the UK’s medicines regulator, acknowledged the lack of a specified percentage RNA integrity, but declined to provide further detail. “The specification limit acceptance criteria are commercially confidential,” the agency said in an email.

The US Food and Drug Administration (FDA) directed The BMJ to read its guidance documents78 and its review of Pfizer’s vaccine,9 but none of these specify the percentage RNA the agency is requiring. Asked to comment, the regulator pointed to Pfizer:

“information that you seek that is not addressed in the FDA Review Memorandum should be directed to Pfizer.”

In subsequent correspondence, FDA, EMA, and Canadian government department Health Canada all stated that specific information related to the acceptability criteria is confidential.

EMA did acknowledge, however, that vaccine efficacy depends on the presence of suitable amounts of intact mRNA. In the case of the commercial batches that first raised alarm bells, the agency told The BMJ that the levels of truncated mRNA “and the amounts of a potential protein produced by the truncated mRNA would be too low to constitute a safety risk.” EMA did not comment on how truncated mRNA might affect efficacy. The issue was satisfactorily addressed, the agency underlined, when further information was supplied by the manufacturer.

Health Canada told The BMJ that Pfizer had conducted investigations into the root cause of reduced integrity in the commercial vaccine batches, and “changes were made in their processes to ensure that the integrity was improved and brought in line with what was seen for clinical trial batches.” Health Canada said the three agencies subsequently determined that “there was no concern with the RNA integrity or any other product specifications.”

Correspondence in the leaked documents suggests that FDA, Health Canada, and EMA were aligned on clinically qualified specifications of percentage mRNA integrity. Health Canada has confirmed to The BMJ that regulators “have worked together to align those requirements,” but all agencies declined to share with The BMJ any specifics on grounds that such information was commercially sensitive.

Pfizer also declined to comment on what percentage mRNA integrity it is aiming for, nor would it address questions about the cause of the unexpectedly low percentage mRNA integrity in certain batches, leaving open the question of whether it could happen again. Pfizer stressed: “Each batch of vaccines is tested by the official medicinal control laboratory—the Paul Ehrlich Institute in Germany—before final product release. As a result, the quality of all vaccine doses that are placed on the market in Europe has been double tested to ensure compliance with the specifications agreed upon with the regulatory authorities.”

Moderna’s chief corporate affairs officer Ray Jordan declined to respond to any of The BMJ’s questions, stating: “At this point, Moderna will not be offering additional commentary on these topics.”

CureVac, whose mRNA vaccine was submitted for EMA’s “rolling review” in February,10 told The BMJ that “it is too soon to give details.”

The shortage of information may reflect the lack of certainty, even among regulators, about how to assess the evidence fully for this novel technology. Professor Crommelin told The BMJ that, “For small, low molecular weight products, the active pharmaceutical ingredient integrity is typically close to 100%.”

But for mRNA vaccines? “Experience with mRNA integrity is limited.”

Lipid nanoparticles—where do they go and what do they do?

Conceived three decades ago, RNA based therapeutics11 have long inspired imaginations for their theoretical potential to transform cells of the body into “an on-demand drug factory.”12 But despite heavy investment by the biotech industry, bench-to-bedside translation was constantly hindered by the fragility of mRNA.

Over the years, researchers attempted to resolve intrinsic instability by encapsulating mRNA in nanocarriers made of polymers, lipids, or inorganic materials. Lipid nanoparticles (LNPs) were chosen by Moderna, Pfizer-BioNTech, CureVac, and Imperial College London for their covid-19 vaccines. This has attracted the attention of specialists in the field of pharmaceutical biotechnology, some of whom have raised concerns about further unknowns.

In a rapid response posted on bmj.com, JW Ulm, a gene therapy specialist who has published on tissue targeting of therapeutic vectors,13 raised concerns about the biodistribution of LNPs:

“At present, relatively little has been reported on the tissue localisation of the LNPs used to encase the SARS-CoV-2 spike protein-encoding messenger RNA, and it is vital to have more specific information on precisely where the liposomal nanoparticles are going after injection.”14

It is an unknown that Ulm worries could have implications for vaccine safety.

Ulm told The BMJ:

“Pfizer-BioNTech and Moderna did a remarkable job of rapidly scaling up manufacturing of such a novel system in swift fashion, which is genuinely a landmark technological achievement. However, pharmacokinetic studies, with independent laboratory confirmation, are essential to ascertain potential cytotoxicity and macroscopic toxicity, especially given the likelihood of booster injections over months or years, since the tissue trafficking patterns of the mRNA vaccine payload will determine which cells and tissues are killed by cytotoxic T-cells in each round.”

Given the variation in LNP formulations, it is unclear how relevant previous animal experiments are to answering this question.

Regulators and manufacturers contacted by The BMJ for this article did not wish to address any of the questions raised by Ulm’s rapid response.

Footnotes

  • Competing interests: I have read and understood the BMJ Group policy on declaration of interests and have no relevant interests to declare.

  • Provenance and peer review: commissioned; externally peer reviewed

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

References

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Category:

Activism, research, vaccines, Viruses

Five Herbal Medicines Potent Against Babesia Duncan in Test Tube

https://www.lymedisease.org/five-herbal-medicines-babesia/

Five herbal medicines potent against Babesia duncani in test tube

babesia duncani

Five herbal medicines had potent activity compared to commonly-used antibiotics in test tubes against Babesia duncani.

B. duncani is a malaria-like parasite carried by ticks which causes the disease babesiosis.

Published in the journal Frontiers in Cellular and Infection Microbiology, the laboratory study was funded in part by the Bay Area Lyme Foundation.

Collaborating researchers were from Johns Hopkins Bloomberg School of Public Health, California Center for Functional Medicine, and FOCUS Health Group, Naturopathic.

This research is particularly important because babesiosis is a significant emerging health risk, according to co-author Sunjya K. Schweig, MD.

“Due to limited therapeutics and a rise in treatment resistance, current treatment options for this disease are inadequate. Many patients rely on herbal therapies for which there is only anecdotal evidence of efficacy,” Schweig said.

“We hope this data offers inspiration to other researchers to further explore similar options for people living with persistent tick-borne diseases that do not respond to current treatments.”

Testing 46 herbs

Researchers tested a panel of 46 herbal medicine extracts against B. duncani compared to the commonly used medications quinine and clindamycin. Both are currently used to treat active babesiosis, a common co-infection with Lyme disease.

Plant extracts selected for the study included herbs or agents that are already in clinical use, have been previously used to manage the symptoms of patients who do not respond to standard Lyme antibiotic treatment, and have favorable safety profiles.

According to this study, the five herbal medicines that demonstrated inhibitory activity against B. duncani are:

  • Cryptolepis sanguinolenta
  • Artemisia annua (Sweet wormwood)
  • Scutellaria baicalensis (Chinese skullcap)
  • Alchornea cordifolia (African Christmas bush)
  • Polygonum cuspidatum (Japanese knotweed)
These compounds still need to be tested both in vitro and in animal models as well as in clinical trials.

While each of these botanical medicines are already in clinical use, it is important for future studies to evaluate them directly in patients using specific clinical treatment regimens, as each have the potential to produce side effects in patients, and should be taken only under the care of a clinician knowledgeable of their capabilities and toxicities.

The paper titled “Botanical medicines Cryptolepis sanguinolenta, Artemisia annua, Scutellaria baicalensis, Polygonum cuspidatum, and Alchornea cordifolia demonstrate inhibitory activity against Babesia duncani,” was authored by Yumin Zhang, Hector Alvarez-Manzo, Jacob Leone, ND, Sunjya Schweig, MD, and Ying Zhang, MD, PhD.

SOURCE OF PRESS RELEASE: Bay Area Lyme Foundation

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**Comment**

Paper found here:  https://www.frontiersin.org/articles/10.3389/fcimb.2021.624745/full

We must be careful when we read studies done in vitro, or a test tube.  Years back a similar study was done on Stevia and the shot heard round the world was that Stevia cured Lyme.  Obviously, if this were true we’d all be walking around healthier than cows in the field.  But, alas, we are not. Work has also been done on oregano, cinnamon and clove for Lyme.  (I’ve used each of these essential oils as well as stevia internally and never herxed or improved on them, and trust me when I say there’s nobody who wants these things to work more than I!)

I’m not saying these herbs won’t work at all.  I’ve tried them all except African Christmas bush, but to be honest, I didn’t herx on any of them and that was my marker for determining effectiveness. I realize I’m treading into muddy waters here as we are told that herxing isn’t required for effective treatment.  And then there’s the issue of whether you even herx with Babesia.  Since I had a hodgepodge of infections, treatment often hit numerous things simultaneously so it became nearly impossible to tease out what was doing what; however, I can tell you I herxed to high heaven on Babesia treatment  (I put my personal experience and treatment toward the end of the article).  I’m happy to report that after 1 solid year of treatment, both my husband and I are symptom-free.  I will add an ending note; however, that from the time we became infected my husband mysteriously became anemic and had strange blood cell counts and vessel size.  The problem at first it appeared to be low ferritin, which iron sucrose infusions helped with, but over time we found isn’t altogether the answer.  In short, I feel Babesia is behind this – but I may be wrong.

The interesting thing about any strain of Babesia is it isn’t bacteria – but protozoan. Antibiotics are not as effective for this.  Antimalarials have the best action upon Babesia, which thankfully do not hurt the gut like antibiotics used for Lyme.  While there is resistance to quinine due to a heavy reliance upon it for Malaria, another protozoan, there are numerous other options that appear to still be working.  I will add that from my reading another part of this drug resistance is not treating Babesia long enough, and in combination with other drugs. Please discuss this with your practitioner.  This is why many Lyme literate doctors use a drug cocktail (multiple drugs simultaneously). Also, from my discussions with practitioners, it’s important that once you start treating Babesia, stick with it for a solid 9 months to a year. Unfortunately, patients often jump from one thing to another attempting to find relief.  From experience, I can honestly say there isn’t much relief, if you are chronically infected.  You may have a good day or two or even maybe a week, but once the meds are switched, BAM! You feel like death on wheels again. Over time, symptoms disappear one by one.

I know this isn’t fun to read and may be downright depressing – but it’s important to remember this is a marathon not a sprint.  Patience truly is golden when it comes to treating tick-borne illness.  You need to be as tenacious as a Bull dog and as patient as a Basset Hound.

Word on the street is that Disulfiram, the new wonder-drug for Lyme (for some) also has action against Babesia.  (Study in link showing it works on malaria).  This is a very balanced article on DSM.

For more on Babesia treatment: https://madisonarealymesupportgroup.com/2016/01/16/babesia-treatment/

Category:

Babesia, Herbs, research, Treatment

25-Year-Old With Transverse Myelitis & Lyme

https://danielcameronmd.com/lyme-podcast-transverse-myelitis-lyme-disease/

LYME PODCAST: A 25-YEAR-OLD MAN WITH TRANSVERSE MYELITIS AND LYME DISEASE

A 25-year-old man with transverse myelitis and Lyme disease

I will be discussing a 25-year-old man with transverse myelitis and Lyme disease. “He showed gradual improvement in gait, motor and sensory functions of his lower extremities along with a resolution of neurogenic bowel.” wrote the authors. The authors added. “He continues to need intermittent self-catheterization for neurogenic bladder.”

By
 
 
Podcast:  https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5idXp6c3Byb3V0LmNvbS83NzIxNjAucnNz/episode/QnV6enNwcm91dC0zMDE1NDE4?sa=X&ved=0CAUQkfYCahcKEwjgy6vH3KPvAhUAAAAAHQAAAAAQAg

Dumic and colleague first discussed this case in the journal IDCases  in 2019.

“A previously healthy 25-year-old man presented with inability to urinate and frequent falls associated with bilateral lower extremity weakness and numbness.” wrote the authors.

Two weeks earlier, he described a red circumferential rash. His rash was approximately 10 cm in diameter, which is about 4 inch in diameter. The CDC only requires a 5 cm rash to diagnose Lyme disease criteria, which is about 2 inches.

He lived in Wisconsin, USA, with extensive exposure to ticks. He lived next to the woods, hiked, camped, and fished, and has two dogs. He had no recent history of a tick bite.

He also developed a mild, intermittent headache, mild neck stiffness, and thought he had a fever. Flu-like symptoms have commonly been reported in Lyme disease.

Did he get treated for Lyme disease? No.

The rash disappeared within a week without treatment. The erythema migrans rash of Lyme disease often clears without treatment.

His condition took a turn for the worse. “Five days prior to admission, he developed urinary retention as well as progressive numbness and weakness in his lower extremities.” wrote the authors. He was also not able to move his bowels.

His sensory deficit progressed from “left foot numbness to the upper thorax right below the nipple line anteriorly and below the shoulder blades posteriorly.” write the authors.

He began to fall due to the weakness of both legs and problems with his gait.

His physical examination revealed several findings. He had weakness of both legs, mild spasticity in both knees, increased reflexes in his legs, a diminished sensation in his legs, and a Babinski sign of the left foot.

A positive Babinski sign occurs when a doctor stimulates the bottom of the foot. The big toe bends up and back to the top of the foot, and the other toes fan out. This can mean there is some problem with the nervous system.

He had evidence suggestive of myelitis on an MRI “MRI of the cervical and thoracic spine revealed T2 signal hyperintensity in the central spinal cord gray matter at C5, C6 and T3 to T9 levels suggestive of myelitis.” write the authors. They use the term suggestive as a T2 signal hyperintensity can be from other causes. Myelitis refers to inflammation of the spinal cord.

He had strong evidence of an inflammatory process in his spinal fluid as measured by a pleocytosis in his spinal fluid. These are white cells in his spinal fluid. His antibody test for Lyme disease was negative.

His PCR for Lyme disease was positive. They were able to confirm PCR tests were positive for Lyme disease using a molecular detection test at the Mayo Medical Laboratories.

He was diagnosed and treated for acute transverse myelitis.

TRANSVERSE MYELITIS AND LYME DISEASE

The man’s motor, sensory, and autonomic dysfunction were typical of acute transverse myelitis. Autonomic dysfunction is a part of the nervous system that regulates internal organs such as the heart, stomach and intestines. The autonomic nervous system is composed of the Sympathetic and Parasympathetic system. It has also been called the fight-or-flight response. The man was unable to control his bowels and bladder.

OUTCOME

He was treated for Lyme disease with IV ceftriaxone. He also was treated with an intravenous antiviral medicine, Acyclovir, for two days until the spinal tap PCR was positive. Finally, he was treated with the steroid methylprednisolone 1 g IV daily for three days.

“He showed gradual improvement in gait, motor and sensory functions of his lower extremities along with a resolution of neurogenic bowel.” wrote the authors.

The authors added, “he continues to need intermittent self-catheterization for neurogenic bladder.”

This is not the first case of transverse myelitis and Lyme disease patients according to the authors. Their search revealed six other cases of neurologic Lyme disease associated with acute transverse myelitis.

What can we learn from this cases?

  1. Acute transverse myelitis can occur in Lyme disease.
  2. The spinal tap in Lyme disease can present with a high white count, also called pleocytosis, and still have a negative antibody test.
  3. A positive PCR test was able to confirm Lyme disease in this patient.
  4. The man’s acute transverse myelitis and Lyme disease improved with antibiotic treatment.

What questions does these cases raise?

  1. How often does transverse myelitis occur in Lyme disease?
  2. Would the man have been treated for Lyme disease if the PCR test at the Mayo had been negative?
  3. Would the man no longer need intermittent self-catheterization for neurogenic bladder if he were treated with more than a single one-month course of intravenous ceftriaxone?</li
  4. Were there other autonomic issues not described by the authors?</li
TREATING TICK-BORNE DISEASE IN MY PRACTICE

In my practice, each individual requires a careful assessment. That is why I order a broad range of blood tests for other illnesses in addition to tick-borne infections. I also arrange consultations with specialists as needed.

Many patients are complex, as highlighted in this Inside Lyme Podcast series.

We need more doctors with skills recognizing a tick-borne illness in an individual with acute transverse myelitis and Lyme disease. We hope that professionals evaluating individuals with acute transverse myelitis can use this case to remind them to look for tick-borne illnesses and treat accordingly.

Inside Lyme Podcast Series

This Inside Lyme case series will be discussed on my Facebook 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.  Sign up for our newsletter to keep up with our cases.

References:
  1. Dumic I, Vitorovic D, Spritzer S, Sviggum E, Patel J, Ramanan P. Acute transverse myelitis – A rare clinical manifestation of Lyme neuroborreliosis. IDCases. 2019;15:e00479.
  2. Kenney MJ, Ganta CK. Autonomic Nervous System and Immune System Interactions. Compr Physiol. 2014 July ; 4(3): 1177–1200.

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Category:

Inflammation, Lyme, research

Study Finds Half of Sampled Birds Have Competence for Lyme

https://onlinelibrary.wiley.com/doi/10.1111/geb.13256

RESEARCH PAPER

The macroecology and evolution of avian competence for Borrelia burgdorferi

First published: 21 January 2021
https://doi.org/10.1111/geb.13256
Read the full text

Abstract

Aim

Prediction of novel reservoirs of zoonotic pathogens would be improved by the identification of interspecific drivers of host competence (i.e., the ability to transmit pathogens to new hosts or vectors). Tick‐borne pathogens can provide a useful model system, because larvae become infected only when feeding on a competent host during their first blood meal. For tick‐borne diseases, competence has been studied best for Borrelia burgdorferi sensu lato (Bbsl), which causes Lyme borreliosis. Major reservoirs include several small mammal species, but birds might play an under‐recognized role in human risk given their ability to disperse infected ticks across large spatial scales. Here, we provide a global synthesis of the ecological and evolutionary factors that determine the ability of bird species to infect larval ticks with Bbsl.

Location

Global.

Time period

1983–2019.

Major taxa studied

Birds.

Methods

We compiled a dataset of Bbsl competence across 183 bird species and applied meta‐analysis, phylogenetic factorization and boosted regression trees to describe spatial and temporal patterns in competence, characterize its phylogenetic distribution across birds, reconstruct its evolution and evaluate the trait profiles associated with competent avian species.

Results

Half of the sampled bird species show evidence of competence for Bbsl. Competence displays moderate phylogenetic signal, has evolved multiple times across bird species and is pronounced in the genus Turdus. Trait‐based analyses distinguished competent birds with 80% accuracy and showed that such species have low baseline corticosterone, exist on both ends of the pace‐of‐life continuum, breed and winter at high latitudes and have broad migratory movements into their breeding range. We used these trait profiles to predict various likely but unsampled competent species, including novel concentrations of avian reservoirs within the Neotropics.

Main conclusion

Our results can generate new hypotheses for how birds contribute to the dynamics of tick‐borne pathogens and help to prioritize surveillance of likely but unsampled competent birds. Our findings also emphasize that birds display under‐recognized variation in their contributions to enzootic cycles of Bbsl and the broader need to consider competence in ecological and predictive studies of multi‐host pathogens.

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Category:

Lyme, research, Ticks