Archive for the ‘research’ Category

Powassan Virus in Children

https://danielcameronmd.com/powassan-virus-in-children/

CASE REPORTS: POWASSAN VIRUS IN CHILDREN

powassan-virus-in-children

Powassan virus (POWV) is a tick-borne illness that can cause severe encephalitis. Animal studies have shown the virus can be transmitted to humans following a tick bite within 15 minutes. However, the cases described in a recent article “Powassan Virus Encephalitis Following Brief Attachment of Connecticut Deer Ticks” by Feder et al. “strongly suggest that infected ticks may also rapidly transmit POWV to people.” [1]

Powassan virus in children is not often reported. In this article, the authors describe two cases involving infants with tick bites who developed Powassan virus encephalitis. As the authors point out, their case report not only demonstrates that rapid transmission of POWV can occur, but it highlights the importance for parents/caregivers to follow tick bite prevention methods. In these cases, adults unknowingly exposed their children to ticks infected with Powassan virus.

Powassan virus encephalitis in two children

A 5-month-old child was hospitalized after experiencing fevers for two days, along with vomiting and facial twitching which progressed to seizures. Two weeks prior to the onset of symptoms, a tick was removed from the infant’s forehead. Test results for the Powassan virus were positive.

The second case involved a 2-month-old child who presented with a fever and listlessness for one day. “He then developed left sided focal seizures (rhythmic left arm twitching, facial deviation to the left, and tongue thrusting with lip smacking),” the authors write.

A tick was removed from the infant’s arm approximately two weeks before he was hospitalized. The parents believed the father or dog had brought a tick into the house following a walk outside. The tick was not engorged and had not fed for more than 24 hours, the authors report.

READ MORE: No neurologic damage in 3 children with Lyme disease and Powassan virus

“POWV infection was confirmed by a positive PRNT on both serum and CSF,” the authors explain.

“POWV infection of humans has been notable for the severity of both the acute disease and the long-term sequelae.”  In fact, chronic illness occurs in approximately 50% of patients, the authors report, with symptoms including hemiplegia [paralysis on one side of the body], wasting, personality changes, and headaches.

Adults unknowingly expose children

“The circumstances under which the 2 children reported here acquired infection require some comments that are pertinent to prevention of future cases,” the authors write.

Infants typically would not be exposed to tick bites. These cases demonstrate the importance in adopting tick bite prevention methods. Feder points out, “in both of our cases, parents presumably brought ticks into their homes after outdoor activities.”

In the first case, the father had been out walking in the woods and brushed off multiple ticks outside. He presumably brought a tick into the home. In the second case, a father had been walking outside with a dog. The family believed either the father or dog had brought the tick into the house.

Parents/caregivers should be educated about several preventative measures:

  • “Outdoor clothing may prevent access to skin, but the ticks may remain undetected and will crawl off the person when body heat is reduced, such as when a coat is removed.”
  • Parents should check for ticks more than once. “Because of searching for an optimal skin site, ticks will not immediately attach to a person.”
  • “Parents should be educated about the need to treat outdoor clothing with Permethrin, an effective mode of preventing tick bites … Contact with treated fabric will kill all ticks within 2 hours.”
  • “Parents should also be educated about the possibility that dogs could bring ticks into homes, and that these animals should be inspected after every outdoor exposure.”
  • “Most anti-tick preventives only work after a tick has attached to a dog [the tick needs to ingest the chemical], although there are collars that are impregnated with Permethrin or similar products that might repel or kill ticks.”

Editor’s Note:  Although the authors did not discuss treatment of the two infants, both recovered.

References:
  1. Feder HM, Telford S, Goethert HK, Wormser GP. Powassan Virus Encephalitis Following Brief Attachment of Connecticut Deer Ticks. Clin Infect Dis. 2020.

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**Comment**

Despite being told that all of this is “rare,” please remember that Powassan, along with numerous other tick-borne infections are not reportable illnesses; therefore, nobody has a clue about prevalence. Coppe Lab out of Wisconsin emphatically states Powassan is NOT rare:

For the last two years, Coppe Laboratories has dedicated a significant amount of time and resources to dispelling the myth that infection with Powassan virus, a virus transmitted by tick bite, is rare. The Centers for Disease Prevention and Control (CDC) reports only 100 cases of Powassan virus infection in the United States in the last 10 years. Indeed, that statistic gives the illusion that Powassan infection is rare. However, did you know that the only infections reported to CDC are those that are life-threatening, particularly cases causing severe inflammation of the brain like the case reported in LiveScience? Coppe has published three new papers in the last year that clearly show Powassan virus infection is not rare are at all,and until testing for this virus is included as part of tick-borne disease screening panels infections will continue to be underreported. Coppe’s Powassan Guide, which can be downloaded from the website, summarizes the findings from both tick and human Powassan prevalence studies, as well as defining the patient populations that would benefit most from Powassan testing.

For more:

Tick prevention:

https://madisonarealymesupportgroup.com/2019/04/12/tick-prevention-2019/

https://madisonarealymesupportgroup.com/2020/07/20/ticks-lyme-disease-information-for-families/

Remember, pets are called “Tick taxies” for a reason:  https://madisonarealymesupportgroup.com/2017/08/12/pet-owners-have-nearly-2-times-the-risk-of-finding-ticks/

Lyme Disease: Are We Looking For the Wrong Culprit?

http://  Approx. 18 Min

Oct. 1, 2020

Lyme Disease: Are We Looking For the Wrong Culprit?

Tatjana Mijatovic, PhD

The video describes the overall high expansion of undiagnosed Lyme disease cases worldwide and the possible link to screening only for B. burgdorferi and rarely testing for B. miyamotoi. Identify the utilization of phage-based testing and bacterial presence as related to testing choices and late/chronic stage patients Discuss how the overall high failure rate of tick-borne infection (TBI)-related testing underscores the necessity for novel approaches.

Background: Borrelia-related diseases (Lyme disease and relapsing fevers) are increasingly prevalent, severe, difficult to diagnose and treat. The high failure rate of tick-borne infection testing undermine treatments‘ strategy and monitoring.
Aims: The goal of this contribution is to bring the focus on the importance to enlarge borreliosis-related testing targets and shed some light on high prevalence of B. miyamotoi presence both in ticks and late stage undiagnosed patients.

Methods: Bacteriophages could become a diagnostic tool based on the principle that if there are phages it is because there are living bacteria. Phelix Charity together with Leicester University microbiology department have recently developed a Borrelia Phage-based PCR test searching for 3 major Borrelia groups (Borrelia burgdorferi sl (including B. burgdorferi ss, B. afzelii, B. garinii, B. spielmanii, etc), Borrelia miyamotoi and Relapsing fever group (B. recurrentis, B. hermsii, etc). This method is efficiently used to assess both human samples and ticks.

Results: Since July 2019, over 2100 results from patients originating various countries have been obtained. Testing included mainly late stage / chronic patients and the aggregated data are showing 30 % negative results and 70% positive among which over 60 % indicated the presence of specific Borrelia miyamotoi phages. Furthermore, ticks from 2019 and 2020 have been analyzed by the same method. The obtained results on ticks showed that over 60% were found positive for Borrelia miyamotoi and only 15% for B. burgdorferi sl.

Conclusion: This is the first large scale report on prevalence of B. miyamotoi in the ticks, as well as in late stages of borreliosis. Seen a high prevalence of B. miyamotoi in tested ticks, further supported by similar percentages found in tested patients, one can hypothesize that the high failure rate of current two-tier screening testing, searching for B. burgdorferi sl only, might be due to the wrong testing target. In other words, the overall high expansion of undiagnosed Lyme disease cases worldwide might be linked to the screening choice focusing only on B. burgdorferi sl and only rarely testing for B. miyamotoi while the later one seems to be much more prevalent. Further accumulation of data both from the patients and ticks should bring the answer to the question are we searching for a wrong culprit. Searching for actual bacterial presence using phage-based testing might pacify the debate and controversies on testing choices and late/chronic stage patients.

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**Comment**

Since Borrelia miyamotoi is not a reportable illness to the CDC, no one has any clue about prevalence but reports are coming in continually that it’s highly likely to be a much bigger problem than ‘authorities’ believe.

For more:  https://madisonarealymesupportgroup.com/2020/12/14/how-many-negative-lyme-tests-are-due-to-b-miyamotoi/

https://madisonarealymesupportgroup.com/2020/11/18/what-you-need-to-know-about-borrelia-miyamotoi/

https://madisonarealymesupportgroup.com/2020/12/23/could-borrelia-miyamotoi-infections-explain-persistent-lyme-symptoms/

https://madisonarealymesupportgroup.com/2018/02/15/b-miyamotoi-in-ca-ticks-for-a-long-time/

Ticks Produce Antibiotic That Protects Them From Human Skin Bacteria

https://www.ucsf.edu/news/2020/12/419216/lyme-disease-ticks-produce-antibiotic-protects-them-human-skin-bacteria

Lyme Disease Ticks Produce Antibiotic That Protects Them From Human Skin Bacteria 

Gene Provides Protection During the ‘Really Risky Sport’ of Feeding on Blood

By Vicky Stein

Dec. 10, 2020

Ticks live dangerous lives, spending most of their time questing for a host across wildly different habitats and seasons. Once they encounter a reptile, bird, or a mammal like us, they become intimately connected with it – and all of its bacteria and viruses – for days on end. Though ticks are notorious for transmitting pathogens such as the Lyme disease bacterium, how does their immune system keep them safe from contracting pathogens themselves?

In a study published in Cell on Dec. 10, 2020, a research team led by UC San Francisco’s Seemay Chou, PhD, provides an answer to this mystery. The work, Chou said, reveals that ticks are exquisitely constructed blood-sucking machines, with immune systems specially tailored for this unique lifestyle. Their defense strategies are carried out both inside and outside their bodies, she said, killing even our resident microbes as they feed on us.

Five years ago, in work published in Nature, Chou and colleagues found a gene in tick DNA that produces a microbe-killing protein. In the new study, senior author Chou leveraged that discovery to show that, without the protection offered by this gene, ticks are vulnerable to infection with Staphylococcus, one of the most common types of “commensal” bacteria. These bacterial species carpet our skin surface, but generally don’t harm us.

“This is the first time anybody’s identified a natural pathogen of ticks, and established a mechanism for it,” said Chou, an assistant professor of biochemistry and biophysics at UCSF and Chan Zuckerberg Biohub Investigator whose work is supported by a Sanghvi-Agarwal Innovator Award. “Ticks pass more microbes to humans, livestock, and other animals than any other known arthropod, but now their own vulnerabilities are on the table.”

The tick gene in question, known as dae2, originally evolved in bacteria, where the protein it encoded worked as an offensive agent against other bacteria. Several hundred million years ago, right around the time that the ancestors of some of today’s ticks began feeding on blood, those ticks “stole” the gene, making it a part of their own genomes.

According to Chou, dae2 represents a rare example of so-called horizontal transfer of a gene from a bacterium to an animal, and the fact that this transfer occurred as blood feeding evolved might not be a coincidence.

“I’ve always wondered why blood-feeding is even a thing,” said Chou. Not only does blood take a lot of energy to process into useful food, but biting on and attaching to much larger animals “seems inherently like a really risky sport.” With a strong, dae2-enhanced immune system, she said, tick species could have flourished, expanding to fill their bloody ecological niche.

When she first began working with dae2 in Ixodes scapularis, the deer tick, Chou thought ticks’ acquisition of the gene must have something to do protection against tick-dwelling bacteria like B. burgdorferi, which causes Lyme disease in humans and other animals. In experiment after experiment, she and members of her lab tried to find a mechanism for the gene to inhibit this bacterium, until they had an epiphany.

It makes no sense for ticks to have acquired this immune effector to kill off the bacteria that it’s most notoriously known to stably associate with,” she said. So instead, the lab began the much more complicated process of looking for bacteria that ticks are not known to live with peaceably. When members of the lab, including co-first authors Beth M. Hayes, PhD, and Atanas D. Radkov, PhD, proposed exploring the idea that dae2 might protect against Staphylococcus bacteria, “I actually pooh-poohed the idea – I bet a beer against it,” said Chou.

But after the dae2 protein was introduced to a cloudy vial of cultured staph bacteria, Chou was shocked. “The tube went from murky to clear in like, a second,” she said. “I was kind of glad to have lost this bet. After two years of trying to figure out what was going on, it all started falling together.”

Now the team had a direction. As detailed in the Cell paper, the researchers embarked on a series of wide-ranging experiments, first comparing dae genes in a range of tick species with the bacterial tae genes from which they were originally derived. With these comparisons and high-resolution protein structures in hand, they used computer models of these proteins to compare their shape and orientation when they came in contact with molecules found in bacterial cell walls.

Next, they moved on to testing the proteins directly against actual molecules extracted from bacterial cell walls. While dae2 protein could quickly degrade this material, taken from common skin bacteria, Tae2 could not. Dae2 also killed a wide a range of bacteria, notably three very common species that are symbiotic partners of human skin.

The researchers then investigated whether dae2 could reach our skin. They found dae2 protein in tick salivary glands and saliva, and observed that, from there, the protein was transferred to the ticks’ blood meal hosts.

When Chou and the team cancelled out the effects of dae2 in a group of blood-fed ticks, using a technique known as RNA interference in some mice and immunizing other mice to the protein, they found higher levels of Staphylococcus bacteria than in ticks with the functioning protein. These ticks also stayed smaller and gained less weight than ticks with dae2.

“This is a new way of thinking about how ticks interact with microbes,” said Chou. Microbes borne by ticks cause disease in humans and animals worldwide, but that’s only half the story, she said. “Their commensal is our pathogen, and our commensal is their pathogen.”

Authors: Joining Chou, Hayes, and Radkov were Fauna Yarza, Sebastian Flores, Jungyun Kim, Ziyi Zhao, and Victoria Bowcut, all of UCSF; Katrina W. Lexa, of Denali Therapeutics, Liron Marnin and Joao H.F. Pedra of the University of Maryland School of Medicine; and Jacob Biboy and Waldemar Vollmer of Newcastle University.

Funding: The research was funded in part by grants from the NIH (R01AI132851, R01AI134696, R01AI116523), Research Councils UK (EP/T002778/1), the UCSF Program for Breakthrough Biomedical Research, and the Sandler Foundation. Additional support came from the Chan Zuckerberg Biohub, the Johnson & Johnson WiSTEM2D Award, the Pew Biomedical Research Foundation, and the Sangvhi-Agarwal Innovation Award. Yarza was supported by the National Science Foundation (1650113) and a grant to UCSF from the Howard Hughes Medical Institute through the James H. Gilliam Fellowships for Advanced Study program.

Disclosures: The authors declare no competing interests.

The University of California, San Francisco (UCSF) is exclusively focused on the health sciences and is dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. UCSF Health, which serves as UCSF’s primary academic medical center, includes top-ranked specialty hospitalsand other clinical programs, and has affiliations throughout the Bay Area.

Lyme Disease: Acute and Chronic-Defined & “It Ain’t Just One Thing”

Samuel M Shor, MD

Objective: Chronic Lyme disease has been a poorly defined term and often dismissed as a fictitious entity. In this paper, the International Lyme and Associated Diseases Society (ILADS) provides its evidence-based definition of chronic Lyme disease.

Definition: ILADS defines chronic Lyme disease (CLD) as a multisystem illness with a wide range of symptoms and/or signs that are either continuously or intermittently present for a minimum of six months. The illness is the result of an active and ongoing infection by any of several pathogenic members of the Borrelia burgdorferi sensu lato complex (Bbsl). The infection has variable latency periods and signs and symptoms may wax, wane and migrate. CLD has two subcategories,

  • CLD, untreated (CLD-U)
  • CLD, previously treated (CLD-PT)

The latter requires that CLD manifestations persist or recur following treatment and are present continuously or in a relapsing/remitting pattern for a duration of six months or more.

Methods: Systematic review of over 250 peer reviewed papers in the international literature to characterize the clinical spectrum of CLD-U and CLD-PT.

Conclusion: This evidence-based definition of chronic Lyme disease clarifies the term’s meaning and the literature review validates that chronic and ongoing Bbsl infections can result in chronic disease.

Use of this CLD definition will promote a better understanding of the infection and facilitate future research of this infection.

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**Comment**

Words matter.

This, right here, is a main difference between what mainstream medicine ascribes to and what a Lyme literate doctor ascribes to.  The difference is life-changing to say the least.  Those in the former camp will treat patients with the woefully inadequate 21 days of doxycycline while the latter camp realizes this illness can wax, wane, and linger – and this isn’t even taking into account the many coinfections that can also wax, wane, and linger.  

If patients have numerous persisting infections they have more severe cases for a longer duration of time, requiring numerous medications for far longer than the unscientific CDC Lyme guidelines.

For more:  https://madisonarealymesupportgroup.com/2020/11/25/what-makes-a-doctor-lyme-literate/

https://madisonarealymesupportgroup.com/category/lyme-disease-treatment/

http://  Approx. 42 Min.

Sept. 30, 2020

It Ain’t Just One Thing

David Kaufman, MD; Ilene Ruhoy, MD, PhD

Chronic Lyme Disease (CLD) is a complex chronic illness. Controversy exists regarding whether it represents persistent Lyme infection or a post-infectious, possibly autoimmune syndrome, or a combination of both. This is an important topic as a greater understanding of CLD can help guide treatment options for these patients who suffer sometimes for decades and are often turned away from healthcare providers. Effective treatment has been notoriously difficult. Importantly, patients with CLD generally meet all the criteria for a diagnosis of ME/CFS. Interestingly as discussed below, these same patients very often present with similar signs, symptoms, and diagnoses that are seen in a large majority of ME/CFS patients regardless of any history of CLD.

We will discuss the diagnostic concept of a Septad which includes:

  • Autoimmune disease
  • Mast Cell Activation Syndrome
  • Dysautonomia including small and large fiber neuropathy
  • Dysmotility/Dysbiosis/SIBO
  • hypermobility Ehler Danlos Syndrome (hEDS)
  • Cranial Cervical Instability (CCI)/Tethered Cord (TC)
  • Infection including especially tick borne diseases, viral reactivation, and mycoplasma

The Septad concept provides a guide for both physician and patient regarding both the work up and the treatment plans. The identification of these particular entities can be made with objective data and can assist physicians in implementing management options. This presentation will briefly discuss each of these disorders including symptoms, evaluation, and possible treatment suggestions.

4 Distinct Post-Treatment Lyme Disease Syndromes?

https://danielcameronmd.com/4-distinct-post-treatment-lyme-disease-syndromes/

4 DISTINCT POST-TREATMENT LYME DISEASE SYNDROMES?

Man holding head, looking tired from post treatment lyme disease

In a recent editorial, Dr. Allen Steere describes the clinical features and proposed mechanisms triggering what he believes are 4 distinct post-treatment Lyme disease syndromes (PTLDS) in patients who fail antibiotic treatment for Lyme disease. [1]

Individuals who suffer from persistent symptoms may be diagnosed with post-treatment Lyme disease or ‘chronic Lyme disease.’  Studies estimate that between 34% and 62% of patients continue to have ongoing, chronic symptoms even after standard antibiotic therapy. Many remain ill for months to years. In fact, according to one study, 34% of a population-based, retrospective cohort were still ill an average of 6.2 years after antibiotic treatment.

Additionally, four clinical trials, sponsored by the National Institutes of Health (NIH), demonstrated the potential seriousness of Lyme disease. According to the findings, the quality of life for chronically ill patients “was equivalent to that of patients with congestive heart failure; pain levels were similar to those of post-surgical patients and fatigue was on par with that seen in multiple sclerosis.”

In his editorial, “Post-treatment Lyme disease syndromes: distinct pathogenesis caused by maladaptive host responses,” Steere concedes that patients can remain seriously ill. “These patients may have severe pain around joints (tender points), headache, brain fog, sleep disorder, and incapacitating fatigue, which have a major impact on the quality of life.”

“Physicians are often in a quandary regarding whether these patients still have active infection or postinfectious phenomena,” he writes.

Unfortunately, Steere dismisses the hypothesis that a persistent and active infection could be causing ongoing illness in patients with ‘chronic Lyme disease’ or post-treatment Lyme disease syndrome, as he claims, there is a “current lack of evidence of persistent infection or antibiotic efficacy in human patients with PTLDS.” (A statement which I dispute.)

Instead, he has developed and proposes that patients suffer from various post-infectious syndromes, which include:

Post-infectious Lyme arthritis

“Massive inflammatory, synovial proliferation usually affecting a knee, emerging from Lyme arthritis.”

  • Pathogenesis: Excessive pro-inflammatory immune response with high IFN-γ levels persistent in the post-infectious period, blocking appropriate wound repair processes.

Post-treatment Lyme disease syndrome

“Pain, neurocognitive, and fatigue symptoms emerging after any LD [Lyme disease] manifestation.”

Autoimmune joint disease

“Rheumatoid arthritis, psoriatic arthritis, or peripheral spondyloarthropathy emerging after any LD [Lyme disease] manifestation.”

  • Pathogenesis: Adjuvant effect of infection activating latent autoimmune disease.

Autoimmune neurologic disease

“Chronic idiopathic demyelinating polyneuropathy emerging from Lyme radiculoneuropathy.”

  • Pathogenesis: Unknown.

Steere points out, that individuals with systemic autoimmune diseases following Lyme disease may benefit from immunosuppressive or anti-inflammatory therapy.

He concludes, “disabling posttreatment syndromes may still develop, which appear to result primarily from disadvantageous or maladaptive host responses to the infection that persist after spirochetal killing with antibiotics.”

Editor’s note: I do not agree with Dr. Steere’s position. And for transparency purposes, I’m an author of the International Lyme and Associated Diseases Society (ILADS) guidelines, which does not dismiss the persistent infection hypothesis but supports ongoing antimicrobial treatment until Lyme disease symptoms resolve.
References:
  1. Steere AC. Posttreatment Lyme disease syndromes: distinct pathogenesis caused by maladaptive host responses. J Clin Invest. 2020;130(5):2148-2151.

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**Comment**

This would almost be humorous if it wasn’t so serious.  

Having just read Polly Murray’s “The Widing Circle,” and revisiting the beginning of it all from the woman who contacted health authorities to report on a mysterious illness afflicting her entire household and a majority of her neighbors, I realize that very little has changed.

40 years ago, Murray was frustrated with Steere’s stubborn refusal to acknowledge the persistent infection that seemed to affect so many patients.

I was also shocked anew at these authorities who often preferred sitting back to observe suffering patientsrather than treat them.  Nearly all responded that were able to receive continuing treatment.  I wrote about our experience here:  https://madisonarealymesupportgroup.com/2020/11/06/the-proof-is-in-the-pudding-my-letter-to-the-tbdwg/

I hesitate to think where we would be now without this life-saving treatment that took over 5 years.

For more:  

I highly recommend bypassing mainstream medicine completely and heading directly to a Lyme literate doctor:  https://madisonarealymesupportgroup.com/2020/11/25/what-makes-a-doctor-lyme-literate/

The Lyme War continues unabated.