Minimal Duration of Tick Attachment Sufficient for Transmission of Infectious Rickettsia rickettsii (Rickettsiales: Rickettsiaceae) by Its Primary Vector Dermacentor variabilis(Acari: Ixodidae): Duration of Rickettsial Reactivation in the Vector Revisited
It has been reported that starving ticks do not transmit spotted fever group Rickettsia immediately upon attachment because pathogenic bacteria exist in a dormant, uninfectious state and require time for ‘reactivation’ before transmission to a susceptible host. To clarify the length of reactivation period, we exposed guinea pigs to bites of Rickettsia rickettsii-infected Dermacentor variabilis (Say) and allowed ticks to remain attached for predetermined time periods from 0 to 48 h. Following removal of attached ticks, salivary glands were immediately tested by PCR, while guinea pigs were observed for 10–12 d post-exposure. Guinea pigs in a control group were subcutaneously inoculated with salivary glands from unfed D. variabilis from the same cohort. In a parallel experiment, skin at the location of tick bite was also excised at the time of tick removal to ascertain dissemination of pathogen from the inoculation site. Animals in every exposure group developed clinical and pathological signs of infection.The severity of rickettsial infection in animals increased with the length of tick attachment, but even attachments for less than 8 h resulted in clinically identifiable infection in some guinea pigs.Guinea pigs inoculated with salivary glands from unfed ticks also became severely ill.Results of our study indicate that R. rickettsii residing in salivary glands of unfed questing ticks does not necessarily require a period of reactivation to precede the salivary transmission and ticks can transmit infectious Rickettsia virtually as soon as they attach to the host.
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**Comment**
For far too long authorities have told us that there’s something called a “grace period,” in which ticks supposedly delay transmitting pathogens to us and that a period of 24-48 hours is required before we can become infected.
There is only one study which they base that information upon, and there’s never been a study on the minimum time for transmission.
This study blows the “grace period” theory out of the water and proves what we all know to happen in reality. People can become infected in mere hours upon attachment. It also proves another point as well: that some ticks have the pathogens already in their salivary glands making transmission times even shorter.
How many have been sent home with a false sense of security after a doctor, going by information authorities have proliferated, told them they can’t be infected because the tick wasn’t attached for a long enough period of time? Thousands?
Please spread the word. There shouldn’t be any more patients falling through the cracks.
Bartonella henselae is a relatively uncommon pathogen that can present as a serious disease in immunocompromised patients. We present a case of a 76-year-old man with stable chronic lymphocytic leukemia (CLL) who presented to the emergency department (ED) with an onset of right axillary lymphadenitis after recovering from a recent cat bite on the ipsilateral finger. Doppler ultrasound demonstrated an irregular, circumscribed 5cm x 4cm, hypoechoic mass with mild vascular flow consistent with an enlarged abnormal lymph node. The patient was diagnosed with cat scratch disease and discharged on oral antibiotics with spontaneous drainage of the purulent materials in subsequent outpatient oncology visits. This case highlights the classic presentation of this rare disease in an immunocompromised patient with feline contact. Early antibiotics should be considered for at-risk and immunocompromised patients due to low sensitivity and specificity for Bartonella serologic tests. CLL can also present with similar progressive lymphadenopathy with severe systemic symptoms and extranodal involvement that requires emergent oncologic interventions and diagnostic vigilance.
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**Comment**
Bartonella is NOT rare.
In this article, Dr. Mozayeni talks about Bartonella being one of the major co-infections of Lyme disease. It’s even more prevalent than Lyme, as there are many more ways to contract the disease (eg. flees, cats). In a study, that Dr. Breitschwerdt and Mozayeni published in The Journal of Emerging Diseases, about 60% of Lyme patients tested positive for Bartonella: https://madisonarealymesupportgroup.com/2016/01/03/bartonella-treatment/ If you want to know the likelihood of infection, please see the checklist within the article. Print it out and check how many symptoms you have. Take this with you to your doctor appointment and discuss the likelihood.
I’m glad this research article points out that testing is poor. This is true of each and every test for tick borne illness. This requires an educated and experienced practitioner to discover what patients are infected with. If you have tick borne illness, save your time and money and get to an ILADS trained doctor.
In my experience, I’ve found Bartonella to be harder to deal with than Lyme disease.
New research shows spinal stimulation may work better than medication for long-term pain reduction
By Elizabeth Zimmermann
In a recent study, a team of Mayo Clinic researchers examined the effectiveness of spinal stimulation for pain control, compared to medical therapy or multiple surgeries for patients with long-term spine or limb pain.
They found spinal stimulation was significantly more likely to reduce pain than medication for patients with intractable pain. Their findings were published in Mayo Clinic Proceedings.
“Intractable pain, or refractory pain is pain that occurs when multiple evidence‐based treatments have been tried and the patient has not reached treatment goals,” says study first author Tim Lamer, M.D., an anesthesiologist, pain management, and spine care specialist at Mayo Clinic. “Typically this means they have not achieved satisfactory pain reduction and/or functional improvement.”
According to the National Institutes of Health, “almost 11 million U.S. adults have ‘High Impact Chronic Pain,’ that is, pain that has lasted 3 months or longer and is accompanied by at least one major activity restriction, such as being unable to work outside the home, go to school, or do household chores.”
Because back and/or limb problems are the commonest pain complaints, Dr. Lamer says it made sense to try and determine the most effective ways to help patients.
The research
In this meta-analysis (analysis of a collection of relevant studies), the team study used a random-effects model to compare any type of spinal stimulation to medical therapy. They also compared newer stimulation technologies such as high frequency spinal cord stimulation and dorsal root ganglion stimulation to conventional spinal stimulation.
“This kind of research (random-effects) incorporates uncertainties due to differences between the settings of the studies, like patient or provider characteristics,” says senior author M. Hassan Murad, M.D., a preventive medicine physician and health services researcher at Mayo Clinic. “It’s a common tool in meta-analyses.”
After conducting a search of peer-reviewed publications, they found 17 manuscripts, from 12 clinical trials comparing medical therapy or repeated surgeries to either conventional or new spinal stimulation for pain control.
The researchers also employed the indirect comparison technique. “If studies compare treatments A vs B, and B vs C, we can indirectly compare A and C,” explains Dr. Murad.
“Because we found no studies comparing new spinal stimulation technologies to medical therapy, we needed to indirectly compare them.”
Although there are some limitations, Dr. Murad says this kind of research can help lead to the best possible outcomes for patients.
“The estimates we provide should be used to support shared-decision making,” he says. “Other factors, such as patient’s values and preferences, feasibility and accessibility of treatment also need to be considered when making treatment decisions.”
Publishing the meta-analysis in and of itself may prove to be helpful for patients, as it calls attention to the option of spinal stimulation for pain control.
“Many non-pain specialists are not generally aware of spinal cord stimulation,” says Dr. Lamer, “and how effective it can be for properly selected patients with difficult to manage chronic pain.”
He says that this includes patients with complex spinal pain syndromes, painful neuropathies including diabetic neuropathy, and post-traumatic pain syndromes such as complex regional pain syndrome.
“Patients who are not responding to conventional conservative measures such as medications and physical therapy should be referred to a qualified interventional pain specialist to be evaluated for spinal cord stimulation candidacy.”
To correctly interpret the serological markers of Lyme disease, it is very important to determine the region’s infection rate. The aim of this study was to ascertain the prevalence of specific antibodies against Borrelia burgdorferi in a rural district in northern Spain.
METHODS:
The presence of IgG antibodies against B. burgdorferi was determined by qualitative enzyme immunoassay in the serum of 1,432 people divided into 3groups: 316 blood donors, 432 individuals who attended the hospital without infection and 684 for whom Lyme serology testing was specifically requested as part of a differential diagnosis. In the latter group, the presence or absence of an occupational risk factor was recorded.
RESULTS:
Antibodies against B. burgdorferi were detected in 189 individuals (13.2%): 16 (5.1%) in the blood donors group, 62 (14.4%) in subjects who attended hospital without infection and 111 (16.2%) in subjects in whom a differential diagnosis of Lyme disease was requested (p < 0.0001). In subjects with an occupational risk factor, the prevalence was 23.5%, peaking at 45.8% in men over 65 years.
CONCLUSION:
Our study showed a high prevalence of antibodies against B. burgdorferi and higher than that seen in other areas with similar characteristics in Spain. However, our results are similar to those published from other European regions. The prevalence in the blood donors group was lower than that observed in the other groups. Older age, the male gender and occupational risks were associated with a higher prevalence of Lyme disease.
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**Comment**
Please remember that tests which look for antibodies are insensitive – missing many who actually are infected. I was told by the most experienced practitioner in Wisconsin that some of the sickest patients NEVER test positive.
The organism doesn’t hang out in the blood but sequesters in tissues.
The question of what causes eating disorders has puzzled the medical community since “wasting disease” was first described in the 17th century. Today, researchers and clinicians agree that, in addition to psychosocial and environmental risk factors, there is a strong biological basis to these disorders. Now, new data from a Massachusetts General Hospital researcher suggests that exposure to common childhood infections, such as strep throat or bronchitis, may significantly raise a person’s risk of developing anorexia nervosa, bulimia nervosa and other eating disorders.
“Infections, by and large, have typical behaviors associated with them, and among those most commonly reported is loss of appetite.”
Results of the population-based study, published in JAMA Psychiatry, found that infections that required hospitalization or treatment with anti-infective medications, such as antibiotics, antifungals or antivirals, increased the risk of developing an eating disorder by as much as 39%. The multi-institutional study, which analyzed the health histories of more than 500,000 adolescent girls in Denmark, also found that recurrent infections and repeated treatment increased the risk.
Infections and Behavior
“Infections and inflammation more broadly have been recognized to play a role in psychiatric diseases like schizophrenia, but this has been less explored in eating disorders,” says Lauren Breithaupt, PhD, a clinical psychologist in the Mass General Eating Disorder Clinical and Research Program, and lead author of the study. “We’re hoping that a better understanding of the relationship between the immune system and disordered eating will help identify a mechanism behind the increased risk and biochemical changes we see happening.”
Lauren Breithaupt, PhD
As an observational study, the findings don’t point to a single cause or effect, but one possible explanation, according to Dr. Breithaupt, is that the infection or treatment of the infection disrupts the gut microbiome, which in turn alters the brain’s neurobiological reward system. Another possibility is the body’s own inflammatory response. Inflammatory proteins have been shown to cause changes in behavior, such as loss of appetite.
“Infections, by and large, have typical behaviors associated with them, and among those most commonly reported is loss of appetite,” Dr. Breithaupt says. “If you’re already at risk for an eating disorder, this period of no appetite could have a priming effect.” Although more research is needed, Dr. Breithaupt is encouraged the findings further enforce the biological nature of the disease.
Eating Disorder Stereotype
“Eating disorders have long been seen as social constructs — think of the stereotype of the wealthy white girl who isn’t eating because she wants to look a certain way,” says Dr. Breithaupt. “It’s taken a lot of evidence — more than most other mental illnesses — to blow that stereotype out of the water. We now know that the rates are similar across the world and across cultures. We’re even seeing that there may not be as big a gender discrepancy as we previously thought.”
Despite mounting biological evidence, there is still a great deal of confusion in the medical community about how to diagnose and treat eating disorders. Dr. Breithaupt is hopeful that the team’s findings can lead to increased awareness of the signs and symptoms and that more hospitals and treatment centers adopt a more scientific approach to treating these diseases.
The Role of Philanthropy
“The Eating Disorders Clinical and Research Program at Mass General offers gold standard evidence-based treatment for eating disorders, but we receive so many referrals per year that unfortunately we can’t treat every patient who seeks services,” she says. “That’s why philanthropy is so important to the growth of our program. The work that we do is often funded by individuals and families who have been touched by these diseases.”
The other key to advancing the understanding and treatment of eating disorders, Dr. Breithaupt says, is education.
“In order to identify biological markers, we need larger sample sizes and data sets, which requires individuals with the disorder to come forward and to participate in research,” she says. “By educating the public about the biology underlying eating disorders, we can break down barriers and overcome the stigma.”
To learn more about how you can support eating disorder programs and research at Mass General, please contact us.
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**Comment**
Great read and a fantastic reminder that eating disorders often have a biological basis.
In addition, Lyme can trigger a condition known as pediatric acute-onset neuropsychiatric syndrome (PANS) which in turn can also cause eating disorders. http://www.childrenslymenetwork.org/children-pans-pandas/ PANS, similarly to Lyme, still has not been accepted by mainstream medicine despite thousands upon thousands suffering from both.
Hypoglycemia can also be a player. And according to this article, insulin resistance “causes the body to have problems metabolizing carbohydrates into biological energy called ATP. This energy is essential in the production of feel good neurotransmitters such as serotonin. Thus without that energy the person may tend to feel depressed. The unabsorbed carbohydrates are converted to, first, glycogen and then into fat cells. Thus we find that depressed people may be overweight AND depressed. They are not depressed because of obesity, but because of insulin resistance!! (MedicalNewsToday 8 Oct 2009) See also Hemat.” http://www.hypoglycemia.asn.au/2011/eating-disorders-anorexia-and-bulimia/
The article has great advice if you suspect hypoglycemia is your issue:
“If you suspect that an eating disorder is related to insulin resistance (a pre-diabetic condition called hypoglycemia) then have this tested by a doctor. See How to test for hypoglycemia. If found to be positive, encourage your client to adopt the Hypoglycemic Diet.
For most people sticking to a regime of frequent snacks of high proteins (every 2 ½ hours), plus various vitamins and mineral – so as never to feel hungry – should supply sufficient energy from proteins to produce feel good neurotransmitters such as serotonin. This together with regular – but not excessive – exercises should prevent unabsorbed carbohydrates from being converted to fat cells! But keep in mind possible allergies and food sensitivities that may affect the digestive system.”
I knew a patient who was not over weight at all but due to severe hypoglycemia and hypothyroidism they developed eating disorders. When they adopted the hypoglycemic diet and began supplementing with natural thyroid hormone the eating disorders disappeared.
Please spread the word as many doctors will only continue to look at this as a psychiatric problem when there are often biological causes.
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Madison Area Lyme Support Group 