Archive for the ‘research’ Category

CA Ticks Spread Lyme But That’s Not the Whole Story

https://www.globallymealliance.org/blog/california-ticks-can-spread-lyme-disease-but-thats-not-the-whole-story

If you find a tick bite from an Ixodes tick in California, it’s important to consider possible exposure to pathogens that cause more than Lyme disease

Originally published on Medzulabs.org 

The risk of contracting Lyme disease from a tick bite in California has been well-documented, though there is still a long way to go in educating health providers and the broader community in the exposure risk from a tick bite. TickReport’s surveillance of ticks from California (and Oregon and Washington) goes back as far as 2006 and has expanded in recent years.

What ticks are endemic (commonly and consistently found in wild populations) to California and other West Coast states?

That’s a big question, and there are a few dozen species from different genera or families. Many of those species are specialist feeders and—if everything goes “right” in their life cycle—they will only feed on certain wild mammals, birds, or lizards and will bite humans very rarely. That’s doesn’t mean that finding one of these “specialists” attached to ourselves or a family member is impossible: it’s just much less common (and a topic we’ll try to visit soon in another post).

Our surveillance shows that the majority (91.5%) of human or human-adjacent (dogs, cats, horses, etc) tick bites are caused by the following ticks:

  • Ixodes pacificus (“Western black-legged tick,” a close relative of the Deer tick in the Eastern U.S.)
  • Dermacentor variabilis (“American dog tick”)
  • Dermacentor occidentalis (“Pacific Coast tick”)
  • Dermacentor andersoni (“Rocky Mountain Wood tick”)
  • Ixodes spinipalpis
  • Ixodes angustus
What pathogens can these ticks transmit to humans?

Vector competence (the ability of a vector like a tick to transmit a given disease-causing pathogen) tends to run along genus lines, so species within the Ixodes genus tend to be able to transmit pathogens X and Y but not Z, while Dermacentor species tend to transmit Z but not X and Y.

The most common pathogen found in California ticks is Borrelia burgdorferi, which causes Lyme disease in humans and pets. But there’s more than Lyme in those hills! If you find a tick bite from an Ixodes tick in California, it’s also important to consider possible exposure to these pathogens:

  • Borrelia miyamotoi: a bacterium that can cause hard tick relapsing fever—sometimes called Borrelia miyamotoi disease.
  • Anaplasma phagocytophilum: a bacterium that can cause Human granulocyctic Anaplasmosis.
*For every two ticks we find infected with Borrelia burgdorferi (Lyme disease bacteria), we detect one (or more) of these other pathogens

It’s vital that both tick surveillance and diagnostic approaches keep these non-Lyme pathogens in mind. For every two ticks we find infected with Borrelia burgdorferi (Lyme disease bacteria), we detect one (or more) of these other pathogens, so be sure to resist Lyme Tunnel Vision when responding to a tick bite! Common diagnostic tests for Lyme disease have a specific focus on Lyme disease and will not detect infection by these other pathogens if present. Make sure you and your doctor are considering the whole story of a tick bite.

To learn more about the pathogens we find in West Coast ticks, browse our real-time testing data at TickReport.com/stats. If you find and remove a tick, arrange for fast and accurate identification and testing at TickReport.com.
The above material is provided for information purposes only. The material (a) is not nor should be considered, or used as a substitute for, medical advice, diagnosis, or treatment, nor (b) does it necessarily represent endorsement by or an official position of Global Lyme Alliance, Inc. or any of its directors, officers, advisors or volunteers. Advice on the testing, treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history. 

Paul Killinger oversees tick surveillance and pathogen testing at the TickReport testing lab in Amherst, Massachusetts. He has led the lab's public health education and outreach since 2018.

Reversible Dementia Caused By Lyme: Case Study

https://www.globallymealliance.org/news/2023-case-study-reversible-dementia-caused-by-lyme-disease

A case of reversible dementia with Lyme treatment?

Annals of Geriatric Medicine and Research (Sanchini, C., et al.) 2.6.23, published “A case of reversible dementia? Dementia vs delirium in Lyme disease.” The report describes a case of a 75-year-old man who was admitted to the Alzheimer’s Disease Care Unit of the Institute Golgi in Abbiategrasso, Italy.

According to the case report, the man had been recently discharged from a local hospital with a diagnosis of “cognitive impairment, deficit of memory, and poor capacity of criticism compatible with degenerative disease.”

The patient was a multilingual interpreter with a high school degree. He enjoyed walking in the countryside with his dog, but he had been experiencing knee pain – for about a month. The pain would worsen and migrate to his other joints. The case also reports that he had been showing minor memory deficiency and ideomotor slowdown.

A CT scan showed abnormalities, but blood tests were within normal ranges, the only thing noted was increased inflammation. As time went on, the patient became more confused and disoriented, presenting with hallucinations, aggressive behavior, and insomnia.

With the patient having arthritis, he was tested for Lyme. Lyme antibodies were detected by the western blot. Initial intravenous ceftriaxone treatments did not alleviate the patient’s symptoms. Oral doxycycline was administered as well as a brief course of quetiapine to manage the hallucinations.

Soon after 6–7 days of antibiotic therapy, delusional symptoms and hallucinations were reduced, and his insomnia improved. Urinary incontinence completely resolved. His behavioral profile also improved, with a reduction in agitation, aggression, and depression. His language became more fluent and communicative.

Read the full case study here.

_______________

**Comment**

This proves that antimicrobial therapy helps Lyme/MSIDS patients, unfortunately, this patient will most probably suffer relapses as this duration of therapy has been proven to be insufficient time and time again.  Herein lies one of the most glaring problems that has not changed in 40 years.  The other glaring problem is the coinfection involvement that often occurs, necessitating different medications.

But, the band plays on…..

For more:

How many more dementia/Alzheimer’s patients have undiagnosed tick-borne illness?

Molecular Detection of Bartonellosis

https://wwwnc.cdc.gov/eid/article/29/3/22-1223_article

Bartonella spp. Infections Identified by Molecular Methods, United States

David W. McCormick, Sara L. Rassoulian-Barrett, Daniel R. Hoogestraat, Stephen J. Salipante, Dhruba SenGupta, Elizabeth A. Dietrich, Brad T. Cookson, Grace E. Marx1Comments to Author , and Joshua A. Lieberman1
Author affiliations: Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (D.W. McCormick, E.A. Dietrich, G.E. Marx)University of Washington, Seattle, Washington, USA (S.L. Rassoulian-Barrett, D.R. Hoogestraat, S.J. Salipante, D. SenGupta, B.T. Cookson, J.A. Lieberman)
March, 2023

Abstract

Molecular methods can enable rapid identification of Bartonella spp. infections, which are difficult to diagnose by using culture or serology. We analyzed clinical test results of PCR that targeted bacterial 16S rRNA hypervariable V1–V2 regions only or in parallel with PCR of Bartonella-specific ribC gene. We identified 430 clinical specimens infected with Bartonella spp. from 420 patients in the United States. Median patient age was 37 (range 1–79) years; 62% were male.

We identified:

  • B. henselae in 77%
  • B. quintana in 13%
  • B. clarridgeiae in 1%
  • B. vinsonii in 1%
  • B. washoensis in 1% of specimens
  • B. quintana was detected in 83% of cardiac specimens
  • B. henselae was detected in 34% of lymph node specimens

We detected novel or uncommon Bartonella spp. in 9 patients. Molecular diagnostic testing can identify Bartonella spp. infections, including uncommon and undescribed species, and might be particularly useful for patients who have culture-negative endocarditis or lymphadenitis.

______________

Currently, 12 species of Bartonella genus are associated with human infection, but that number is constantly changing. Because Bartonella spp. infections are not nationally notifiable diseases, there is limited knowledge of the epidemiology of this disease in the US.  In my experience it is prolific.

For more:

Pacemakers for Lyme Carditis

https://danielcameronmd.com/pacemakers-for-lyme-carditis/

PACEMAKERS FOR LYME CARDITIS

pacemaker-lyme-carditis

Some patients with Lyme carditis (LC) require implantation of a pacemaker. Yeung and Baranchuk discussed the need for “preventing unnecessary implantation of permanent pacemakers in otherwise healthy young individuals” in the Journal of the American College of Cardiology in 2019.

Lyme disease can directly infiltrate the heart leading to an exaggerated inflammatory response when spirochetes penetrate the heart. Lyme carditis can appear within 1 to 2 months after the onset of a Lyme disease infection, wrote Yeung and Baranchuk.¹ They point out, the most common presentation of LC (90%) is high-degree atrioventricular (AV) block (AVB).

AV block due to Lyme disease can be successfully treated with antibiotics in a hospital setting. However, in some cases, a temporary or permanent pacemaker is required. In reviewing the literature, Besant and colleagues found that 17.9% of patients with LC required a permanent pacemaker and 10.3% required a temporary and a permanent pacemaker.²

“High-degree atrioventricular block is the most common presentation of [Lyme carditis], and usually resolves with antibiotic therapy.”¹

Yeung et al. highlighted the importance of avoiding a permanent pacemaker “to prevent the inherent risks of pacemaker implantation, including periprocedural infections and complications, lead dislodgement, etc.”

Furthermore, the authors emphasized the importance in avoiding a permanent pacemaker in children. “An unnecessary pacemaker implantation would result in a subsequent lifetime of multiple pulse generator changes, psychological/physical sequelae, and burden of associated cumulative health care costs.”

They concluded, “A systematic approach to the diagnosis and treatment of LC will facilitate the identification of LC in patients with high-degree AVB, thus preventing unnecessary implantation of permanent pacemakers.”

Both a standard transvenous temporary pacemaker lead, or modified temporary–permanent transvenous pacing are available.

“In modified temporary– permanent transvenous pacing, an active fixation lead is attached to a resterilized permanent pace- maker generator taped to the patient’s skin and used as a temporary external device, which allows for early ambulation,” wrote Yeung and Baranchuk.

A permanent pacemaker has been recommended if AV conduction is not restored.

References:
  1. Yeung C, Baranchuk A. Diagnosis and Treatment of Lyme Carditis: JACC Review Topic of the Week. J Am Coll Cardiol. Feb 19 2019;73(6):717-726. doi:10.1016/j.jacc.2018.11.035
  2. Besant G, Wan D, Yeung C, et al. Suspicious index in Lyme carditis: Systematic review and proposed new risk score. Clin Cardiol. Dec 2018;41(12):1611-1616. doi:10.1002/clc.23102

For more:

Clinical Microbiology Reviews; “Lab Diagnosis of Lyme Borreliosis”

https://www.change.org/p/the-us-senate-calling-for-a-congressional-investigation-of-the-cdc-idsa-and-aldf/u

Clinical Microbiology Reviews; “Laboratory Diagnosis of Lyme Borreliosis”

Carl Tuttle

Hudson, NH, United States

FEB 21, 2023 — 

Please see the inquiry below addressed to the authors of this publication titled Laboratory Diagnosis of Lyme Borreliosis. There has been no response from Branda or Steere…

———- Original Message ———-
From: CARL TUTTLE <runagain@comcast.net>
To: “branda.john@mgh.harvard.edu” <branda.john@mgh.harvard.edu>, “asteere@mgh.harvard.edu” <asteere@mgh.harvard.edu>
Cc: “cmr-eic@asmusa.org” <cmr-eic@asmusa.org>, “jdienbard@chla.usc.edu” <jdienbard@chla.usc.edu>, “fcfang@uw.edu” <fcfang@uw.edu>, “louisa.messenger@unlv.edu” <louisa.messenger@unlv.edu>, “johann.pitout@cls.ab.ca” <johann.pitout@cls.ab.ca>, “schuetz.audrey@mayo.edu” <schuetz.audrey@mayo.edu>, “cmstaley@umn.edu” <cmstaley@umn.edu>, “achen@mathematica-mpr.com” <achen@mathematica-mpr.com>, “info@mathematica-mpr.com” <info@mathematica-mpr.com>, “pdecker@mathematica-mpr.com” <pdecker@mathematica-mpr.com>, “lwx1@cdc.gov” <lwx1@cdc.gov>, “frederick.chen@ama-assn.org” <frederick.chen@ama-assn.org>, “gmarx@cdc.gov” <gmarx@cdc.gov>, “acoyne@mathematica-mpr.com” <acoyne@mathematica-mpr.com>, “jconstantine@mathematica-mpr.com” <jconstantine@mathematica-mpr.com>, “ctrenholm@mathematica-mpr.com” <ctrenholm@mathematica-mpr.com>, “tbarnes@mathematica-mpr.com” <tbarnes@mathematica-mpr.com>, “sboudreau@mathematica-mpr.com” <sboudreau@mathematica-mpr.com>, “jdevallance@mathematica-mpr.com” <jdevallance@mathematica-mpr.com>, “sara.berg@ama-assn.org” <sara.berg@ama-assn.org>, “jack.resneck@ucsf.edu” <jack.resneck@ucsf.edu>, “jack.resneck@ama-assn.org” <jack.resneck@ama-assn.org>, “todd.unger@ama-assn.org” <todd.unger@ama-assn.org>, “jon.burkhart@ama-assn.org” <jon.burkhart@ama-assn.org>, “karen.kmetik@ama-assn.org” <karen.kmetik@ama-assn.org>, “sanjay.desai@ama-assn.org” <sanjay.desai@ama-assn.org>, “william_henderson@paul.senate.gov” <william_henderson@paul.senate.gov>

Date: 02/10/2023 9:02 AM
Subject: Clinical Microbiology Reviews; “Laboratory Diagnosis of Lyme Borreliosis”
Clinical Microbiology Reviews
Published online 2021 Jan 27
 
Laboratory Diagnosis of Lyme Borreliosis
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7849240

John A. Branda and Allen C. Steere

“Lyme borreliosis is caused by a growing list of related, yet distinct, spirochetes with complex biology and sophisticated immune evasion mechanisms.”

Dear Drs. Branda and Steere,
I read your manuscript with great interest. While searching for the word “seronegative” I came across seven results in your publication but could not find the following references:

There is a wrongful death lawsuit in the state of NY where a 17yr old collapsed in his front yard later pronounced dead at the hospital. His Lyme test was negative.

1. Wrongful death suit shows pitfalls of IDSA Lyme guidelines
Joseph Elone died of Lyme disease
By Mary Beth Pfeiffer Sept 9, 2019
https://www.lymedisease.org/elone-wrongful-death-lawsuit-lyme/

In Pennsylvania there was a civil lawsuit against doctors who misdiagnosed Lyme disease as multiple sclerosis. The patient had four negative serologies but the fifth one came back positive.

2. Pa. Supreme Court to Hear Medical Liability Case with Statute of Limitations Implications
https://www.pamedsoc.org/list/articles/Statute-of-Limitations

Duke University Oncologist Dr. Neil Spector required a heart transplant; his Lyme serology was repeatedly negative.

3. Gone in a Heartbeat: A Physician’s Search for True Healing
https://lymediseaseassociation.org/book-list/gone-in-a-heartbeat-a-physician-s-search-for-true-healing-by-neil-spector-md/

I would like to point out the following case study from Stony Brook Lyme clinic. I understand the patient received thirteen spinal taps, multiple courses of IV and oral meds, and relapsed after each one, proven by CSF antigens and/or PCR. The only way this patient (said to be a physician) remained in remission was to keep her on open ended clarithromycin- was on it for 22 months by the time of publication. Standard antibody tests were negative.

4. Seronegative Chronic Relapsing Neuroborreliosis.  
https://www.ncbi.nlm.nih.gov/pubmed/7796837
Lawrence C. Lipton R.B. Lowy F.D. Coyle P.K.

Department of Medicine, Department of Neurology, and Division of Infectious Diseases, Albert Einstein College of Medicine, and Department of Neurology, State University of New York at Stony Brook, New York, NY., USA

Abstract
We report an unusual patient with evidence of Borrelia burgdorferi infection who experienced repeated neurologic relapses despite aggressive antibiotic therapy. Each course of therapy was associated with a Jarisch-Herxheimer-like reaction. Although the patient never had detectable free antibodies to B. burgdorferi in serum or spinal fluid, the CSF was positive on multiple occasions for complexed anti-B. burgdorferi antibodies, B. burgdorferi nucleic acids and free antigen.

5. Seronegativity in Lyme borreliosis and Other Spirochetal Infections 16 September 2003
https://www.dropbox.com/s/3d6m45jzlhhwalu/Seronegativity.pdf?dl=0

Here is a recent wrongful death lawsuit in the state of Maine: (I understand Mr. Smith’s Lyme test was negative)

Mercy Hospital, physician ordered to pay $6.5M for deadly misdiagnosis
Pete Smith, 25, died in 2017 after a doctor failed to recognize the signs of Lyme Disease
https://www.wmtw.com/article/mercy-hospital-physician-ordered-to-pay-dollar65m-for-deadly-misdiagnosis/42745675

Regardless of your so-called “advances in diagnostics” these references prove serology has always been the wrong diagnostic tool for an infection that often produces no detectable antibodies in all stages of disease.   “Spirochetes with complex biology and sophisticated immune evasion mechanisms” as you pointed out in your summary.

Is there a reason why the references I have presented here are missing from your publication?
A response to this inquiry is requested.
A copy of this inquiry has been sent to the management team at Mathematica Policy Research who have recently been contracted by the CDC.

Respectfully submitted,
Carl Tuttle
Hudson, NH

Cc: CMR Editorial Board

Reference:

1.  HB490 COMMISSION TO STUDY TESTING FOR LYME AND OTHER TICK-BORNE DISEASES
https://www.change.org/p/the-us-senate-calling-for-a-congressional-investigation-of-the-cdc-idsa-and-aldf/u/30346445

In November 2021, a commission created by the State of New Hampshire finished an exhaustive investigation of Lyme disease test accuracy. The commission reported that only 20-30% of people exhibit antibodies at detectable levels, and the commission concluded that “CDC-approved serologic tests for Lyme disease are unreliable in all stages of the disease.”