Archive for the ‘Rickettsia’ Category

HHS Working Group Calls for Tick-Borne Disease Strategic Plan

https://ohsonline.com/articles/2018/11/15/hhs-working-group-calls-for-strategic-plan.aspx?m=1

HHS Working Group Calls for Tick-Borne Disease Strategic Plan

The Tick-Borne Disease Working Group, a federal advisory committee established by Congress in the 21st Century Cures Act, issued its first report Nov. 14.

The Tick-Borne Disease Working Group, an HHS advisory committee established by Congress in the 21st Century Cures Act, issued its first report Nov. 14. The document recommends that the National Institutes of Health create an NIH tick-borne disease strategic plan to address these diseases, including all stages of Lyme disease; that funding be dedicated within CDC to study babesiosis incidence; that the Department of Defense begin a study of tick-borne disease incidence among active-duty service members and their dependents; and that the Veterans Administration begin a study of tick-borne disease incidence and prevalence among veterans and eligible family members.

The DoD recommendation says the department should compile data on the impact of tick-borne diseases on military readiness and should create education and preparedness programs that address the unique risks service members face during training and on deployment and by their families.

The working group consists of 14 people appointed by the HHS secretary in December 2017. They include scientists, physicians, patients, patient advocates, and representatives of HHS, DoD, and the Office of Management and Budget.

Their report calls Lyme disease a growing public health threat, with about 300,000 new cases reported in the United States every year. A map of U.S. states in the report indicates the hardest-hit states, those reporting more than 12,856 cases each in 2004-2016, include Minnesota, Wisconsin, Pennsylvania, Maryland, Virginia, New York, New Jersey, Massachusetts, and Maine.

Most Lyme disease patients who are diagnosed and treated early can fully recover, but 10-20 percent of patients suffer from persistent symptoms, which for some are chronic and disabling. The report says while studies indicate Lyme disease costs approximately $1.3 billion annually in direct medical costs in the United States,

“a comprehensive understanding of the full economic and societal cost remains unknown. It is likely orders of magnitude higher and potentially a $50- to $100-billion-dollar problem for the United States, although more research is needed.”

On Nov. 14, CDC reported that new data show tick-borne diseases are again on the rise, and that in 2017, state and local health departments reported a record number of cases of tick-borne disease to CDC. Cases of Lyme disease, anaplasmosis/ehrlichiosis, spotted fever rickettsiosis (including Rocky Mountain spotted fever), babesiosis, tularemia, and Powassan virus disease all increased—from 48,610 cases in 2016 to 59,349 cases in 2017. However, the 2017 data capture only a fraction of the number of people with tick-borne illnesses, according to CDC. According to the agency, between 2004 and 2016, the number of reported cases of tick-borne disease doubled and researchers discovered seven new tick-borne pathogens that infect people. The new data are from the Notifiable Disease Surveillance System.

_________________

**Comment**

Bartonella is never mentioned yet it is a HUGE player in this madness.  There is little to no research showing how concurrent infection is playing into this.  Here’s a few recent studies:  https://madisonarealymesupportgroup.com/2018/11/17/investigating-disease-severity-in-an-animal-model-of-concurrent-babesiosis-lyme-disease/  THESE FINDINGS SUGGEST THAT B. BURGDORFERI COINFECTION ATTENUATES PARASITE GROWTH WHILE B. MICROTI PRESENCE EXACERBATES LYME DISEASE-LIKE SYMPTOMS IN MICE.

https://madisonarealymesupportgroup.com/2018/10/30/study-shows-lyme-msids-patients-infected-with-many-pathogens-and-explains-why-we-are-so-sick/  For the first time, Garg et al. show a 85% probability for multiple infections including not only tick-borne pathogens but also opportunistic microbes such as EBV and other viruses.
I’m thankful they included Bartonella as that one is often omitted but definitely a player. I’m also thankful for the mention of viruses as they too are in the mix. The mention of the persister form must be recognized as well as many out there deny its existence.

Key Quote:

“Our findings recognize that microbial infections in patients suffering from TBDs do not follow the one microbe, one disease Germ Theory as 65% of the TBD patients produce immune responses to various microbes.”

But there is another important point.

According to this review, 83% of all commercial tests focus only on Lyme (borrelia), despite the fact we are infected with more than one microbe. The review also states it takes 11 different visits to 11 different doctors, utilizing 11 different tests to be properly diagnosed. https://www.news-medical.net/news/20181101/Tick-borne-disease-is-multiple-microbial-in-nature.aspx?

We have many problems, Houston, and much work is being left undone.

 

 

 

Study Shows Lyme in 15 Species of Canadian Ticks – 6 of which Bite Humans. Numerous New Bird Species Acting As Hosts

Scott et al., 2018, Canada-wide tick-host-pathogen study, Bbsl

Healthcare 2018, 6, 131; doi:10.3390/healthcare6040131

John D. Scott, Kerry L. Clark, Janet E. Foley, John F. Anderson, Bradley C. Bierman, and Lance A. Durden

Abstract:

Lyme disease, caused by the spirochetal bacterium, Borrelia burgdorferi sensu lato (Bbsl), is typically transmitted by hard-bodied ticks (Acari: Ixodidae).  Whenever this tick-borne zoonosis is mentioned in medical clinics and emergency rooms, it sparks a firestorm of controversy.  Denial often sets  in, and healthcare practitioners dismiss the fact that this pathogenic spirochetosis is present in their area.  For distribution of Bbsl across Canada, we conducted a 4-year, tick-host study (2013-2016), and collected ticks from avian and mammalian hosts from Atlantic Canada to the West Coast.  Overall, 1,265 ticks consisting of 27 tick species belonging to four genera were collected.  Of the 18 tick species tested, 15 species (83%) were positive for Bbsl and, of these infected ticks, 6 species bite humans.  Overall, 13 of the 18 tick species tested are human-biting ticks.  Our data suggest that a 6-tick, enzootic maintenance cycle of Bbsl is present in southwestern B.C., and five of these tick species bite humans.  Biogeographically, the groundhog tick, Ixodes cookei, has extended its home range from central and eastern Canada to southwestern British Columbia (B.C.).  We posit that the Fox Sparrow, Passerella iliaca  is a reservoir-competent host for Bbsl.  The Bay-breasted Warbler, Setophaga castanea, and the Tennessee Warbler, Vermivora peregrina, are new host records for the blacklegged tick, Ixodes scapularis.  We provide the first report of a Bbsl-positive Amblyomma longirostre larva parasitizing a bird; this bird parasitism suggests that a Willow Flycatcher is a competent reservoir of Bbsl.  Our findings show that Bbsl is present in all provinces, and that multiple tick species are implicated in the enzootic maintenance cycle of this pathogen.  Ultimately, Bbsl poses a serious public health contagion Canada-wise.

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**Comment**

This study highlights the fact that it’s not just the blacklegged tick transmitting pathogens.

Six tick species capable of transmitting to humans have been found in Canada.

Two ticks species known to be transmitters of disease (I. affinis and I. minor) were transported into Canada and are actually more important vectors of Bbsl in the southeastern U.S. than the blacklegged tick.

These findings underscore the fact people do not have to go an endemic area to contract Lyme disease and associated tick-borne diseases. 

Amblyomma longirostre ticks are typically in countries of South, Central and North America.  The fact one was  found in Canada is quite telling.  The fact it was infected with Borrelia burgdorferi – even more telling.  They’re known to transmit Rickettsia.  The larvae are found on birds, while nymphs are reported as parasitizing songbirds and mammals. The adult stages are typically found on mammals such as rodents.

This study supports the fact that birds are the major transporters of ticks, and that mice aren’t the largest concern in tick propagation:  https://madisonarealymesupportgroup.com/2018/11/07/ticks-on-the-move-due-to-migrating-birds-and-photoperiod-not-climate-change/

https://madisonarealymesupportgroup.com/2017/08/17/of-birds-and-ticks/

The 13 ticks in Canada found to be able to potentially infect humans are:

  1. Amblyomma longirostre*
  2. Dermacentor albipictus*
  3. Haemaphysalis leporispalustris*
  4. Ixodes affinis* 
  5. Ixodes angustus
  6. Ixodes banksi*
  7. Ixodes brunneus* 
  8. Ixodes cookei
  9. Ixodes muris
  10. Ixodes pacificus
  11. Ixodes spinipalpis 
  12. Ixodes scapularis
  13. Ixodes texanus*

Of note:  previously Ixodes dentatus were positive for Bbsl (Scott et al, 2012).  In addition, Ixodes urrae can transmit Bbsl to humans as well.

*rarely transmits to humans

The four year study found a number of new bird hosts of importance as well.  

In sum:

  1. Birds are transiting ticks worldwide, with the exception of the arctic and antarctic.  This study blows holes in the climate change theory, as does this study:  https://madisonarealymesupportgroup.com/2018/08/13/study-shows-lyme-not-propelled-by-climate-change/
  2. Throw the maps away.  Maps have been used against patients for decades.
  3. Numerous species of ticks are transmitting diseases.  There’s no such thing as a “good tick.”
  4. Ticks are nature’s dirty syringes with the capability of infecting humans with numerous pathogens.  The following link is another study that corroborates this: https://madisonarealymesupportgroup.com/2018/10/30/study-shows-lyme-msids-patients-infected-with-many-pathogens-and-explains-why-we-are-so-sick/  For the first time, Garg et al. show a 85% probability for multiple infections including not only tick-borne pathogens but also opportunistic microbes such as EBV and other viruses.  Yet, 83% of all commercial tests focus only on Lyme (borrelia).
  5. Bbsl is present in ALL Canadian provinces.  
  6. Tick-borne illness is a crisis.
  7.  Doctors desperately need tick-borne illness education:  https://madisonarealymesupportgroup.com/2018/02/19/calling-all-doctors-please-become-educated-regarding-tick-borne-illness-heres-how/, and  https://madisonarealymesupportgroup.com/2018/06/06/lyme-education-for-healthcare-professionals/

The denial of Lyme/MSIDS must end.  The data keeps pouring in and it’s not going to get better with time.  Patients have been ill for decades but denied medical treatment.  Many have needlessly died.  Stop the madness.  Do your part by spreading the correct information in your sphere of influence.  

Thirty Percent Finnish Ticks Carry at Least One Pathogen & Candidas Rickettsia Tarasevichiae Found for the First Time

https://www.ncbi.nlm.nih.gov/pubmed/30355331

Parasit Vectors. 2018 Oct 24;11(1):556. doi: 10.1186/s13071-018-3131-y.

Tick-borne pathogens in Finland: comparison of Ixodes ricinus and I. persulcatus in sympatric and parapatric areas.

Laaksonen M1, Klemola T2, Feuth E3, Sormunen JJ2, Puisto A2, Mäkelä S2, Penttinen R4, Ruohomäki K2, Hänninen J4, Sääksjärvi IE4, Vuorinen I4, Sprong H5, Hytönen J3, Vesterinen EJ4,6.

Abstract
BACKGROUND:
Almost 3500 tick samples, originally collected via a nationwide citizen science campaign in 2015, were screened to reveal the prevalence and distribution of a wide spectrum of established and putative tick-borne pathogens vectored by Ixodes ricinus and I. persulcatus in Finland. The unique geographical distribution of these two tick species in Finland allowed us to compare pathogen occurrence between an I. ricinus-dominated area (southern Finland), an I. persulcatus-dominated area (northern Finland), and a sympatric area (central Finland).
RESULTS:
Of the analysed ticks, almost 30% carried at least one pathogen and 2% carried more than one pathogen. A higher overall prevalence of tick-borne pathogens was observed in I. ricinus than in I. persulcatus: 30.0% (604/2014) versus 24.0% (348/1451), respectively. In addition, I. ricinus were more frequently co-infected than I. persulcatus: 2.4% (49/2014) versus 0.8% (12/1451), respectively. Causative agents of Lyme borreliosis, i.e. bacterial genospecies in Borrelia burgdorferi (sensu lato) group, were the most prevalent pathogens (overall 17%). “Candidatus Rickettsia tarasevichiae” was found for the first time in I. ricinus ticks and in Finnish ticks in general. Moreover, Babesia divergens, B. venatorum and “Candidatus Neoehrlichia mikurensis” were reported for the first time from the Finnish mainland.
CONCLUSIONS:
The present study provides valuable information on the prevalence and geographical distribution of various tick-borne pathogens in I. ricinus and I. persulcatus ticks in Finland. Moreover, this comprehensive subset of ticks revealed the presence of rare and potentially dangerous pathogens. The highest prevalence of infected ticks was in the I. ricinus-dominated area in southern Finland, while the prevalence was essentially equal in sympatric and I. persulcatus-dominated areas. However, the highest infection rates for both species were in areas of their dominance, either in south or north Finland.

________________

**Comment**

Candidatus Rickettsia tarasevichiae:

Causes human disease and is a new species of rickettsiae of the spotted fever group.  https://www.nejm.org/doi/full/10.1056/NEJMc1303004

Symptoms:

  • hospitalized with fever
  • asthenia (weakness)
  • anorexia
  • nausea
  • headache
  • eschar (dead tissue that falls off healthy skin)
  • lymphadenopathy (swollen lymph nodes)
  • meningitis-like manifestations: vomiting, neck stiffness, and Kernig’s sign.
  • Coma, renal dysfunction, respiratory acidosis then developed, and the patient died 4 days after admission to the hospital.
  • Laboratory tests showed a slight increase in the leukocyte count
  • elevated level of aspartate aminotransferase
  • proteinuria
  • increase in the level of cerebrospinal fluid protein and leukocyte count
  • Since none of the patients presented with rash, which is considered to be a typical sign of infections with species of rickettsiae of the spotted fever group their conditions were initially misdiagnosed, and they received penicillin G, leading to a prolonged hospitalization for approximately 20 days.
Babesia venatorum

Causes human disease: https://wwwnc.cdc.gov/eid/article/20/5/pdfs/12-1034.pdf  B. venatorum was first known as Babesia sp. EU1 and was named after the Latin word for hunter because the first reported infected patients were 2 occupational hunters from Austria and Italy.

Symptoms:

  • irregular fever (38.6°C–41.0°C) for 12 days
  • anemi
  • malaise
  • myalgia
  • fatigue
  • progressive weakness
  • shortness of breath
Candidatus Neoehrlichia mikurensis:

Causes human disease:  https://jcm.asm.org/content/48/5/1956.full, and is an uncultured emerging bacterium that is in the family of Anaplasmosis. It’s close relatives Ehrlichia chaffeensis and Anaplasma phagocytophilum selectively infect the professional phagocytes monocytes/macrophages and neutrophilic granulocytes, which suggests that “Ca. Neoehrlichia mikurensis” may display tropism for leukocytes also.  Until now, no one has been able to grow “Ca. Neoehrlichia mikurensis”, which explains why  blood cultures remain negative. 

https://www.sciencedirect.com/science/article/pii/S2052297518300027

Symptoms:

  • immunosuppressive conditions
  • haematologic neoplasia
  • fever
  • myalgia (muscle pain)
  • arthralgia (joint pain)
  • Vascular events such as deep vein thrombosis, thromboembolic events, aneurysm and transitory ischemic accidents
  • skin manifestations, such as erythema nodosum or erysipelas-like rashes
  • elevated C-reactive protein levels
  • leukocytosis (neutrophilia) 
  • anemia

Ixodes ricinus tick, a.k.a castor bean tick, or sheep tick info:  http://www.cfsph.iastate.edu/Factsheets/pdfs/ixodes_ricinus.pdf  I. ricinus can also transmit a number of pathogens including Babesia divergens (babesiosis), louping ill virus, tick-borne encephalitis virus, Borrelia burgdorferi (Lyme disease) and Anaplasma phagocytophila (tick-borne fever of ruminants, human granulocytic anaplasmosis).  Add to this growing list “Candidatus Rickettsia tarasevichiae,” a new species of rickettsiae of the spotted fever group.

Ioxodes persulcatus tick, a.k.a. Taiga tick info:  http://www.bristoluniversitytickid.uk/page/Ixodes+persulcatus/25/#.W-mzZREeteI  Transmits Russian Spring-Summer encephalitis and Lyme disease.

Babesia divergens, B. venatorum and “Candidatus Neoehrlichia mikurensis” were reported for the first time from the Finnish mainland.

This article demonstrates why many in “Lyme land” remain ill.

You can’t diagnose what you can’t see, grow, and test for.

Authorities have absolutely no idea what is infecting everyone, and Lyme is only the tip of the ice-berg.

 

 

 

 

 

 

 

Hawk Found Carrying Asian Long-horned Tick – the One that Drains Cattle of all Their Blood

https://www.localdvm.com/news/virginia/virginia-hawk-first-bird-in-north-america-found-carrying-invasive-tick/1560920669  (News story found here)

It’s confirmed.  The tick from hell has been found on a hawk in Virginia.  

This Asian “dracula” tick causes SFTS (severe fever with thrombocytopenia syndrome), “an emerging hemorrhagic fever,” causing  fever, fatigue, headache, nausea, muscle pain, diarrhea, vomiting, abdominal pain, disease of the lymph nodes, and conjunctival congestion, but the potential impact of this tick on tickborne illness is not yet known. In other parts of the world, this Longhorned tick, also called the East Asian or bush tick, and has been associated with several tickborne diseases, such as spotted fever rickettsioses, Anaplasma, Ehrlichia, and Borrelia, the causative agent of Lyme Disease.  https://madisonarealymesupportgroup.com/2018/06/12/first-longhorned-tick-confirmed-in-arkansas/

Main concerns:

  1. IT CLONES ITSELF & MULTIPLIES QUICKLY…..
  2. It can drain cattle of their blood: https://madisonarealymesupportgroup.com/2018/03/12/asian-tick-found-in-new-jersey-can-kill-cattle-by-draining-them-of-blood/
  3. It’s been known to cause disease in Asia
  4. A top ecologist wonders if infection by this tick has gone undetected in the past.
  5. There isn’t a systematic national method to look for invasive ticks.
  6. It’s quickly showing up in other states: https://madisonarealymesupportgroup.com/2018/05/26/tick-from-hell-now-sited-in-west-virginia/
  7. It survives cold temps: https://madisonarealymesupportgroup.com/2018/04/21/ticks-from-hell-survived-the-winter/ (Again, the spread if ticks and infection has ZIPPO to do with climate change)

https://madisonarealymesupportgroup.com/2018/09/12/three-surprising-things-i-learned-about-asian-longhorned-ticks-the-tick-guy-tom-mather/  Tick guy, Tom Mather, found that this particular tick, which reproduces by cloning itself, lines up on a single blade of grass motionless, tightly knitted together like the scales on a snake.  Once they found one glad of grass like this, they started seeing this every couple of feet.  He quickly realized this is NOT a rare tick.

LIKE A BOMB, THEY EXPLODE WHEN SOMETHING BRUSHES BY.

three_surprising_4.png

https://madisonarealymesupportgroup.com/2018/07/19/rutgers-racing-to-contain-asian-longhorned-tick/

https://madisonarealymesupportgroup.com/2017/08/17/of-birds-and-ticks/

https://madisonarealymesupportgroup.com/2018/06/08/hemorrhagic-fever-virus-found-on-ticks-on-migratory-birds/

https://madisonarealymesupportgroup.com/2016/10/02/the-role-of-birds-in-tickborne-illness/

Study Shows Lyme/MSIDS Patients Infected With Many Pathogens and Explains Why We Are So Sick

https://www.nature.com/articles/s41598-018-34393-9?fbclid=IwAR3k-zPy2rJu8OuFl3HHqJ0twLPJvQrxiIUALUs0T-BuuJ50_1VQVwcflIQ (Please see comment at end of article)

Evaluating polymicrobial immune responses in patients suffering from tick-borne diseases

Kunal Garg, Leena Meriläinen, Ole Franz, Heidi Pirttinen, Marco Quevedo-Diaz, Stephen Croucher & Leona Gilbert
Scientific Reportsvolume 8, Article number: 15932 (2018)   https://doi.org/10.1038/s41598-018-34393-9

Abstract
There is insufficient evidence to support screening of various tick-borne diseases (TBD) related microbes alongside Borrelia in patients suffering from TBD. To evaluate the involvement of multiple microbial immune responses in patients experiencing TBD we utilized enzyme-linked immunosorbent assay. Four hundred and thirty-two human serum samples organized into seven categories followed Centers for Disease Control and Prevention two-tier Lyme disease (LD) diagnosis guidelines and Infectious Disease Society of America guidelines for post-treatment Lyme disease syndrome. All patient categories were tested for their immunoglobulin M (IgM) and G (IgG) responses against 20 microbes associated with TBD. Our findings recognize that microbial infections in patients suffering from TBDs do not follow the one microbe, one disease Germ Theory as 65% of the TBD patients produce immune responses to various microbes. We have established a causal association between TBD patients and TBD associated co-infections and essential opportunistic microbes following Bradford Hill’s criteria. This study indicated an 85% probability that a randomly selected TBD patient will respond to Borrelia and other related TBD microbes rather than to Borrelia alone.

A paradigm shift is required in current healthcare policies to diagnose TBD so that patients can get tested and treated even for opportunistic infections.
Please see link for full article.  Snippets below:

Introduction
Tick-borne diseases (TBDs) have become a global public health challenge and will affect over 35% of the global population by 20501. The most common tick-borne bacteria are from the Borrelia burgdorferi sensu lato (s.l.) group. However, ticks can also transmit co-infections like Babesia spp.2, Bartonella spp.3, Brucella spp.4,5,6,7,8, Ehrlichia spp.9, Rickettsia spp.10,11, and tick-borne encephalitis virus12,13,14. In Europe and North America, 4–60% of patients with Lyme disease (LD) were co-infected with Babesia, Anaplasma, or Rickettsia11,15,16. Evidence from mouse and human studies indicate that pathogenesis by various tick-borne associated microbes15,16,17 may cause immune dysfunction and alter, enhance the severity, or suppress the course of infection due to the increased microbial burden18,19,20,21,22. As a consequence of extensive exposure to tick-borne infections15,16,17, patients may develop a weakened immune system22,23, and present evidence of opportunistic infections such as Chlamydia spp.24,25,26,27, Coxsackievirus28, Cytomegalovirus29, Epstein-Barr virus27,29, Human parvovirus B1924, and Mycoplasma spp.30,31. In addition to tick-borne co-infections and non-tick-borne opportunistic infections, pleomorphic Borrelia persistent forms may induce distinct immune responses in patients by having different antigenic properties compared to typical spirochetes32,33,34,35. Nonetheless, current LD diagnostic tools do not include Borrelia persistent forms, tick-borne co-infections, and non-tick-borne opportunistic infections.

The two-tier guidelines36,37,38 for diagnosing LD by the Centers for Disease Control and Prevention (CDC) have been challenged due to the omission of co-infections and non-tick-borne opportunistic infections crucial for comprehensive diagnosis and treatment39,40. Emerging diagnostic solutions have demonstrated the usefulness of multiplex assays to test for LD and tick-borne co-infections41,42. However, these new technologies do not address seroprevalence of non-tick-borne opportunistic infections in patients suffering from TBD and they are limited to certain co-infections41,42. Non-tick-borne opportunistic microbes can manifest an array of symptoms24,29 concerning the heart, kidney, musculoskeletal, and the central nervous system as seen in patients with Lyme related carditis43, nephritis44, arthritis45, and neuropathy46, respectively. Therefore, Chlamydia spp., Coxsackievirus, Cytomegalovirus, Epstein-Barr virus, Human parvovirus B19, Mycoplasma spp., and other non-tick-borne opportunistic microbes play an important role in the differential diagnosis of LD24,29. As the current knowledge regarding non-tick-borne opportunistic microbes is limited to their use in differential diagnosis of LD, it is unclear if LD patients can present both tick-borne co-infections and non-tick-borne opportunistic infections simultaneously.

For the first time, we evaluate the involvement of Borrelia spirochetes, Borrelia persistent forms, tick-borne co-infections, and non-tick-borne opportunistic microbes together in patients suffering from different stages of TBD. To highlight the need for multiplex TBD assays in clinical laboratories, we utilized the Bradford Hill’s causal inference criteria47 to elucidate the likelihood and plausibility of TBD patients responding to multiple microbes rather than one microbe. The goal of this study is to advocate screening for various TBD microbes including non-tick-borne opportunistic microbes to decrease the rate of misdiagnosed or undiagnosed48 cases thereby increasing the health-related quality of life for the patients39, and ultimately influencing new treatment protocol for TBDs.

Results
Positive IgM and IgG responses by CDC defined acute, CDC late, CDC negative, PTLDS immunocompromised, and unspecific patients to 20 microbes associated with TBD (Fig. 1) were utilized to evaluate polymicrobial infections (Figs 2–4). Patient categories included CDC acute (n = 43), CDC late (n = 43), CDC negative (n = 46), PTLDS (n = 31), immunocompromised (n = 61), unspecific (n = 31), and healthy (n = 177).

Polymicrobial infections are present at all stages of tick-borne diseases.

Microbes include Borrelia burgdorferi sensu stricto, Borrelia afzelii, Borrelia garinii, Borrelia burgdorferi sensu stricto persistent form, Borrelia afzelii persistent form, Borrelia garinii persistent form, Babesia microti, Bartonella henselae, Brucella abortus, Ehrlichia chaffeensis, Rickettsia akari, Tick-borne encephalitis virus (TBEV), Chlamydia pneumoniae, Chlamydia trachomatis, Coxsackievirus A16 (CVA16), Cytomegalovirus (CMV), Epstein-Barr virus (EBV), Mycoplasma pneumoniae, Mycoplasma fermentans, and Human parvovirus B19 (HB19V).

In Fig. 2A, 51% and 65% of patients had IgM and IgG responses to more than one microbe, whereas 9% and 16% of patients had IgM and IgG responses to only one microbe, respectively. Immune responses to Borrelia persistent forms (all three species) for IgM and IgG were 5–10% higher compared to Borrelia spirochetes in all three species (Fig. 2B). Interestingly, the probability that a randomly selected patient will respond to Borrelia persistent forms rather than the Borrelia spirochetes (Fig. S2) is 80% (d = 1.2) for IgM and 68% for IgG (d = 0.7). Figure 2A and B indicated that IgM and IgG responses by patients from different stages of TBDs are not limited to only Borrelia spirochetes.

In Fig. 3 sub-inlets, more than 50% of the patients reacted to only the individual Borrelia strains suggesting that Borrelia antigens are not cross-reactive. If patients were cross-reacting among antigens, a larger percentage of the patients would be seen with the combination of all three species (Fig. S2). These results provide evidence to suggest that the inclusion of different Borrelia species and their morphologies in current LD diagnostic tools will improve its efficiency.

Discussions
The study outcome indicated that polymicrobial infections existed at all stages of TBD with IgM and IgG responses to several microbes (Fig. 2). Results presented in this study propose that infections in patients suffering from TBDs do not obey the one microbe one disease Germ Theory. Based on these results and substantial literature11,15,16,17,27,49,50,51 on polymicrobial infections in TBD patients, we examined the probability of a causal relationship between TBD patients and polymicrobial infections following Hill’s nine criteria47.

An average effect size of d = 1.5 for IgM and IgG (Fig. 4A) responses is considered very large52. According to common language effect size statistics53, d = 1.5 indicates 85% probability that a randomly selected patient will respond to Borrelia and other TBD microbes rather than to only Borrelia. Reports from countries such as Australia27, Germany49, Netherlands11, Sweden50, the United Kingdom51, the USA15,16, and others indicate that 4% to 60% of patients suffer from LD and other microbes such as Babesia microti and human granulocytic anaplasmosis (HGA). However, previous findings11,15,16,27,49,50,51 are limited to co-infections (i.e., Babesia, Bartonella, Ehrlichia, or Rickettsia species) in patients experiencing a particular stage of LD (such as Erythema migrans). In contrast, a broader spectrum of persistent, co-infections, and opportunistic infections associated with diverse stages of TBD patients have been demonstrated in this study (Fig. 2). From a clinical standpoint, the likelihood for IgM and IgG immune responses by TBD patients to the Borrelia spirochetes versus the Borrelia persistent forms, and responses to just Borrelia versus Borrelia with many other TBD microbes has been quantified for the first time (Fig. S2).

Borrelia pathogenesis could predispose individuals to polymicrobial infections because it can suppress, subvert, or modulate the host’s immune system18,19,20,21,22 to create a niche for colonization by other microbes54. Evidence in animals55 and humans11,15,16,27,49,50,51 frequently indicate co-existence of Borrelia with other TBD associated infections. Interestingly, IgM and IgG immune levels by patients to multiple forms of Borrelia resulted in immune responses to 14 other TBD microbes (Fig. 4B). In contrast, patient responses to either form of Borrelia (spirochetes or persistent forms) resulted in reactions to an average of 8 other TBD microbes (Fig. 4B). Reaction to two forms of Borrelia reflected an increase in disease severity indicating biological gradient for causation as required by Hill’s criteria47.

Multiple microbial infections in TBD patients seem plausible because ticks can carry more than eight different microbes depending on tick species and geography56,57. Moreover, Qiu and colleagues reported the presence of at least 18 bacterial genera shared among three different tick species and up to 127 bacterial genera in Ixodes persulcatus58. Interestingly, research indicates Chlamydia-like organism in Ixodes ricinus ticks and human skin59 that may explain immune responses to Chlamydia spp., seen in this study (Fig. 2). Additionally, prevalence of TBD associated co-infections such as B. abortus, E. chaffeensis, and opportunistic microbes such as C. pneumoniae, C. trachomatis, Cytomegalovirus, Epstein-Barr virus, and M. pneumoniae have been recorded in the general population of Europe and the USA (Table S2). However, true incidence of these microbes is likely to be higher considering underreporting due to asymptomatic infections and differences in diagnostic practices and surveillance systems across Europe and in the USA. More importantly, clinical evidence for multiple microbes has been reported in humans11,15,16,27,49,50,51, and livestock55 to mention the least. Our findings regarding the presence of polymicrobial infections at all stages of TBD further supports the causal relationship between TBD patients and polymicrobial infections (Fig. 2). Various microbial infections in TBD patients have been linked to the reduced health-related quality of life (HRQoL) and increased disease severity39.

An association between multiple infections and TBD patients relates well to other diseases such as periodontal, and respiratory tract diseases. Oral cavities may contain viruses and 500 different bacterial species60. Our findings demonstrate that TBD patients may suffer from multiple bacterial and viral infections (Fig. 4). In respiratory tract diseases, influenza virus can stimulate immunosuppression and predispose patients to bacterial infections causing an increase in disease severity61. Likewise, Borrelia can induce immunosuppression that may predispose patients to other microbial infections causing an increase in disease severity.

Traditionally, positive IgM immune reaction implies an acute infection, and IgG response portrays a dissemination, persistent or memory immunity due to past infections. Depending on when TBD patients seek medical advice, the level of anti-Borrelia antibodies can greatly vary as an Erythema migrans (EM) develops and may present with IgM, IgG, collective IgM/IgG, or IgA62. This study recommends both IgM and IgG in diagnosing TBD (Figs 5 and S4–S6) as unconventional antibody profiles have been portrayed in TBD patients. Presence of long-term IgM and IgG antibodies have been reported in LD patients that were tested by the CDC two-tier system. In 2001, Kalish and colleagues reported anti-Borrelia IgM or IgG persistence in patients that suffered from LD 10–20 years ago63. Similarly, Hilton and co-workers recorded persistent anti-Borrelia IgM response in 97% of late LD patients that were considered cured following an antibiotic treatment64.

Similar events of persistent IgM and IgG antibody reactions were demonstrated in patients treated for Borrelia arthritis and acrodermatitis chronica atrophicans65, chronic cutaneous borreliosis66, and Lyme neuroborreliosis67. A clear phenomenon of immune dysfunction is occurring, which might account for the disparities in LD patient’s antibody profiles and persistence. Borrelia suppresses the immune system by inhibition of antigen-induced lymphocyte proliferation18, reducing Langerhans cells by downregulation of major histocompatibility complex class II molecules on these cells19, stimulating the production of interleukin-10 and anti-inflammatory immunosuppressive cytokine20, and causing disparity in regulation and secretion of cytokines21. Other studies have demonstrated low production or subversion of specific anti-Borrelia antibodies in patients with immune deficiency status22.

In the USA alone, the economic healthcare burden for patients suffering from LD and ongoing symptoms is estimated to be $1.3 billion per year69. Additionally, 83% of all TBD diagnostic tests performed by the commercial laboratories in the USA accounted for only LD70. Globally, the commercial laboratories’ ability to diagnose LD has increased by merely 4% (weighted mean for ELISA sensitivity 62.3%) in the last 20 years71. This study provides evidence regarding polymicrobial infections in patients suffering from different stages of TBDs. Literature analyses and results from this study followed Hill’s criteria indicating a causal association between TBD patients and polymicrobial infections. Also, the study outcomes indicate that patients may not adhere to traditional IgM and IgG responses.

__________________

**Comment**

For the first time, Garg et al. show a 85% probability for multiple infections including not only tick-borne pathogens but also opportunistic microbes such as EBV and other viruses.

I’m thankful they included Bartonella as that one is often omitted but definitely a player.  I’m also thankful for the mention of viruses as they too are in the mix.  The mention of the persister form must be recognized as well as many out there deny its existence.

Key Quote:  Our findings recognize that microbial infections in patients suffering from TBDs do not follow the one microbe, one disease Germ Theory as 65% of the TBD patients produce immune responses to various microbes.”

But there is another important point.

According to this review, 83% of all commercial tests focus only on Lyme (borrelia), despite the fact we are infected with more than one microbe.  The review also states it takes 11 different visits to 11 different doctors, utilizing 11 different tests to be properly diagnosed.  https://www.news-medical.net/news/20181101/Tick-borne-disease-is-multiple-microbial-in-nature.aspx?

This is huge.  Please spread the word.

 

Tick, Flea, & Louse-Borne Diseases of Public Health & Veterinary Significance in Nigeria

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6136614/

Tick, Flea, and Louse-Borne Diseases of Public Health and Veterinary Significance in Nigeria

Abstract

Mosquito-borne diseases are common high-impact diseases in tropical and subtropical areas. However, other non-mosquito vector-borne pathogens (VBPs) may share their geographic distribution, seasonality, and clinical manifestations, thereby contributing their share to the morbidity and mortality caused by febrile illnesses in these regions. The purpose of this work was to collect and review existing information and identify knowledge gaps about tick, flea-, and louse-borne diseases of veterinary and public health significance in Nigeria. Full-length articles about VBPs were reviewed and relevant information about the vectors, their hosts, geographic distribution, seasonality, and association(s) with human or veterinary diseases was extracted. Specific laboratory tools used for detection and identification of VBPs in Nigeria were also identified. A total of 62 original publications were examined. Substantial information about the prevalence and impacts of ticks and fleas on pet and service dogs (18 articles), and livestock animals (23 articles) were available; however, information about their association with and potential for causing human illnesses was largely absent despite the zoonotic nature of many of these peri-domestic veterinary diseases.

Recent publications that employed molecular methods of detection demonstrated the occurrence of several classic (Ehrlichia canis, Rickettsia africae, Bartonella sp.) and emerging human pathogens (R. aeschlimannii, Neoehrlichia mikurensis) in ticks and fleas. However, information about other pathogens often found in association with ticks (R. conorii) and fleas (R. typhi, R. felis) across the African continent was lacking. Records of louse-borne epidemic typhus in Nigeria date to 1947; however, its current status is not known. This review provides an essential baseline summary of the current knowledge in Nigeria of non-mosquito VBPs, and should stimulate improvements in the surveillance of the veterinary and human diseases they cause in Nigeria. Due to increasing recognition of these diseases in other African countries, veterinary and public health professionals in Nigeria should expand the list of possible diseases considered in patients presenting with fever of unknown etiology.

____________________

**Comment**

I find it increasingly interesting that everyone’s picking up Bartonella, yet it’s hardly on the radar here despite thousands of Lyme/MSIDS patients having symptoms of it.  Bartonella is a tough pathogen & can be the guy behind so many psychiatric issues as well as heart issues.

We need to know for certain ticks can transmit it because if they don’t, either the tick bite itself is reactivating a latent infection or we are coming by it another way.  One thing’s for certain:  it needs to be dealt with on the research front as well as on the medical front.

For more on Bartonella:  https://madisonarealymesupportgroup.com/2016/01/03/bartonella-treatment/

https://madisonarealymesupportgroup.com/2018/10/02/1st-documented-case-of-girl-with-blood-stream-infection-with-bartonella-with-coinfection-of-another-bartonella-strain/

https://madisonarealymesupportgroup.com/2018/10/02/bartonella-found-in-deer-flies-deer-moose/

https://madisonarealymesupportgroup.com/2018/09/28/bartonella-infective-endocarditis-with-dissemination-a-case-report-literature-review/

https://madisonarealymesupportgroup.com/2016/08/09/a-bartonella-story/

For a great read on how those working with animals are especially vulnerable to Bartonella:  https://madisonarealymesupportgroup.com/2018/09/20/humana-bartonellosis-perspectives-of-a-veterinary-internist/

Excerpt:

 

Due to extensive contact with a spectrum of animal species, veterinary professionals appear to have an occupational risk of infection because of frequent exposure to Bartonella spp., therefore these individuals should exercise increased precautions to avoid arthropod bites, arthropod feces (i.e. fleas and lice), animal bites or scratches and direct contact with bodily fluids from sick animals. As Bartonella spp. have been isolated from cat, dog or human blood, cerebrospinal fluid, joint fluid,aqueous fluid, seroma fluid and from pleural, pericardial and abdominal effusions, a substantial number of diagnostic biological samples collected on a daily basis in veterinary practices could contain viable bacteria.
The increasing number of defined Bartonella spp., in conjunction with the high level of bacteremia found in reservoir adapted hosts, which represent the veterinary patient population, ensures that all veterinary professionals will experience frequent and repeated exposure to animals harboring these bacteria. Therefore, personal protective equipment, frequent hand washing and avoiding cuts and needle sticks have become more important as our knowledge of this genus has improved and various modes of transmission have been defined.
Physicians should be educated as to the large number of Bartonella spp. in nature, the extensive spectrum of animal reservoir hosts, the diversity of confirmed and potential arthropod vectors, current limitations associated with diagnosis and treatment efficacy, and the ecological and evolving medical complexity of these highly evolved intravascular, endotheliotropic bacteria.

Study Finds Q Fever & Rickettsia (Typhus) in Australian Ticks and People

https://www.ncbi.nlm.nih.gov/m/pubmed/30270855/

Ixodes holocyclus Tick-Transmitted Human Pathogens in North-Eastern New South Wales, Australia.

Graves SR, et al. Trop Med Infect Dis. 2016.

Abstract

A group of 14 persons who live in an area of Australia endemic for the Australian paralysis tick, Ixodes holocyclus, and who were involved in regularly collecting and handling these ticks, was examined for antibodies to tick-transmitted bacterial pathogens.

Five (36%) had antibodies to Coxiella burnetii, the causative agent of Q fever and three (21%) had antibodies to spotted fever group (SFG) rickettsiae (Rickettsia spp). None had antibodies to Ehrlichia, Anaplasma, Orientia, or Borrelia (Lymedisease) suggesting that they had not been exposed to these bacteria.

A total of 149 I. holocyclus ticks were examined for the citrate synthase (gltA) gene of the SFG rickettsiae and the com1 gene of C. burnetii; 23 (15.4%) ticks were positive for Rickettsia spp. and 8 (5.6%) positive for Coxiella spp. Sequencing of fragments of the gltA gene and the 17 kDa antigen gene from a selection of the ticks showed 99% and 100% homology, respectively, to Rickettsia australis, the bacterium causing Queenslandtick typhus.

Thus, it appears that persons bitten by I. holocyclus in NE NSW, Australia have an approximate one in six risk of being infected with R. australis. Risks of Q fever were also high in this region but this may have been due to exposure by aerosol from the environment rather than by tick bite. A subset of 74 I. holocyclus ticks were further examined for DNA from Borrelia spp., Anaplasma spp. and Ehrlichia spp. but none was positive. Some of these recognised human bacterial pathogens associated with ticks may not be present in this Australian tick species from northeastern New South Wales.

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**Comments**

Folks in Australia have been fighting the denial of authorities for decades regarding Lyme Disease:  https://madisonarealymesupportgroup.com/2018/08/21/our-battle-ongoing-lyme-disease-in-australia/

https://madisonarealymesupportgroup.com/2016/11/03/ld-not-in-australia-here-we-go-again/

https://madisonarealymesupportgroup.com/2018/10/03/aussie-widow-of-lyme-disease-victim-to-sue-nsw-health/  A SYDNEY woman launches a class action against NSW Health after autopsy results showed her husband was riddled with Lyme in his liver, heart, kidney, and lungs.  He was only 44 years old and was bitten by a tick while filming a TV show in Sydney.

Now how in the world did that happen?

While they still deny Lyme (borrelia) this recent study definitively shows a number of pathogens in Australian ticks and humans including Rickettsia (more commonly known as Tick & arthropod TyphusQueensland typhus or Rickettsia australis), as well as Q Fever.

Tick Typhus is similar to Rocky Mountain spotted fever, but deemed not as severe.  Symptoms include:

  • Fever
  • Headache
  • Malaise
  • Bloodshot eyes
  • Red lump at tick bite site
  • Ulceration at tick bite site
  • Black scab at tick bite site
  • Enlarged local lymph nodes
  • Forearm red rash
  • Red body rash
  • Palm rash
  • Rash on soles of feet

Doxycycline is the front-line drug for typhus and broad-spectrum antibiotics aren’t helpful.

Fact sheet on typhus:  https://www.health.nsw.gov.au/Infectious/factsheets/Factsheets/typhus.PDF  The perps are typically lice, fleas, mites, and ticks.

https://madisonarealymesupportgroup.com/2018/08/19/monster-ticks-found-in-germany-threaten-europe-with-deadly-disease-crimean-congo-fever/  In this article, they found a tropical form of tick typhus in tropical ticks found in Germany. Typhus is making a comeback, particularly in the southern U.S. Migrating birds are transporting ticks as well as the diseases they carry worldwide 

Fact sheet on Q Fever: http://www.stopticks.org/ticks/qfever.asp

Caused by the bacteria Coxiella burnetii, it can cause pneumonia and hepatitis (liver inflammation) in its early stage, and infection of the heart valves (endocarditis) in its chronic stage.  Perps are the Brown Dog Tick (Rhipicephalus sanguine us), Rocky Mountain Wood Tick (Dermacentor andersoni), and the Lone Star Tick (Amblyomma americium).

https://coloradoticks.org/tick-borne-diseases/q-fever/  This article states it’s usually a mild disease with flu-like symptoms but sometimes it can resurface years later.  This more deadly, chronic form, of Q fever can damage heart, liver, brain and lungs. C. burnetii is highly infectious. Humans that are susceptible to this disease can be infected by a single organism. It is considered a significant threat for bio warfare and is classified as a Category B agent of bioterrorism.

The severity and combination of signs and symptoms vary greatly. About half the people infected with Q fever will get sick. Symptoms include:

  • High fever (up to 105°F)
  • Fatigue
  • Severe headache
  • General malaise
  • Myalgia
  • Chills or sweats
  • Non-productive cough
  • Nausea
  • Vomiting
  • Diarrhea
  • Abdominal pain
  • Chest pain

Doxycycline is also the front-line drug for this with quinolone antibiotics as an alternative.

Add the Ixodes holocyclus tick to this list as well.

And before you think it can only ever be in Australia, this article in the 2013 issue of the Australian Veterinary Journal shows the likelihood of a population of Ixodes holocyclus breeding outside their common range.  https://conference.ava.com.au/13097.

Well there goes the neighborhood.

Here’s a nifty chart:  https://www.lymedisease.org/lyme-basics/co-infections/other-co-infections/ (Please remember this is constantly changing)

Screen-Shot-2014-08-26-at-5.27.54-PM

If there’s one think I know for sure, it’s that nothing about ticks and the diseases they carry is sure.

They are finding tropical ticks in Germany (where they shouldn’t be) https://madisonarealymesupportgroup.com/2018/08/19/monster-ticks-found-in-germany-threaten-europe-with-deadly-disease-crimean-congo-fever/ and they are finding Asian ticks in the U.S. (where they shouldn’t be) https://madisonarealymesupportgroup.com/2018/10/03/1st-person-bitten-by-east-asian-longhorned-tick/.

When is the CDC going to get the memo and scrap the tick maps?