Archive for the ‘Rocky Mountain Spotted Fever’ Category

Rocky Mountain Spotted Fever is Not the Only Rickettsiosis

https://www.galaxydx.com/rickettsiosis_rocky_mountain_spotted_fever/

Rocky Mountain Spotted Fever is not the only Rickettsiosis

 

 

Tularemia in Minnesotan Ticks

https://www.liebertpub.com/doi/abs/10.1089/vbz.2018.2388

Prevalence of Francisella tularensis in Dermacentor variabilis Ticks, Minnesota, 2017

Tory Whitten, Courtney Demontigny, Jenna Bjork, Mandy Foss, Molly Peterson, Joni Scheftel, Dave Neitzel, Maureen Sullivan, and Kirk Smith
Published Online:https://doi.org/10.1089/vbz.2018.2388

Introduction: The prevalence of Francisella tularensis in Minnesota ticks is unknown. Ticks collected at seven sites were tested to determine the infection prevalence of F. tularensis in Dermacentor variabilis in Minnesota.

Materials and Methods: Ticks were collected from two properties at an epizootic site and at five long-term tick research sites. Ticks were pooled by species, sex, date, and site with a maximum of 10 ticks per pool. Ticks were bisected and homogenized; DNA from supernatant was extracted and tested by real-time PCR (RT-PCR). Twice, additional ticks were collected for bacterial culture and isolation of F. tularensis. Proportion of positive pools and minimum infection rate (MIR) were calculated.

Results: A total of 3527 ticks were tested for F. tularensis including 1601 male D. variabilis and 1926 female D. variabilis. Across all sites, 128 (34%) of 378 pools were RT-PCR positive for F. tularensis. Of 128 positive pools, F. tularensis from 96 (75%) was identified as type A; F. tularensis from 32 pools was unable to be subtyped. The overall MIR was 3.6%. The MIR was significantly lower at the epizootic site compared with Morrison County 1 (3.9% vs. 7.2%; p = 0.02) but did not differ between the epizootic site and Pine County 1 (3.9% vs. 2.1%; p = 0.49). Within the epizootic site, the MIR was significantly higher at Washington County 2 compared with the adjacent property (5.7% vs. 2.3%; p < 0.001). F. tularensis was cultured from 6 (15%) of 40 pools.

Conclusions: F. tularensis was found in ticks at a majority of sites tested. The MIR of F. tularensis in D. variabilis ticks in Minnesota varied geographically. Our findings support the hypothesis that D. variabilis plays an important role in the natural history of tularemia in Minnesota. Further ecologic studies are needed to fully understand the importance of tick species in the maintenance and transmission of F. tularensis in Minnesota.

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**Comment**

The Dermacentor variabilis tick is a hard bodied tick, also known as the American Dog tick or Wood tick and is widely known.  It transmits Rocky Mountain spotted fever (RMSF) and tularemia to humans as well as canine tick paralysis to dogs.  http://edis.ifas.ufl.edu/in781

LyraEDISServlet-2

Dorsal view of American dog ticks, Dermacentor variabilis (Say), with male on left, and female on right.  Credit: J.F. Butler, University of Florida

It was been suggested that adult ticks move to the edge of the roads and trails in an attempt to find a host, or “quest.” Some have hypothesized that because many animals typically follow trails, they leave an odor that attracts these ticks causing them to move toward and quest alongside trails in attempts to find a host (Mcnemee et al. 2003).

More on Tularemia:  https://madisonarealymesupportgroup.com/2016/10/25/of-rabbits-and-men/ 

https://madisonarealymesupportgroup.com/2018/09/28/after-tularemia-death-experts-stress-education/

https://madisonarealymesupportgroup.com/2018/08/07/tularemia-hunting-dogs-as-possible-vectors/

https://madisonarealymesupportgroup.com/2018/02/27/tularemia-infected-ticks-found-on-sorrento-valley-trail-in-ca/

https://madisonarealymesupportgroup.com/2018/03/07/hantavirus-tularemia-warnings-issued-in-san-diego-county/

https://madisonarealymesupportgroup.com/2018/09/19/glandular-tularemia/

Normally thought of as inhabiting areas east of the Rocky Mountains, the Wood tick is obviously defying entomology maps and traipsing all over – from Minnesota to Missouri, California, and most probably everywhere in-between.

I remember hearing Timothy Lepore, MD, FACS, surgeon at Nantucket Cottage Hospital, at a Lyme conference.  He explained that Tularemia is also a disease of those who work with the land such as landscapers and farmers, as well as those who get bit by a tick. There are cases reported in every state but Hawaii, and many other wild and domestic animals can be infected. The highest rates of infection are in Arkansas.  Please see this link for more details but know that this is a bioweaponized pathogen:  https://madisonarealymesupportgroup.com/2016/10/25/of-rabbits-and-men/  The WHO estimates that an aerosol dispersal of 50 kg of F. tularensis over an area with 5 million people would result in 25,000 incapacitating casualties including 19,000 deaths.

Transmission: Transmission can occur through the skin or mucous membranes when handling infected animals as well as through tick bite, contact with fluids from infected deer flies, mosquitoes or ticks, handling or eating undercooked rabbit, drinking contaminated water, inhaling dust from contaminated soil, and handling contaminated pelts or paws of animals. It can also be inhaled from infected hay, grain, or soil. Dr. Lepore had patients who contracted it from their pet dog who shook rain water on them after chewing on a dead rabbit, as well as from folks eating road kill, a person who held sick animals, and a gentleman who slept with his pet bunny.

Another reminder – don’t sleep with pets!
The fact that 35% of Minnesotan ticks are infected with Tularemia is concerning.  Spread the word.

 

 

 

 

North Dakota Tick Survey Sees Large Uptick of Samples. Here’s What the Health Department Found

https://www.thedickinsonpress.com/lifestyle/health/4556529-north-dakota-tick-survey-sees-large-uptick-samples-heres-what-health

North Dakota tick survey sees large uptick of samples. Here’s what the health department found.

ticks1_0

The American Dog tick was the most common tick surveyed in 2018 by the North Dakota Department of Health. This adult female is a known carrier of Rocky Mountain spotted fever.   submitted photo
BISMARCK – Those creepy, crawly creatures are living up to their nasty reputation. In brief, the summary of a second season of a statewide survey of ticks confirms what most people fear – a high percentage of the bloodsucking, pincer pests are carriers of disgusting diseases that are easily transmitted to hosts.

 

The North Dakota Department of Health first ventured into tick surveillance in 2017 by collecting and testing a relatively small sample of ticks. The ticks in the sample were provided with the help of veterinarians and zoos in the state. The program was significantly expanded in 2018 with active participation from 37 veterinarians, four zoos, North Dakota Game and Fish, Department of Agriculture Wildlife Services and at least one individual.

“They all submitted ticks, which was a huge help,”said Laura Cronquist, NDDOH division of disease control. “We had more coverage throughout the state in 2018, which was real nice.”

Of the 13,640 ticks collected and sent to the state laboratory for disease testing, nearly half were contributed by a single interested individual – John Heiser of Grassy Butte. In all, ticks were submitted from 25 counties in the state.

“We had more participation last year, which was awesome,” said Cronquist. “More ticks were submitted. Our project is really unique for our area.”

The state’s most common tick is the American Dog tick. The dog tick and Rocky Mountain wood tick, which is also found within the state, are closely related. Both are known for their speciality, carrying the dreaded Rocky Mountain spotted fever virus.

Rocky Mountain spotted fever symptoms include stomach pain, nausea, vomiting, loss of appetite and muscle pain. Delayed treatment may lead to severe illness or death. Some Rocky Mountain spotted fever victims may suffer irreversible hearing loss, paralysis, mental disability and damage to blood vessels which could lead to amputation of extremities. Fourteen cases of Rocky Mountain spotted fever were reported in the state in 2017.

There’s another tick present in North Dakota with a well-deserved and ugly reputation too. A surprising number of them were collected in 2018.

“We ended up with more deer ticks from across the state,” noted Cronquist.

While the number of deer ticks submitted to the NDDOH was small in comparison to the number of other ticks, just 51, they were found in 22 of the 25 counties surveyed, including Ward County. Deer ticks are are known carriers of Lyme disease, 56 cases of which were reported in the state in 2017. In addition, deer ticks are believed to have transmitted 17 cases of anaplasmosis and one case of Powassan in 2017.

The symptoms of anaplasmosis are similar to Rocky Mountain spotted fever but can include chills, cough and confusion. Severe cases can lead to difficulty breathing, hemorrhage, kidney failure and disrupt various functions of the nervous system.

Fortunately, Powassan transmission from ticks remains quite rare in North Dakota. It is closely related to West Nile disease. A tick can transmit Powassan in as little as 15 minutes after biting a human. About 10 percent of Powassan cases result in death. According to the NDDOH report on the 2018 study, statistics show that approximately half of Powassan survivors have permanent neurologic conditions including headaches, muscle wasting and memory problems.

The Lone Star tick, whose range is primarily the southern and eastern United States, and has been linked to red meat allergies, is believed to be expanding its range. However, Lone Star ticks remain extremely rare in North Dakota.

“That’s correct,” said Cronquist. “Two years ago two were found. Last year just one and it’s unknown how they got here. They are not all that concerning yet.”

The state was divided into eight regions for the tick surveillance survey. Tick pools from each region, consisting of up to 20 ticks each, were tested for the presence of several diseases. Of the 176 pools made up of American Dog ticks and Rocky Mountain wood ticks, 106 tested positive for disease carrying pathogens. Half of the deer tick pools tested positive.

According to the NDDOH report, ticks can transfer some pathogens to their hosts in as little as 15 minutes. Some pathogens require that the tick to be attached from 24 to 48 hours. When a tick bites into flesh it inserts a feeding tube into the incision which enables the transmission of disease.

Complete results and information regarding the 2018 tick surveillance project can be found on the NDDOH website.

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For more:  https://madisonarealymesupportgroup.com/2018/07/22/citizen-scientists-help-track-tick-borne-illness-exposure/

https://madisonarealymesupportgroup.com/2018/04/10/canadian-citizen-scientists-helping-with-tick-surveillance/

https://madisonarealymesupportgroup.com/2018/10/26/scientists-high-school-students-find-new-pathogens-hiding-in-indiana-ticks/

https://madisonarealymesupportgroup.com/2018/10/22/tick-project-takes-a-deeper-look-at-disease/

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/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 Project Takes a Deeper Look at Disease

http://www.wboi.org/post/tick-project-takes-deeper-look-disease#stream/0

Tick Project Takes A Deeper Look At Disease

Oct 19, 2018

A project to track ticks in Indiana hosted student scientists at Purdue University last week. The students have been involved in the statewide collection of ticks to better understand what diseases they carry.

Purdue University entomology professor Catherine Hill leads the project. She says a better understanding of what else is inside a tick influences diagnosis and treatment.

“We always think about one tick bite, one pathogen, one disease and that’s not really the case,” says Hill.

The Tick INsider project was created because so many Hoosiers reported difficulty getting an accurate right diagnosis.

“What we’re beginning to understand is that ticks are filled with lots of different bacteria and probably some parasites and protozoa and viruses,” says Hill.

These factors are influenced by what animal the tick feeds on.

The students visited the Purdue labs to learn about how the analysis works.

Hill says students are drawn to this opportunity because of the intersection of environment, entomology and health. Another class of student scientists will be recruited next year.

Nine different diseases have been identified in ticks in Indiana including Rocky Mountain spotted fever and Lyme disease.
**Comment**
Don’t forget nematodes (worms), eggs, & larvae:  https://madisonarealymesupportgroup.com/2016/06/03/borrelia-hiding-in-worms-causing-chronic-brain-diseases/  Lyme discoverer, Willy Burgdorfer, wrote of finding nematodes in tick guts way back in 1984 and in 2014 University of New Haven researcher, Eva Sapi, found 22% of nymphs and 30% of adult Ixodes ticks carried nematodes.

One thing is for sure, the idea of numerous pathogens working symbiotically is not even on The Cabal’s radar.  No research exists.  No treatments are offered – just a “one-size fit’s all”  21 days of doxy to “cure” you of this complex monster, which if you ponder that for just 1 solitary second would be a joke if it wasn’t so deadly.

 

 

All His Symptoms Pointed Toward the Flu. But the Test Was Negative. RMSF in Connecticut

https://www.nytimes.com/2018/10/17/magazine/flu-symptoms-diagnosis-infection.html

All His Symptoms Pointed Toward the Flu. But the Test Was Negative.

CreditCreditIllustration by Andreas Samuelsson

 

“I think I’m losing this battle,” the 58-year-old man told his wife one Saturday night nearly a year ago.

While she was at the theater — they’d bought the tickets months earlier — he had to crawl up the stairs on his hands and knees to get to bed. Terrible bone-shaking chills racked him, despite the thick layer of blankets. The chills were followed by sudden blasts of internal heat and drenching sweats that made him kick off the covers — only to haul them back up as the cycle repeated itself.

“I need to go to the E.R.,” he told his wife. He’d been there three times already. They’d give him intravenous fluids and send him home with the diagnosis of a viral syndrome. He would start to feel better soon, he was told. But he didn’t.

This all began nine days before. That first day he called in sick to his job as a physical therapist. He felt feverish and achy, as if he had the flu. He decided to drink plenty of fluids, take it easy and go back to work the next day. But the next day he felt even worse. That’s when the fever and chills really kicked in. He was alternating between acetaminophen and ibuprofen, but the fever never let up. He’d started sleeping in the guest room because his sweat was soaking the sheets, and his chills shook the bed, waking his wife.

After three days of this, he made his first visit to the Yale New Haven Hospital emergency room. He was already taking antibiotics. Several weekends earlier, he developed a red, swollen elbow and went to an urgent-care center, where he was started on one antibiotic for a presumed infection. He took it for 10 days, but his elbow was still killing him. He went back to urgent care, where he was started on a broader-spectrum drug, which he had nearly finished. Now his elbow was fine. It was the rest of his body that ached as if he had the flu.

But at the hospital, his flu swab was negative. So was his chest X-ray. It was probably just a virus, he was told. He should take it easy until it passed. And come back if he got any worse.

The next day his fever spiked above 105. He went again to the E.R. It was a mob scene — crowded with people who, like him, appeared to have the flu. It would be hours before he could be seen, he was told, because they already knew he didn’t have it. Discouraged, he went home to bed. He went back the next morning after a nurse called to say the E.R. was more manageable.

He might not have the flu, he thought, but he was sure he had something. But the E.R. doctor didn’t know what. He didn’t have chest pain or shortness of breath. No cough, no headache, no rash, no abdominal pain, no urinary symptoms. He felt weak but no longer achy. His heart was beating hard and fast, but otherwise his exam was fine. His white count was low — which was a little strange. White blood cells are expected to increase with an acute infection. Still, a virus can cause white counts to drop. His platelets — the tiny blood fragments that form clots — were also low. That can also be seen in viral infections, but it was less common.

The E.R. staff sent the abnormal blood results to the patient’s primary-care provider and told the patient to follow up with him. He’d been trying get in to see him for days, but the doctor’s schedule was full. When he called again, he was told that the soonest he could be seen was the following week.

The patient asked the doctor to order blood tests to look for an infection in his blood. And could they also test him for tick-borne infections? This was Connecticut, after all. He dragged himself to the lab and then waited for his doctor to call with the results. The call never came. In his mind, he fired his doctor. He’d been sick for over a week, and the doctor’s office couldn’t arrange an appointment, and they couldn’t even call him with the lab results for the test he had to ask for in the first place.

That Sunday morning after the man’s wife had been to the theater, he went once more to the emergency room. It was brought to the attention of the physician assistant on duty that the man had been there several times before and had lab abnormalities. She ordered a bunch of blood tests — looking for everything from H.I.V. to mono. She ordered another chest X-ray and started him on broad-spectrum antibiotics, as well as doxycycline, an antibiotic often used for tick-borne infections. He was given Tylenol for his fever and admitted to the hospital. As he was preparing to leave the emergency department, a new flu test came back positive. He was pretty sure he didn’t have it; he’d never heard of a flu being this bad for this long. But if he could stay in the hospital, where someone could monitor him, he was happy to take Tamiflu.

The lab called again the next day to say that the test had been read incorrectly; he did not have the flu. By then other results started to come in. It wasn’t an infection in his elbow. He didn’t have H.I.V.; he didn’t have mono or Lyme; he didn’t have any of the other respiratory viruses that, along with the worse influenza outbreak in years, had filled up so much of the hospital.

CreditIllustration by Andreas Samuelsson

Yet after a couple of days, the patient began to feel better. His fever came down. The shaking chills disappeared. His white count and platelets edged up. It was clear he was recovering, but from what? More blood tests were ordered, and an infectious-disease specialist consulted.

Gabriel Vilchez, the infectious-disease specialist in training, reviewed the chart and examined the patient. He thought that the patient most likely had a tick-borne infection. The hospital had sent off blood to test for the usual suspects in the Northeast: Lyme, babesiosis, ehrlichiosis and anaplasmosis. Except for the Lyme test, which was negative, none of the results had come back yet. Vilchez considered that given the patient’s symptoms — and his response to the doxycycline — it would turn out that he’d have one of them.

And yet, the results for tick-borne infections were negative. Vilchez thought about other tick-borne diseases that are not on the usual panel. The most likely was Rocky Mountain spotted fever (R.M.S.F.). The name is a misnomer: R.M.S.F. is much more common in the Smoky Mountains than the Rocky Mountains, and the spotted-fever part, the rash, is not seen in all cases. It’s unusual to acquire the infection in Connecticut but not unheard-of. Vilchez sent off blood to be tested for R.M.S.F. The following day, the patient felt well enough to go home. A couple of days later, he got a call. He had Rocky Mountain spotted fever.

Why did the diagnosis take so long? The patient had an unusual infection. But perhaps the bigger issue was that he was one of many patients in the emergency room with flulike symptoms in the midst of a flu epidemic. Under those circumstances, the question for the staff simply becomes: Does he have the flu? When the answer is no, doctors tend to move on to the next very sick patient in line. It’s hard to get back to the question of what the nonflu patient does have.

For the patient, recovery has been tough. Though the antibiotic helped with the acute symptoms, it took months before he had the stamina to resume his usual patient load at work. He feels that the illness brought him as close to dying as he had ever been. Indeed, Rocky Mountain spotted fever is one of the most dangerous of all the tick-borne infections, with a mortality rate as high as 5 percent even with current antibiotics.

One thing he was certain about, however: He needed a new primary-care doctor. And he got one.

Lisa Sanders, M.D., is a contributing writer for the magazine and the author of “Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis.” If you have a solved case to share with Dr. Sanders, write her at Lisa.Sandersmd@gmail.com.

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**Comment**

This is playing out all over the world.  He was one of the lucky ones to finally get an accurate diagnosis.

It is interesting; however, that they are quick to state he doesn’t have the other tick-borne infections when the testing for all of them misses over half of all cases.  Once they gave him doxy, they should have retested him.  This is called a “provocation test” and is used by many LLMD’s (Lyme literate doctors) as they’ve learned this often finally shows an active infection(s) due to the ability of the body to NOW see the pathogens in the blood stream allowing antibodies to be made and picked up by the tests.

RMSF is a nasty beast on it’s own; however, this man should be monitored over time.  If symptoms come back or new ones show up, TBI’s should be suspected.

It’s also a mind boggler how in Connecticut of all places, TBI’s wouldn’t be the FIRST thing medical practitioners think of.  It’s literally ground zero.  

Please know RMSF IS IN WISCONSIN and is on the move:   https://madisonarealymesupportgroup.com/2018/07/10/first-rmsf-death-in-wisconsin/

More on RMSF:  https://madisonarealymesupportgroup.com/2018/09/14/rocky-mountain-spotted-fever-rmsf/

It’s also been found to be spread by the common brown dog tick:

https://madisonarealymesupportgroup.com/2018/08/16/new-tick-causes-epidemic-of-rmsf/  It’s usually spread by the American dog tick and the closely related Rocky Mountain wood tick. But in recent years the bacterial infection has also been spread by the brown dog tick — a completely different species…The researchers were investigating an epidemic of the infection that broke out in the border town of Mexicali starting in 2008. It’s already sickened at least 4,000 people, according to Mexican government estimates. Several hundred have died, and at least four people have died in the U.S. after crossing the border, according to this report and others.

“I was absolutely startled,” Foley said in an interview.

The people who had been sickened in Mexicali had a heavy load of the infectious agent in their blood — something that had not been seen in past outbreaks.
The epidemic is worrisome because the brown dog tick is more likely to bite people and it adapts easily to living in a house, as opposed to living on wild animals, the researchers said.

“The Rocky Mountain spotted fever epidemic in Mexicali has not been contained and may be spreading to other parts of Baja California and into the United States,” the team wrote.

And now it’s possible that for some reason, the infection the brown dog tick transmits is more virulent, Foley said.

https://madisonarealymesupportgroup.com/2017/06/10/two-deaths-from-rmsf-indiana-has-tbis/

https://madisonarealymesupportgroup.com/2015/08/13/severe-case-of-rmsf-had-to-remove-patients-arms-and-legs/

https://madisonarealymesupportgroup.com/2017/10/21/mom-got-rocky-mountain-spotted-fever-while-picking-pumpkins/  “When you go to these pumpkin patches and petting zoos and all those fun fall activities, wear pants, long socks and shoes!”
“Make sure you check for tics! This was me 2 years ago after being bit by a tick and contracting Rocky Mountain spotted fever at a pumpkin patch,” she continued. “I couldn’t walk, my whole body was in pain, my hair fell out, and I almost died.”

https://madisonarealymesupportgroup.com/2018/06/12/georgia-mom-warns-others-after-son-contracts-rocky-mountain-spotted-fever-after-tick-bite/  “This has been a horribly scary experience for our family. I’m thankful that I did my own research and brought it to my doctors attention. So don’t EVER be afraid to be an advocate for your child or yourself when it comes to things like this!” McNair continued, adding that “doctors are humans and have to figure out the puzzle just like the rest of us do!”

Wiser words were never spoken.

P.s. Regarding the red, swollen elbow…..

My journey was similar with the same issue in both my elbow and knee in the middle of January in Wisconsin.  I was told, and I promise I didn’t make this up, that I had “Washer Woman’s Knee,” and “Barstool elbow.”  

I kid you not.

Now, first, I use a mop and rarely get on my knees.  Second, I assure you, I’m not sitting at the bar and have NO reason to have a red, swollen, excruciatingly painful elbow.

Effective tick borne illness treatment completely ameliorated both conditions once I was finally diagnosed with Lyme/MSIDS.  For that exciting journey, that continues to this day, go here:  https://madisonarealymesupportgroup.com/2017/02/24/pcos-lyme-my-story/

For effective Lyme treatment:  https://madisonarealymesupportgroup.com/2016/02/13/lyme-disease-treatment/

Please remember, Lyme is the rock star we all know by name.  There are many, many other players involved and people are often coinfected.  Mainstream medicine has yet to accept and deal with this very real fact.