Kelly Oggenfuss is walking into the woods. Leading her team of four young researchers through a thicket of slender oak trees, she doles out assignments by letters corresponding to a grid. As early morning light filters through the canopy, Oggenfuss and her colleagues pull on latex gloves then disperse to gather surveillance data.
For 20 years, this has been a post-dawn ritual for Oggenfuss, a senior research specialist at the Cary Institute of Ecosystem Studies in Millbrook, New York, a bucolic town in the state’s Hudson Valley region. Four times a week from April to November — traditionally the most active tick season in the Northeast — she leads a platoon of field researchers as they don white coveralls, drive a pair of old Chevy Tracker SUVs down an overgrown dirt road, and hike to a five-acre tract designated “Henry Control” on the grounds of the institute. Their mission is to seek out and study ticks in one of the most tick-infested areas in America.
Oggenfuss and the others work methodically across a grid of 242 spring-loaded box traps, checking for rodents lured overnight by whole-oat seeds. Sharing updates via walkie-talkie, the team gathers after a squirrel is found in one of the traps. The new researchers transfer the animal to a plastic mesh sleeve and take turns examining it. A similar process unfolds with chipmunks.
Most often, the traps capture mice, which Oggenfuss and her team carry with them, still in the trap, until the grid check is complete. Then the group convenes around a collapsible table. As one researcher records data (grid location, gender, tag number, etc.), the others apply tags to the mice and collect blood, urine, and stool samples. Finally, Oggenfuss and her team meticulously comb the mice with tweezers and blow on their fur, pushing it aside in search of ticks.
“Look there’s a nymph,” says Oggenfuss. “And I’ve got one, two, three larvae. Can you see them?” She pulls a patch of the mouse’s fur back to reveal a blacklegged tick no bigger than a poppy seed burrowed into its head. The larvae are barely perceptible.
A researcher named Agi holds up another mouse. “Look,” she announces. “That’s a larva on top of that nymph. We have a co-feeding situation here.” The theory is that their feeding sites are so close that pathogens move between them easily, Oggenfuss explains. The potential result is one tick sharing infectious material directly with another through the host mouse as if it were a straw, speeding the spread of disease. “That could have an effect on infection prevalence,” Oggenfuss adds. “It’s one of the things we’re studying.”
Since 1992, the Cary Institute has been compiling a record of tick ecology that they believe to be the longest continuous study of this kind in the U.S. and possibly the world. Mostly its researchers encounter the blacklegged, or deer, tick (Ixodes scapularis), but in recent years, they’ve also been seeing increasing numbers of lone star ticks (Amblyomma americanum), which are native to the American Southeast but now range from northern Mexico to Canada. Over the years, an alarming number of ticks in the surrounding area have been revealed to carry Borrelia burgdorferi, the bacteria that causes Lyme disease, while others have tested positive for the pathogens that cause other tick-borne illnesses, including the potentially fatal Powassan virus.
Because ticks acquire pathogens from hosts, understanding tick-borne diseases means understanding ticks’ so-called disease reservoir, especially mice. If the urban rat was the primary carrier of bubonic plague, the country mouse is it for Lyme disease. And just as the fleas that fed on infected rats spread the plague, ticks that feed on infected mice transmit Lyme.
On this early May morning, the team’s trap yield is relatively modest — four mice, two squirrels, and a chipmunk. “It’s early days still,” says Oggenfuss. In August, during the so-called larval peak, the researchers sometimes catch as many as 220 mice and can find 150 or even 200 tick larvae crawling on a single mouse. It can be an unnerving moment. “When the ticks are looking for a feeding site,” Oggenfuss says, “the mouse fur just seems to move on its own.”
The process for counting ticks not affixed to hosts is called a drag — the researchers pull a one-square-meter sheet of fabric along the ground for 30 meters then tally the number of ticks affixed to it. Oggenfuss holds the Cary Institute record for ticks collected in a single drag: 1,700. As horrifying as that haul was — and it would, by extrapolation, put the tick population on the Cary Institute’s 2,000-acre campus at 2 billion — Oggenfuss is quick to note it was exceptional, and tick density is irregular. Her more conservative calculations of average tick populations, based on drags done during the same time of year (August, the larval peak), are only reassuring by comparison: upward of 20,000 ticks per acre, more than 100,000 on the Henry Control grid, and more than 40 million on the Cary Institute grounds.
The scary thing is, that’s nothing. Experts say the worldwide tick population is exploding,triggering a dramatic spike in the incidence of Lyme disease and a rise in other tick-borne illnesses, some of which, like Powassan, are far more dangerous than Lyme.
First identified in 1975 in the leafy New England town of Old Lyme, Connecticut, Lyme disease has now reached what experts consider pandemic proportions. According to the Centers for Disease Control and Prevention (CDC), the number of confirmed cases of Lyme disease in the U.S. has more than doubled in the two decades leading up to 2017 (the most recent year for which final figures are available) and increased 17% from 2016 to 2017 alone. More than half the counties in the U.S. are considered high-risk areas for Lyme, according to the CDC, and in some areas, as many as six out of 10 ticks carry the infection.
“It’s been a relentless expansion since the 1980s,” says John Aucott, director of the Lyme Disease Clinical Research Center at Johns Hopkins University School of Medicine. “There may be down years and up years, but the trends are in place, and there’s no indication that they’re going to reverse.”
We now live in a frightening new normal: It’s estimated that 300,000 people contract Lyme every year in the U.S., with victims found not just in traditionally tick-heavy areas like upstate New York and Maine, but also in all 50 states and Washington, D.C. While most people are cured quickly with antibiotics, some go on to experience lingering symptoms characteristic of Lyme, like headaches, fatigue, and joint and muscle pain, for months or longer after they’ve been treated, a condition known as post-treatment Lyme disease syndrome (PTLDS). According to a recent study led by experts at the Brown University School of Public Health, the number of people in the U.S. with PTLDS was estimated to be 1.5 million in 2016 and is predicted to rise to nearly 2 million by 2020.
“There is little doubt that [Lyme disease] is pandemic. It calls for a huge national and concerted international effort to bring it under control.”
Tick populations now exist on every continent, even Antarctica, and Lyme disease can be found throughout most of Europe, where it ranks as the most common vector-borne disease, and beyond. “To me, there is little doubt that it is pandemic,” says Mary Beth Pfeiffer, author of Lyme: The First Epidemic of Climate Change. “It’s in China, Russia, Japan, Australia. It’s moving fast into Canada. It is all across the U.S. It calls for a huge national and concerted international effort to bring it under control.”
The incidence of other tick-borne illnesses is also sharply rising. According to the CDC, the occurrence of those diseases in the U.S. has nearly tripled since 2004 and increased more than 22% from 2016 to 2017. In addition to Lyme, ticks transmit a slew of pathogens, including those that cause babesiosis, ehrlichiosis, anaplasmosis, southern tick-associated rash illness, tick-borne relapsing fever, tularemia, Colorado tick fever, Q fever, Rocky Mountain spotted fever, and Powassan encephalitis. Most of the bacterial diseases are treatable if diagnosed early. Others, like Rocky Mountain spotted fever, are potentially fatal, particularly in children, if not treated quickly. Incidences of spotted fever rickettsiosis, which includes Rocky Mountain spotted fever, increased more than 12-fold from 2000 to 2017 (up from 495 to 6,248). And while more rare still, cases of Powassan virus, which can kill one in 10 people who are infected and for which there is no treatment, are rising as well. In 2008, only two cases were reported. In 2016, that number jumped to 22 and again in 2017 to 33.
“Ticks account for more diseases than all other biting insects and arthropods in the United States,” says Ben Beard, deputy director for the Division of Vector-Borne Diseases at the CDC. “It’s hard to know what the maximum or the ceiling might be. All we can say is that the number of cases is growing every year.”
Alarms are going off all over the globe. South Africa, where tick-bite fever (a form of rickettsias) is common, has seen an increase in incidences of Crimean-Congo hemorrhagic fever (CCHF), which is deadly in 30% to 40% of cases. The tick that carries CCHF, a native of sub-Saharan Africa and eastern Europe, has been found in Spain, Portugal, Germany, and the United Kingdom, where it is believed to have been brought from Africa by migratory birds. Bites from the lone star tick have been shown to cause alpha-gal syndrome, which manifests in rapid-onset allergies to meat, typically beef and pork, that can result in unexplained anaphylactic reactions. There is no treatment, other than eschewing the consumption of red meat.
In North America, news reports in Maine and southern Canada this spring featured a shocking number of sightings of what are called ghost moose — skeletal-looking, malnourished, denuded animals that have rubbed off their fur in response to tick irritation after hosting up to 75,000 feeding ticks through the winter. Many emerged anemic after being the source of so many blood meals, and a number of calves died after losing too much blood to ticks — a vampire-like end to life known as exsanguination.
If Lyme disease has reached pandemic proportions, why haven’t we heard more about it? Because, experts say, Lyme doesn’t strike fear into people’s hearts the way some other illnesses, like Ebola or Zika, do. People respond to dramatic pictures or dramatic mortality, says Aucott.
“It’s hard for them to have a perspective on the real impact of Lyme disease because it doesn’t cause visible changes. People with Lyme disease don’t look sick.”
Babesiosis is a tick-transmitted intraerythrocytic zoonosis. In Korea, the first mortalities were reported in 2005 due to Babesia sp. detection in sheep; herein we report epidemiological and genetic characteristics of a second case of babesiosis. Microscopic analysis of patient blood revealed polymorphic merozoites. To detect Babesia spp., PCR was performed using Babesia specific primers for β-tubulin, 18S rDNA, COB, and COX3 gene fragments. 18S rDNA analysis for Babesia sp., showed 98% homology with ovine Babesia sp. and with Babesia infections in Korea in 2005. Moreover, phylogenetic analysis of 18S rDNA, COB, and COX3 revealed close associations with B. motasi. For identifying the infectious agent, Haemaphysalis longicornis (296) and Haemaphysalis flava (301) were collected around the previous residence of the babesiosis patient.Babesia genes were identified in three H. longicornis: one sample was identified as B. microti and two samples were 98% homologous to B. motasi.
Our study is the first direct confirmation of the infectious agent for human babesiosis.This case most likely resulted from tick bites from ticks near the patient house of the babesiosis patient. H. longicornis has been implicated as a vector of B. microti and other Babesia sp. infections.
The full-length article tells the unfortunate story of an elderly men’s death 36 hours after hospitalization due to an emerging type of Babesia due to a tick bite.
A blood sample was obtained from the jugular vein in the patient that presented with dizziness and general weakness.
No microorganisms were isolated from the blood culture.
Microscopy revealed the following:
Upon light microscopic examination, variable intraerythrocytic parasites as ring forms, pear-shaped forms, paired pyriforms, pleomorphic ring forms, and multiple-infected parasites and clusters of extracellular rings were detected in Giemsa-stained blood smears. The percentage of parasitaemia was 1.8% (Figure 1). Maltese cross forms comprising four masses in an erythrocyte that are often described as a characteristic of B. microti infection were not detected in most blood smears (Figure 1).
Please note that the patient would have failed a simple blood test and even microscopy revealed atypical findings as well as the fact parasitemia was less than 2%.
Yet, 2% was enough to kill a man.
Tick collections were performed by dividing the area around the patient’s residence and the findings were:
A total of 597 ticks were collected around the patient’s residence, including 296 H. longicornis(186 adult, 41 nymphs, and 68 larvae) and 301 Haemaphysalis flava (1 adult and 300 larvae) (Table 2). Among these, 94% of the ticks were collected in both the front yard of patient’s residence (442 ticks) and associated hill III (124 ticks). Based on the results of the amplification of Babesia genes in each tick, 2 (0.3%) were positive for 18S rDNA of Babesia species, 1 (0.2%) for COB and COX3, and 1 (0.2%) for β-tubulin gene of B. microti. While the nymph of H. longicornis yielded a positive result for only 18S rDNA, one female tick of H. longicornis yielded positive results for 18S rDNA, COB, and COX3 gene fragments. Also, one female tick of H. longicornis only yielded positive results for β-tubulin gene of B. microti (Table 3).
Please note two things: the high amount of ticks found right in his yard and the low incidence of infected ticks – yet, it only took one to kill him.
The Discussion section reveals some interesting things:
Previously, seven different Babesia spp., B. microti, B. divergens, B. bovis, B. canis, B. duncani, B. venatorium, and a novel Babesia sp. similar to ovine babesias were reported to cause human babesiosis...Human babesiosis (KCDC-1) in 2017 was the second case identified in Korea and the sequence of Babesia sp. was very closely related to that of KO1 and Liaoning, China. These large Babesia are clearly distinct from other agents of human babesiosis based on their shape and phylogeny. These results suggest that the causative agent in their case of babesiosis is a novel large Babesia parasite infecting humans and may be highly fatal….
the identified Babesia parasites (in the patient) might be B. motasi, and this is the first study to detect B. motasi in human babesiosis and H. longicornis in Korea.
Updates in the Diagnosis and Treatment of Resistant Lyme and Chronic Disease
(Used with permission from Dr. Horowitz)
Lyme & TBD Congressional Town Meeting
May 29, 2019
Dr. Richard Horowitz
The above link of a pdf by Dr. Horowitz is chuck-full of information. For those of you who are just beginning this journey, this Lyme/MSIDS treating doctor has written numerous books I highly recommend. He has many ideas & suggestions for why many do not get better. He also is the one who came up with the MSIDS questionnaire, which you can access here: https://madisonarealymesupportgroup.files.wordpress.com/2016/01/symptomlist.pdf
Decoding NeuroLyme: Live Webinar with Dr. Bill Rawls
Wednesday 6/19, 8pm EDT
Lyme disease can manifest in seemingly endless ways. But neurological symptoms such as brain fog, limb pain, muscle weakness, anxiety, and more can feel especially debilitating and difficult to diagnose, manage, and overcome.
So why are some people more likely to experience neurological Lyme disease — and what can you do to feel better?
Join a live webinar with Dr. Bill Rawls, best-selling author of Unlocking Lyme, who knows firsthand what it’s like to live with chronic Lyme disease, as he demystifies neurological Lyme and offers an alternative view of causes and solutions.
You’ll learn how to take control of your health, and the essential steps for empowering your body’s natural defenses.
PLUS: Don’t miss an exclusive gift for webinar attendees, and have your questions ready for a LIVE Q&A on neurological Lyme disease with Dr. Rawls.
“Dr. Rawls is such a genuine resource in this bewildering Lyme maze. I appreciate you making his insights readily available.” – David
Understanding and Overcoming Neurological Lyme Disease
“Super helpful and informative. It was great to hear someone talk about this in a knowledgeable manner given that it seems like a mystery to so many others in the medical community. Thank you!” – Christian
In this webinar, Dr. Rawls will also discuss:
Why neurological symptoms such as cognitive impairment, nerve and limb pain, mood disruption, and more are so prevalent among Lyme sufferers
What causes these symptoms to become so overpowering in some people
Connections between neurological Lyme and other infections and chronic illnesses
Why conventional methods of diagnosis and treatment are limited and controversial
His holistic, restorative approach to overcoming neurological Lyme
“Neurological symptoms are the most exasperating of all Lyme symptoms, because they disconnect you from the world at large. There is a path to recovery.” — Dr. Bill Rawls
Breaking down the Bartonella spp. ePCR Triple Blood Draw: How does it work?
Galaxy customers often ask our team, “Why do results for a Bartonella ePCR test take 3 weeks?” By the time a customer has decided to get a Bartonella ePCR triple draw test they may have had symptoms for some time, seen many doctors, and made difficult decisions about where to spend their healthcare dollars. We know you want results quickly!
Research shows that the Bartonella bacteria that make people sick can cause a cyclical bacteremia. That means that sometimes the bacteria is in the blood and sometimes it isn’t. This allows the bacteria to evade the host immune response and makes it very hard to test for.
The Bartonella spp. ePCR Triple Blood Draw is an advanced testing method that increases the likelihood of detecting Bartonellaspecies in a sample. The triple draw involves collection of blood and blood serum samples on three different days over a 5 to 7-day period to match the cyclical behavior of Bartonella. In a research study of veterinary staff, the sensitivity of ePCR was about doubled when samples from three different days were tested versus just one.
But this is just the first part of the advanced methods Galaxy Diagnostics uses. How are the samples processed once the lab receives them?
Culturing is a common method that clinical diagnostic companies and researchers use to grow microorganisms under controlled laboratory conditions. Clinical samples such as blood are added to a liquid or gel-like growth medium to grow bacteria of interest to a detectable level.
The formulation of the growth medium varies depends on the bacteria being targeted. There are a variety of growth media that are commonly used in clinical laboratories. For example, a lab may use a growth medium called Luria broth to look for multiple bacteria species that do not have specialized growth requirements.
Galaxy Diagnostics uses Bartonella alphaproteobacteria growth medium, or BAPGM, a patented growth medium that selectively grows Bartonella species. It was developed at North Carolina State University by Dr. Ed Breitschwerdt and Dr. Ricardo Maggi, who are respectively the chief scientific officer and chief technology officer of Galaxy Diagnostics.
Since Bartonella species can survive in arthropods such as ticks, the medium formulation was modified to mimic arthropod growth requirements more closely. By matching the environment where the bacteria could normally be found, there is a higher chance of successfully growing the infectious bacteria in the lab. Galaxy Diagnostics scientists have published findings related to the analytical utility of pre-enrichment BAPGM in peer-reviewed journals. A selected list of these publications can be found here.
When whole blood samples for Bartonella species testing are received, a BAPGM culture is prepared for each one. The cultures are incubated for a week, during which environmental parameters are strictly monitored and adjusted as needed. Since Bartonellaspecies require 22-24 hours to replicate, it can take a week for substantial growth to occur. By comparison, this is more than 20 times slower than the replication rate of Streptoccocus pygones, the bacteria responsible for strep throat.
Pre- and Post-Enrichment PCR
Polymerase chain reaction, or PCR, is a method of detecting target bacterial DNA in a sample. Performing PCR on a sample after allowing bacteria to grow maximizes the chance of detecting present DNA. This “enrichment” of the sample is where the “e” in ePCR comes from. Research shows that Bartonella species infect at low levels, so using PCR after culturing reduces the chance of false negatives.
The PCR process starts by using a DNA primer (a small fragment of DNA) that a diagnostic or research lab designs to bind to target DNA (“anneal”). An enzyme is then used to amplify the DNA that is present. This process is repeated to maximize the amount of DNA present.
Galaxy combines the previously described culturing step with PCR to maximize the sensitivity and specificity of the test. The broad-spectrum primers can detect a range of pathogenic Bartonella species that may be present in samples. This means that more species can be detected in a single test.
If PCR detects target DNA in a sample, the laboratory still may not know what species of Bartonella was found. There’s even a possibility the primer has annealed to an unexpected microbe. The next step is DNA sequencing to verify that the DNA detected in a sample is what the test is designed to find and to determine the species of bacteria that is present.
The Bartonella spp. ePCR Triple Blood Draw panel can include a Bartonella IFA serology panel, IgG for B. henselae and B. quintana. This serology panel can also be ordered separately, and a Single Blood Draw ePCR test is available.
Galaxy Diagnostics also offers testing for other vector-borne pathogens and Borrelia burgdorferiELISA and Western blot. A new serology panel includes Bartonella and Lyme Borrelia serology testing.
The complete Galaxy Diagnostics testing menu can be found here. More about the ordering process can be found here.
Episode #93: ArminLabs with Dr. Armin Schwarzbach, MD, PhD
Created: 27 February 2019
Why You Should Listen
In this episode, you will learn about EliSpot testing and the various testing options available through ArminLabs in Germany.
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About My Guest
My guest for this episode is Dr. Armin Schwarzbach. Armin Schwarzbach, MD, PhD is a medical doctor and a specialist in laboratory medicine from the laboratory ArminLabs in Augsburg, Germany. Dr. Schwarzbach began by studying biochemistry at Hoechst AG in Frankfurt, Germany and pharmacy at the University of Mainz in Germany in 1984. In 1985 he studied medicine for 6 years at the University of Mainz and finished his MD in 1991. Dr. Schwarzbach developed the worldwide first Radioimmunoassay (RIA) for human Gastric Inhibitory Polypeptide from 1986 – 1991, getting his PhD in 1992. He is member of the Swiss Association for tick-borne diseases, the German Association of Clinical Chemistry and Laboratory Medicine, and the German Society for Medical Laboratory Specialists. He is an Advisory Board member of AONM London, England, and Board member of German Borreliosis Society, and Member and former Board Member of the International Lyme and Associated Diseases Society (ILADS) and has served as an expert on advisory committees on Lyme Disease in England, Australia, Canada, Ireland, France, and Germany. Dr. Schwarzbach is the founder and CEO of ArminLabs in Augsburg, Germany and has specialized in diagnostic tests and treatment options for patients with tick-borne diseases for over 20 years.
What is an EliSpot?
What organisms can be tested for using EliSpot technology?
How specific is the EliSpot in testing for Borrelia, Bartonella, Babesia, and other organisms?
Does the state of the immune system matter when considering EliSpot results?
Which infections are the most persistent?
Can the EliSpot be used to track progress or success of treatment?
What is Yersinia and where might it be encountered?
Can EliSpot testing be used in newborns and infants?
What role do viruses such as EBV, CMV, Coxsackie, and others play in chronic illness?
Can Mast Cell Activation Syndrome be triggered by viruses?
Why are Mycoplasma and Chlamydia so important to explore?
Why is IgA testing a promising new direction in laboratory medicine?
Is CD57 helpful clinically?
What microbes are more commonly associated with specific medical conditions?
The content of this show is for informational purposes only and is not intended to diagnose, treat, or cure any illness or medical condition. Nothing in today’s discussion is meant to serve as medical advice or as information to facilitate self-treatment. As always, please discuss any potential health-related decisions with your own personal medical authority.