Treatment of infective endocarditis (IE) should be initiated promptly. This might hamper the chances to identify the causative organism in blood cultures. Microbiological sampling of infected valve in patients undergoing surgery might identify the causative organism. The impact of pre-operative antimicrobial treatment on the yield of valve samples is not known. This study evaluated the impact of the duration of the pre-operative antibiotic treatment on valve culture and 16S rRNA PCR findings from resected endocardial samples. Patients meeting the modified Duke criteria of definite or possible IE and undergoing valve surgery due to IE during 2011-2016 were included from Southern Finland. Eighty-seven patients were included.
In patients with shorter than 2 weeks of pre-operative antimicrobial treatment, PCR was positive in 91% (n = 42/46) and valve culture in 41% (n = 19/46) of cases. However, in patients who had 2 weeks or longer therapy before operation, PCR was positive in 53% (n = 18/34) and all valve cultures were negative. In 14% of patients, PCR had a diagnostic impact. In blood-culture negative cases (n = 13), PCR could detect the causative organism in ten patients (77%). These included five cases of Bartonella quintana, one Tropheryma whipplei, and one Coxiella burnetii. Long pre-operative antimicrobial treatment was shown to have a negative impact on microbiological tests done on resected endocardial material. After 2 weeks of therapy, all valve cultures were negative, but PCR was positive in half of the cases. PCR aided in diagnostic work-up, especially in blood culture negative cases.
The dilemma “to treat or not to treat” because of hampered ability to subsequently test for organisms is real; however, the risk for not treating is potentially death.
The big point for Lyme/MSIDS patients; however, is the fact they found Bartonella and Coxiella burnettii, also known as Q-fever in patients with infective carditis.
https://www.columbia-lyme.org/q-fever Those working with farm animals are at greater risk through inhalation or ingestion of soil or animal waste particles; however, ticks do transmit it.
Signs and Symptoms
Symptoms include high fever, headache, sore throat, malaise, nausea, diarrhea, chest pain, nonproductive cough, pneumonia, and hepatitis. Neurological manifestations occur in about one percent of patients and could develop into meningitis, encephalitis, myelitis and/or peripheral neuropathy. Endocarditis, infection of the heart valves, is the most serious manifestation. However, it is usually found in patients with preexisting valvular disease. Unfortunately, the mortality rate is increasingly high, currently at 65 percent.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC88923/ Interestingly, even as far back as the 30’s, Q fever was noted to have properties of both viruses and rickettsiae. This document states Q fever may occur in patients without any animal contact due to it’s ability to be spread by wind. The same document states human Q fever cases have occurred in the following:
An OB after an abortion on an infected woman
sexually in infected mice
possibly from infected dogs
The real kicker on that last one was the 1984 report of 13 people who developed febrile respiratory disease by playing poker in a room where a cat had delivered kittens. Abstract here:
Kosatsky T. Household outbreak of Q-fever pneumonia related to a parturient cat. Lancet. 1984;ii:1447–1449. [PubMed]
bradycardia (slow heart rate)
palatal petechiae (red or purple spots on mouth palate)
rapidly enlarging bilateral pulmonary infiltrates (fluid in both lungs)
Overall, 129/929 (13.9%) Ixodes ticks were PCR positive for Borrelia burgdorferi sensu stricto, 48/929 (5.1%) for B. bissettiae whereas 23/929 (2.5%) were PCR positive for a Bartonella henselae. Borrelia bissettiae or B. burgdorferi s.s. and B. henselaeco-infections were found in I. affinis from North Carolina at a rate of 4.5%; in a single I. scapularis from Minnesota, but not in I. pacificus. For both bacterial genera, PCR positive rates were highly variable depending on geographic location and tick species, with Ixodes affinis (n = 155) collected from North Carolina, being the tick species with the highest prevalence’s for both Borrelia spp. (63.2%) and B. henselae (10.3%). Based on the results of this and other published studies, improved understanding of theenzootic cycle, transmission dynamics, and vector competence of Ixodes species (especially I. affinis) for transmission of Borrelia spp. and B. henselae should be a public health research priority.
One of the most understated studies yet. Research on transmission and vector competence is screaming to be done – especially for Bartonella as mainstream medicine still thinks it’s a simple disease caused by the scratch of a cat that only affects immunocompromised people. They also insist the black-legged tick is the sole perp for Lyme. Both of these tenets are being shattered on a daily basis.
Two ticks species known to be transmitters of disease (I. affinis and I. minor)were transported into Canada and are actually moreimportant 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.
Valvular involvement in Lyme disease is rare. Confirmation of Borrelia species as the causative agent by Polymerase Chain Reaction (PCR) was done in a few cases in Europe and the US. We describe a case of mitral regurgitation with a preoperative diagnosis of myxomatous mitral valve degeneration. During surgery, the surgeon suspected infective rather than degenerative; etiology; tissue cultures were negative. However, universal bacterial PCR on explanted valve tissue detected Borrelia burgdorferiDeoxyribonucleic Acid(DNA). If a surgeon suspects infective endocarditis at the time surgery, appropriate specimens should be sent for histopathology, culture, and PCR.
If I’ve said it once, I’ve said it 1,000 times: researchers need to obstain from using the word “rare” in anything they write about MSIDS. Nobody has a clue about numbers. Testing misses over half of all cases and this study is a perfect example in that it proves tissue cultures can be negative yet a person can still be infected with Lyme. Lyme experts have talked about seronegativity for decades yet mainstream medicine continues to deny it exists. This must change.
ROBERT HERRIMAN WITH OUTBREAK NEWS INTERVIEWS GLA’S CHIEF SCIENTIFIC OFFICER TIMOTHY SELLATI, PH.D. TO DISCUSS LYME DISEASE, THE TICK-BORNE DISEASE WORKING GROUP, AND THE IDSA
Read the complete transcript below or listen to the podcast:
Approx. 15 Min.
Robert Herriman: Well hey everybody, this is Robert, and welcome to Outbreak News Interviews. Now the Federal Tick-Borne Disease Working Group recently released their first report to Congress about one year after the panel first convened. The Infectious Disease Society of America, or the IDSA, responded to the report in a letter that contained some criticisms of the report. So what is the Federal Tick-Borne Disease Working Group, what’s in the report, and what did the IDSA have to say? Well joining me to discuss these issues is Chief Scientific Officer for the Global Lyme Alliance, Timothy Sellati, Ph.D. Dr. Sellati, welcome to the show, sir.
Timothy Sellati: Thank you for having me.
Robert Herriman: You bet. So Dr. Sellati, let’s go ahead and start out with some basics ’cause some people may not be aware of this. What is the Federal Tick-Borne Disease Working Group, what’s their mission, and what’s the personnel composition of this group?
Timothy Sellati: So the Working Group was established as part of the Congress’s passage of the 21st Centuries Act, back in December 2016. The intent of that Act was to promote new healthcare initiatives for addressing array of public health issues, and one in particular was the advancement of research on tick-borne diseases. So with that as a backdrop, the US Department of Health and Human Services established the Federal Advisory Committee, the Tick-Borne Disease Working Group. So the Working Group is comprised of 14 voting members, there were seven public members and seven Federal members, and the composition of the Working Group was really drawn from a diverse group of professions. We had individuals that are world renounced research scientists, and physicians from top tier academic institutions and hospitals, subject matter experts from government agencies, as well as key stakeholders from the public sector including patients, and their advocates from several Lyme and other tick-borne disease nonprofit organizations.
Robert Herriman: Okay. So they recently released their first report, it’s a pretty hefty 108-page document. Dr. Sellati, what did you find good and important in the report?
Timothy Sellati: So I think some of the most important or key recommendations out of the report really related to epidemiology, and ecology, that was one of the subcommittees of the Working Group. And there, it was really driven home, the idea that Lyme disease surveillance criteria, which is a criteria that the CDC the Centers for Disease Control and Prevention, use for calculating the number of Lyme disease cases that occur annually. Those really should be used for surveillance purposes alone, and not for diagnostic purposes. The other important take home message from the prevention subcommittee was a focus on development of anti tick feeding vaccines, and really trying to work with key stakeholders to build trust via transparent mechanism to help examine and discuss the past Lyme disease vaccine activities, what some of the issues were with it, and the potential for adverse events so that that information coming from a number of different sources could help inform future vaccine development in Lyme disease. In terms of diagnosis, the real take home message was the importance of evaluating new technologies or approaches for the diagnosis of Lyme disease and other tick-borne diseases because of the inherent limitations with the current two-tier testing method. And the importance of including children in the process of diagnostic test validation as well, because children are particularly prone to the devastating consequences of dealing with Lyme disease, or other tick-borne diseases.
Timothy Sellati: In terms of treatment, I think conduct of additional clinical trials using appropriate target populations where gaps may exist. And there really, the glaring gap is with respect to patients, that experience, persistent symptoms and disability and diminished quality of life following the current standard of care, which is 10 to 28 days of antibiotics. So it’s really important to understand, this really came through as the overall gestalt of the report, that Lyme disease can be treated with antibiotics, but as many as 10% to 20% of infected individuals do not respond favorably to those antibiotics, so they go on to develop what we call Post Treatment Lyme Disease Syndrome, or in some circles, chronic Lyme disease. And so it’s really important to really address that gap in our understanding of how best to treat that patient population.
Timothy Sellati: And then the one last thing, and this was really a common theme that came out of all of the subcommittees’ reports, was the need to allocate increased funding for tick-borne diseases in the areas of research, treatment, and prevention, and have it really pegged to the burden of illness. So proportionally, there is much less federal funding to tackle tick-borne diseases than there are funding for other infectious diseases where the number of cases per year are considerably smaller.
Robert Herriman: Yeah. Now, were you 100% on board with everything in the report, or were there any issues that you had a problem with?
Timothy Sellati: I didn’t have any issues per se, with the report, as much as a concern about one of the recommendations. And this related to the protection of the rights of license and qualified clinicians to use individual clinical judgment to diagnose and treat patients in accordance with the needs and goals of each individual patient. I’m sort of reading that, verbatim almost, and while I don’t have any concerns about allowing licensed and qualified clinicians to care for their patients as they see fit, I also recognize that as a result of desperation on the part of some patients that have dealt with Lyme and other tick-borne diseases for years, if not decades, they are driven to seek out medical care from clinicians using treatment options that have not been carefully vetted by the scientific research establishment, or the medical research establishment. And so there’s a concern that there are some treatment options out there that really have not been proven to effectively treat the symptoms or the diseases that these desperate patients are dealing with.
Robert Herriman: Not too long after the release of the Working Group’s report, the IDSA sent a letter to DHHS Secretary Alex Azar, and it contained some criticisms of the report. You responded to the letter in a post on the Global Lyme Alliance website. Can you spend some time talking about that?
Timothy Sellati: Sure.
Some of the criticisms leveled by the IDSA that really caught my attention was that they had significant concerns with the Working Group’s lack of transparency, and minimal opportunities for meaningful public input. And I just didn’t understand the basis for that criticism, given that the Working Group was really comprised of so many different subject matter experts, and physicians that are treating patients, and the patients themselves, that I think the greater concern on the part of IDSA is that perhaps they didn’t have as much input into the report, or the content of the report, that came out of the Working Group’s extensive efforts.
Timothy Sellati: The IDSA also suggested that some of the recommendations of the working group would “cause significant harm to patients in public health,” and they really urged Alex Azar to ensure that the Federal government response to tick-borne disease’s fallacy rooted in the best available scientific evidence. And you know, part of the problem is in the controversy surrounding Lyme disease, is that the IDSA takes a strict parochial approach to considering Lyme disease, and the consequences of infection with bacteria that causes Lyme disease. From their perspective, they think Lyme disease, or promulgates this idea that Lyme disease is easily treated, and it’s easily diagnosed, and only very rarely does it result in lasting consequences of infection. But there is more and more well established scientific evidence in the main stream literature that argues against that very narrow understanding or narrative that IDSA wants to push forward.
Robert Herriman: Now, going to your first point, on the Working Group, is there any former or current IDSA members on that Working Group? I mean, do you know that?
Timothy Sellati: Yes, I believe there are.
Robert Herriman: Okay.
Timothy Sellati: I believe there are. But on the flip side, there are also, from what I understand, members of the ILADS organization as well. The composition of the subcommittees also was careful to include research scientists and physicians that really span the spectrum from IDSA on one of the end of the spectrum, to ILADS on the other. So I really do think that within the limited, within the capabilities of the Working Group, they were as intent as possible, in terms of hearing the voices of a wide variety of individuals. And again, to some extent, maybe IDSA would like to have had a larger bullhorn in terms of influencing the Working Group’s final report to the Congress.
Robert Herriman: So I just take it from your previous answer, that you don’t think most of the IDSA criticisms really hold a lot of water?
Timothy Sellati: No. No, I really don’t. And that’s what really spurred me to write this rebuttal in the first place. Again, I believe many of IDSA’s criticisms stem from the fact that the overall content of the report doesn’t necessarily fit into their mantra that Lyme disease is easy to diagnose, it’s easy to treat, and only very rarely results in lasting consequences of infection. So when you come into trying to solve a problem with that mindset, it limits how you approach trying to solve that problem.
Robert Herriman: Okay. Well, for the audience if you haven’t seen any of this, I will put up a link to Dr. Sellati’s rebuttal on the website when I publish the podcast, and I’ll also put up a link to the IDSA letter, and you can read it, and you can judge for yourselves. Dr. Sellati, any final thoughts on any of these issues?
Timothy Sellati: Yes, I’m glad you asked. So there is one final thought. As far as the report is concerned, I think there was a very important section in the report titled, “Looking Forward,” and in my opinion, I think one of the most important take home messages from that section was the need to develop and disseminate more comprehensive clinical education that highlights the diversity of symptoms that Lyme and other tick-borne disease patients might present with, expand the geography of infecting tics, and also the limitations of the current testing procedures. So I think if we do a better job of communicating to clinicians, and maybe even at the level of medical school students, the complexity of Lyme disease, and what some of the true limitations are in terms of prevention, diagnosis, and treatment, they will be better prepared to take care of the diversity of patients that they see during their practice.
Robert Herriman: Well very good. Well, I wanted to thank you Dr. Timothy Sellati for joining me to discuss these very important issues, I appreciate it, sir.
Borreliosis after sucking ticks is an acute problem in the world. People do not go to doctors after that often, which leads to the development of various complications. Thrombosis of veins of various localization can be one of them. Thrombosis of the portal vein represents a significant problem too with high morbidity and mortality. The risk factors for splanchnic vein thrombosis include infections, but its relationship with borreliosis has not been studied.
А 34-year-old man with chronic helicobacter-associated gastritis and gallstones was hospitalized due to development during the last 11 days of epigastric pain and fever to 38.7 °C after a picnic at the forest without a registered tick bite. The blood leukocytes were increased to 11.2*109/l, lymphocytes 70%, C-reactive protein 34.6 mg/l, procalcitonin 0.195 ng/ml. The multispiral computed tomography of the abdominal cavity revealed thrombosis of portal, lienalis and superior mesenteric veins. D-dimer was 1.98 mcg/ml, antithrombin III 75%. JACK2V617F, oncological, rheumatic, thrombophilia markers, blood and urine cultures were negative. A high concentration of anti-Borrelia burgdorferi IgM 62.2 U/ml and its increasing to 190 U/ml in dynamics was revealed at the immunofluorescence assay. Anti-Borrelia IgM to OspA, p31 and OspC, p25 were detected at the immunoblotting assay.
Anticoagulation, doxycycline, detoxification therapy reduced pain and normalized temperature and inflammation markers. Vein thrombosis was not detected at the control tomography after 2 weeks. Despite that the combination of thrombosis and borreliosis is rare, it is necessary to screen for Borrelia antigens in patients with splanchnic vein thrombosis and fever.
For PVT, doctors recommend anticoagulant drugs — blood thinners such as heparin. If PVT, as in this case, is caused by an infection, antibiotics will also be prescribed to cure the source of the problem.
Interestingly, heparin helps many MSIDS patients:
http://aac.asm.org/content/48/1/236.full.pdf Similarly with Bartonella, some respond miraculously to Heparin, which is a blood thinner. In the above link, heparin was found to inhibit Babesia growth. Horowitz also found it helps clear the parasites from the body.
Heparin helped my husband immensely. His blood looked like snot and continually clotted in catheters.
Interestingly, the authors state that vein thrombosis caused by borreliosis has not been studied, yet emphatically state that the combination of thrombosis and borreliosis is rare.
This is the bizarre disconnect patients live through.
HONOLULU (HawaiiNewsNow) – A new University of Hawaii study shows Hawaii keiki are more than three times more likely to get severe forms of cat scratch disease than mainland kids.
“It’s caused by a bacteria that you primarily get from cats that you get through a scratch or a bite and it’s transmitted to cats by fleas,” said Dr. Scarlett Johnson, a UH pediatric resident.
Symptoms include fever and swollen lymph nodes. UH and Kapiolani Medical Center doctors studied 18 children who got severe reactions.
“These were children who had infections of their spleen, liver, meningitis, encephalitis. involvement of their eye. Some even developed bone lesions so it was a significant illness in these children,” said Dr. Jessica Kosut, a pediatric hospitalist.
Sarah Pacheco got a mild form of the illness years ago when her new kitten, Kipling, scratched her arm.
“I had just gotten a kitten and they play and you are bound to get scratched, but I noticed I lost my voice completely,” she said.
Cat scratch disease is still rare. Doctors think Hawaii’s humid climate, outdoor lifestyle and higher feral cat population could be partly to blame.
“I don’t think it’s cats that are in people’s homes, but it can be, but a couple of the children that we took care of described playing with cats that were out in the neighborhood and one child was hiding cats in his closet to keep them a secret from his mother,” said Dr. Kosut.
Doctors say cat scratch disease is treatable. Just make sure your cat doesn’t have fleas and doesn’t play with feral cats, and you don’t have to kick out your kitty.
“I’m definitely a fan of cats and I wouldn’t say that this should discourage anyone from getting cats or adopting cats. I just want providers to be aware of it,” said Dr. Johnson.
Cat Scratch Disease (CSD) or Bartonella IS NOT RARE! And while some develop fever and swollen lymph nodes, it presents in a million different ways – some purely psychological.
And cats aren’t the only things transmitting it.
http://townsendletter.com/July2015/bartonellosis0715_3.html Mode of Transmission: Arthropod vectors including fleas and flea feces, biting flies such as sand flies and horn flies, the human body louse, mosquitoes, and ticks; through bites and scratches of reservoir hosts; and potentially from needles and syringes in the drug addicted. Needle stick transmission to veterinarians has been reported. There is documentation that cats have received it through blood transfusion. 3.2% of blood donors in Brazil were found to carry Bartonella in their blood. Bartonella DNA has been found in dust mites. Those with arthropod exposure have an increased risk, as well as those working and living with pets that have arthropod exposure. 28% of veterinarians tested positively for Bartonella compared with 0% of controls. About half of all cats may be infected with Bartonella – as high as 80% in feral cats and near 40% of domestic cats. In various studies dogs have close to a 50% rate as well. Evidence now suggests it may be transmitted congenitally from mother to child – potentially leading to birth defects.
I’m glad they mentioned:
infections of their spleen & liver
involvement of the eye
Because, these are the things crossing my desk on a daily basis.
Bartonella is prolific, tenacious, and can cause severe illness, and many LLMD’s consider it a major coinfection of Lyme.
https://www.ncbi.nlm.nih.gov/pubmed/19303175 Besides the case report of a woman with osteomyelitis, the study states a literature review identified 51 other cases of osteomyelitis associated with cat scratch disease, 14 of those confirmed by PCR.
Opsoclonus consists of massive erratic rapid eye jerks. They may occur in isolation or in association with myoclonus and ataxia, i.e., opsoclonus-myoclonus syndrome (OMS). We report the case of a 9-year-old girl who suffered from headaches for several days and was shown to have opsoclonus and left peripheral facial palsy. Work-up excluded the diagnosis of neuroblastoma, but CSF analysis showed aseptic meningitis, and serology for Borrelia burgdorferi (Lyme) was positive. The outcome was favorable with complete regression of symptoms after treatment with ceftriaxone 2g/day for 3 weeks. Although rare, the diagnosis of Lyme neuroborreliosis must be raised in the presence of isolated opsoclonus, particularly if the clinical picture is incomplete and if other features, such as peripheral facial palsy and pleocytosis in the CSF, are present.
To see what Opsoclonus looks like:
Again, researchers shouldn’t be writing that this manifestation is “rare,” because nobody’s truly keeping track of this. For decades folks have been undiagnosed due to horrifically abysmal testing that misses half of all cases.
Facial palsy and aseptic meningitis are huge clues for Lyme
Aseptic meningitis is when the lining of the brain becomes inflamed. In this case, due to a Borrelia burgdorferi (Bb) infection. This explains the headaches.
As the picture shows, the meninges cover the entire brain so the headache caused by this is going to cover the entire head. This is what I personally had that took years of antibiotics to rid. I wondered if there would ever be a day without this type of headache.
I’ve spoken with many Lyme/MSIDS patients who have had exactly the same thing. It is not rare. The pain is unbelievable, and ONLY treatment took it away. Ibuprophen will not touch this Mother one little bit. CBD, systemic enzymes, NOTHING will touch this if you have a Bb infection. The infection must be dealt with first.