Archive for the ‘Testing’ Category

Multistate Infestation with the Exotic Disease Vector Tick Haemaphysalis Longhornis – U.S., Aug. 2017- Sept. 2018

https://www.cdc.gov/mmwr/volumes/67/wr/mm6747a3.htm

Multistate Infestation with the Exotic Disease–Vector Tick Haemaphysalis longicornis — United States, August 2017–September 2018

C. Ben Beard, PhD1; James Occi, MA, MS2; Denise L. Bonilla, MS3; Andrea M. Egizi, PhD4; Dina M. Fonseca, PhD2; James W. Mertins, PhD3; Bryon P. Backenson, MS5; Waheed I. Bajwa, PhD6; Alexis M. Barbarin, PhD7; Matthew A. Bertone, PhD8; Justin Brown, DVM, PhD9; Neeta P. Connally, PhD10; Nancy D. Connell, PhD11; Rebecca J. Eisen, PhD1; Richard C. Falco, PhD5; Angela M. James, PhD3; Rayda K. Krell, PhD10; Kevin Lahmers, DVM, PhD12; Nicole Lewis, DVM13; Susan E. Little, DVM, PhD14; Michael Neault, DVM15; Adalberto A. Pérez de León, DVM, PhD16; Adam R. Randall, PhD17; Mark G. Ruder, DVM, PhD18; Meriam N. Saleh, PhD14; Brittany L. Schappach10; Betsy A. Schroeder, DVM19; Leslie L. Seraphin, DVM3; Morgan Wehtje, PhD3; Gary P. Wormser, MD20; Michael J. Yabsley, PhD21; William Halperin, MD, DrPH22 (View author affiliations)

Summary

What is already known about this topic?

Haemaphysalis longicornis is a tick indigenous to Asia, where it is an important vector of human and animal disease agents, which can result in human hemorrhagic fever and substantive reduction in dairy production.

What is added by this report?

During 2017–2018, H. longicornis has been detected in Arkansas, Connecticut, Maryland, New Jersey, New York, North Carolina, Pennsylvania, Virginia, and West Virginia on various species of domestic animals and wildlife, and from two humans.

What are the implications for public health practice?

The presence of H. longicornis in the United States represents a new and emerging disease threat. Characterization of the tick’s biology and ecology are needed, and surveillance efforts should include testing for potential indigenous and exotic pathogens.

Haemaphysalis longicornis is a tick indigenous to eastern Asia and an important vector of human and animal disease agents, resulting in such outcomes as human hemorrhagic fever and reduction of production in dairy cattle by 25%. H. longicornis was discovered on a sheep in New Jersey in August 2017 (1). This was the first detection in the United States outside of quarantine. In the spring of 2018, the tick was again detected at the index site, and later, in other counties in New Jersey, in seven other states in the eastern United States, and in Arkansas. The hosts included six species of domestic animals, six species of wildlife, and humans. To forestall adverse consequences in humans, pets, livestock, and wildlife, several critical actions are indicated, including expanded surveillance to determine the evolving distribution of H. longicornis, detection of pathogens that H. longicornis currently harbors, determination of the capacity of H. longicornis to serve as a vector for a range of potential pathogens, and evaluation of effective agents and methods for the control of H. longicornis.

H. longicornis is native to eastern China, Japan, the Russian Far East, and Korea. It is an introduced, and now established, exotic species in Australia, New Zealand, and several island nations in the western Pacific Region. Where this tick exists, it is an important vector of human and animal disease agents. In China and Japan, it transmits the severe fever with thrombocytopenia syndrome virus (SFTSV), which causes a human hemorrhagic fever (2), and Rickettsia japonica, which causes Japanese spotted fever (3). Studies in Asia identified ticks infected with various species of Anaplasma, Babesia, Borrelia, Ehrlichia, and Rickettsia, and all of these pathogen groups circulate zoonotically in the United States (4,5). In addition, parthenogenetic reproduction, a biologic characteristic of this species, allows a single introduced female tick to generate progeny without mating, thus resulting in massive host infestations. In some regions of New Zealand and Australia, this tick can reduce production in dairy cattle by 25% (6). Before 2017, H. longicornis ticks were intercepted at U.S. ports of entry at least 15 times on imported animals and materials (James W. Mertins, U.S. Department of Agriculture [USDA], personal communication).

The USDA Animal and Plant Inspection Service coordinated cooperative efforts through telephone conference calls with various local, state, and federal agricultural and public health agencies. Through these efforts, enhanced vector and animal surveillance were implemented to detect additional tick infestations. Suspect archival specimens that were available among previously collected ticks were also examined. Ticks were identified definitively by morphology at the USDA National Veterinary Services Laboratories or by DNA sequence analysis (molecular barcoding) at Rutgers University Center for Vector Biology, Monmouth County (New Jersey) Mosquito Control Division; College of Veterinary Medicine, University of Georgia; and Center for Veterinary Health Sciences, Oklahoma State University. By definition, a “report” is any new morphologic or molecular identification of H. longicornis ticks with a new county or host species from that county, identified from August 2017 through September 2018. Subsequent repeat collections are not reported here.

From August 2017 through September 2018, vector and animal surveillance efforts resulted in 53 reports of H. longicornis in the United States, including 38 (72%) from animal species (23 [61%] from domestic animals, 13 [34%] from wildlife, and two [5%] from humans), and 15 (28%) from environmental sampling of grass or other vegetation using cloth drags or flags* or carbon dioxide–baited tick traps. With the exception of one report from Arkansas, the remaining reports of positively identified ticks are from eight eastern states: New Jersey (16; 30%), Virginia (15; 28%), West Virginia (11; 21%), New York (three; 6%), North Carolina (three; 6%), Pennsylvania (two; 4%), Connecticut (one; 2%), and Maryland (one; 2%) (Figure). Among the 546 counties or county equivalents in the nine states, ticks were reported from 45 (8%) counties (1.4% of all 3,109 U.S. counties and county equivalents) (Table 1). Excluding 15 reports of positive environmental sampling using flagging, dragging, or carbon dioxide traps, the remaining 38 reports reflect collection of ticks from infested host species (Table 2). Surveillance efforts did not include testing the ticks or hosts for pathogens. No cases of illness in humans or other species were reported. Concurrent reexamination of archived historical samples showed that invasion occurred years earlier. Most importantly, ticks collected from a deer in West Virginia in 2010 and a dog in New Jersey in 2013 were retrospectively identified as H. longicornis.

Discussion

Cooperative efforts among federal, state, and local experts from agricultural, public health, and academic institutions during the last year have documented that a tick indigenous to Asia is currently resident in several U.S. states. The public health and agricultural impacts of the multistate introduction and subsequent domestic establishment of H. longicornis are not known. At present, there is no evidence that H. longicornis has transmitted pathogens to humans, domestic animals, or wildlife in the United States. This species, however, is a potential vector of a number of important agents of human and animal diseases in the United States, including Rickettsia, Borrelia, Ehrlichia, Anaplasma, Theileria, and several important viral agents such as Heartland and Powassan viruses. Consequently, increased tick surveillance is warranted, using standardized animal and environmental sampling methods.

The findings in this report are subject to at least two limitations. First, the findings are limited by the variable surveillance methods used to identify the geographic and host distribution of H. longicornis. These methods included both passive and active surveillance. Conclusions about the geographic and host distribution might reflect the biases in the collection and submission of samples to states and USDA and the paucity of available information. Second, the data in this report reflect the collection of specimens that were positively identified by morphology or molecular barcoding. These represent sentinels that H. longicornis is present in different U.S. states and regions, and not a comprehensive assessment of the distribution of H. longicornis in the United States. The absence of positive samples from many states and counties might reflect the absence of infestation, absence of sampling, or failure to recover the tick. Even in states where H. longicornis has been found, the available data do not describe the actual extent or intensity of infestation.

The biology and ecology of H. longicornis as an exotic species in the United States should be characterized in terms of its vector competence (ability to transmit a pathogen) and vectorial capacity (feeding habits, host preference, climatic sensitivity, population density, and other factors that can affect the risk for pathogen transmission to humans) for tickborne pathogens known to be present in the United States (5). Surveillance for H. longicornis should include adequate sampling of companion animals, commercial animals, wildlife, and the environment. Where H. longicornis is detected, there should be testing for a range of indigenous and exotic viral, bacterial, and protozoan tickborne pathogens potentially transmitted by H. longicornis. Given the similarity between SFTSV and Heartland virus, a tickborne phlebovirus (https://www.cdc.gov/heartland-virus/index.html), further evaluation of the potential role of H. longicornis in transmission of this disease agent among animal reservoirs and possibly to humans is warranted. A broad range of interventions should be evaluated, including insecticide and acaricide sensitivity testing. Many state and federal agencies are developing and disseminating information for stakeholders, including development of hotlines, and some states are identifying ticks submitted by the public. The recently documented occurrence of H. longicornis in the United States presents an opportunity for collaboration among governmental, agricultural, public health agencies and partners in academic public health, veterinary sciences, and agricultural sciences to prevent diseases of potential national importance before onset in humans and other animal species.

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Acknowledgments

Wes Watson, Andrew D. Haddow, Naomi Drexler, Gleeson Murphy, Harry Savage, Howard Ginsberg, Kim Cervantes, field and laboratory personnel.

Corresponding author: C. Ben Beard, cbeard@cdc.gov, 970-221-6418.


* Drags consist of white cloth (usually 1 m2) that have a wooden leading frame and are dragged by a cord through grass or a leafy forest floor. Flags are similar but are used to brush uneven surfaces such as small bushes in wooded areas. Drags and flags are used to sample the environment for ticks trying to locate a host.

Carbon dioxide traps consist of dry ice–filled small boxes with holes that allow the CO2 to escape which are placed on a white cloth or mat in a grassy area or forest floor. Ticks, attracted by the CO2, crawl on to the cloth or mat surface, which is inspected for ticks after a period of time.

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References

  1. Rainey T, Occi JL, Robbins RG, Egizi A. Discovery of Haemaphysalis longicornis (Ixodida: Ixodidae) parasitizing a sheep in New Jersey, United States. J Med Entomol 2018;55:757–9. CrossRef PubMed
  2. Luo L-M, Zhao L, Wen H-L, et al. Haemaphysalis longicornis ticks as reservoir and vector of severe fever with thrombocytopenia syndrome virus in China. Emerg Infect Dis 2015;21:1770–6. CrossRef PubMed
  3. Mahara F. Japanese spotted fever: report of 31 cases and review of the literature. Emerg Infect Dis 1997;3:105–11. CrossRef PubMed
  4. Kang J-G, Ko S, Smith WB, Kim H-C, Lee I-Y, Chae J-S. Prevalence of Anaplasma, Bartonella and Borrelia species in Haemaphysalis longicornis collected from goats in North Korea. J Vet Sci 2016;17:207–16. CrossRef PubMed
  5. Rosenberg R, Lindsey NP, Fischer M, et al. Vital signs: trends in reported vectorborne disease cases—United States and territories, 2004–2016. MMWR Morb Mortal Wkly Rep 2018;67:496–501. CrossRef PubMed
  6. Heath A. Biology, ecology and distribution of the tick, Haemaphysalis longicornis Neumann (Acari: Ixodidae) in New Zealand. N Z Vet J 2016;64:10–20. CrossRef PubMed
Return to your place in the textFIGURE. Counties and county equivalents* where Haemaphysalis longicornis has been reported (N = 45) — United States, August 2017–September 2018

The figure is a map showing the counties and county equivalents where Haemaphysalis longicornis has been reported (N = 45), in the United States, during August 2017–September 2018.* Benton County, Arkansas; Fairfield County, Connecticut; Washington County, Maryland; Bergen, Hunterdon, Mercer, Middlesex, Monmouth, Somerset, and Union Counties, New Jersey; Davidson, Polk, and Rutherford Counties, North Carolina; Richmond, Rockland, and Westchester Counties, New York; Bucks and Centre Counties, Pennsylvania; Albemarle, Augusta, Carroll, Fairfax, Giles, Grayson, Louisa, Page, Pulaski, Rockbridge, Russell, Scott, Smyth, Staunton City, Warren, and Wythe Counties, Virginia; Cabell, Hardy, Lincoln, Mason, Marion, Monroe, Putnam, Ritchie, Taylor, Tyler, Upshur Counties, West Virginia.

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TABLE 1. Percentage of Haemaphysalis longicornis–infested counties or county equivalents in infested states — nine states, August 2017–September 2018Return to your place in the text
State No. of counties* per state No. (%) of counties* with H. longicornis on host or in environment
Arkansas 75 1 (1)
Connecticut 8 1 (13)
Maryland 24 1 (4)
New Jersey 21 7 (33)
New York 62 3 (5)
North Carolina 100 3 (3)
Pennsylvania 67 2 (3)
Virginia 134 16 (12)
West Virginia 55 11 (20)
Total 546 45 (8)

* Counties or county equivalents

TABLE 2. Distribution of Haemaphysalis longicornis, by host and species — nine states, August 2017–September 2018Return to your place in the text
Host category, no. (% of total)/Species No. (% of host category)
Domestic animal, 23 (61)
Cat 1 (4)
Cow 4 (17)
Dog 12 (52)
Goat 2 (9)
Horse 2 (9)
Sheep 2 (9)
Total 23 (100)
Wildlife, 13 (34)
Coyote 1 (8)
White-tailed deer 7 (54)
Gray fox 1 (8)
Groundhog 1 (8)
Virginia opossum 2 (15)
Raccoon 1 (8)
Total 13 (100)
Human, 2 (5) 2 (100)
Total 38 (100)

Beard CB, Occi J, Bonilla DL, et al. Multistate Infestation with the Exotic Disease–Vector Tick Haemaphysalis longicornis — United States, August 2017–September 2018. MMWR Morb Mortal Wkly Rep 2018;67:1310–1313. DOI: http://dx.doi.org/10.15585/mmwr.mm6747a3.

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**Comment**

In the section discussing the species and the other pathogens it’s been known to transmit, Theileria was mentioned. Theileria is a malarial-like pathogen similar to Babesia:

https://en.wikipedia.org/wiki/Theileria_microti

Babesia IS also spread by ticks and is a frequent coinfection with Lyme.

An important difference from malaria is that T. microti does not infect liver cells. Additionally, the piroplasm is spread by tick bites (Ixodes scapularis, the same tick that spreads Lyme disease), while the malaria protozoans are spread via mosquito. Finally, under the microscope, the merozoite form of the T. microti life cycle in red blood cells forms a cross-shaped structure, often referred to as a “Maltese cross“, whereas malaria forms more of a diamond ring structure in red blood cells.[3]

Much is yet to be discovered about the Asian tick that clones itself and can drain cattle of its blood.  For more:  https://madisonarealymesupportgroup.com/2018/09/12/three-surprising-things-i-learned-about-asian-longhorned-ticks-the-tick-guy-tom-mather/

One of the biggest discoveries by Mather was how the ticks line up on stalks of grass resembling grains of wheat.  When anything touches this, it’s like a tick cluster bomb and ticks go everywhere.  Not just one or two, mind you, but hundreds at one time.  See link for pictures.

https://madisonarealymesupportgroup.com/2018/03/01/asian-ticks-mysteriously-turn-up-in-new-jersey/

https://madisonarealymesupportgroup.com/2018/10/03/1st-person-bitten-by-east-asian-longhorned-tick/

https://madisonarealymesupportgroup.com/2018/11/05/hawk-found-carrying-asian-long-horned-tick-the-one-that-drains-cattle-of-all-their-blood/

 

 

 

Wisconsin Tick-Borne Illness Center of Excellence

  Approx. 3 Min

OMI/HYF Tick-Borne Illness Center of Excellence

The Howard Young Foundation’s Women’s Legacy Council presents a campaign to establish the foremost center in the Midwest for identifying and treating tick-borne illnesses and advancing medical knowledge. Led by the Open Medicine Institute, this center will feature state-of-the-art diagnostic equipment and advanced research methodology, and will work collaboratively with patients, referring physicians and regional specialists. Imagine Diagnosis, Treatment, Follow-up and Research for tick-borne illnesses all in one place. With your leadership and support, we can deliver this journey to giving hope, restoring health, and research for patients with tick-borne illnesses.

 Approx 30 Sec

HTF Tick Center

For more:  https://madisonarealymesupportgroup.com/2018/12/16/tick-borne-illness-center-of-excellence-set-to-see-patients-in-early-2019/

https://www.howardyoungfoundation.org/Howard-Young-Foundation-In-the-News/tick-center.html

 

 

 

 

22 With Babesia, 8 Develop Acute Respiratory Distress Syndrome – 3 Die

https://www.ncbi.nlm.nih.gov/pubmed/30585748

2018 Dec 26:1-6. doi: 10.1080/00325481.2019.1558910. [Epub ahead of print]

Babesiosis as a cause of acute respiratory distress syndrome: a series of eight cases.

Abstract

OBJECTIVES:

The characteristics of patients with Acute Respiratory Distress Syndrome (ARDS) as a complication of Babesia microti infection have not been systematically described.

METHODS:

Adult patients admitted to the medical intensive care unit (MICU) of a tertiary care hospital in the Lower Hudson Valley of New York from 1/1/2008 to 8/1/2016 were evaluated for ARDS complicating babesiosis.

RESULTS:

Of 22 patients with babesiosis in the MICU, eight (36.4%; 95% CI: 19.7-57.0%) had ARDS. Six patients (75%) developed ARDS following initiation of anti-babesia drug therapy; however, the mean duration of symptoms in these patients exceeded that of patients who developed ARDS prior to initiation of treatment (7.50 ± 3.83d vs. 4.50 ± 0.71d, p = 0.34). Three patients (37.5%; 95% CI: 13.7-69.4%) expired without recovery from ARDS. In comparison, the mortality rate for the 14 MICU babesiosis patients without ARDS was 14.3% (p = 0.31). There was a trend toward younger age in survivors relative to non-survivors (mean age 54.6 ± 13.8y vs. 74.0 ± 6.24y, p = 0.07). Three of the five survivors did not require mechanical ventilation. The mean sequential organ failure assessment score of non-survivors was significantly higher than that of survivors (12.3 ± 1.15 vs. 6.0 ± 1.4, p = 0.0006).

CONCLUSION:

Among 22 critically ill adult patients with B. microti infection, ARDS developed in eight (35.4%), and three (37.5%) expired without resolution of the ARDS. ARDS often followed the initiation of anti-babesia drug therapy, raising the question of whether the death of the parasite per se contributed to its development. However, this observation was confounded by the longer duration of symptoms preceding initiation of drug therapy.

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More on Babesia:  https://madisonarealymesupportgroup.com/2016/01/16/babesia-treatment/ According to Dr. Horowitz ARDS is often worsened in hospitalized patients who were given steroids (which suppress the immune system) which can cause death.

The number of symptoms and duration of illness in patients with concurrent Lyme disease and babesiosis are greater than in patients with either infection alone:  http://www.lymepa.org/c07%20Lyme%20disease%20and%20Babesiosis%20coinfection.pdf

This finding implies the presence of living spirochetes, because spirochete DNA in blood is amplifiable only when these pathogens remain viable.  It also suggests a synergistic inflammatory response to both a parasitemia and an increased spirochetemia. In addition, babesial infection enhances Lyme disease myocarditis in mice, which suggests that coinfection might also synergize spirochete-induced lesions in human joints, heart, and nerves.

The same was found in animals:  https://www.sciencedirect.com/science/article/abs/pii/S0020751918302406

Similar to humans, B. microti coinfection appears to enhance the severity of Lyme disease-like symptoms in mice. Coinfected mice have lower peak B. microti parasitaemia compared to mice infected with B. microti alone, which may reflect attenuation of babesiosis symptoms reported in some human coinfections. These findings suggest that B. burgdorferi coinfection attenuates parasite growth while B. microti presence exacerbates Lyme disease-like symptoms in mice.

https://www.sciencedirect.com/science/article/pii/S1877959X18302978  Our findings suggest that Babesia infections may indeed be quite common among individuals who have been exposed to tick bites.

Authorities and mainstream doctors to this day are not considering Lyme/MSIDS a polymicrobial illness, but it usually is:  https://madisonarealymesupportgroup.com/2018/10/30/study-shows-lyme-msids-patients-infected-with-many-pathogens-and-explains-why-we-are-so-sick/

https://madisonarealymesupportgroup.com/2018/12/11/babesia-widespread-in-canada-its-high-tolerance-to-therapy/

https://madisonarealymesupportgroup.com/2018/10/06/case-of-recurrent-fever-multiple-splenic-infarcts-why-short-treatment-duration-often-doesnt-work-for-babesia/

https://madisonarealymesupportgroup.com/2018/03/22/what-is-air-hunger-anyway/

https://madisonarealymesupportgroup.com/2018/02/20/babesia-and-heart-issues/

https://madisonarealymesupportgroup.com/2018/10/11/babesia-found-in-patient-with-persistent-symptoms-following-lyme-treatment/

https://madisonarealymesupportgroup.com/2018/02/20/babesia-and-heart-issues/

Rickettsia Found in Ticks on Brazilian Snakes

https://www.ncbi.nlm.nih.gov/m/pubmed/30484879/

Microorganisms in the ticks Amblyomma dissimile Koch 1844 and Amblyomma rotundatum Koch 1844 collected from snakes in Brazil.

Ogrzewalska M, et al. Med Vet Entomol. 2018.

Abstract

Knowledge about ticks (Acari) and screening of ticks parasitizing various hosts are necessary to understand the epidemiology of tick-borne pathogens. The objective of this study was to investigate tick infestations on snakes (Reptilia: Squamata: Serpentes) arriving at the serpentarium at the Institute Vital Brazil, Rio de Janeiro. Some of the identified ticks were individually tested for the presence of bacteria of the genera Rickettsia (Rickettsiales: Rickettsiaceae), Borrelia (Spirochaetales: Spirochaetaceae), Coxiella (Legionellales: Coxiellaceae), Bartonella (Rhizobiales: Bartonellaceae), Ehrlichia (Rickettsiales: Anaplasmataceae), Anaplasma (Rickettsiales: Anaplasmataceae), and Apicomplexa protozoa of the genera Babesia (Piroplasmida: Babesiidae) and Hepatozoon (Eucoccidiorida: Hepatozoidae).

A total of 115 hard ticks (Ixodida: Ixodidae) were collected from 17 host individuals obtained from four Brazilian states. Two species of tick were identified: Amblyomma dissimile Koch 1844 (four larvae, 16 nymphs, 40 adults), and Amblyomma rotundatum Koch 1844 (12 nymphs, 43 adults).

Rickettsia bellii was found in A. rotundatum and A. dissimile ticks and Rickettsia sp. strain Colombianensi, Anaplasma-like and Hepatozoon sp. in A. dissimile ticks. Among the tested ticks, no DNA of Borrelia, Bartonella, Coxiella or Babesia was found. The present findings extend the geographic range of Rickettsia sp. strain Colombianensi in Brazil and provide novel tick-host associations.

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**Comment**

Great example of how we need to expand our minds regarding ticks and the hosts they feed on.  For far too long the white footed mouse has been the sole perp blamed along with the black-legged tick.  There are many other ticks transmitting disease and many other hosts.

Please understand that researchers in their vying for dollars want to simplify and whittle things down into a narrow, confined project.  Unfortunately, nothing about Lyme/MSIDS is simple or narrow and this type of thinking has hurt patients for over 40 years.

More is coming out on the importance of birds transiting ticks everywhere:  https://madisonarealymesupportgroup.com/2018/11/07/ticks-on-the-move-due-to-migrating-birds-and-photoperiod-not-climate-change/

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

Key quote:

“We see that infectious diseases can spread to new geographical areas and that is why it is necessary to understand the role of different animal species in the dynamics of these diseases,” says Tove Hoffman.

https://madisonarealymesupportgroup.com/2018/11/05/hawk-found-carrying-asian-long-horned-tick-the-one-that-drains-cattle-of-all-their-blood/

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

Lizards must be factored in as well:  https://madisonarealymesupportgroup.com/2018/06/25/the-confounding-geography-of-lyme-disease-in-the-u-s/

And for Wisconsinites, lizards are a problem here too:

Researchers working at Fort McCoy near Sparta, as part of a multi-university project Michigan State ecologist Jean Tsao leads, have collected deer ticks from five-lined skinks and snakes.

For pictures and the geographical range of WI skinks, see (yes, they are in Dane County):  https://dnr.wi.gov/topic/WildlifeHabitat/Herps.asp?mode=detail&spec=ARACH01050

Bartonella Presenting with Lymphadenopathy

https://www.ncbi.nlm.nih.gov/m/pubmed/30068900/

Cat-Scratch Disease in an AIDS Patient Presenting with Generalized Lymphadenopathy: An Unusual Presentation with Delayed Diagnosis.

Mantis J, et al. Am J Case Rep. 2018.

Abstract

BACKGROUND Bartonella infection is the causative organism of cat-scratch disease (CSD), which typically presents with self-limited localized lymphadenopathy. In HIV-infected patients, Bartonella infection can cause systemic illnesses with significant morbidity and mortality manifesting as bacillary angiomatosis (BA), hepatic peliosis, splenitis, bacteremic febrile illness, and other organ involvement. To the best of our knowledge, there have been no reports of HIV-infected patients presenting with generalized lymphadenopathy caused by Bartonella infection. We report an unusual case of CSD presenting with generalized lymphadenopathy in an AIDS patient with advanced immunosuppression.

CASE REPORT A 44-year-old woman with AIDS, advanced immunosuppression, and intermittent adherence to antiretroviral therapy and medical care, presented with cough and increased generalized tender lymphadenopathy. A lymph node biopsy 1 year earlier was non-diagnostic for tuberculosis, fungal infection, and lymphoproliferative disorders. She remained with generalized lymphadenopathy. A repeat biopsy with the addition of Warthin-Starry silver staining suggested the diagnosis of cat-scratch lymphadenitis. She responded well to a long course of azithromycin antibiotic therapy, with the resolution of lymphadenopathy. CONCLUSIONS Cat-scratch disease may present with prolonged generalized lymphadenopathy, an unusual presentation in HIV patients with advanced immunosuppression. Awareness of the possibility of CSD in a similar clinical scenario may prompt early recognition and management of this disease.

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**Comment**

While this case study is on an HIV-infected patient, those infected with Lyme/MSIDS can have similar presentations with systemic illness, and significant morbidity and mortality due to the immunosuppressive nature of tick borne infections (TBI’s).

Both my husband and I had Bartonella yet no lymph-node involvement.  This checklist outlines most of the most prevalent symptoms & we had many:  https://madisonarealymesupportgroup.com/2016/01/03/bartonella-treatment/  (Checklist within link along with other symptoms and cases)

Notice that treatment was a “long course” of antibiotics that for some reason is acceptable for an immunosuppressed HIV patient but NOT an immunosuppressed Lyme/MSIDS patient.  It’s a head scratcher for sure.

Congenital transmission is highly likely:  https://madisonarealymesupportgroup.com/2019/01/02/bartonella-in-entire-canadian-family/