Archive for the ‘Testing’ Category

PCR Assays for Borrelia Hermsii (Tick-borne Relapsing Fever Species)

https://www.ncbi.nlm.nih.gov/m/pubmed/30131238/

Novel real-time PCR assays for genomic group identification of tick-borne relapsing fever species Borrelia hermsii.

Modarelli JJ, et al. Diagn Microbiol Infect Dis. 2018.
Diagn Microbiol Infect Dis. 2018 Aug 8. pii: S0732-8893(18)30257-8. doi: 10.1016/j.diagmicrobio.2018.08.001. [Epub ahead of print]

Abstract

Borrelia hermsii is a non-Lyme borreliosis pathogen that is responsible for causing tick-borne relapsing fever in humans and animals in the western United States. B. hermsii has been described to encompass two divergent genomic groups, GGI and GGII, which have been suggested to maintain a unique geographical distribution and potential range of pathogenicity. Though the genomic groups have been extensively documented in the literature, a real-time PCR tool for identifying these genomic groups is lacking. This study describes the development and validation of two flaB-based quantitative real-time PCR assays for differentiating between the two genomic groups of B. hermsii while also maintaining specificity against other closely related Borrelia species. The diagnostic specificity of the assays were evaluated using a large panel of various Borrelia species, including a collection of 22 B. hermsii culture isolates purified from various hosts. The high sensitivity and specificity of the assays provide a useful tool for supporting future studies aimed at evaluating the geographical distribution as well as potential intraspecies pathogenicity within arthropod vectors and mammalian hosts.

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**Comment**

While the study outcome was to determine geographical distribution and potential intraspecies pathogenicity, I for one would like to see a switch in thinking to less concern for geography and more concern for accurate testing for patient diagnosis.  The geographical emphasis has worked against patients for over 40 years and according to everything coming across this desk, I think we need to embrace this pandemic for what it is – a pandemic that knows no borders.

The sooner we quit looking at maps the sooner patients are going to be believed, validated, and actually helped.

Go here for more on Tick-relapsing fever:  https://madisonarealymesupportgroup.com/2018/09/04/borrelia-miyamotoi-in-immunocompetent-patient/  Please notice Dr. Cameron’s comment about another relapsing fever caused by Bm:  “You might assume a patient infected with Borrelia miyamotoi, a relapsing fever spirochete, to present with a relapsing fever. However, your assumption would be wrong 48 out of 50 times, according to a case series published in the Annals of Internal Medicine. [1] The authors found that only 2 out of 50 patients infected with the relapsing spirochete B. miyamotoi actually presented with a relapsing fever. [1]….The individuals exhibited symptoms similar to those found in other tick-borne illnesses.

So while researchers are trying to separate out all the various strains and the particular geography, clinicians are struggling with the fact that although many of the strains are supposed to be “relapsing fever” they actually present clinically like other TBI’s such as Lyme and cause a clinical picture quite different from relapsing fever.  This is paramount for clinicians to understand as the patients showing up in their offices have symptoms quite different from what the researchers are stating.

Be your own advocate and learn as much as you can.  Chances are you will be educating your practitioner.

 

Category:

Borrelia Miyamotoi (Relapsing Fever Group), research, Testing

Borrelia Miyamotoi in Immunocompetent Patient

https://wwwnc.cdc.gov/eid/article/24/9/18-0806_article

Borrelia miyamotoi Disease in an Immunocompetent Patient, Western Europe

Hoornstra D, Koetsveld J, Sprong H, et al. Borrelia miyamotoi Disease in an Immunocompetent Patient, Western Europe. Emerging Infectious Diseases. 2018;24(9):1770-1772. doi:10.3201/eid2409.180806.

Abstract

Borrelia miyamotoi disease is a hard tick–borne relapsing fever illness that occurs across the temperate climate zone. Human B. miyamotoi disease in immunocompetent patients has been described in Russia, North America, and Japan. We describe a case of B. miyamotoi disease in an immunocompetent patient in western Europe.

“Molecular tests of blood and skin biopsy and serologic testing for Borrelia burgdorferi sensu lato and syphilis were repeatedly negative, except for a C6 EIA IgM/IgG seroconversion (Immunetics, Boston, MA, USA) in convalescent-phase serum samples that was positive but could not be confirmed by either IgM or IgG immunoblot (Mikrogen, Neuried, Germany) (Technical Appendix Table 2). We did not admit the patient to the hospital, and we did not initiate antimicrobial drug treatment because her symptoms had largely resolved. At a 2-month follow-up visit, the patient had fully recovered, and laboratory test results were normal.

In a well-described cohort of PCR-positive patients in Russia, characteristic clinical symptoms were fever, myalgia, nausea, and headaches; laboratory findings showed thrombocytopenia and diffuse organ damage (3).

That the patient recovered even without antimicrobial treatment is consistent with a recent BMD case described in the United States (9). Because of the initial skin rash, we did not completely rule out B. burgdorferi s.l. co-infection; however, prior evaluation by an independent dermatologist, a negative B. burgdorferi s.l. immunoblot despite high C6 reactivity, and a negative PCR on DNA obtained from the skin biopsy argue against co-infection. Regardless, the clinical picture of fever and mild leukopenia and thrombocytopenia is compatible with BMD and not with Lyme borreliosis. Of interest, C6 reactivity in combination with a negative B. burgdorferi s.l. immunoblot has been described in BMD patients in the United States (10).”

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**Comment**

Three weeks after a tick bite, a 72 year old Dutch woman reported a bullseye rash several days later with a fever.  This was followed by headache, weight loss, and muscle & joint pain.

Notice the repeatedly negative test results.  

The denial of antimicrobial treatment is pretty amazing considering the admission of the “well-described cohort of PCR-positive patients in Russia, characteristic clinical symptoms were fever, myalgia, nausea, and headaches; laboratory findings showed thrombocytopenia and diffuse organ damage.”

Are they really going to deny an elderly woman antimicrobial treatment even when diffuse organ damage is on the record?

Medical professionals continue to baffle me.

Dr. Cameron states:  “Until now, there have been no treatment guidelines for B. miyamotoi and regimes have been empirically based on the treatment for Lyme disease. ‘The antimicrobial susceptibility of B. miyamotoi has not yet been elucidated, due to difficulties with cultivation of B. miyamotoi spirochetes in vitro,’ according to Koetsveld.  http://danielcameronmd.com/best-antibiotics-treat-borrelia-miyamotoi/  The study authors demonstrated that B. miyamotoi is susceptible to doxycycline, azithromycin, and ceftriaxone but resistant to amoxicillin in vitro. The next step would be to show whether these drugs work in patients.”

The denial of this plague where so much is unknown is an ever cause for concern.  People are dying out here and all they can do is smugly state that her symptoms had largely resolved.  I will add to this very troubling statement, and will very probably come raging back at an undetermined date in the future!

For more:  https://madisonarealymesupportgroup.com/category/borrelia-miyamotoi-relapsing-fever-group/

http://danielcameronmd.com/dont-count-on-a-relapsing-fever-to-diagnose-borrelia-miyamotoi/   “You might assume a patient infected with Borrelia miyamotoi, a relapsing fever spirochete, to present with a relapsing fever. However, your assumption would be wrong 48 out of 50 times, according to a case series published in the Annals of Internal Medicine. [1] The authors found that only 2 out of 50 patients infected with the relapsing spirochete B. miyamotoi actually presented with a relapsing fever. [1]….The individuals exhibited symptoms similar to those found in other tick-borne illnesses. The majority presented with headaches, myalgias, arthralgias, and malaise/fatigue. ‘More than 50% were suspected of having sepsis, and 24% required hospitalization,’ states Molloy. [1]…..’Serologic testing using the rGlpQ EIA seems insensitive in diagnosing acute BMD infection given that it was positive for IgG or IgM in only 16% of the case patient samples at the time of clinical presentation,’ states Molloy. The rGlpQ was positive after the fact in 86% of the patients during convalescence. [1]….Elevated liver enzyme levels, neutropenia, and thrombocytopenia were common in 75%, 60% and 51% respectively. ‘Borrelia miyamotoi disease may be clinically similar to or be confused with human anaplasmosis,’ according to Molloy….B. miyamotoi has emerged as a leading cause of hard tick-transmitted infections but lacks a clear diagnostic criteria. According to Molloy, “Infection with B. miyamotoi is the fifth recognized Ixodes-transmitted infection in the northeastern United States and should be part of the differential diagnosis of febrile patients from areas where deer tick–transmitted infections are endemic.'”

http://danielcameronmd.com/larval-ticks-borrelia-miyamotoi/

https://igenex.com/ticktalk/2018/01/11/borreliosis-relapsing-fever-disease/

 

 

Category:

Borrelia Miyamotoi (Relapsing Fever Group), Lyme, research, Testing, Treatment

Particles May be the Answer to Accurate Lyme Disease Detection

https://www.northernvirginiamag.com/health/medical-features/2018/08/29/particles-may-be-the-answer-to-accurate-lyme-disease-detection/

Particles may be the answer to accurate Lyme disease detection

AUGUST 29, 2018 by RACHAEL KEENEY

Named a breakthrough device by the FDA, Ceres Nanosciences’ Nanotrap Lyme Antigen Test System offers a less invasive, more efficient way to test for the tick-borne disease.

lyme-disease-detection
Courtesy of Ceres Nanosciences

It all started in 2008 when Ross Dunlap, CEO of Manassas-based Ceres Nanosciences, decided he wanted to take a risk. Instead of continuing his work as a technology and management consultant, Dunlap wanted to switch gears to work for an organization with its own innovative product. Dunlap found that product, Nanotrap particles, through what he calls “serendipity and crossing paths at the right time.” His brother’s law firm put him in contact with George Mason University inventors funded by the National Institutes of Health to find a better way to detect various cancers, which led to the particles’ creation.

“It was understood when we were introduced to [the Nanotrap particles] that they had broad utility … basically in any kind of biofluid that could be processed with these particles we could look for markers of other diseases. We saw an opportunity … to do a lot of good, to really be a powerful tool for life sciences for patient benefit,” Dunlap explains of the decision to license the Nanotrap technology from GMU and create the particle manufacturing company in 2009.

Years later, Ceres published a 2015 clinical study citing how their technology could improve Lyme disease diagnosis by adding the particles to urine samples, a less invasive and potentially more accurate alternative to the serology (blood) test that is typically administered. In a blood sample, scientists look for biomarkers produced when an infected individual’s immune system responds to the tick-borne bacteria, a response that could take several weeks to develop and become detectable. As such, the current standard of care test has been known to result in false negatives.

“Our technology is novel in several ways in that we are detecting the disease itself, not your body’s immune response … [and] we are looking for the bacteria that the tick transfers into your system upon infection,” Dunlap says, explaining that the particles can either be present in a collection cup or be added into a sample later, where they then seek out and isolate the bacteria.

In 2016, through a clinical lab within GMU’s Center for Applied Proteomics and Molecular Medicine, Ceres began offering their Nanotrap Lyme Antigen Test System, which was named a Breakthrough Device by the Food and Drug Administration (FDA) this past July. With this endorsement, Ceres and the FDA maintain an open dialogue and are working to develop a clinical trial running through the 2019 tick season, early spring through summer. Depending on its results, an FDA-approved product could hit the market by the end of the year.

In the meantime, those believing they may have Lyme disease can approach their doctor about ordering a Nanotrap Lyme Antigen Test from Ceres’ website, with the option of taking the test at the doctor’s office or self-collecting at home and shipping the samples back to the lab. Because Lyme disease must be reported to state and federal health agencies, a prescription is required. // ceresnano.com

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For More:  https://madisonarealymesupportgroup.com/2018/08/06/lyme-nanotrap-test-granted-breakthrough-device-designation-by-fda/

https://madisonarealymesupportgroup.com/2018/01/16/2-tier-lyme-testing-missed-85-7-of-patients-milford-hospital/

https://madisonarealymesupportgroup.com/2017/08/15/reliability-of-lyme-testing/

https://madisonarealymesupportgroup.com/2017/08/08/lyme-testing-using-two-recominant-proteins/

https://madisonarealymesupportgroup.com/2017/04/12/comparing-lyme-testing-with-hiv-testing/

https://madisonarealymesupportgroup.com/2018/05/11/lyme-sci-we-need-better-testing-and-we-need-it-now/

 

 

Category:

Activism, Lyme, Testing

Schumer Says Amendment Would Increase Funding To Fight Lyme Disease

http://www.wamc.org/post/schumer-says-amendment-would-increase-funding-fight-lyme-disease  (audio here)

Schumer Says Amendment Would Increase Funding To Fight Lyme Disease

By Allison Dunne • Aug 28, 2018

Photo by Scott Bauer (USDA ARS)

U.S. Senate Minority Leader Charles Schumer says his amendment to boost funding to combat Lyme disease is a victory for upstate New York. The Democrat says it would be the first such increase for the Centers for Disease Control and Prevention in five years.

Schumer says his amendment that passed in the Senate will become part of the Health and Human Services Appropriations bill.

“I fought for more money and it’s the first time we’ve had a breakthrough,” Schumer says. “There are going to be significant more dollars to fight Lyme disease.”

He says the legislation would increase Lyme disease funding from fiscal year 2018’s level of $10.7 million to $12 million for fiscal year 2019. Schumer vows to shepherd the funding through Congress and onto the president’s desk. Jill Auerbach chairs the Hudson Valley Lyme Disease Association. She is thankful for the funding proposal, but says more is needed.

“It’s a spit in the bucket,” says Auerbach. “If you were to compare what’s spent on some of the other infectious diseases as compared to what’s spent on Lyme and tick-borne disease and the numbers of people that are affected, I mean, it’s just, it’s appalling.”

Auerbach is also a member of the Dutchess County Legislature Tick Task Force. Dutchess has long been considered the epicenter of Lyme disease.

“Tick disease has been spreading like wildfire, and it’s been so underfunded. People need to be protected, and our government has not done enough to do that,” says Auerbach. “We desperately need appropriations for Lyme disease research and, in particular, tick research to stop the scourge of these ever increasing and spreading ticks.”

She points to the longhorned tick, which was found for the first time in New York earlier this summer, in Westchester County, as an example of the compounding problem. Schumer says he met with CDC Director Dr. Robert Redfield earlier this year, and explained the need to address Lyme disease in New York. Schumer says Redfield committed to working on it. Schumer says there are a number of approaches to fighting the tick-borne diseases, including education.

“I actually was bitten by a Lyme disease tick. I could have had it, but I saw that night on my shin —  I was inspecting dams in Ulster County — and I saw this telltale bullseye rash on my skin, saw a little black thing, picked it up, put it in a bag, I knew what to do, went to the doctor,” Schumer says. “And there’s a simple antibiotic they can give you for 10 days and it wipes it out, if they catch it early. But, if people aren’t educated, they won’t know. And after two weeks it’s in your system and very hard to resist.”

And, he says:

“We need a test. So many people get tested and there are false positives and false negatives. It wouldn’t cost that much, but our legislation will increase money to get a test done,” Schumer says. “And third, there can be a cure like we cure many other diseases like Lyme disease.”

Again, Auerbach:

“If we don’t get funding, I don’t know what’s going to happen, but our children and their children are really going to pay the consequences,” Auerbach says.

Schumer says the funding increase would be used to target vector-borne pathogens which cause diseases in humans. He says the additional money would help officials understand when, where, and how people become exposed to vector-borne pathogens, as well as help prevent exposure to vector-borne pathogens and mitigate potential consequences of infection. Additionally, the funding would be used to implement vector-borne disease diagnostics, surveillance, control and prevention programs.

 

Category:

Activism, Lyme, Testing, Ticks

How to Spot the Symptoms of Lyme Disease in Dogs

https://www.thesprucepets.com/lyme-disease-in-dogs-3384701

How to Spot the Symptoms of Lyme Disease in Dogs

By Lianne McLeod, DVM

Updated 04/23/18

Lyme disease is caused by a bacteria called Borrelia burgdorferi and is spread by ticks. Ticks become infected with the bacteria by feeding on infected mice and other small animals. When an infected tick bites other animals, it can transmit the bacteria to these animals. Lyme disease is transmitted by the deer tick (black-legged tick) and a small group of other closely related ticks. The deer tick is small and may bite animals and people without being detected. Lyme disease affects a variety of species, including dogs, cats, and people. Up to 95 percent of dogs infected with B. burgdorferi do not develop symptoms (people are much more likely to become ill with Lyme disease).

There is no evidence that Lyme disease is spread by direct contact with infected animals. However, keep in mind that ticks can hitch a ride home on your pets and move on to the humans in the household. **Please see my comment at end of article**

Risk Factors

Dogs that spend a lot of time outdoors, especially in the woods, bush, or areas of tall grass are most commonly infected with Lyme disease. However, ticks can be carried into yards on other animals, and dogs can become infected anywhere ticks are found.

Infections occur during tick season (usually spring through early fall), but the time between infection and the appearance of Lyme disease symptoms can be up to 2-5 months. **Please see comment**

Lyme disease is seen across the US and in many other parts of the world. In the US. Lyme disease is most common in the northeastern US, along with the Pacific coast, and in the midwest.

Signs of Lyme Disease

When clinical signs do develop, they may be transient or recurrent, and can include:

  • Fever.
  • Decreased appetite.
  • Swollen, painful joints (dogs may be reluctant to move).
  • Lameness — limping which may be mild at first, then worsen, and may also shift from one leg to another.
  • Lethargy.
  • Swollen lymph nodes.

Some dogs with Lyme disease may develop kidney disease.

Signs of kidney disease may include depression, vomiting, loss of appetite, and increased thirst and urination (sometimes a lack of urination will develop). Dogs who develop kidney disease can become very ill and may not respond to treatment.

Neurological disease (behavioral changes, seizures) and heart complications, which are sometimes seen in humans, are rare in dogs.

Diagnosis of Lyme Disease

The diagnosis of Lyme disease must be based on a combination of factors, including history (tick exposure), clinical signs, finding antibodies to B. burgdorferi bacteria, and a quick response to treatment with antibiotics.

A positive antibody test is not enough to make a diagnosis on its own, because not all dogs that are exposed to B. burgdorferi get sick, and antibodies can persist in the blood for a long time after exposure.

Other diagnostic testing, such as blood and urine tests, x-rays, and sampling of joint fluid, may be done to check for signs of kidney disease and to rule out other conditions with similar signs and symptoms.

Treating Lyme Disease

Treatment with antibiotics usually produces rapid improvement in symptoms (antibiotics will be continued for a few weeks). Treatment may not be completely clear the bacteria, but produces a state where no symptoms are present (similar to the condition in dogs that don’t have symptoms from infection).

Kidney disease may develop some time after the initial infection, so is it a good idea to regularly check for excess protein in the urine of dogs that have had Lyme disease. Catching the kidney disease early in its course offers the best prognosis. If kidney disease is present, a longer course of antibiotics along with additional medications to treat the kidney disease is usually necessary.

Preventing Lyme Disease
  • Tick Control is extremely important for the prevention of Lyme disease (and many other diseases that can be transmitted by ticks). Check your dog daily for ticks and remove them as soon as possible, since ticks must feed for at least 12 hours (possibly 24-48 hours) before transmitting the bacteria causing Lyme disease. This is especially important in peak tick season and after your dog spends time in the bush or tall grass (consider avoiding these areas in tick season).  Products that prevent ticks such as monthly parasite preventatives (e.g., Frontline®, Revolution®) or tick collars (e.g., Preventic®) can be used; be sure to follow your veterinarian‘s advice when using these products. Keep grass and brush trimmed in your yard, and in areas where ticks are a serious problem, you can also consider treating your yard for ticks.  **Again, please see my comment at end of article**
  • Vaccines for Lyme Disease: Vaccination against Lyme disease is a controversial topic and is something that should be discussed in depth with your veterinarian. Many specialists do not recommend routine vaccination because so few dogs develop symptoms of Lyme disease, and when Lyme disease does occur in dogs, it is usually readily treated. Additionally, because arthritis and kidney problems associated with Lyme disease are at least partly related to the immune response to the bacteria (rather than the bacteria itself), there is concern that vaccination may contribute to problems. Vaccination is also not 100 percent effective, and it’s only helpful in dogs that have not already been exposed to B. burgdorferi. However, vaccination before exposure can help prevent dogs from getting Lyme disease and also prevent them from becoming a carrier of the bacteria. Where vaccines are used, it is usually recommended to start vaccinating dogs as young puppies (e.g., at around 12 weeks, with a booster 2-4 weeks later). The vaccine does not provide long-lasting immunity, so annual re-vaccination (ideally before tick season) is necessary. The recombinant form of the vaccine is considered to have less potential for side effects than the bacteria form of the vaccine.
Please note: this article has been provided for informational purposes only. If your pet is showing any signs of illness, please consult a veterinarian as quickly as possible.
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**Comment**
While there are many useful take-aways from this article, a number of myths continue to be propagated.  
  1. There is evidence that there is transmission by direct contact with animals.  http://www.lymerick.net/Transmission-Bb-contact.htm  (Here we see evidence of Bb in feces, urine, tick excretes, cow milk, food, in utero, transplacental, sexual, semen, and mucus membranes.)
  2. My vet treated my dog for longer than a couple of weeks.  I think that wise knowing the organism reproduces slowly.  They also have the canine equivalent of probiotics but they are designed for a dog’s micro biome so don’t give him yours.
  3. The fallacy of it taking 24-48 hours to be transmitted, is just that – a fallacy.  Please read more about transmission time here:  https://madisonarealymesupportgroup.com/2017/04/14/transmission-time-for-lymemsids-infection/
  4. Transmission can occur at ANY TIME of the YEAR.  I have buddies pulling live ticks off their dogs in Northern Wisconsin in February.

Also, please note the comments about the vaccine.  They always want to state how great it is in animals but I see many comments that suggest extreme caution – similarly to the human Lyme vaccine.  First, it doesn’t provide lasting immunity, it causes obvious side-effects, it’s not 100% effective, and vaccination can make things worse for dog exposed to Bb.  Since this can be transmitted congenitally, it’s pretty hard to know what dogs already have Bb.  It’s Russian Roulette with dogs just as much as with humans.  Buyer beware.

Category:

Lyme, Lyme Vaccine, Testing, Ticks, Transmission, Treatment