Archive for the ‘Testing’ Category

With Unexpected Death, Autopsies Should Look For Lyme Carditis

https://www.lymedisease.org/lyme-carditis-autopsies-mervine/

With unexpected death, autopsies should look for Lyme carditis

By Phyllis Mervine

A friend of mine died last week in her sleep. She was only 49. She wasn’t my close friend, but she was a very close friend of close friends, so it was shocking nonetheless and totally unexpected. Suspecting something cardiac, they scheduled an autopsy. I don’t know her history or if she had any health complaints recently. I also don’t know what they found.

But being a Lyme advocate, I immediately thought of Lyme carditis and decided I should try to educate the forensic pathologist who would be responsible for conducting the autopsy. After all, he was unlikely to look without some prodding and probably was unaware that our county in northern California is a high-risk area for Lyme. I also remembered a talk I had heard a couple of years ago at the Lyme Disease Association conference.

When young people die suddenly

In his talk, a young doctor from the Centers for Disease Control (CDC) described three cases where young people had died suddenly and had donated tissues to a tissue bank for possible transplantation. Testing at the tissue bank showed inflammation in tissue from their hearts, suggestive of Lyme carditis. Further tests were positive for infection with the spirochetes that cause Lyme disease.

Relatives of one patient said he had had a flu-like illness with muscle and joint pain during the two weeks preceding death. The patient also lived with a dog that was reported to have ticks frequently. Another patient had been diagnosed with a cardiac conduction abnormality in the past and was a hiker but had no known tick contact or rashes. The third patient had seen a doctor for episodes of shortness of breath and anxiety the day before he died. He was given anti-anxiety medication but no one suggested Lyme disease, although he lived on a heavily wooded lot in Connecticut and had frequent tick exposure.

The CDC immediately issued an advisory to medical examiners and pathologists in the agency’s MMWR (Morbidity and Mortality Weekly Report): “Three Sudden Cardiac Deaths Associated with Lyme Carditis — United States, November 2012–July 2013.” This is what the article said:

Medical examiners and pathologists should be aware that Lyme carditis is a potential, albeit rare, cause for sudden cardiac death in persons from high-incidence Lyme disease areas. Diffuse, mixed perivascular lymphoplasmacytic infiltrates seen on pathologic examination of heart tissue from patients who have sudden cardiac death in high-incidence Lyme disease areas should prompt serologic evaluation for Lyme disease and further histopathologic examination for spirochetes, including IHC evaluation and PCR.

Resources for the coroner

I thought of trying to set up an appointment with the sheriff/coroner but wanted to do something right away, so I called the sheriff’s office and sent an email, putting the CDC advisory right at the top and asking him to discuss the matter with the forensic pathologist. I added that his deputies are at risk, as are many others in our community who work and play outdoors. I included some other information but the advisory was the main thing.

I suspect I was too late to change protocol on this case, but maybe now that I’ve cracked open the door I can go talk with the sheriff and tell him about our local epidemiological study. I feel it was more about getting myself prepared than anything else. Below is some additional information I may include when I meet with the sheriff.

An article on five cases of sudden cardiac death due to Lyme disease was published in the American Journal of Pathology in 2016. The abstract lists the tests they did, which the pathologist might want to refer to.

“light microscopy, Warthin-Starry stain, immunohistochemistry, and PCR for B. burgdorferi, and immunohistochemistry for complement components C4d and C9, CD3, CD79a, and decorin.”

https://www.ncbi.nlm.nih.gov/pubmed/26968341

There’s also the problem that serology, which tests blood for antibodies, generally has poor sensitivity. All the big labs like ARUP and LabCorp use a strain from NY. IGeneX Lab in Palo Alto includes strains found in California.

Lyme expert Dr. Daniel Cameron has done a nice job of summarizing five cases in a blog. http://danielcameronmd.com/autopsy-study-reviews-cases-due-to-sudden-cardiac-death-from-lyme-disease/

Cardiac Tropism of Borrelia burgdorferi: An Autopsy Study of Sudden Cardiac Death Associated with Lyme Carditis. (March 2016)
http://ajp.amjpathol.org/article/S0002-9440(16)00099-7/abstract

Excerpt:

“Fatal Lyme carditis caused by the spirochete Borrelia burgdorferi rarely is identified. Here, we describe the pathologic, immunohistochemical, and molecular findings of five case patients.”

Mayhe this is something you want to do in your own hometown—preferably before someone dies of cardiac Lyme. They say it is “rare,” but who really knows?

Read the entire case report in the MMWR here https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6249a1.htm

Phyllis Mervine is Founder and President of LymeDisease.org. She has advocated for the rights of people with Lyme disease for three decades.

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**Comment**

Great article.  It’s a reminder that we all need to pull up our shirt sleeves and go the extra mile educating others just like Phyllis is doing.  Take this info and copy it for future reference.  We all may have an opportunity to do the same thing.

In my study of this fiasco, I’ve noticed that the reason researchers declare something “rare” is because there is no formal record of it.  If we all do what Phyllis is doing, there will be more and more public records (death certificates, case studies, and surveillance reports) for researchers to pull up.

Microbiologist Tom Greer has a fantastic article about how post-mortem work is one of the only ways we are going to get to the bottom of the Lyme Wars:  https://madisonarealymesupportgroup.com/2018/04/13/chronic-lyme-post-mortem-study-needed-to-end-the-lyme-wars/

For information on preparing for brain and tissue donations upon death for Lyme research, please see:  http://whatislyme.com/guidelines-for-brain-and-tissue-donations-for-lyme-patients/

 

Category:

Activism, Inflammation, Lyme, Testing

Integrated Control of Juvenile Ixodes Scapularis Parasitizing Peromyscus Leucopus in Residential Settings in Connecticut, United States

https://www.ncbi.nlm.nih.gov/m/pubmed/29859885/

Integrated control of juvenile Ixodes scapularis parasitizing Peromyscus leucopus in residential settings in Connecticut, United States.

Williams SC, et al. Ticks Tick Borne Dis. 2018.

Abstract
Lyme disease continues to be the most common vector-borne disease in the United States with an estimated 330,000 human cases annually. In the eastern United States, the blacklegged tick, Ixodes scapularis, is the primary vector of the Lyme disease spirochete, Borrelia burgdorferi, and the white-footed mouse, Peromyscus leucopus, is a primary reservoir host. In four residential neighborhoods in Connecticut over three years, we tested the effectiveness of different low-toxicity integrated tick management approaches to control larval and nymphal I. scapularis parasitizing P. leucopus.

  • Combinations of white-tailed deer, Odocoileus virginianus, reduction,
  • broadcast application of the entomopathogenic fungus Metarhizium anisopliae,
  • distribution of fipronil-based rodent-targeted bait boxes were evaluated against an
  • experimental control

Deer reduction with no other intervention likely forced juvenile I. scapularis to obtain blood meals from available reservoir hosts, resulting in increased exposure of P. leucopus to B. burgdorferi compared to control sites. The M. anisopliae/bait box and the deer reduction/M. anisopliae/bait box treatment combinations resulted in 94% and 85% reductions in larvae parasitizing P. leucopus that tested positive for B. burgdorferi, respectively, compared to control. Deer reduction alone resulted in only a 3% reduction, likely because parasitizing juvenile I. scapularis were not targeted by bait box-delivered fipronil. Unless there is community support to reduce and maintain deer at very low densities (<5 deer/km2), it is clear that a combination of M. anisopliae/fipronil-based bait boxes offers an effective, localized, low-toxicity option for reducing I. scapularis parasitizing P. leucopus without complications from host switching.

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For more on successful tick reduction methods:  https://madisonarealymesupportgroup.com/2018/04/03/fire-good-news-for-tick-reduction/

https://madisonarealymesupportgroup.com/2018/06/06/mc-bugg-z/

https://madisonarealymesupportgroup.com/2017/05/11/tick-prevention-and-removal-2017/

https://madisonarealymesupportgroup.com/2018/05/27/study-conforms-permethrin-causes-ticks-to-drop-off-clothing/

 

Category:

research, Testing, Ticks, Treatment

New UVA Study Tentatively Links Ticks to Heart Disease

https://news.virginia.edu/content/new-uva-study-tentatively-links-ticks-heart-disease?utm_source=DailyReport&utm_medium=email&utm_campaign=news

NEW UVA STUDY TENTATIVELY LINKS TICKS TO HEART DISEASE

The bite of the lone star tick had previously been shown to cause an allergy to red meat. Now it is linked with an increased risk of heart disease.

June 14, 2018 Josh Barney, jdb9a@virginia.edu

University of Virginia School of Medicine researchers have linked sensitivity to an allergen in red meat – a sensitivity spread by tick bites – with a buildup of fatty plaque in the arteries of the heart. This buildup may increase the risk of heart attacks and stroke.

The bite of the lone star tick can cause people to develop an allergic reaction to red meat. However, many people who do not exhibit symptoms of the allergy are still sensitive to the allergen found in meat. UVA’s new study linked sensitivity to the allergen with the increased plaque buildup, as measured by a blood test.

The researchers emphasize that their findings are preliminary, but say further research is warranted.

tick_story_da_inline_01
The research team drew from both allergists and cardiologists, and included, from left, Dr. Thomas Platts-Mills, Dr. Coleen McNamara, Dr. Jeff Wilson and Anh Nguyen. (Photo by Dan Addison, University Communications)

“This novel finding from a small group of subjects examined at the University of Virginia raises the intriguing possibility that asymptomatic allergy to red meat may be an under-recognized factor in heart disease,” said study leader Dr. Coleen McNamara of UVA’s Robert M. Berne Cardiovascular Research Center and UVA’s Division of Cardiovascular Medicine. “These preliminary findings underscore the need for further clinical studies in larger populations from diverse geographic regions.”

Allergens and Clogged Arteries

Looking at 118 patients, the researchers determined that those sensitive to the meat allergen had 30 percent more plaque accumulation inside their arteries than those without the sensitivity. Further, a higher percentage of the plaques had features characteristic of unstable plaques that are more likely to cause heart attacks.

With the meat allergy, people become sensitized to alpha-gal, a type of sugar found in red meat. People with the symptomatic form of the allergy can develop hives, stomach upset, have trouble breathing or exhibit other symptoms three to eight hours after consuming meat from mammals. (Poultry and fish do not trigger a reaction.)

What’s it like to develop a meat allergy?   https://makingofmedicine.virginia.edu/2018/03/29/the-meat-allergy-whats-it-like/

Other people can be sensitive to alpha-gal and not develop symptoms. In fact, far more people are thought to be in this latter group. For example, up to 20 percent of people in Central Virginia and other parts of the Southeast may be sensitized to alpha-gal, but not show symptoms.

The allergy to alpha-gal was first reported in 2009 by Dr. Thomas Platts-Mills, who heads UVA’s Division of Allergy and Clinical Immunology, and his colleague Dr. Scott Commins. Since then, there have been increasing numbers of cases of the meat allergy reported across the U.S., especially as the lone star tick’s territory grows. Previously found predominantly in the Southeast, the tick has now spread west and north, all the way into Canada.

UVA’s new study suggests that doctors could develop a blood test to benefit people sensitive to the allergen.

“This work raises the possibility that in the future a blood test could help predict individuals, even those without symptoms of red meat allergy, who might benefit from avoiding red meat. However, at the moment, red meat avoidance is only indicated for those with allergic symptoms,” said researcher Dr. Jeff Wilson of UVA’s allergy division.

Findings Published

The work represents a significant collaboration between allergy and cardiology experts at UVA. The researchers have published their findings in Arteriosclerosis, Thrombosis and Vascular Biology, a journal of the American Heart Association. The research team consisted of Wilson, Anh Nguyen, Alexander Schuyler, Commins, Angela Taylor, Platts-Mills and McNamara.

The work was supported by the National Institutes of Health, grants KO8-AI085190, K23-HL093118, RO1-AI 20565, PO1-HL55798, RO1-HL136098-01 and RO1-HL107490.

MEDIA CONTACT

Josh Barney
UVA Health System
jdb9a@virginia.edu 434-243-1988

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For more:  https://madisonarealymesupportgroup.com/2018/05/04/arkansas-woman-develops-deadly-meat-allergy-after-tick-bite/

https://madisonarealymesupportgroup.com/2017/01/12/tick-related-red-meat-allergy-found-in-minnesota-wisconsin/

https://madisonarealymesupportgroup.com/2018/06/27/alpha-gal-perioperative-management/

https://madisonarealymesupportgroup.com/2018/01/16/a-strange-itch-trouble-breathing-then-anaphylactic-shock/

 

Category:

Activism, Alpha Gal Meat Allergy, research, Testing, Ticks, Transmission

Surveillance For Heartland & Bourbon Viruses in Eastern Kansas

https://academic.oup.com/jme/advance-article/doi/10.1093/jme/tjy103/5045816

Surveillance for Heartland and Bourbon Viruses in Eastern Kansas, June 2016

Savage HM, Godsey MS Jr, Tatman J, Burkhalter KL, Hamm A, Panella NA, Ghosh A, Raghavan RK.
Journal of Medical Entomology, online first 2018 Jun 27.

Abstract

In June 2016, we continued surveillance for tick-borne viruses in eastern Kansas following upon a larger surveillance program initiated in 2015 in response to a fatal human case of Bourbon virus (BRBV) (Family
Orthomyxoviridae: Genus Thogotovirus). In 4 d, we collected 14,193 ticks representing four species from four sites.

Amblyomma americanum (L.) (Acari: Ixodidae) accounted for nearly all ticks collected (n = 14,116, 99.5%), and the only other species identified were Amblyomma maculatum Koch (Acari: Ixodidae),
Dermacentor variables (Say) (Acari: Ixodidae) and Ixodes scapulars Say (Acari: Ixodidae). All ticks were tested for both BRBV and Heartland virus (Family Bunyaviridae: Genus Phlebovirus) in 964 pools.

Five Heartland virus positive tick pools were detected and confirmed by real-time reverse transcription PCR (rRT-PCR), while all pools tested negative for BRBV. Each Heartland positive pool was composed of 25 A. americium nymphs with positive pools collected at three different sites in Bourbon County.

A. americanum is believed to be the primary vector of both Heartland and BRBVs to humans based upon multiple detections of virus in field-collected ticks, its abundance, and its aggressive feeding behavior on mammals including humans. However, it is possible that A. americium encounters viremic vertebrate hosts of BRBV less frequently than viremic hosts of Heartland virus, or that BRBV is less efficiently
passed among ticks by co-feeding, or less efficiently passed vertically from infected female ticks to their offspring resulting in lower field infection rates.

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For more:  https://madisonarealymesupportgroup.com/2017/07/01/one-tick-bite-could-put-you-at-risk-for-at-least-6-different-diseases/ (Actually it’s 18 and counting)

Category:

research, Testing, Ticks, Transmission, Viruses

Lyme Disease Presenting With Multiple Cranial Neuropathies on MRI

Lyme disease presenting with multiple cranial neuropathies on MRI

Piché-Renaud PP, Branson H, Yeh EA, Morris SK.
IDCases. 2018 Apr 11;12:117-118. eCollection 2018.

https://doi.org/10.1016/j.idcr.2018.04.004

Abstract

We present the case of a 10-year old patient from southeastern Ontario with severe bilateral facial palsy. MRI was performed that showed extensive symmetric enhancement of cervical cranial nerve roots and multiple cranial nerves (III, V, VI, VII, VIII, X and XII).

Lumbar puncture was performed that revealed pleocytosis and elevated proteins in the cerebrospinal fluid. Serology confirmed the diagnosis of neuroborreliosis. The patient was treated with a 4-week course of IV ceftriaxone, following which he returned to baseline.

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**Comment**

This case is a perfect example of the importance understanding the organism and of the need for follow up.  The case study follows the idea that borrelia can be eradicated quickly and easily which is just not to case for many patients.

It is my strong opinion that people once infected with Lyme/MSIDS should be checked yearly if not more frequently for symptoms.  Once Bb is in the central nervous system, it can proliferate anywhere.  Follow up would show most probably show symptoms that come and go that are directly related to infection.  People treated like this often fall through the cracks and physicians do not connect later symptoms with previous infection.

For an example of how a successful doctor, also a founding member of the IDSA,  treated Lyme/MSIDS cases right here in Wisconsin: https://madisonarealymesupportgroup.com/2017/07/09/idsa-founder-used-potent-iv-antibiotics-for-chronic-lyme/

“….two protocols to be considered for the treatment of chronic LD that includes 6-8 grams of IV ceftriazone for at least 6 weeks and longer if the syndrome has entrenched itself for over a year or if the response is coming along slowly. In tandem with the IV antibiotics he typically also used doxycycline, an erythromycin, Diflucan, Flagyl, Valtrex, and gamma globulin. When there was not a satisfactory clinical response he would treat Babesia with Mepron and/or other antimalarials. For evidence of intransigent bartonellosis (Bell’s palsy of the face and gut, and chronic dermatitis) he would add rifampin and sometimes intravenous genamicin.  That’s a far cry more than the CDC/IDSA mono treatment mandate of doxycycline.

Notice the overlapping treatment?  This is how most knowledgable practitioners treat this complex illness which automatically takes into account the probably of other pathogens besides Bb.

For more treatment options:  https://madisonarealymesupportgroup.com/2016/02/13/lyme-disease-treatment/

More cases of cranial neuropathy:  https://madisonarealymesupportgroup.com/2017/06/01/cns-lyme-disease-with-cranial-neuropathies-and-mimicking-b-cell-lymphoma/

https://madisonarealymesupportgroup.com/2018/02/07/cranial-neuropathy-severe-pain-due-to-bb-infection/

Category:

Lyme, research, Testing, Treatment