Archive for the ‘Testing’ Category

Spatial and Temporal Patterns of Borrelia Miyamotoi in NY Deer Ticks

https://parasitesandvectors.biomedcentral.com/articles/10.1186/s13071-020-04569-2

Spatial and temporal patterns of the emerging tick-borne pathogen Borrelia miyamotoi in blacklegged ticks (Ixodes scapularis) in New York

Parasites & Vectors volume 14, Article number: 51 (2021) Cite this article

Abstract

Borrelia miyamotoi, a bacterium that causes relapsing fever, is found in ixodid ticks throughout the northern hemisphere. The first cases of human infection with B. miyamotoi were identified in 2011. In the eastern USA, blacklegged ticks (Ixodes scapularis) become infected by feeding on an infected vertebrate host, or through transovarial transmission. We surveyed B. miyamotoi prevalence in ticks within forested habitats in Dutchess County, New York, and identified possible reservoir hosts. To assess spatial variation in infection, we collected questing nymphal ticks at > 150 sites. To assess temporal variation in infection, we collected questing nymphs for 8 years at a single study site. We collected questing larval ticks from nine plots to estimate the amount of transovarial transmission. To evaluate potential reservoir hosts, we captured 14 species of mammal and bird hosts naturally infested with larval blacklegged ticks and held these hosts in the laboratory until ticks fed to repletion and molted to nymphs. We determined infection for all ticks using quantitative polymerase chain reaction.

  • The overall infection prevalence of questing nymphal ticks across all sites was ~ 1%, but prevalence at individual sites was as high as 9.1%.
  • We detected no significant increase in infection through time.
  • Only 0.4% of questing larval ticks were infected.
  • Ticks having fed as larvae from short-tailed shrews, red squirrels, and opossums tended to have higher infection prevalence than did ticks having fed on other hosts.

Further studies of the role of hosts in transmission are warranted. The locally high prevalence of B. miyamotoi in the New York/New England landscape suggests the importance of vigilance by health practitioners and the public.

______________________

**Comment**

A perfect example of how there can be high infection rates in humans but low infection rates in ticks.

Category:

Borrelia Miyamotoi (Relapsing Fever Group), research, Testing, Ticks

Pediatric Lyme Disease Biobank, USA, 2015–2020: An Innovative Approach to Understanding Pediatric Lyme Disease

https://wwwnc.cdc.gov/eid/article/26/12/20-0920_article

Pediatric Lyme Disease Biobank, United States, 2015–2020

Lise E. NigrovicComments to Author , Desire N. Neville, Fran Balamuth, Michael N. Levas, Jonathan E. Bennett, Anupam B. Kharbanda, Amy D. Thompson, John A. Branda, Aris C. Garro, and the Pedi Lyme Net Working Group
Author affiliations: Boston Children’s Hospital, Boston, Massachussetts, USA (L.E. Nigrovic); Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA (D.N. Neville); Milwaukee Children’s Hospital, Milwaukee, Wisonsin, USA (F. Balamuth); Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA (M.N. Levas); Nemours/Alfred I. duPont Children’s Hospital, Wilmington, Delaware, USA (J.E. Bennett, A.D. Thompson); Children’s Minnesota, Minneapolis, Minnesota, USA (A.B. Kharbanda); Massachusetts General Hospital, Boston (J.A. Branda); Rhode Island Hospital, Providence, Rhode Island, USA (A.C. Garro)

Abstract

In 2015, we founded Pedi Lyme Net, a pediatric Lyme disease research network comprising 8 emergency departments in the United States. Of 2,497 children evaluated at 1 of these sites for Lyme disease, 515 (20.6%) were infected. This network is a unique resource for evaluating new approaches for diagnosing Lyme disease in children.

https://globallymealliance.org/an-innovative-approach-to-understanding-pediatric-lyme-disease/

An Innovative Approach to Understanding Pediatric Lyme Disease

by Mayla Hsu, Ph.D., Director of Research and Science, GLA

In the late 1970s, children presenting with arthritic symptoms were among the first cases of what is now known to be Lyme disease. Almost 50 years later, the incidence among kids remains high. Despite an estimated 400,000 new cases of Lyme disease annually in the U.S., with more than half being children, focused research to develop accurate diagnostics and improved treatments for them is lacking.

Global Lyme Alliance (GLA) funded the Pedi Lyme Net led by Lise Nigrovic, M.D., M.P.H., of the Division of Emergency Medicine at Boston Children’s Hospital.

To address this critical need, Global Lyme Alliance (GLA) funded the Pedi Lyme Net led by Lise Nigrovic, M.D., M.P.H., of the Division of Emergency Medicine at Boston Children’s Hospital. Dr. Nigrovic established Pedi Lyme Net, a network of seven children’s hospital emergency departments in five Lyme-endemic states. After obtaining informed parental consent, this network of pediatricians collects patient specimens from children suspected of having Lyme disease, or their clinical mimics, for testing and further research within Pedi Lyme Net.

Currently, the standard Lyme disease diagnostic blood test is problematic. Besides its inaccuracy in detecting early disease, the test also cannot distinguish new or persistent infections. Developing better diagnostic tests relies on having patient samples, alongside careful patient histories. An added feature of Pedi Lyme Net is that samples are also collected from control patients who visit the emergency room for non-Lyme related conditions, such as accidental fractures or lacerations. Altogether, the goal is to build a comprehensive data set for research.

Dr. Nigrovic recently published an article that describes Pedi Lyme Net’s Lyme disease screening results. Between June 2015 to January 2020, blood samples were obtained from 2,497 Lyme disease symptomatic patients and 377 asymptomatic control patients. All were analyzed with the C6 Lyme disease enzyme immunoassay, and those that were positive or equivocal were further tested with Western immunoblot, the standard Lyme disease test.

Among the 515 patients who tested positive for Lyme disease, the median age was 8, and 67% were boys, which correlates with national Lyme disease incidence statistics. The most common symptoms of those diagnosed with Lyme disease were fever, headache, facial palsy, and arthritis. These symptoms were used to classify Lyme patients into early, early disseminated, and late stage disease.

Among the Lyme-positive patients:

  • 8.9% had erythema migrans (EM) skin rashes alone
  • 89.5% had positive blood test results
  • 1.6% had both

These results show that the classic EM rash was only present in a minority of Lyme disease patients, and indicates that blood test results identify many more patients than skin rash alone. It also shows that many patients who are positive by blood test lack the skin rash.

Interestingly, only 15.6% of Lyme disease patients and their parents recalled a tick bite in the past year.

This is further evidence that tick bites are often missed, and reinforces that tick bite prevention is an important first step to reduce infections. A more in-depth study led by Dr. Nigrovic addressing this question shows the unreliability of tick bite history at predicting Lyme disease in children.

Pedi Lyme Net is a unique resource for advancing Lyme disease research. Besides being exclusively composed of pediatric samples, it also includes control pediatric samples, which are more appropriate as comparators than adults. Children’s bodies and physiology are not merely small versions of those of adults. Also, because the Pedi Lyme Net enrolls patients from emergency rooms, the samples are from symptomatic individuals, whose specific clinical presentations may be important information in understanding the basic science of disease. Finally, patient samples are from Lyme-endemic areas across the U.S., ensuring broad representation of pediatric Lyme patients.

Further studies of samples collected in the Pedi Lyme Net may involve understanding how different disease stages manifest in children, along with varied inflammatory biomarkers or immune correlates. One limitation of this study is the Western immunoblotting blood test may have given false negative results to some individuals who, early in disease, might not have developed the antibodies detected by this test. Follow-up calls to test later time points were done by Pedi Lyme Net researchers. And, since samples were banked, they can be tested with newly emerging diagnostic technologies in pursuit of designing tests with higher accuracy. Eventually, other tick-borne co-infections may also be studied in this population, since ticks frequently transmit not only Borrelia burgdorferi, the bacteria that cause Lyme disease, but other pathogens as well.

GLA is proud to support Pedi Lyme Net as it expands under the leadership of Dr. Nigrovic. This is an important research initiative that will lead to improved patient diagnostics and care. To date, Pedi Lyme Net data has led to over 10 peer-reviewed publications and scientific presentations.

Learn more about preventing Lyme in kids.
Blog: Kids and Lyme Disease: Cognitive Symptoms and School

Category:

Lyme, research, Testing, Ticks

Mapping Lyme: CDC Reveals Distribution of Lyme Disease-Causing Bacteria by County

https://entomologytoday.org/2021/01/22/mapping-lyme-cdc-reveals-distribution-of-lyme-disease-causing-bacteria-county-ticks/

Mapping Lyme: CDC Reveals Distribution of Lyme Disease-Causing Bacteria by County

U.S. distribution of Lyme disease-causing bacteria in ticks

A new study by CDC researchers maps the distribution of Lyme disease spirochetes, Borrelia burgdorferi sensu stricto and Borrelia mayonii, in host-seeking blacklegged ticks (Ixodes scapularis, in the eastern U.S.) or western blacklegged ticks (I. pacificus, in the western U.S.), relative to the previously reported distribution of these vector species. Ticks were considered present in a county if at least one tick was recorded. Counties where ticks have been reported without records of infection may be reported as such either if ticks were not tested or if the pathogen was not detected in tested samples. (Image originally published Fleshman et al 2021, Journal of Medical Entomology)

By Melissa Mayer

Excerpts from article (See link for article):

The team limited their search to data reported after 2000 that used advanced detection methods to identify spirochetes, since only B. burgdorferi s.s. or B. mayonii are confirmed to cause Lyme disease in the U.S.—and data that included related species could skew the map.

It turns out that, while vector ticks are distributed broadly, ticks carrying Lyme disease spirochetes have a more limited range. The ticks are established in 41 states (35 eastern and 6 western), but mapping revealed spirochetes in three-quarters of those eastern states and one-third of those western states. At a more local level, about 26 percent of counties where the ticks are established have records for Lyme disease spirochetes.

That news comes with some caveats, the researchers say. These numbers are a baseline and probably low. One reason is that surveillance efforts vary, with more monitoring happening in regions with more reports of Lyme disease cases. And, the team excluded records that didn’t adequately identify the spirochetes or list the county of collection.

Of course, Lyme disease isn’t the only tickborne illness in the country. “Tickborne diseases are becoming increasingly more common and widespread in the U.S.,” says Eisen. She points out that blacklegged ticks also carry pathogens that cause the relapsing fever Borrelia miyamotoi disease, anaplasmosis, babesiosis, one form of ehrlichiosis, and Powassan virus.

Reported County-Level Distribution of Lyme Disease Spirochetes, Borrelia burgdorferi sensu stricto and Borrelia mayonii (Spirochaetales: Spirochaetaceae), in Host-Seeking Ixodes scapularis and Ixodes pacificus Ticks (Acari: Ixodidae) in the Contiguous United States”

Category:

Activism, Lyme, research, Testing, Ticks

Case Report: ALS or Lyme Disease?

https://danielcameronmd.com/als-mimicked-by-lyme-disease/  Podcast here

CASE REPORT: ALS OR LYME DISEASE?

ALS-mimicked-lyme-disease

Hello, and welcome to another Inside Lyme Podcast. I am your host Dr. Daniel Cameron. In this episode, I will be discussing the case involving a 63-year-old man with ALS mimicked by Lyme disease.

By

I first read about this case by Wirsching and colleagues in the journal Clinical Case Reports. [1]

Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease, is a progressive motor neuron disease.

The 63-year-old man developed bilateral atrophic arm paresis with preserved reflexes and met the criteria for probable ALS. However, he also tested positive for Lyme disease by spinal tap.

In the year prior to developing ALS symptoms, the patient reportedly had a tick bite without a rash.

“In July 2018, that is, within six months, he developed paraparesis of both arms and also suffered from cramps in the shoulder girdle and hand muscles,” wrote the authors. “By August 2018, the patient was severely impaired in everyday life activities.”

His spinal tap revealed pleocytosis (an elevated white count) and elevated protein. The spinal fluid was positive for IgM and IgG titers for Lyme disease. His blood test was positive by ELISA and IgG Western blot tests. The antibody index was higher in the spinal tap than the blood by IgM but not IgG.

He was prescribed a three-week course of intravenous ceftriaxone but his symptoms did not improve.

“Hence, it is unlikely that neuroborreliosis was the main cause of symptoms in our patient,” wrote the authors.

Instead, the authors concluded that the patient’s ALS mimicked by Lyme disease.

Considering Lyme disease in differential diagnosis

The authors of another study, suggested that Lyme disease should be considered in patients presenting with ALS. “There appears to be a statistically significant association between ALS and immunoreactivity to B burgdorferi.” [2] Subsequent larger studies did not show an association.

Although the association between these two diseases remains controversial, Wirsching et al. highlighted the importance of considering Lyme disease in an ALS workup.

“It is vital to exclude potentially treatable diseases in the differential diagnostic work-up of all patients not to miss seldom, but treatable differential diagnoses such as neuroborreliosis,” the authors concluded.

The following questions are addressed this podcast:

  1. What is ALS?
  2. What is the difference between motor and sensory nerve disease?
  3. Why was Lyme disease considered?
  4. What is the significance of the positive spinal tap for Lyme disease?
  5. Were there any other tick-borne infections discussed?
  6. Was a single 3-week course of IV antibiotics sufficient?
  7. Why is it important to consider reversible causes of ALS?
  8. Have you seen cases of motor nerve disease in your practice?

Editor’s note:

Harvey and Martz described the case of a patient with motor nerve disease (ALS) who improved with antibiotic therapy.[3]

I have had Lyme disease patients with motor neuron disease who have improved with antibiotic treatment and others who have failed. I continue to encourage research in this area.

    1. Thanks for listening to another Inside Lyme Podcast. You can read more about these cases in my show notes and on my website @DanielCameronMD.com. As always, it is your likes, comments, reviews, and shares that help spread the word about Lyme disease. Until next time on Inside Lyme.

Please remember that the advice given is general and not intended as specific advice as to any particular patient. If you require specific advice, then please seek that advice from an experienced professional.

Inside Lyme Podcast Series

This Inside Lyme case series will be discussed on my Facebook and made available on podcast and YouTube.  As always, it is your likes, comments, and shares that help spread the word about this series and our work. If you can, please leave a review on iTunes or wherever else you get your podcasts.

References:
  1. Wirsching I, Ort N, Uceyler N. ALS or ALS mimic by neuroborreliosis-A case report. Clin Case Rep. Jan 2020;8(1):86-91. doi:10.1002/ccr3.2569
  2. Halperin JJ, Kaplan GP, Brazinsky S, et al. Immunologic reactivity against Borrelia burgdorferi in patients with motor neuron disease. Arch Neurol. 1990;47(5):586-594.
  3. Harvey WT, Martz D. Motor neuron disease recovery associated with IV ceftriaxone and anti-Babesia therapy. Acta Neurol Scand. Feb 2007;115(2):129-31. doi:10.1111/j.1600-0404.2006.00727.x

For more:

Category:

Lyme, research, Testing, Treatment

Human Tacheng Tick Virus 2 Detected in China

https://wwwnc.cdc.gov/eid/article/27/2/19-1486_article

Volume 27, Number 2—February 2021
Dispatch

Human Tacheng Tick Virus 2 Infection, China, 2019

Zhihui Dong1, Meihua Yang1, Zedong Wang1, Shuo Zhao, Songsong Xie, Yicheng Yang, Gang Liu, Shanshan Zhao, Jing Xie, Quan LiuComments to Author , and Yuanzhi WangComments to Author 
Author affiliations: Shihezi University, Shihezi, China (Z. Dong, M. Yang, Shuo Zhao, Y. Yang, G. Liu, Shanshan Zhao, Y. Wang); Foshan University, Foshan, China (Z. Wang, Q. Liu); First Affiliated Hospital of Shihezi University, Shihezi (S. Xie, J. Xie); Shihezi People’s Hospital, Shihezi (Y. Yang)

Abstract

We used metagenomic analysis to identify Tacheng tick virus 2 infection in a patient with a history of tick bite in northwestern China. We confirmed the virus with reverse transcription-PCR, virus isolation, and genomic analysis. We detected viral RNA in 9.6% of ticks collected from the same region.

Important excerpt:

Emerging pathogenic tickborne viruses have attracted much attention because of the increasing incidence of tickborne viral diseases and their effects on human health (1–4). In 2015, high-throughput sequencing of samples from ticks in China revealed several novel phleboviruses, including

  • Tacheng tick virus 2 (TcTV-2)
  • Changping tick virus 1
  • Bole tick virus 1 (BlTV-1)
  • Lihan tick virus
  • Yongjia tick virus 1
  • Dabieshan tick virus (5)

However, the risk for human infection from these viruses is not yet known.

The 38-year old Chinese man who had frequent contact with horses and sheep removed a tick from his arm and had the following symptoms: chills, severe fatigue, headache, anorexia, nausea, vomiting, fever, erythema at the bite site and neck stiffness. 

The researchers further gathered nearly 350 ticks from the patient’s geographical area and found nearly 10% carried the virus.  The sequences from the ticks closely related the isolate in the patient.

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**Comment**

Despite the fact the authors stated this particular virus didn’t show growth in numerous media, a human contracted the virus.  This is important to remember.  All the statistics in the world don’t matter a tittle when you are the sorry sucker who becomes ill, despite everyone around you saying it’s ‘rare’! 

Phleboviruses can cause severe fever with thrombocytopenia syndrome, and multiple organ damage, including to the liver and kidneys.

For more:  https://madisonarealymesupportgroup.com/2018/08/20/first-identification-in-china-of-guertu-virus-from-ticks/  SFTS explained within – of which the Asian Longhorned tick is often the culprit, which is spreading through the U.S right now.

Category:

research, Testing, Ticks, Viruses