Archive for the ‘Tickborne Relapsing Fever’ Category

Know Your Ticks

https://www.globallymealliance.org/tick-table/

Know your ticks

Easy to read table shows the most common ticks found in the U.S. that transmit pathogens to humans.
Note: only a partial list. To learn more about tick-bite prevention and how to be Tick AWARE, click here

Click here to download the Tick Table

Tick Table

For more:

Remember, in Wisconsin, ticks are found in every county in the state. Researchers are also finding them in bright, open, mowed lawns.

Dr. Burrascano on Tick-borne Illness Testing

http://  Approx. 15 Min

IGeneX 2021 Presentation Wisconsin Naturopathic Doctors Association (WNDA)

May 10, 2021

See Dr. Joseph Burrascano presenting on behalf of IGeneX Laboratory at the annual WNDA conference. Topics cover testing for Lyme Disease, Tick-Borne Relapsing Fever, Bartonella, Babesia, Rickettsia, Anaplasma, and Ehrlichia.

Dr. Burrascano discusses the Lyme ImmunoBlot test for early Lyme, validated with CDC test samples, that will identify 93% of cases.

He discussed a 2018 study of over 10,000 patient samples from nearly every state which found patients testing positive for the following pathogens:

  • nearly 38% for Babesia
  • 32% for Lyme borrelia
  • nearly 28% for TBRF borrelia
  • 19% for Bartonella
  • nearly 17% for Anaplasma
  • nearly 13% for Rickettsia
  • nearly 7% for Ehrlichia

Further:

  • 40% tested positive for 2 pathogens
  • 15% for 3
  • 4.6% for 4
  • 0.7% for 5

1st Cases of Natural Infections With Borrelia Hispanica in European Dogs and Cat

https://pubmed.ncbi.nlm.nih.gov/32824647/

First Cases of Natural Infections with Borrelia hispanica in Two Dogs and a Cat from Europe

Free PMC article

Abstract

Canine cases of relapsing fever (RF) borreliosis have been described in Israel and the USA, where two RF species, Borrelia turicatae and Borrelia hermsii, can cause similar clinical signs to the Borrelia persica in dogs and cats reported from Israel, including fever, lethargy, anorexia, thrombocytopenia, and spirochetemia. In this report, we describe the first clinical cases of two dogs and a cat from Spain (Cordoba, Valencia, and Seville) caused by the RF species Borrelia hispanica. Spirochetes were present in the blood smears of all three animals, and clinical signs included lethargy, pale mucosa, anorexia, cachexia, or mild abdominal respiration. Laboratory findings, like thrombocytopenia in both dogs, may have been caused by co-infecting pathogens (i.e., Babesia vogeli, confirmed in one dog). Anemia was noticed in one of the dogs and in the cat. Borrelia hispanica was confirmed as an infecting agent by molecular analysis of the 16S rRNA locus. Molecular analysis of housekeeping genes and phylogenetic analyses, as well as successful in vitro culture of the feline isolate confirmed the causative agent as B. hispanica.

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**Comment**

Our feline and canine friends are sentinels for human diseases and these cases are no different.

To date, 23 TBRF-related Borrelia species have been confirmed, but additional species are proposed (2). B. hispanica is the primary TBRF-related Borrelia species identified in Spain (3,4), where it is endemic.  It is transmitted mainly through the bite of O. erraticus ticks (5) but also can be transmitted by O. occidentalis ticks (4). B. hispanica also has been found in Portugal (6), Morocco (4,7,8), and Tunisia (4).  https://wwwnc.cdc.gov/eid/article/26/5/19-0745_article?deliveryName=USCDC_331-DM26146

As of 2015, B. hispanica is considered an emerging infectious agent causing Neuroborreliosis:  https://n.neurology.org/content/84/14_Supplement/P6.310

Please keep in mind that migrating birds and animals are transporting ticks everywhere and spreading the pathogens they carry.

O. erraticus ticks feed nocturnally on multiple warm- blooded vertebrate hosts, including humans, and are found living buried in soil of traditional pigpens: https://repository.uel.ac.uk/download/ef62f8a0e6b1b15a27c35d240d126464385ad171f0be9af9d7768571b17460b0/128662/Portuguese%2520hosts%2520for%2520Ornithodoros%2520erraticus%2520ticks.pdf

Regarding O. occidentals ticks, according to this 2020 article,

“we have not sampled Ornithodoros ticks to evaluate densities and infection rates, nor have we collected samples from small mammals to investigate the reservoir of Borrelia spp.” 19-0745

Important excerpt:

Because the spirochetemia phase is short and laboratory diagnosis is exclusively dependent on the observer, we believe TBRF is underdiagnosed, even in areas where suspicion should be relatively high. 19-0745

A Case of Borrelia Miyamotoi

https://www.nejm.org/doi/full/10.1056/NEJMcpc2004996?

Case 32-2020: A 63-Year-Old Man with Confusion, Fatigue, and Garbled Speech

Authors:  Shibani S. Mukerji, M.D., Ph.D., Kevin L. Ard, M.D., Pamela W. Schaefer, M.D., and John A. Branda, M.D.

The following was obtained from the case presented in the link above in the New England Journal of Medicine.A 63-year-old retired government employee who lived with his wife in northern New England had recently traveled to Florida and to rural Canada to hunt was evaluated at the hospital because of:

  • fever
  • confusion
  • headache
  • garbled speech
  • fatigue
  • vision changes & floaters
  • lymphocytic pleocytosis
  • elevated protein level in the cerebrospinal fluid (CSF)
  • worsening proteinuria and hypertension
  • flash of light accompanied by transient sharp pain in the left retro-orbital area and forehead, with monocular blurry vision
  • garbled and nonsensical speech with impaired comprehension
  • word-finding difficulty
  • photophobia
  • sonophobia
  • staring spells that lasted for 1 minute
  • low-grade fever 
  • somnolence
  • generalized weakness
  • unsteadiness
  • mild neck stiffness
  • unintentional weight loss of 10 kg in the past 6 months
  • nocturia
  • cachectic appearing
  • perseverative thoughts
  • unable to name days of the week backward
  • when asked to remember three words, he could recall only one word after 5 minutes
  • he reported that nine quarters equaled $4.25
  • dilated-eye examination revealed edema in both optic nerves

Interestingly, after IV acyclovir, ceftriaxone, ampicillin, vancomycin, and thiamine, he developed myoclonic jerks with marked lethargy, and the photophobia, and nonsensical speech persisted. He was intermittently impulsive and uncooperative. After 4 days of IV treatment he reported feeling better and having increased strength, allowing him to walk. On the fifth hospital day, he was calm and cooperative; oriented to person, place, and time; and able to follow complex commands.

Administration of broad-spectrum antimicrobial agents resulted in rapid improvement in his clinical condition within days despite increasing neurologic symptoms over the course of several months, findings that suggested meningoencephalitis.  Despite an extensive evaluation for likely causes of meningoencephalitis, a definitive diagnosis was not established. This patient’s presentation and clinical course are emblematic of challenges faced by clinicians, given that the causative agent in meningoencephalitis is identified in only 30 to 60% of cases, despite extensive and invasive testing.1,2

There are three important clinical features of this patient’s presentation:

  • uveitis associated with meningoencephalitis
  • subacute cognitive decline
  • clinical improvement after the administration of antimicrobial therapy

A unique feature of this patient’s presentation is his exposure to rituximab, a humanized chimeric anti-CD20 monoclonal antibody that causes B-cell depletion. The effects of rituximab should be considered when interpreting the results of IgG and IgM serologic tests. This concern is relevant to testing for West Nile virus infection and eastern equine encephalitis, both of which can cause neuroinvasive viral encephalitis and are endemic in the northeastern United States. The antibody response during these infections can be delayed or absent in patients with B-cell depletion.4,5 Such a response may also occur in Powassan virus infection, an emerging cause of viral meningoencephalitis in the United States that is transmitted by ticks.6

A key question remains: What pathogen can cause uveitis and meningoencephalitis and result in rapid clinical improvement after the administration of vancomycin, ampicillin, ceftriaxone, and acyclovir?

The authors point out that spirochete infections can cause uveitis and meningoencephalitis.

Due to the patient’s history of living in an endemic area for tick-borne diseases, is an avid hunter, whose condition improved dramatically after IV antibiotics, infection with borrelia species seemed a logical diagnosis.

The authors point out the problem with testing:

Testing for Lyme disease occurs as a part of a two-tiered algorithm and measures a person’s antibody response to the spirochete. Whether treatment with rituximab delays formation of antibodies in blood and CSF is unknown, thus complicating the interpretation of this patient’s serologic test results.

They further state that those with neurological Lyme infection often have abnormal imaging findings of the head or spine but that this patient had neither.

Then they state that B. miyamotoi, another borrelia species, causes a symptom complex that is consistent with this patient and that there are two case reports of meningoencephalitis in immunocompromised patients receiving rituximab, where B. miyamotoi was the causative agent.  These patients received rituximab for hematologic cancers, and in both, Wright-Giemsa staining of CSF showed spirochetes, and a definitive diagnosis of B. miyamotoi infection was made based on nucleic acid testing of the blood.

The authors state the patient’s recurrent fever but lack of rash also support a B. miyamotoi infection, but that the opthalmologic findings do not.  They admit; however, that there is limited understanding of B. miyamotoi but since other spirochetes can cause eye issues, B. miyamotoi is likely no different. ( I must add here that I know many Lyme disease patients who get recurrent fevers and have never seen a rash.  This is a perfect example of how researchers and doctors have falsely pigeon-holed Lyme symptoms into a box of their own making).  For more:  https://madisonarealymesupportgroup.com/2019/02/22/why-mainstream-lyme-msids-research-remains-in-the-dark-ages/

Regarding testing, a lumbar puncture targeting the glpQ gene of borrelia that causes relapsing fever, which is absent in Lyme disease, was positive. Serum showed strong reactivity on the ELISA that detects IgG antibodies directed against the GlpQ protein of B. miyamotoi.  Corresponding IgM ELISA was negative, consistent of B. miyamotoi infection of several months duration.

Unfortunately there are no randomized controlled trials and no formal treatment recommendations.  Patients typically receive Lyme disease treatment.  An in vitro study showed B. miyamotoi was susceptible to doxycycline, azithromycin, and ceftriaxone but not amoxicillin. (Again, I must add that current Lyme disease treatment advocated by the CDC/IDSA only works for a small percentage of patients and that studies from the beginning have shown treatment failures using their approach.  For more:  https://madisonarealymesupportgroup.com/2016/02/13/lyme-disease-treatment/)

The patient was sent home with 4 weeks of IV ceftriaxone but developed a facial rash and was switched to doxycycline.  After 3 weeks all symptoms had resolved but the blurry vision which improved slowly over 3 months.

This patient should be followed up for years, but won’t be.
And the question begging to be asked is: how many people with B. miyamotoi are falling through the cracks?  It isn’t even reportable to the CDC yet (which notoriously undercounts all things tick-borne-related).

For more:  https://igenex.com/tick-talk/what-you-need-to-know-about-borrelia-miyamotoi/

This article points out the confusion with B. miyamotoi: 

  • many separate it from other tick-borne relapsing fevers
  • while it can cause relapsing fevers, it sometimes doesn’t
  • it appears to be the only TBRF transmitted from a hard bodied tick, unlike TBRF which is mainly transmitted from a soft bodied tick (I remain skeptical of this as ticks have repeatedly been found to transmit things they shouldn’t – just like they are found in places they shouldn’t be.)
  • symptoms often resemble Lyme disease
  • you can be infected with BOTH B. miyamotoi AND Lyme disease (as well as numerous other coinfections) which will complicate symptom presentation
  • testing for B. miyamotoi is just as abysmal as it is for Lyme/MSIDS:  https://madisonarealymesupportgroup.com/2020/03/01/study-cdcs-2-tier-lyme-testing-inaccurate-in-more-than-70-of-cases/

Lyme & Tick-born Disease Symptom Checker

https://igenex.com/tick-talk/symptom-checker  (Go here for Symptom Checker)

Lyme and Tick-borne Disease Symptom Checker

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If you’ve been sick and aren’t getting better, use this IGeneX symptom checker to determine your likelihood of having Lyme disease or other associated tick-borne illnesses.

The Lyme and Tick-Borne Disease Symptom Checker is for informational purposes only and should not be considered, or used as a substitute for, medical advice, diagnosis, or treatment. By using this website and the Symptom Checker, you agree that this website and the Symptom Checker is not intended to and does not replace the advice of your own physician or other medical professional and that this website does not constitute the practice of any medical or other professional healthcare advice, diagnosis, or treatment. You are solely responsible for your own health care decisions regarding the use of this website and the Lyme and Tick-Borne Disease Symptom Checker and your use is entirely at your own risk. You should consult a medical professional for all questions or concerns you may have relating to your health. If this is an emergency in the United States, call 911.

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**Comment**

A very helpful online quiz. You can also read about common symptoms for Lyme disease, Babesia, Tick-borne Relapsing Fever, Bartonella, Ehrlichiosis, Anaplasmosis, and Rickettsiosis.

My only caution is that there are other symptoms omitted from this quiz. My own case is a perfect example.

All my initial symptoms were gynecological and I believe strongly were my first signs of Lyme/MSIDS infection, obtained from my husband who is also infected. You can read about that here: https://madisonarealymesupportgroup.com/2017/02/24/pcos-lyme-my-story/

Those infected congenitally will also find fault with this quiz which is why you need to see an experienced Lyme literate physician.

It is quite common to have an initial 90 minute appointment with these ILADS trained doctors as you fill out medical history forms going back to infancy. The doctor then discusses these with you to further ascertain the potential of early infection (perhaps in utero). Often, many health issues can be traced back to infancy if you were infected congenitally. For more: https://madisonarealymesupportgroup.com/2018/06/19/33-years-of-documentation-of-maternal-child-transmission-of-lyme-disease-and-congenital-lyme-borreliosis-a-review/

https://madisonarealymesupportgroup.com/2018/11/11/gestational-lyme-other-tick-borne-diseases-dr-jones/

While sexual transmission of Lyme/MSIDS has not been admitted to by ‘authorities,’ congenital transmission recently has been:  https://madisonarealymesupportgroup.com/2020/02/01/cdc-website-updated-today-possibility-of-mother-to-fetus-transmission-of-lyme-disease/

It is also quite common for ‘authorities’ to first admit something is ‘rare’ only to have to admit later it’s more common than first thought.  This is their modus operandi.  For years I’ve watched them state Lyme doesn’t exist in certain geographical locations because the ticks that transmit it aren’t there, only to have to update that information later on. This has happened repeatedly.  But before the information gets updated, infected patients are told “it’s all in their heads,” left to rot, and are denied treatment.  These patients only go on to worsen, making their cases far more difficult to treat:  https://madisonarealymesupportgroup.com/2017/09/21/its-all-in-your-head-until-finally-a-lyme-diagnosis/

Rather than admit a patient could be infected, despite prior findings in the literature or of ticks in certain locations, patients are handed from doctor to doctor like a football, and are more likely to be given an anti-depressant than life-saving antimicrobials.

This must end.  Using entomology maps to diagnose has hurt patients.  While maps are interesting, they should never keep patients from getting diagnosed.

For the Horowitz symptom questionnaire, which has been validated:  https://madisonarealymesupportgroup.files.wordpress.com/2016/01/symptomlist.pdf  Print, fill out, and tally up the points.  

Just remember that while these checklists are helpful, and in fact probably far better than current testing, they are not perfect.  Lyme/MSIDS is wiley – with waxing and waning symptoms. Your best hope of correct diagnosis and treatment remain in the hands of an experienced Lyme literate doctor, although nothing replaces learning all you can to be a helpful partner in your own healing.