Archive for the ‘Tickborne Relapsing Fever’ Category

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

iu-90

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.

______________________

**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.

 

Borrelia Crocidurae in Vaginal Swab After Miscarriage

https://www.ncbi.nlm.nih.gov/pubmed/31863877

2019 Dec 18. pii: S1201-9712(19)30493-X. doi: 10.1016/j.ijid.2019.12.020. [Epub ahead of print]

Detection of Borrelia crocidurae in a vaginal swab after miscarriage, rural Senegal, Western Africa.

Abstract

Tick-borne relapsing fever (TBRF) borrelias are one of the main causes of fever in rural Africa and can cause miscarriages. Here, we detected, for the first time to the best of our knowledge, Borrelia crocidurae in a self-vaginal sampling as a probable cause of spontaneous miscarriage.

_________________

**Comment**

When will mainstream medicine wake up?  When will they connect the dots that borrelia is all over genitilia?  That there is a real probability it can be sexually and congenitally transmitted?  When will they quit saying that because something is “rare” it doesn’t happen?  If you are the sorry sucker who contracted it that way – are you unimportant?

Borrelia is defying all boxes people attempt to put it into.

According to this paper written in 2013, Borrelia crocidurae, associated with tick-borne relapsing fever, is stated as being benign in one breath and then extremely neurotropic and can cross the blood/brain barrier and persist, as well as cause encephalitis and meningitis, in the next breath.  None of which are benign in my book:  https://wwwnc.cdc.gov/eid/article/19/2/12-1325_article

And now it’s been found in a vaginal swab after a miscarriage.
This is a perfect example of how research for all things tick related is still in the Dark Ages.

Immunosuppressive Proteins Found in Tick Saliva – In Every Life Stage

https://www.ncbi.nlm.nih.gov/pubmed/31734217

2019 Nov 10:101332. doi: 10.1016/j.ttbdis.2019.101332. [Epub ahead of print]

Immunosuppressive effects of sialostatin L1 and L2 isolated from the taiga tick Ixodes persulcatus Schulze.

Abstract

Tick saliva contains immunosuppressants which are important to obtain a blood meal and enhance the infectivity of tick-borne pathogens. In Japan, Ixodes persulcatus is a major vector for Lyme borreliosis pathogens, such as Borrelia garinii, as well as for those causing relapsing fever, such as B. miyamotoi. To date, little information is available on bioactive salivary molecules, produced by this tick. Thus, in this study, we identified two proteins, I. persulcatus derived sialostatin L1 (Ip-sL1) and sL2 (Ip-sL2), as orthologs of I. scapularis derived sL1 and sL2. cDNA clones of Ip-sL1 and Ip-sL2 shared a high identity with sequences of sL1 and sL2 isolated from the salivary glands of I. scapularis. Semi-quantitative PCR revealed that Ip-sL1 and Ip-sL2 were expressed in the salivary glands throughout the life of the tick. In addition, Ip-sL1 and Ip-sL2 were expressed even before the ticks started feeding, and their expression continued during blood feeding. Recombinant Ip-sL1 and Ip-sL2 were developed to characterize the proteins via biological and immunological analyses. These analyses revealed that both Ip-sL1 and Ip-sL2  had inhibitory effects on cathepsins L and S. Ip-sL1 and Ip-sL2 inhibited the production of IP-10, TNFα, and IL-6 by LPS-stimulated bone-marrow-derived dendritic cells (BMDCs). Additionally, Ip-sL1 significantly impaired BMDC maturation. Taken together, these results suggest that Ip-sL1 and Ip-sL2 confer immunosuppressive functions and appear to be involved in the transmission of pathogens by suppressing host immune responses, such as cytokine production and dendritic cell maturation. Therefore, further studies are warranted to investigate the immunosuppressive functions of Ip-sL1 and Ip-sL2 in detail to clarify their involvement in pathogen transmission via I. persulcatus.

_________________

For more:  https://madisonarealymesupportgroup.com/2019/08/14/what-tick-saliva-does-to-the-human-body/

https://madisonarealymesupportgroup.com/2018/01/20/potential-medical-adhesive-tick-saliva/

https://madisonarealymesupportgroup.com/2019/04/26/three-strains-of-borrelia-other-pathogens-found-in-salivary-glands-of-ixodes-ticks-suggesting-quicker-transmission-time/

https://madisonarealymesupportgroup.com/2018/12/28/relapsing-fever-spirochete-uniquely-adapted-to-highly-oxidative-salivary-glands-of-soft-bodied-tick/

https://madisonarealymesupportgroup.com/2019/07/29/how-quickly-can-an-attached-tick-make-you-sick/

https://madisonarealymesupportgroup.com/2019/11/19/to-milk-a-tick/

https://madisonarealymesupportgroup.com/2018/05/22/mosquito-spit-alone-may-significantly-alter-your-immune-system-for-days-after-a-bite/

NY Grants Approval for IGeneX’s Newly Developed Tick-Borne Relapsing Fever ImmunoBlot Tests

https://www.prnewswire.com/news-releases/new-york-state-grants-approval-for-igenexs-newly-developed-tick-borne-relapsing-fever-tbrf-immunoblot-tests-300933720.html

New York State Grants Approval for IGeneX’s Newly Developed Tick-Borne Relapsing Fever (TBRF) ImmunoBlot Tests

TBRF ImmunoBlots (IgM and IgG) represent a quantum leap in testing for tick-borne diseases, particularly for patients with Lyme-like symptoms

NEWS PROVIDED BY

IGeneX


MILPITAS, Calif., Oct. 8, 2019 /PRNewswire/ — The Division of Laboratories of the Department of Health of the State of New York has approved IGeneX’s newly developed Tick-Borne Relapsing Fever (TBRF) ImmunoBlots (IgM and IgG), making them immediately available to New Yorkpractitioners.

Until recently, diagnostic tests for TBRF have been grossly insensitive and have not been able to detect many of the ever-growing list of species and strains of TBRF Borrelia carried by hard and soft ticks. The new IGeneX ImmunoBlots overcome these obstacles with the ability to detect antibodies to TBRF Borrelia species including, but not limited to, B. hermsii, B. miyamotoi, and B. turicatae.

TBRF is often considered a Lyme disease imitator because both TBRF and Lyme sufferers display many similar symptoms, such as high fever, chills, and headache, often leading to misdiagnosis. Moreover, some of the Borrelia that cause TBRF are transmitted by the same ticks that transmit B. burgdorferi, the causative agent of Lyme disease. Therefore, it is important for physicians to test for both TBRF and Lyme.

“We are very excited to be able to offer the TBRF ImmunoBlots to physicians in New York State,” said Dr. Jyotsna Shah, President of IGeneX. “Doctors use to call me and say ‘my patients have Lyme-like symptoms. Why are your tests negative?’ We now know that their symptoms might have been due to TBRF Borrelia infection. These new TBRF ImmunoBlot tests will help patients in this group, as well as patients with Lyme and TBRF Borrelia mixed infections.”

The accuracy of the TBRF ImmunoBlot has been established. The specificity is 98.5% for IgM and IgG based on a study performed on 212 well characterized samples, of which 50 were provided by the CDC. Additionally, the TBRF ImmunoBlots can detect the full spectrum of disease: early, active and late-stage disease.

For more information on IGeneX and the TBRF ImmunoBlot tests, please visit http://igenex.com.

About IGeneX
For over 25 years, IGeneX has been at the forefront of research and development of diagnostic testing for Lyme disease, TBRF, Bartonella, and other tick-borne diseases. IGeneX arms its talented scientists with the most cutting-edge technology available to enable them to find new solutions that challenge the status quo of testing for Lyme and associated tick-borne diseases. The mission of IGeneX is to aid practitioners in their diagnosis of tick-borne illnesses by providing the most comprehensive testing possible. Learn more at: www.igenex.com

Media Contact:
Joseph Sullivan
225913@email4pr.com 
408-504-7691

SOURCE IGeneX

Related Links

http://www.igenex.com

___________________

More on Relapsing Fever:  https://madisonarealymesupportgroup.com/2018/12/28/relapsing-fever-spirochete-uniquely-adapted-to-highly-oxidative-salivary-glands-of-soft-bodied-tick/

https://madisonarealymesupportgroup.com/2019/03/22/tick-borne-relapsing-fever-in-arizona/

https://madisonarealymesupportgroup.com/2017/12/22/tbrf-in-texan-dogs-yep-despite-poor-tests-its-there/

https://madisonarealymesupportgroup.com/2019/01/10/relapsing-fever-found-at-popular-recreation-site-in-ca-ticks/

https://madisonarealymesupportgroup.com/2018/12/20/tick-borne-relapsing-fever-as-a-potential-veterinary-medical-problem/

https://madisonarealymesupportgroup.com/2017/05/04/us-soldier-aquires-tickborne-relapsing-fever-caused-by-b-turicatae-from-a-ornithodoros-turicata-tick/

https://madisonarealymesupportgroup.com/2019/03/17/first-case-of-b-corocidurae-in-native-european-presenting-as-meningitis-with-cranial-polyneuritis-cavernous-sinus-thrombosis/