Archive for the ‘Ticks’ Category

New IDSA Guidelines for Prevention, Diagnosis, and Treatment of Lyme Disease

IDSA, AAN, and ACR Release Guidelines for Prevention, Diagnosis, and Treatment of Lyme Disease

Newswise — New evidence-based clinical practice guidelines for the prevention, diagnosis, and treatment of Lyme disease have been developed by a multidisciplinary panel led by the Infectious Diseases Society of America, the American Academy of Neurology, and the American College of Rheumatology. Representatives from an additional 12 medical specialties and patients also served on the panel.

The guidelines provide practical recommendations for clinicians treating patients with Lyme disease, including, but not limited to, primary care physicians, infectious diseases specialists, emergency physicians, internists, pediatricians, family physicians, neurologists, rheumatologists, cardiologists, and dermatologists.

These recommendations aim to serve as a meaningful resource for the safe, effective, evidence-based care of people with Lyme disease. They address clinical questions related to the prevention, diagnosis, and treatment of Lyme disease; complications from neurologic, cardiac, and rheumatic symptoms; disease expression commonly seen in Eurasia; and complications from coinfection with other tick-borne pathogens.

The guidelines include 43 recommendations related to diagnostic testing, including testing scenarios (such as for certain neurologic, psychologic, behavioral, cardiac, and rheumatologic syndromes); detailed recommendations about Lyme carditis; and a discussion of “chronic Lyme disease.”

Among the diagnostic testing recommendations, the guidelines recommend clinical diagnosis without laboratory testing for people with a skin rash characteristic of early Lyme disease. For people with other signs of Lyme disease, such as swollen joints or meningitis, the guidelines recommend antibody testing.

Among the treatment recommendations, the guidelines recommend oral antibiotic therapy for most patients with Lyme disease. The recommended duration of therapy is 10 to 14 days for early Lyme disease, 14 days for Lyme carditis, 14 to 21 days for neurologic Lyme disease, and 28 days for late Lyme arthritis. Retreatment may be indicated for individuals with arthritis who have failed a first course of treatment.

The recommendations are grounded in a rigorous, systematic review of available evidence surrounding prevention, diagnosis and treatment of the disease. The panel adhered to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the certainty of the evidence and strength of recommendations. The guidelines are voluntary and it is up to clinicians to determine which treatments are best for individual patient scenarios. 

Each of the three sponsoring organizations elected a co-chair to lead the guideline panel. A fourth co-chair was selected for their expertise in guideline methodology. A total of 36 panelists comprised the full panel, and the panel also included three patient representatives and one health care consumer representative.

About 30,000 cases of Lyme disease are reported annually, but the Centers for Disease Control and Prevention estimates there are more than 300,000 cases in the United States each year.

About IDSA

The Infectious Diseases Society of America is a community of over 12,000 physicians, scientists, and public health experts who specialize in infectious diseases. Its purpose is to improve the health of individuals, communities, and society by promoting excellence in patient care, education, research, public health, and prevention relating to infectious diseases. Learn more at

About AAN

The American Academy of Neurology is the world’s largest association of neurologists and neuroscience professionals, with more than 36,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. Learn more at

About ACR

The American College of Rheumatology (ACR) is an international medical society representing over 7,700 rheumatologists and rheumatology health professionals with a mission to empower rheumatology professionals to excel in their specialty. In doing so, the ACR offers education, research, advocacy, and practice management support to help its members continue their innovative work and provide quality patient care. Learn more at

Paper here:



For those of you new to the world of tick-borne illness, please read:  This article will fill you in on the ugly, sordid back-story of Lyme/MSIDS.  It will educate you on the polarization within the medical community and that your best help will come from Lyme literate doctors trained by ILADS.  They appreciate the complexity of this illness and that it takes numerous anti-microbials for a longer period of time than what the IDSA/CDC state.  

For ILADS 2014 Guidelines:

ILADS Lyme 101 Series:

ILADS Basics for Providers:  Within this link is a link that leads you to an article in Antibiotics on : “Chronic Lyme Disease: An Evidence-Based Definition by the ILADS Working Group“.  It also includes an article utilizing numerous Lyme literate doctors’ clinical experience with treatment.


Study Shows 35% of Atypical Pneumonia in Chile Caused by Q Fever & Rickettsia

Evidence of Q Fever and Rickettsial Disease in Chile


Free PMC article


Q fever and rickettsial diseases occur throughout the world and appear to be emergent zoonoses in Chile. The diagnosis of these diseases is currently uncommon in Chile, as their clinical presentations are non-specific and appropriate diagnostic laboratory assays are of limited availability. During a recent outbreak of undiagnosed human atypical pneumonia, we serologically investigated a series of 357 cases from three regions of southern Chile. The aim was to identify those caused by Coxiella burnetii and/or Rickettsia spp. Serological analysis was performed by ELISA and an immunofluorescence assay (IFA) for acute and convalescence sera of patients. Our results, including data from two international reference laboratories, demonstrate that

  • 71 (20%) of the cases were Q fever
  • 44 (15%) were a likely rickettsial infection, although the rickettsial species could not be confirmed by serology
This study is the first report of endemic Q fever and rickettsial disease affecting humans in Chile.


For more on Q Fever:  

For more on Rickettsia:  

Canadian TV Series About Lyme Disease – “Bitten”  News videos here

Promising treatment brings new hope for patients with chronic Lyme disease

W5 Producer
Published Friday, November 20, 2020 
W5’s Molly Thomas speaks to a Canadian Lyme disease patient who had to struggle for years just to get a diagnosis.
There are more ticks in Canada than ever before, but is the country’s health care system prepared to deal with more Lyme disease cases?
Nikki Kent had to go through a battery of tests and years of uncertainty before she was finally diagnosed with Lyme disease.
Informative Canadian news series on Lyme disease.
The series looks at a number of Canadian Lyme patients that have had trouble obtaining diagnosis and treatment in Canada, necessitating they travel thousands of miles to the United States.
The series points out the:
There is a myth still being perpetrated in the medical community on the effectiveness of 1 or 2 doses of doxycycline:

Daniel J. Cameron, MD MPH, states there has only been one study (Nadelman et al) on the effectiveness of 1 pill of doxycycline and only found a reduction in the number of erythema migraines (EM) rashes compared to the placebo group.  According to him, the IDSA 1 pill of doxy approach started in 2006 despite the fact that three previous prophylactic antibiotic trials for a tick bite had failed.

Only one study in 2001 tested this hypothesis at one hospital in New York.

For the study, the bullseye rash was the diagnostic criteria to determine if doxy prevented LD. The study actually showed that people bitten by nymphs were more likely to develop a bullseye rash and therefore diagnosed with LD in comparison with those bitten by an adult tick. None of those bitten by adult ticks developed a bullseye rash.

The Bullseye is a poor indicator of LD.

Only 50% with LD got any kind of rash and only 9% developed a bullseye.

Two pills used at the time of tick bite by a nymph prevented people from getting the bullseye – so they were not diagnosed as having LDand were excluded from the study.

So, will 2 pills of doxy prevent Lyme?


So much for evidence based medicine.
The article in the top link then goes onto discuss Dr. Tim Cook who has had success using disulfiram/Antabuse.  He quotes:
“OK, now this is exciting,” he said. “Disulfram (DSF) is a breakthrough because it is one of only two or three medications that are known to specifically target the slow-growth phase of Lyme that regular antibiotics do not eradicate.”
“What has surprised me is how patients improve with very little of it. Prior to DSF, the conventional combinations of antibiotics would make most patients feel quite a bit better, but they would often say that their ‘brain fog’ and fatigue never quite went away. These two symptoms are often completely and rapidly resolved with DSF,” Dr. Cook said.

Confused Woman With Anaplasmosis & Babesia Podcast  Go Here for Podcast


confused woman with Anaplasmosis and Babesia infection

Welcome to an Inside Lyme case study. I find that the best way to get to know Lyme disease is through reviewing actual cases.  I will be discussing a 78-year-old confused woman with an Anaplasmosis and Babesia infection.


A 78-year-old woman was evaluated in an emergency room with fever, chills, lethargy, fatigue, and confusion. Her maximum temperature was 100.6° F.

Her blood tests were quite abnormal. She had severe anemia, low white blood count, and low platelet count.

• Anemia (dropped from 10.5 g/dL to a low of 8 g/dL)
• Leukopenia (dropped from 5.0 × 10 9 /L to 2.6 × 10 9 /L)
• Thrombocytopenia (dropped to 39 × 10 9 /L)

The doctor initially considered sepsis. Sepsis is a potentially life-threatening illness triggered by an infection. The body’s immune response can be so strong that the body can attack itself and can lead to organ damage and death.


She also had multiple tick bites.

The doctors were able to identify the parasite that causes a Babesia infection in the woman’s red blood cells under the microscope. Babesia is a disease transmitted by the same tick that carries Lyme disease.

The doctors prescribed a combination of atovaquone and azithromycin for her Babesia infection. These medications are marketed under the names Mepron and Zithromax in the US.

The doctors were also concerned that the woman might suffer from another tick-borne illness called Anaplasmosis because of her low white blood count and low platelet count. Anaplasmosis had previously been called Ehrlichia.

The combination of atovaquone and azithromycin is not effective for Anaplasmosis. The doctors added doxycycline to the woman’s treatment.

The laboratory test confirmed that she had, in fact, an anaplasmosis and babesia infection. The IgM tests were positive for both conditions consistent with early infection.

The woman’s cognitive function improved dramatically following two weeks of treatment, according to the authors.

What can we learn from these cases?

  1. Tick-borne diseases can lead to confusion in the elderly.
  2. An individual with a tick-borne infection can be confused with sepsis.

What questions do these cases raise?

  1. How many elderly with tick-borne illnesses are confused?
  2. What if the parasites associated with the Babesia infection had not been seen in the red blood cells under the microscope? Would the woman have been diagnosed in a timely manner for Babesia?
  3. What would have happened to the woman if the doctors had not considered Anaplasmosis?
  4. What would have happened to the woman if the doctors had stopped treatment if the tests were negative?
  5. What is the long-term outcome for the elderly with tick-borne infections? Could the woman’s short term confusion described in this case lead to long term confusion?


In my practice, each individual requires a careful assessment. That is why I order a broad range of blood tests for other illnesses in addition to tick-borne infections. I also arrange consultations with specialists as needed.

Many patients are complex, as highlighted in this Inside Lyme Podcast series.

We need more doctors with skills diagnosing and treating Lyme disease in the elderly. We hope that a professional evaluating the elderly can use this case to remind them to look for Lyme disease and co-infections and treat accordingly.

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.

Sign up for our newsletter to keep up with our cases.

  1. Paparone P, Paparone PW. Variable clinical presentations of babesiosis. Nurse Pract. 2018;43(10):48-54.



Treatment recommendation:

The optimal dose and duration of antibiotic treatment for anaplasmosis has not been definitively established, but it is clear that A. phagocytophilum is highly sensitive to tetracyclines. Thus, oral doxycycline is the recommended treatment, at the same dose used for Ehrlichia infections: 200 mg/day in two divided doses. The usual treatment duration is 5-10 days, which is extended if there is suspected coinfection with B. burgdorferi, the agent of Lyme disease. In any case, treatment should continue for at least three days after the patient’s fever resolves. Response to treatment is usually rapid; if the patient remains febrile more than two or three days after initiation of doxycycline therapy, the diagnosis should be revisited.  As with Ehrlichia infections, rifampin is used in cases where doxycycline is contraindicated, such as pregnancy or allergy.

The CDC recommends a lower dosage. Lyme literate doctors know that some people need higher dosages. This is an important issue that has kept some from getting better. Consider and discuss with your practitioner.

Please see article for various treatments.  Dr. Horowitz states that Babesia is one of the most tenacious coinfections he deals with.  He recommends treatment of 9-12 months.  Studies have also shown that mono therapies like the singular use of Mepron to be ineffective as the pathogens develop resistance to it.  Lyme literate doctors typically utilize an overlapping treatment with numerous modalities to prevent this from happening.  I’ve heard many professionals state that once you start treating Babesia you need to see it through to completion.  So don’t start until you mean business and then stick it out.  Treatment is typically 3 weeks on, one week off.  In this article I state the treatment that worked for both my husband and I.  

FYI: Two weeks of treatment is hardly ever sufficient.

Removal of Leaf Litter & Snow Reduces Blacklegged Ticks – Webinar

Tick IPM #7: Leaf Litter/Snow Removal for Tick Reduction

http://<iframe width=”925″ height=”520″ src=”” frameborder=”0″ allow=”accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture” allowfullscreen></iframe  Approx. 1 Hour

Recorded October 7, 2020

This webinar focuses on developing preventative landscaping methods to reduce blacklegged tick (a.k.a. deer tick) populations. Research has suggested that both leaf litter and snow were overwintering predictors for nymphal tick survival. Dr. Stafford discusses how the removal of leaf litter and snow reduces the survival of blacklegged ticks and, if these preventive management practices were implemented, they could assist in the reduction of tick-borne diseases in the future.

Download presentation slides (PDF, 4.7 MB)

Dr. Kirby C. Stafford III

Dr. Kirby C. Stafford III, Chief Scientist (Head) of the Department of Entomology and State Entomologist (State Plant Regulatory Official) at the Connecticut Agricultural Experiment Station



I wish that we would also go back to doing prescribed burnings, which work:

Also, for hunters, put down a permethrin treated tarp when hanging deer to kill any females which may drop off:

For more on tick prevention: