Strategic Priority 1: Improve Fundamental Knowledge of TBDs
Strategic Priority 2: Advance Research to Improve Detection & Diagnosis of TBDs
Strategic Priority 3: Accelerate Research to Improve Prevention of TBDs
Strategic Priority 4: Support Research to Advance Treatment of TBDs
Strategic Priority 5: Develop tools & resources to Advance TBD research
Some respondents expressed a desire for greater transparency in the research planning and implementation processes, whereas others suggested changes to the peer review process to include wider representation from the TBD community, such as advocacy group representatives, community physicians, or members of the general public.
More than Lyme: Tick study finds multiple agents of tick-borne diseases
COLUMBIA UNIVERSITY’S MAILMAN SCHOOL OF PUBLIC HEALTH
In a study published in mBio, a journal of the American Society for Microbiology, Jorge Benach and Rafal Tokarz, and their co-authors at Stony Brook University and Columbia University, reported on the prevalence of multiple agents capable of causing human disease that are present in three species of ticks in Long Island.
Tick-borne diseases have become a worldwide threat to public health. In the United States, cases more than doubled, from 22,000 in 2004 to more than 48,000 in 2016, according to the U.S. Centers for Disease Control. Tick-borne diseases range from subclinical to fatal infections with disproportionate incidence in children or the elderly. Moreover, some infections can also be transmitted by blood transfusions and cause severe disease in patients with underlying disorders. While public attention has focused on Lyme disease, in recent years, scientists have uncovered evidence that ticks can carry several different pathogens capable of several different tick-borne diseases, sometimes in a single tick.
In the new study, researchers collected ticks from multiple locations throughout Suffolk county in the central and eastern part of Long Island, where seven diseases caused by microbes transmitted by ticks are present. In total, they examined 1,633 individual ticks for 12 separate microbes. They found that more than half of the Ixodes (deer ticks) were infected with the Lyme disease agent, followed by infections with the agents of Babesiosis and Anaplasmosis. Importantly, nearly one-quarter of these ticks are infected with more than one agent, resulting in the possibility of simultaneous transmission from a single tick bite.
Notably, the lone star tick, a species originating from the southern U.S., has expanded its range, possibly fueled by climate change. This study documents that the invasive lone star tick is abundant in Long Island, and that it is a very aggressive tick that can transmit a bacterium that causes a disease known as Ehrlichiosis. The lone star tick has also been implicated in cases of a novel form of meat allergy, and the immature stages can cause an uncomfortable dermatitis.
“Polymicrobial infections represent an important aspect of tick-borne diseases that can complicate diagnosis and augment disease severity,” says corresponding author Jorge Benach, PhD, Distinguished Professor at the Department of Microbiology and Immunology at the Renaissance School of Medicine at Stony Brook University. “Some of the polymicrobial infections can be treated with the same antibiotics, but others require different therapies, thus enlarging the number of drugs to treat these infections.”
“In evaluating tick-borne infection, more than one organism needs to be considered,” says senior author Rafal Tokarz, PhD, assistant professor of epidemiology in the Center for Infection and Immunity at the Columbia Mailman School of Public Health, and a graduate of the Department of Microbiology and Immunology at Stony Brook University. “This study emphasizes the need to focus on all tick-borne diseases, not just Lyme.”
The first author is Santiago Sanchez, a post-doctoral fellow in the Department of Microbiology and Immunology at Stony Brook University. Teresa Tagliafierro from Columbia and James Coleman from Stony Brook are co-authors of the study.
This study was funded by a grant from the National Institutes of Health to Benach. Support was also provided by the Island Outreach Foundation in Blue Point, NY, to the Stony Brook Renaissance School of Medicine. Support from the Steven & Alexandra Cohen Foundation (CU18-2692) was provided to Tokarz.
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Bad Roommates: Study Tracks Mice To Nests, Finds Ticks Aplenty
By Melissa Mayer
Scientists know a great deal about how blacklegged ticks (Ixodes scapularis) feed on hosts, such as whitefooted mice (Peromyscus leucopus) and woodland deer mice (Peromyscus maniculatus), but what happens after the ticks drink their fill is more mysterious. Lab studies suggest these ticks may detach from mouse hosts inside their nests. However, no field studies have confirmed the presence of blacklegged ticks in naturally occurring mouse nests—until now. Entire article here:https://entomologytoday.org/2019/08/22/bad-roommates-study-tracks-mice-nests-finds-ticks-aplenty/
Last night I had an end-of-summer ice cream with someone who said, “I’ve probably met fifteen people this summer who have Lyme disease. It’s such an urgent problem.” Though I was sorry to hear these individuals were sick, I was glad to hear that they had all been properly and efficiently diagnosed. Patients and doctors alike are becoming more aware of this urgent health threat.
What many don’t realize, however, is that the Lyme disease threat doesn’t disappear with warm summer days. Tick season, and active ticks, are a year-round problem, and it’s important to remain vigilant in the fall as we are in the summer. While it’s the nymphal-stage ticks of spring and early summer we worry about most—predominantly because they’re so microscopic that we often miss them—the larger adult ticks of the current season also transmit tick-borne diseases.
Ticks are especially a danger during this time of year to school children who undertake outdoor sports—or any child who plays outside, be it at home, a park, or school recess. As the weather turns colder, ticks hide out in thick brush and leaf piles. They live in long grass, in wooded areas, and in your garden.
If you, your children or pets spend any time outdoors this fall, keep the following tips in mind:
Continue to wear bug spray: We don’t just need repellent for summer hikes and campfires; we need it in the autumn, too. Before going on a fall hike, walking to a playground, or letting your child roll in the grass, be sure to apply repellent.
Use repellent wipes: Instead of or in addition to bug spray, you can wipe down your skin with repellent wipes before going outdoors. These are great to put in your child’s backpack or in your own purse—you never know when you might need to walk through a grassy area.
Spray your clothes and gear: Bug spray isn’t just for exposed skin. You can buy clothes that are pre-treated with permethrin at many outdoor retailers, or you can buy a bottle and spray everything yourself. Include shoes, clothes, sports bags, and any other type of gear.
Carry a tick removal kit: In case of a tick bite, make sure to bring tweezers or tick removal tool, alcohol wipes, and a Ziploc baggie to put the tick in once you’ve pulled it out (see how to properly remove a tick). Mark the date on the bag. It’s recommended you send tick(s) out for testing.
Wear long pants and sleeves: This is easier when the weather gets cooler. Light-colored clothing is best, because it’s easier to see a tick on a white shirt than a dark shirt. Nerdy as it may look, it’s also helpful to tuck pants into socks, thereby preventing ticks from climbing up your legs.
Carry a small lint brush: Run a lint brush over your hair, skin and clothing after spending time outdoors; the sticky paper can pick up ticks you might miss. I carry a lint brush in my purse and also keep one by my front door.
Wash and dry clothes and equipment immediately after use: As soon as you or your young athlete get home, throw clothes, shin guards, and other washable gear in the dryer on high heat for at least 10-15 minutes. Ticks require moisture to survive and will rapidly die in a quick spin in a hot dryer.
Bathe after outdoor activity: After stripping your clothes and doing a thorough tick check, shower as soon as you come inside (versus waiting even a few hours, and giving the tick time to sit on your body and feed).
Continue to do tick checks every night: Make sure you’re not bringing any bugs into bed. Do a head-to-toe check on yourself, children, and pets. Bath time is a great time to do a once-over on kids. Remember to check in spots like the groin, behind the knees, behind the ears, and the scalp. Always Be Tick AWARE!
U.S. Senator Susan Collins of Maine, the Chairman of the Aging Committee, convened an official Senate field hearing on September 5, at the University of Maine Cooperative Extension Diagnostic and Research Laboratory Tick Lab.
Immediately prior to the hearing, Senator Collins toured the lab, which provides tick diagnostics, offers public outreach, and conducts applied research on ticks in Maine.
The hearing, titled “The TICK Act: An Urgent Public Health Response to Tick-Borne Diseases,” explored the growing public health crisis of Lyme disease and other tick-borne diseases. The legislation would apply a three-pronged approach to tackle Lyme and other tick and vector-borne diseases.
“I greatly appreciated our extraordinary group of witnesses who took the time to share their scientific expertise as well as their personal experiences with Lyme disease,” said Senator Collins.
“I was also very impressed to see firsthand the outstanding work being done by the University of Maine Cooperative Extension’s Tick Lab to better understand the diseases ticks carry and to protect Mainers.”
She continued: “A correct and early diagnosis can reduce costs and improve the prognosis, but we have a long way to go. Lyme disease was identified more than 40 years ago, yet there is still no gold standard for treatment. Existing prevention, education, and diagnostic efforts are helpful but remain fragmented. The TICK Act would help unite our efforts against ticks.”
Patients tell their stories
Chris Philbrook of Cumberland contracted Lyme disease in 2007 on a trip to Hogback Mountain in Virginia. He could barely move a muscle the next day and experienced debilitating pain and partial paralysis of his face.
After a CAT scan showed nothing abnormal, Mr. Philbrook visited a dentist for his tooth pain, who said his symptoms could be due to Lyme disease. Mr. Philbrook was tested for Lyme, but the results came back negative. It was only after Mr. Philbrook’s symptoms progressed and paralysis affected both sides of his face that he received a spinal tap and was properly diagnosed.
“I didn’t realize how important smiling was to my mental health until I couldn’t do it anymore,” said Mr. Philbrook. “I was lucky that my dentist spoke up, that I had a spinal tap—which is not a normal Lyme testing protocol—and that my Lyme disease was treated quickly, within the first month and a half. I’m happy to say that after my antibiotic treatment, I was cleared of the disease, although residual effects remain, mainly sleep disturbances and facial paralysis.”
Unlike Mr. Philbrook, Paula Jackson Jones of Nobleboro faced a frustrating diagnostic odyssey after she contracted Lyme disease while doing yard work in 2009. Over the next two years, she was misdiagnosed by 23 doctors and specialists. Although Ms. Jackson Jones tested negative for Lyme disease on four occasions, she was finally diagnosed with Lyme, Babesia, Bartonella, Rocky Mountain Spotted Fever, and Erlichiosis after a clinical examination and additional blood work and tests.
She co-founded Midcoast Lyme Disease Support & Education to make patients’ search for resources easier, accessible, and affordable. Ms. Jackson Jones said that Senator Collins’ TICK Act would “provide a lifeline” to patients and doctors by funding increased research and education.
Medical experts testify
Dr. Sean McCloy provided a physician’s perspective on the difficulty of diagnosing Lyme. As a young resident at Maine Medical Center, he felt equipped to spot the classic signs of the disease, such as the bull’s-eye rash, but he began seeing more patients who didn’t fit the typical scenario. Dr. Peterson described how he became a “detective doctor” to determine how to help his patients and learned that there is no one-size-fits-all approach that works for every case.
Dr. Jim Dill, a Pest Management Specialist who oversees UMaine’s Tick Lab, spoke about the work the UMaine Cooperative Extension is doing to minimize the occurrence and spread of ticks and tick-borne diseases in Maine.
The Tick Lab monitors tick populations and allows Maine residents to send tick samples for identification and testing. Dr. Dill noted that funding for tick research has been a challenge, but said the TICK Act will “inject a much-needed investment” that will allow the Tick Lab to expand its work.
Dr. LylePetersen, theDirector of the Division of Vector-Borne Diseases at the Centers for Disease Control and Prevention’s (CDC) National Center for Emerging and Zoonotic Infectious Diseases, spoke about the CDC’s efforts to reverse the upward trend in vector-borne disease by focusing on preventing infections.
He pledged that the CDC will continue supporting state and local jurisdictions’ initiatives to address tick-borne disease, and he expressed his commitment to supporting the development of an effective vaccine.
Last year, an estimated 450,000 Americans were diagnosed with Lyme disease, a staggering 1,400 percent increase since 2003. In the last year in Maine alone, there were approximately 1,400 new cases of Lyme disease, a sharp increase from the 752 cases in 2010. Other tick-borne diseases are also on the rise in Maine.
Maine has the highest rate of Lyme disease in the country, with per capita diagnoses 10 times higher than the national average. Tick-borne diseases disproportionately affect people over age 65, who are afflicted at higher rates than any other age group.
Medical costs of Lyme disease are estimated at $1.3 billion per year. When accounting for indirect medical costs, including loss of work, the annual costs balloon to $75 billion per year.
Patients with Bartonella species infection (bartonellosis) complain of a variety of nonspecific vision problems that can affect every function of the eye. Making diagnosis and treatment decisions even more difficult, these problems can be caused by a variety of other pathogens and diseases. Fortunately, many peer-reviewed case publications, especially in ophthalmology journals, are available that describe both common and uncommon eye symptoms caused by bartonellosis.
Documented links between Bartonella species infection and vision problems focus on Bartonella henselae (cat scratch disease) and Bartonella quintana (trench fever). B. henselae is associated with contact with animals and vectors, especially cats and fleas, while B. quintana is associated with body lice. Additional species implicated include B. elizabethae and B. grahamii.
The eye consists of structures that focus light on nerve receptors at the back of the eye, nerves that feed into the optic nerve which connects to the brain, and a blood supply that connects through a central artery and vein into the body’s blood circulation. Bartonellosis can affect each of these parts of the eye.
Patients with bartonellosis-related eye problems may have symptoms in other organs as well that can help clarify whether the eye symptoms are caused by bartonellosis. Ophthalmologists and other physicians look for these additional signs because all of the eye conditions that can be caused by bartonellosis can be caused by a variety of bacteria and viruses, as well as other health conditions including autoimmune disorders.
It can be difficult to narrow down the possible causes of bartonellosis. Sometimes patients can’t remember any events that would have exposed them to Bartonella species. Other times the event, such as a cat scratch, may have occurred weeks to a month or more before symptoms appear and the patient may not think there is a connection. It can take detailed questioning by physicians to identify the possibility of Bartonella species exposure.
Structural Eye Symptoms
The most common way bartonellosis is seen in the eye is called Parinaud oculoglandular syndrome (POGS). About five percent of patients with acute cat scratch disease have this syndrome, which is characterized by follicular conjunctivitis (pink eye) with swollen lymph nodes nearby. It is often accompanied by a fever, and there may be bumps on the eyelid. Other symptoms known to be caused by bartonellosis, such as endocarditis (swelling of the inner lining of the heart), may also indicate that bartonellosis should be suspected.
Inflammation of the middle layer of the structure that surrounds the eyeball is called uveitis. Uveitis causes redness of the eye and can cause light sensitivity, pain and floaters. Uveitis is sometimes associated with bartonellosis.
While case reports of eye symptoms caused by bartonellosis generally describe a sudden-onset condition, one case report describes a woman who had symptoms of bartonellosis in various body organs for more than five years, including chronic conjunctivitis (pink eye). She had multiple tests and treatments over that time including a Bartonella species test that was positive but considered nonspecific. It was only after other treatments didn’t work that antibiotics were administered. The antibiotics resolved her various symptoms.
Neurological Eye Symptoms
Neuroretinitis, an inflammation of the optic nerve head, occurs in about 2% of people with cat scratch disease (acute Bartonella henselae infection). Two-thirds of cases of neuroretinitis are caused by bartonellosis.
Neuroretinitis is usually characterized by sudden, complete vision loss and swelling that creates a star pattern in the macula (the light-sensitive tissue at the back of the eye that feeds information into the optic nerve). Though this is the typical case of neuroretinitis caused by bartonellosis, it can vary greatly. It can cause changes such as seeing odd shapes or colors Furthermore, case reports have included people who lose their vision with no other symptoms, have blurry vision with a headache, and more.
Treatment can usually, but not always, restore vision, but it can take months to resolve and there can still be long-term consequences. Complications can also occur. In one case, a child was diagnosed with neuroretinitis. Treatment was started six weeks after the diagnosis, but his vision in one eye got worse. After treatment, a full-thickness macular hole was discovered. The hole was monitored and resolved after six months.
Vascular Eye Symptoms
The eye has an important network of tiny blood vessels that provide nourishment to the tissue, but unnecessary growth of new capillaries can lead to a range of symptoms such as vision problems. Vasoproliferation (irregular growth of new blood vessels) may be more common in immunocompromised people, such as those being treated with chemotherapy products. These symptoms can be observed on the skin and in the liver and spleen and may also occur in the eye.
Vasoproliferative symptoms seem to be caused by vascular endothelial growth factor (VEGF) stimulated by bartonellosis. More research on the relationship between VEGF and bartonellosis is needed. Meanwhile, anti-VEGF agents have been used to treat vasoproliferative eye symptoms.
Bartonellosis can affect every part of the eye, and symptoms can be sudden and severe. Diagnosis and treatment decisions are complicated by other pathogens and diseases that can cause similar symptoms. It is important for patients and physicians to be aware of any prior animal or insect exposure that may indicate Bartonella infection. Considering additional systemic symptoms of bartonellosis may also help to clarify the diagnosis.
Learn more about bartonellosis and the testing that Galaxy Diagnostics offers here.
Fairbanks, A. M. et al. (2019). Treatment strategies for neuroretinitis: Current options and emerging therapies. Current Treatment Options in Neurology, 21(8), 36. doi:10.1007/s11940-019-0579-0 https://www.ncbi.nlm.nih.gov/pubmed/31278547
Michel, Z. et al. (2019). Multimodal imaging of two unconventional cases of Bartonella neuroretinitis [epub ahead of print]. Retinal Cases & Brief Reports. doi:10.1097/ICB.0000000000000893 https://www.ncbi.nlm.nih.gov/pubmed/31348120
Gunzenhauser, R. C. et al. (2019). The development and spontaneous resolution of a full-thickness macular hole in Bartonella henselae neuroretinitis in a 12-year-old boy. American Journal of Ophthalmology Case Reports, 15, 100515. doi:10.1016/j.ajoc.2019.100515 https://www.ncbi.nlm.nih.gov/pubmed/31341998
Toumanidou, V. et al. (2017). Neuroretinitis secondary to Bartonella henselae in a patient with myelinated retinal nerve fibers: Diagnostic dilemmas and treatment. Ocular Immunology and Inflammation, 27(3), 396-398. doi:10.1080/09273948.2017.1409357 https://www.ncbi.nlm.nih.gov/pubmed/29283743
Beckerman, Z. et al. (2019). Rare presentation of endocarditis and mycotic brain aneurysm [epub ahead of print]. The Annals of Thoracic Surgery. doi:10.1016/j.athoracsur.2019.06.073 https://www.ncbi.nlm.nih.gov/pubmed/31425670
Another great article by Galaxy Lab. Please read the following article for more information on Bartonella, as various strains are suspected to be transmitted by ticks, mites, various flies and spiders, and other modes, and it is far more prevalent than thought: https://madisonarealymesupportgroup.com/2016/01/03/bartonella-treatment/ Fifteen species of gram-negative aerobic Bartonella are known to infect humans; however Dr. Ricardo Maggi’s statement is quite telling, “This case reinforces the hypothesis that any Bartonella species can cause human infection.”
Lyme disease is the most prominent tick-borne disease in the United States. Co-infections with the tick-transmitted pathogens Babesia microti and Borrelia burgdorferi sensu stricto are becoming a serious health problem. B. burgdorferi is an extracellular spirochete that causes Lyme disease while B. microti is a protozoan that infects erythrocytes and causes babesiosis. Testing of donated blood for Babesia species is not currently mandatory due to unavailability of an FDA approved test. Transmission of this protozoan by blood transfusion often results in high morbidity and mortality in recipients.
Infection of C3H/HeJ mice with B. burgdorferi and B. microti individually results in inflammatory Lyme disease and display of human babesiosis-like symptoms, respectively.
Here we use this mouse model to provide a detailed investigation of the reciprocal influence of the two pathogens on each other during co-infection.
We show that
burgdorferi infection attenuates parasitemia in mice while
B. microti subverts the splenic immune response, such that a marked decrease in splenic B and T cells, reduction in antibody levels and diminished functional humoral immunity, as determined by spirochete opsonophagocytosis, are observed in co-infected mice compared to only B. burgdorferi infected mice
immunosuppression by B. microti in co-infected mice showed an association with enhanced Lyme disease manifestations.
This study demonstrates the effect of only simultaneous infection by B. burgdorferi and B. microti on each pathogen, immune response and on disease manifestations with respect to infection by the spirochete and the parasite. In our future studies, we will examine the overall effects of sequential infection by these pathogens on host immune responses and disease outcomes.
Due to the high prevalence of infection and the issues of congenital transmission and transmission through blood transfusion, the issue of concurrent infection and what it does to animal and human health is of paramount importance.