Archive for the ‘Ticks’ Category

Tickpocalypse: The Public Health Crisis Hiding in Plain Sight

TICKPOCALYPSE

IS A GLOBAL LYME DISEASE PANDEMIC COMING? IT’S ALREADY HERE. LEARN WHAT YOU CAN DO ABOUT IT.

Special Report

“Pandemic” isn’t a word responsible health experts toss around lightly. It refers to an infectious disease that’s run rampant—and it’s near the top of the list of major threats to human health. When pandemics occur, newshounds and public health officials jump on it, alerting the masses (albeit sometimes too slowly). When they don’t, pandemics continue to spread unabated. That’s what’s happening now, according to a growing cadre of experts, with Lyme disease.

The worldwide tick population is exploding, and with it, the incidence of Lyme. The number of confirmed cases of the illness in the U.S. more than doubled in the two decades leading up to 2017, and rose 17% from 2016 to 2017 alone. It’s estimated that 300,000 people contract Lyme each year in the U.S., with victims found not just in traditionally tick-heavy areas like upstate New York and Maine, but in all 50 states and Washington, D.C. Lyme is also on the rise in Europe, Africa, and Asia. If all of that isn’t troubling enough, other tick-borne illnesses, like Rocky Mountain Spotted Fever—which experts say is significantly more dangerous than Lyme—are also becoming much more widespread.

“Tickpocalypse,” the collection of stories that follows, documents these looming threats, and shows you how to protect yourself and your family. It’s an eye-opening, and hopefully helpful, report.

Click on initial link for the following stories:

Tick, Tick, Tick….

What it’s Like to Have Lyme Disease Forever

Worrying About Worrying About Lyme disease

When Lyme Kills

What it’s Like to be a Creepy-Crawly Field Researcher

Know Your Enemy: The Black Legged Tick

When That Tick Bites

Lyme Prevention 101

The Mouse Cure

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Category:

Activism, Lyme, research, Testing, Ticks

New York Times’ Story on Lyme Misses the Bull’s Eye

https://www.forbes.com/sites/judystone/2019/07/02/new-york-times-story-on-lyme-misses-the-bulls-eye/

New York Times’ Story on Lyme Misses the Bull’s Eye

July 2, 2019

By Judy Stone, Infectious Disease Specialist

This bull’s eye rash, characteristic of Lyme disease, may be seen in fewer than half of patients. GETTY

An article appeared in this week’s New York Times, “My Son Got Lyme Disease. He’s Totally Fine. Horror stories about lingering Lyme disease proliferate, but the illness is easily treated.” While I am delighted that author Apoorva Mandavilli’s son had a good outcome, I feel a need to respond to aspects of the story that I, a Board Certified Infectious Diseases physician who lives in a Lyme endemic area and has had Lyme, found misleading and disturbing.

Neither the author’s experience—nor that of the pediatrician she quotes as “never had a complication from Lyme—matches mine. Mandavilli says, “many people view Lyme — wrongly — as a debilitating, chronic illness instead of what it is: An easily treated infection with no long-term consequences for children, or even the vast majority of adults.”

I understand that there are a spectrum of patients with Lyme.

I’ve cared for a number of patients with Lyme disease hospitalized with serious complications, including arrhythmias, arthritis, and neurologic symptoms. Occasionally, patients get pacemakers needlessly because the cardiologist does not consider Lyme. Pacemakers are not without their own complications, including life-threatening heart infections.

At the other end of the spectrum, I’ve had some patients, even without confirmatory lab results, who demanded months of IV antibiotics for their symptoms, which may or may not have been due to Lyme. As I would not do, presumably they went to someone else who considered themselves more “Lyme literate” than I, and who went along.

And I had one memorable patient, treated for months with IV ceftriaxone, for what proved to be ALS (amyotrophic lateral sclerosis), a fatal neurologic disease. A different neurologist chided me for taking away the patient’s hope.

Mandavilli, according to her responses to some comments on Twitter, was aiming to reassure parents that most Lyme was benign.

Antibiotics for Lyme

While I likely erred on the side of treating Lyme too conservatively, not wanting to cause more harm with antibiotics, my thinking has evolved some over time. We are learning more about persisting states of Borrelia, the bacteria that causes Lyme. When I spoke a few years ago with Dr. Sam Donta, he had some interesting, thought-provoking hypotheses. He also treated his patients with months of oral antibiotics and Plaquenil, focusing on the intracellular persister bacteria.

Some of Mandavilli’s points were valid, but still off target. The author notes she gave her son a month of doxycycline plus an antacid. I hope that she was careful with the timing, as antacids containing magnesium, aluminum, or calcium make the antibiotic less effective. Recommendations are to take the doxycycline “2 hours before or 6 hours after taking antacids, calcium supplements, and laxatives containing magnesium.” Similarly, vitamin products that contain iron need to be staggered with the antibiotic dosing.

Mandavilli correctly notes that “monthlong course of antibiotics can disrupt the gut microbiome” but she adds “and cause temporary stomach problems.” I guess she’s not seen people lose their colons due to C. difficile colitis, or die of sepsis from that colitis as I have.

My biggest criticisms relate to diagnoses and prevention. Lyme may be readily treated if caught early.

But her child’s physicians missed even thinking of the diagnosis, even though she was in an endemic area and son Akash had a new arthritis of his knee, a classic symptom of Lyme. Lyme should have been a much higher consideration than “juvenile arthritis or any of a long list of autoimmune disorders” his physicians entertained.

Reader Daphne commented in the Times, “The disease IS easily treatable in it’s early stages. The problem is that it IS NOT easily diagnosed. The basis of questioning in the article should not be “What are people so worried about?” Rather, it should be, “How can we assure early detection of Lyme is the norm for everyone?”

With an estimated 300,000 new cases of Lyme each year in the US, and the Tick-Borne Disease Working Group 2018 reporting that “10 to 20% of patients suffer from persistent symptoms, which for some are chronic and disabling,” it is important not to trivialize the disease.

Lack of accurate diagnostic tests

One of the biggest problems with Lyme, besides our lack of knowledge about it, is that we don’t even have good definitions of disease nor do we have any decent diagnostic tests. No definitive biomarker exists either for B. burgdorferi or for PTLDS (post-treatment Lyme disease syndrome).

This difficulty in getting a diagnosis is not unique to Lyme. It is common for patients (especially women) with vague symptoms such as fatigue, difficulty concentrating, or joint pain to go years without a diagnosis. Too many patients have rare diseases or autoimmune overlap diseases and it often takes five years and visits to an average of 7.3 physicians to make a diagnosis. Even for something that should have been fairly straightforward, it took me more than 10 physicians over a long time to have a torn cartilage in my wrist diagnosed—because it is an relatively unusual problem and because I was a woman, doctors refused to take my history seriously.

Diagnosing Lyme is difficult unless the symptoms are “classic.” It’s even worse for PTLDS, although John Aucott and Johns Hopkins researchers are beginning to tease out differences from controls. Lorraine Johnson, CEO of LymeDisease.org argues that the term PTLDS should be eliminated, as it is based on fulfilling the surveillance case definition of the CDC, and should not be used clinically. Lyme tests with the two-tier testing are antiquated and miss too many patients. The tests are generally negative in the first month after a bite, as they are based on the patient developing antibodies to infection. A corollary is that if the patient has taken antibiotics for the bite, they may not develop antibodies at all. The two-tier testing is quite specific, meaning it is unlikely that the patient will have a falsely positive test—at the expense of overlooking many.

Prevention

Not only did Mandavilli miss her mark in terms of being reassuring, I believe she did a huge disservice by minimizing Lyme disease and, by extension, the need for rigorous preventative measures and personal protection. I stress that aspect in my writing and patient care, since I’ve seen such serious complications. If parents think Lyme is a trivial illness, they are unlikely to go to the trouble of treating clothes, shoes and socks with permethrin, using insect repellents, or doing meticulous tick checks after outdoor adventures. This is critically important. Tiny, deer ticks transmit not only Lyme, but a host of other nasty infections, including ehrlichiosis, anaplasmosis, babesiosis, and Powassan virus. The latter can be deadly even if the tick has only been feeding for less than an hour. I say this not for scare-mongering, but to counter the impression the NYTimes article likely left many that tick bites are no big deal. They failed their millions of readers with this post.

Be active, go outdoors, but take precautions would be a safer message.

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**Comment**

A fairly balanced article by an infectious disease specialist. I think I’m going to faint….

Please note: “While I likely erred on the side of treating Lyme too conservatively…”

I would hate to be in a doctor’s shoes when the science finally catches up to the times. I think there’s going to be a lot of regret & guilt.

Regarding getting the EM rash, the percentages vary wildly from 25%-80%, but hardly a symptom that should be used as any sort of standard for anything. If you have it, you have Lyme, but even if you don’t have it, you can still have Lyme: https://madisonarealymesupportgroup.com/2019/02/22/why-mainstream-lyme-msids-research-remains-in-the-dark-ages/

For more: https://madisonarealymesupportgroup.com/2019/07/01/touched-by-lyme-singing-from-the-idsa-lyme-hymnal/

https://www.lymedisease.org/nyt-article-raw-nerve-lyme/

Category:

Activism, Lyme, Ticks

On the Lyme War Path – Chick2Chick

Approx. 14 Min

PennWatch

Published on Jun 30, 2019

Watch out!!! Carrie Perry from @Chick2Chick is on a warpath. She now has 2 daughters diagnosed with Lyme Disease, both missed by her primary care doctor.

Carrie and Flora Posteraro chirp about that and the many ways to protect you and your family against tick bites. #podcast #letschirp #realtalk #womensvoices

You can also listen to this as a podcast at your convenience through your favorite online podcast directory – iTunes, Stitcher, Spotify, TuneIn, Podbean or Google Play.

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Wisconsin desperately needs FREE tick testing. Call your reps and tell them.

You have to remember that tick testing isn’t perfect and can miss things but it’s a place to start & that it only follows that since ticks are filled with many pathogens, people will be too.

Category:

Activism, Lyme, Prevention, Psychological Aspects, Ticks

Deer Ticks Turn Up in East Nebraska; Can Carry Lyme Disease

https://foxnebraska.com/news/local/deer-ticks-turn-up-in-east-nebraska-can-carry-lyme-disease-06-26-2019

by The Associated Press

June 26th 2019

(MGN)

OMAHA, Neb. (AP) — Health officials say deer ticks that can carry Lyme disease have turned up for the first time in eastern Nebraska.

State health officials said Tuesday that lab tests are being done to determine whether the deer ticks collected carry the bacteria that cause Lyme disease. The ticks were found in Douglas, Sarpy and Saunders counties.

Lyme disease can cause fever, headache, fatigue and a skin rash. Health officials say most people recover completely, although some may be left with joint pain that can be treated with medication.

Nebraska health officials have yet to confirm any cases of Lyme disease originating in the state.

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**Comment**

Another tick where it’s not supposed to be….

I wonder when authorities will wave the white flag and admit tick maps are worthless because ticks will go wherever they they please?

Category:

Activism, Lyme, Ticks

The Terrifying Unknowns of an Exotic Invasive Tick

https://www.wired.com/story/the-terrifying-unknowns-of-the-asian-longhorned-tick/

06.28.19

THE TERRIFYING UNKNOWNS OF AN EXOTIC INVASIVE TICK

LAST SUMMER, IN a town just outside New York City, a tick bit a man.

This ought to sound unexceptional. Ticks are normal on the upper East Coast; after all, tick-transmitted Lyme diseasewas first identified next door, in Connecticut. But the tick that covertly slid its pointy barbed mouthparts into an unlucky 66-year-old Yonkers resident was something new. It was the first invasive tick to arrive in the United States in 50 years, and this was the first time it had bitten a human.

That bite didn’t make its victim sick. But that it occurred at all is causing scientists to realize how little they know about the insect involved, known as the Asian longhorned tick: what diseases it transmits, where it prefers to live, and how it manages to move across long distances. Behind those unanswered questions looms a larger problem: We haven’t paid as much attention to ticks as we have to other insects that carry diseases. We have a long way to go to catch up—just as changes in weather patterns have ticks on the move too.

Until recently, the Asian longhorned tick’s home range was understood to be eastern China and Russia, Japan, Australia and New Zealand, and a few Pacific islands. In those countries, it harbors an array of bacterial and viral diseases that infect humans, including a potentially deadly hemorrhagic fever. It’s even more feared for the way it attacks livestock. This tick reproduces asexually, laying thousands of eggs at a time and producing waves of offspring that extract so much blood that grown cattle grow weak and calves die.

In August 2017, a woman who kept a single sheep on a property in the northwest corner of New Jersey, in the midst of a neighborhood of big houses and big lawns, walked into the Hunterdon County health department to complain that she had found ticks on the animal. What she didn’t realize, until horrified employees told her, was that she had ticks on herself as well, more than 1,000 speck-sized larvae all over her clothing.

The investigators gave the woman a spare set of pants and went back to her house with her—where their boots were immediately covered with crawling larvae, many times more than would be normal on a property that size. They found hundreds of ticks sucking on the ears and under the coat of her poor sheep.

An insecticide bath took care of the bugs on the sheep, and a hard freeze in November eliminated the ones in the paddock. By that time, Rutgers University researchers had identified it as the longhorned tick, confirming the bug’s first sighting outside of a quarantine station (where twice in the 1960s they were removed from animals being brought into the United States). They had no idea where it had come from, but they wondered: Given that the paddock was so populated, how long had the ticks been here? Was it long enough that they might already be moving around?

Apparently yes. The CDC said last Wednesday the exotic tick has been found in 11 states now. One is New York, where the Yonkers man lives, about 80 miles away from that infested paddock. At the time of the bite, he didn’t travel much: He hadn’t been outside Westchester County in a month. He wasn’t all that outdoorsy either.

But when investigators inspected the man’s house they found ticks and tick larvae all around it. Unsettlingly, they also found ticks where existing science says ticks shouldn’t be: resting in full sun in the middle of a well-tended lawn, instead of in shaggy, shady tall grass.

The foreign tick had arrived without explanation, moved without notice, flourished in areas where it should not have been successful—and now was posing a possible human health threat.

The exotic Asian longhorned tick has been found in 11 states now.

“I’m alarmed,” says Bobbi Pritt, a physician and pathologist at the Mayo Clinic in Minnesota, who wrote a medical journal commentary reacting to the news of the bite, which was disclosed last month in a medical journal. “Though I’m not surprised. We knew this tick was here, we knew it had the capability of biting people based on its behavior in other countries. So now that raises a lot more questions.”

The problem is finding answers. It’s a truism among tick researchers that their work is underfunded compared with other insect vectors. After all, the US public health system was founded on fighting mosquitoes: The first local health department, created in Philadelphia in 1794, rose out of a devastating yellow fever epidemic the year before. The CDC itself emerged from a World War II program created to suppress malaria in the South, where the illness had wreaked havoc on war preparations, leaving soldiers unfit for duty and taking equipment manufacturing offline

To this day, the CDC maintains national maps of the ranges of different mosquito species. States, counties, and cities operate more than 700 mosquito-abatement districts, and the American Mosquito Control Association estimates those agencies collectively spend $200 million a year on catching, analyzing, and killing the bugs. Ticks don’t get anywhere near that kind of coordinated attention or money. The Entomological Society of America warned four years ago that the US needs comprehensive anti-tick strategies, but only a few states, such as New York in 2018 and Connecticut this year, have even created tick surveillance and control programs.

There’s good reason to do that: Ticks and the diseases they transmit—not just Lyme disease, but babesiosis, erlichiosis, anaplasmosis, and others—represent a huge public health problem. Last year, the CDC reported that cases of disease carried by insects tripled between 2004 and 2016; three-fourths of those cases were caused by ticks. In the period of that study, the CDC identified seven diseases that ticks pass to humans, several of them fatal, that were either brand-new, or new to the US.

When those diseases are diagnosed in people, the CDC requires them to be reported to the agency so the data can be summarized and mapped. But tick scientists such as Rick Ostfeld, a disease ecologist at the Cary Institute of Ecosystem Studies in New York, have said for years that what is most needed is routine catching and sampling of ticks themselves, as is done by mosquito control agencies, to figure out what species are hatching and what diseases they may carry.

At the moment, Ostfeld says, tick surveillance is driven by the interests of academic scientists.

“It’s very much a patchwork,” he says. “You tend to find ticks in the study sites of people who are looking for them, but that leaves vast parts of the country completely unstudied.”

Ben Beard, a medical entomologist who is deputy director of the CDC’s division of vector-borne diseases (“vector” is shorthand for “insects that transmit diseases when they bite”), says that is beginning to change. “We have funded state health departments to begin efforts for tick surveillance,” he says.

The primary source is a CDC program called “epidemiology and laboratory capacity funding,” which sends about $200 million a year to all 50 state health departments; $16 million of that goes for all diseases carried by insects. Until recently the funds were locked to specific projects, but this year the CDC agreed to allow states more latitude in how they spend the money. The result will be a map, by state and possibly by county, of ticks and the pathogens they carry, which the CDC plans to publish once a year.

Beard said it isn’t possible to say at this point how many jurisdictions will choose to concentrate on ticks or how much of that $16 million will be spent on tracking them. So the surveillance picture is likely to have gaps, but “over time it should transform the patchwork to something that is more systematic and complete.” (The CDC has also funded five “centers of excellence” at universities to increase work on diseases carried by insects, including ticks.)

That’s a beginning—though, given the speed at which ticks are emerging and tickborne diseases are increasing, it seems likely not to be enough. What’s needed are investments in tick biology and ecology, and investigations into how ticks arrive in new territory and what carries them around.

The CDC’s data, limited as it is, shows that ticks are getting ahead of us. It’s past time that we tried to catch up.

Maryn McKenna (@marynmck) is an Ideas contributor for WIRED, a senior fellow at the Schuster Institute for Investigative Journalism at Brandeis University, and the author of Big Chicken.

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**Comment**

Great reminder that ticks don’t follow maps or care about the weather.

With that in mind, I encourage you to contact your representatives and senators educating them of this fact. Every state should provide FREE tick testing to discover all the various pathogens present. This would help back up what Lyme literate doctors have discovered long ago – people are infected with a multitude of pathogens from ticks, requiring many medications – NOT the CDC’s abysmally limited “Lyme guidelines” of a mono-therapy of doxycycline. Little research has been done on concurrent infection within the human body, but what little there is indicates these patients have more severe illness for a longer duration of time necessitating many different drugs.