Archive for the ‘Ticks’ Category

FREE: View “Under Our Skin” Best Primer on Lyme Disease

http://www.veoh.com/watch/v21055812yWtmpgB8  Approx. One hour forty five minutes.

If you have not watched the incredible documentary, “Under Our Skin,” please do so.  It reveals what patients and the doctors who dare to treat them go through.  It reveals the controversy up front and personally.  You will learn that Lyme is congenital, very probably a STD, and devastating.

The documentary covers so much ground but unfortunately doesn’t talk about the coinfections that typically come with Lyme (borrelia).

Predators Curb Lyme Disease

https://www.nytimes.com/2017/08/02/science/ticks-lyme-disease-foxes-martens.html?smid=fb-share  Lyme Disease’s Worst Enemy? It Might Be Foxes
By AMY HARMON AUG. 2, 2017

It is August, the month when a new generation of black-legged ticks that transmit Lyme and other diseases are hatching. On forest floors, suburban estates and urban parks, they are looking for their first blood meal. And very often, in the large swaths of North America and Europe where tick-borne disease is on the rise, they are feeding on the ubiquitous white-footed mice and other small mammals notorious for harboring pathogens that sicken humans.

But it doesn’t have to be that way. A new study suggests that the rise in tick-borne disease may be tied to a dearth of traditional mouse predators, whose presence might otherwise send mice scurrying into their burrows. If mice were scarcer, larval ticks, which are always born uninfected, might feed on other mammals and bird species that do not carry germs harmful to humans. Or they could simply fail to find that first meal. Ticks need three meals to reproduce; humans are at risk of contracting diseases only from ticks that have previously fed on infected hosts.

For the study, Tim R. Hofmeester, then a graduate student at Wageningen University in the Netherlands and the lead researcher of the study, placed cameras in 20 plots across the Dutch countryside to measure the activity of foxes and stone martens, key predators of mice. Some were in protected areas, others were in places where foxes are heavily hunted.

Over two years, he also trapped hundreds of mice — and voles, another small mammal — in the same plots, counted how many ticks were on them, and tested the ticks for infection with Lyme and two other disease-causing bacteria. To capture additional ticks, he dragged a blanket across the ground.

In the plots where predator activity was higher, he found only 10 to 20 percent as many newly hatched ticks on the mice. Thus, there would be fewer ticks to pass along pathogens to next generation of mice. In the study, the density of infected “nymphs,” as the adolescent ticks are called, was at 15 percent of levels in areas where foxes and stone martens were less active.

“The predators appear to break the cycle of infection,’’ said Dr. Hofmeester, who earned his Ph.D. after the study.

Despite stuffing his pant legs into his socks and using permethrin, a tick repellent, he said he removed more than 100 ticks from his own body.

Interestingly, the predator activity in Dr. Hofmeester’s plots did not decrease the density of the mouse population itself, as some ecologists had theorized it might. Instead, the lower rates of infected ticks, Dr. Hofmeester suggested in the paper, published in Proceedings of the Royal Society B, may be the result of small mammals curtailing their own movement when predators are around.

“This is the first paper to empirically show that predators are good for your health with respect to tick-borne pathogens,” said Dr. Taal Levi, an ecologist at Oregon State University who was not involved in the study. “We’ve had the theory but this kind of field work is really hard and takes years.” He also said of Dr. Hofmeester, “Wow, I have to send him an email.”

Habitat fragmentation, hunting and the removal of larger predators like cougars may all figure into the dwindling of small mammal predators like foxes, weasels, fishers and martens, Dr. Levi said. If the study’s results are borne out by more research, public health officials might be moved to try interventions like protecting foxes or factoring the habitat needs of particular predators into land-use decisions to foster their population size. Nothing else — like culling deer or spraying lawns with tick-killing pesticide — has worked so far to stem the incidence of tick-borne disease, which is spreading in the Midwestern United States, in parts of Canada and at higher altitudes across Europe.

“The takeaway is, we shouldn’t underestimate the role predators can play in reducing Lyme disease risk,” said Richard S. Ostfeld, a senior scientist at the Cary Institute of Ecosystem Studies, who originally speculated on the importance of small mammal predators in a 2004 paper. “Let’s not discount these cryptic interactions that we don’t see very often unless we put camera traps in the woods.”

Correction: August 3, 2017
Because of an editing error, an earlier version of this article incorrectly described the number of newly hatched ticks found on mice in areas of a study where predator activity was higher. It was 10 to 20 percent, not 5 to 10 percent. The density of infected adolescent ticks in areas where foxes and stone martens were active was also incorrectly described. It was 15 percent, not 6 percent, of levels in areas where foxes and stone martens were less active.

Transmission of Borrelia Miyamotoi Sensu Lato Relapsing Fever Group Spirochetes in Relation to Duration of Attachment by Ixodes Scapularis Nymphs

https://doi.org/10.1016/j.ttbdis.2017.03.008

Transmission of Borrelia miyamotoi sensu lato relapsing fever group spirochetes in relation to duration of attachment by Ixodes scapularis nymphs

Nicole E.Breuner, Marc C.Dolan, Adam J.Replogle, Christopher Sexton, Andrias Hojgaard, Karen A.Boegler, Rebecca J.Clark, Lars Eisen
Ticks and Tick-borne Diseases, Volume 8, Issue 5, August 2017, Pages 677-681.

Abstract

Borrelia miyamotoi sensu lato relapsing fever group spirochetes are emerging as causative agents of human illness (Borrelia miyamotoi disease) in the United States. Host-seeking Ixodes scapularis ticks are naturally infected with these spirochetes in the eastern United States and experimentally capable of transmitting B. miyamotoi. However, the duration of time required from tick attachment to spirochete transmission has yet to be determined.

We therefore conducted a study to assess spirochete transmission by single transovarially infected I. scapularis nymphs to outbred white mice at three time points post-attachment (24, 48, and 72 h) and for a complete feed ( > 72–96 h). Based on detection of B. miyamotoi DNA from the blood of mice fed on by an infected nymph, the probability of spirochete transmission increased from 10% by 24 h of attachment (evidence of infection in 3/30 mice) to 31% by 48 h (11/35 mice), 63% by 72 h (22/35 mice), and 73% for a complete feed (22/30 mice).

We conclude that
(i) single I. scapularis nymphs effectively transmit B. miyamotoi relapsing fever group spirochetes while feeding,
(ii) transmission can occur within the first 24 h of nymphal attachment, and
(iii) the probability of transmission increases with the duration of nymphal attachment.

**Comment**

I thank the authors for stating transmission can occur in 24 hours and that transmission increases with attachment time.  

At first I thought I’d posted this before; however,  https://madisonarealymesupportgroup.com/2017/07/18/transmission-time-for-borrelia-mayonii-by-nymphal-ticks-mouse-model/ in this study, “No evidence of infection with or exposure to B. mayonii occurred in mice that were fed upon by a single infected nymph for 24 or 48 h. The probability of transmission by a single infected nymphal tick was 31% after 72 h of attachment and 57% for a complete feed.”

In essence the newer study found greater evidence of infection in shorter transmission times.  

Transmission time research, similarly to geographical maps of tick populations, has been used against patients for decades. Please read all transmission time studies with healthy skepticism, realizing many patients have become infected in under the oft quoted 24-72 hours. Thankfully, the CDC is now telling doctors to treat patients empirically, without waiting for test results, if they suspect tick borne illness. https://madisonarealymesupportgroup.com/2017/07/12/start-treatment-if-tbis-are-suspected/
https://madisonarealymesupportgroup.com/2017/04/14/transmission-time-for-lymemsids-infection/ Bob Giguere of IGeneX states a case of a little girl who went outside to play about 8:30a.m. and came inside at 10:30 with an attached tick above her right eye. By 2 o’clock, she had developed the facial palsy. At the hospital she was told it couldn’t be Lyme as the tick hadn’t been attached long enough. They offered a neuro-consult…..(not treatment)

http://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(15)00294-3/pdfWhile Borrelia Burgdorferi (Bb) and Borrelia Miyamotoi (Bm) can both be transmitted by the same hard-bodied (ixodid) tick species, Bm is put with the relapsing fever group – normally transmitted by soft-bodied ticks.  Bm  may cause severe disease, including meningoencephalitis. The most common clinical manifestations of B. miyamotoi infection are fever, fatigue, headache, chills, myalgia, arthralgia, and nausea. Symptoms of B. miyamotoi infection generally resolve within a week of the start of antibiotic therapy. B. miyamotoi infection should be considered in patients with acute febrile illness who have been exposed to Ixodes ticks in a region where Lyme disease occurs. Because clinical manifestations are nonspecific, etiologic diagnosis requires confirmation by blood smear examination, PCR, antibody assay, in vitro cultivation, and/or isolation by animal inoculation. Antibiotics that have been used effectively include doxycycline for uncomplicated B. miyamotoi infection in adults and ceftriaxone or penicillin G for meningoencephalitis.

 

 

Neurological and Immunological Dysfunction in Two Patients With Bartonella Henselae Bacteremia

Neurological and Immunological Dysfunction in Two Patients with Bartonella Henselae Bacteremia  Clinical Case Reports March 10, 2017 David L. Kaufman1, Andreas M. Kogelnik1, Robert B. Mozayeni2, Natalie A. Cherry2 & Edward B. Breitschwerdt3  (please see link for specifics on the cases)

Key Clinical Message:  Recently, BAPGM enrichment culture has documented Bartonella bacteremia in previously healthy, “nonimmunocompromised” patients following arthropod exposures. Neurobartonellosis should be among the differential diagnoses for patients with persistent or recurrent neurological symptoms of undetermined etiology. Microbiological and immunological testing should be concurrently pursued to determine whether defective immune function accompanies Bartonella bacteremia.

Discussion:  Two important clinical observations evolved out of the microbiological, immunological, and therapeutic findings associated with the medical management of these two patients. First, persistent or recurrent neurological symptoms of undetermined etiology in patients with historical vector exposures should prompt testing for bartonellosis. Historically, B. henselae infections in immunocompetent individuals have been associated with self-limiting cat scratch disease, whereas recent research supports persistent and potentially relapsing bacteremia [1–3]. As previously reported [2,3], both of these B. henselae bacteremic patients experienced headaches and disequilibrium. Patient 1 also experienced seizures, episodic confusion, and aphasia, which resolved completely following antibiotic therapy, despite persistence of the MRI abnormalities [1].

Secondly, immunological testing should be concurrently pursued to determine whether defective immune function accompanies neurological symptoms. Both patients had immunological abnormalities, including suppression of NK function, despite lacking a prior medical history indicative of immunodeficiency. The extent to which persistent B. henselae bacteremia may have induced immunocompromise or whether a chronic latent infection resulted in bacterial reactivation is unknown. It is important to note that after 9 months of treatment, the CD3, CD4, and CD19 deficiencies in Patient 1 resolved, while Patient 2 remained immunologically impaired after 5 months of therapy. There remains a substantial need for sequential electroencephalographic, MRI, immunological, and bacteriological patient data to guide physician decision making in patients with longstanding B. henselae bacteremia. Using a previously validated diagnostic approach [3,4], B. henselae bacteremia was confirmed in both patients by BAPGM enrichment blood culture, PCR amplification, and DNA sequence confirmation. Importantly, PCR did not amplify B. henselae DNA from patient’s blood, serum, 8-day, or 14-day BAPGM enrichment blood cultures, supporting the need for prolonged bacterial incubation times to obtain PCR confirmation for some B. henselae bacteremic patients. Consistent with previous studies[3,5] in which a subset of patients with persistent bacteremia were not IFA seroreactive to a panel of Bartonella sp. antigens, neither patient was initially B. henselae or B. quintana IFA seroreactive, whereas antibody reactivity was documented after antibiotic treatment in Patient 1, potentially due to enhanced immunological recognition of antigenic epitopes. Based upon these patients and previously published studies [3,5], enrichment blood culture and PCR should be used in conjunction with Bartonella sp. serological analysis when attempting to confirm bacteremic infection with a Bartonella sp. Vector transmission of B. henselae was the suspected source of infection for both patients. The veterinarian had ongoing vector (flea, mite, and potentially ticks) and animal exposure, which are occupational risks for animal health workers [3,5]. The cat flea (Ctenocephalides felis) transmits B. henselae among cats that develop a relapsing bacteremia and remain persistently infected reservoir hosts for months to years [6].

Although there is no evidence that cat-associated mites (S. scabiei or N. cati) are vector competent for the transmission of Bartonella species, rat mite (Ornithonyssus bacoti) and pigeon mite (Dermanyssus spp.) transmissions of B. henselae and B. quintana, respectively, have been suspected [7,8]. Due to an acute-onset illness and presumed tick attachment in a Lyme-endemic region with the subsequent development of erythema chronicum migrans, Lyme disease was initially suspected in Patient 2. Rapid treatment with doxycycline may have prevented serodiagnostic confirmation of B. burgdorferi transmission, whereas testing for other tickborne pathogens was negative. Although tick transmission of B. henselae has not been proven, organism-specific DNA has been PCR-amplified and sequenced from Ixodes sp. ticks [9], vector competence for Bartonella transmission has been demonstrated in a rodent model [10], and French investigators have recently documented Bartonella spp. bacteremia in patients following tick exposures [11]. Historically, systemic bartonellosis has been reported in immunocompromised patients, such as those with HIV/ AIDS and transplant recipients. Recently, infection with Bartonella spp. has been reported in healthy asymptomatic Brazilian blood donor candidates[12] and in previously immunocompetent patients with chronic neurological or rheumatologic symptoms [2,3,5]. Because Bartonella spp. can infect erythrocytes, endothelial cells, and various macrophage-type cells, including brain-derived dendritic cells in vitro, the spectrum of neurological symptoms attributable to bartonellosis appear to be extremely diverse among patients [1,2]. Physicians should be aware of the rapidly increasing number of Bartonella spp., the large number of proven and suspected arthropod vectors, and the large number of reservoir hosts, all of which are collectively contributing to the enhanced recognition of neurobartonellosis as a medically important emerging infectious disease.

For more on Bartonella:  https://madisonarealymesupportgroup.com/2016/01/03/bartonella-treatment/

https://madisonarealymesupportgroup.com/2017/04/26/bartonella-a-growing-health-concern/

https://madisonarealymesupportgroup.com/2017/05/20/bartonella-endocarditis-opportunistic-infection-in-cancer-patients-and-eye-inflammation/

https://madisonarealymesupportgroup.com/2017/01/04/endocarditis-consider-bartonella/

https://madisonarealymesupportgroup.com/2017/05/11/bartonella-henselae-in-children-with-congenital-heart-disease/

 

 

 

Heartland Virus in Arkansas

http://www.thv11.com/mb/news/local/case-of-tick-borne-illness-heartland-virus-found-in-arkansas-resident/454950576

Case of tick-borne illness, Heartland virus, found in Arkansas resident

26 days ago

Lone star tick, Thinkstock

LITTLE ROCK, Ark. (July 7, 2017) — Arkansas has identified its first case of Heartland virus, a relatively new tick-borne disease, in an individual living in the northwest part of the state.

People become infected with Heartland virus through the bite of the Lone Star tick. Patients are most likely to be diagnosed with Heartland virus from May to September. Heartland virus causes a flu-like illness, including fever, headache, muscle aches, diarrhea, appetite loss, and feeling very tired. Most cases have low numbers of cells that fight infection and low numbers of cells that help blood clot. There is no vaccine or drug to prevent or treat the disease.

“It’s a flu-like illness where you’re stiff, you’re achy, you run a fever, you’ve got headaches, this one often has diarrhea, which isn’t always the case with some of the others, loss of appetite,” said Dr. Sue Weinstein, the state public health veterinarian. “It can get quite serious.  A lot of patients with this are hospitalized, but most recover.  There’s only been one death in the nation and that was in someone who was quite elderly and other medical issues at the time.”

In 2009, two people admitted to Heartland Hospital in Missouri were later found to be infected with this virus. Both recovered, but the Missouri Department of Health and Senior Services began working with the Centers for Disease Control and Prevention (CDC) to learn more about the virus.

To date, more than 20 cases of Heartland virus disease have been identified in several states in Southeast and South Central United States, so it is not surprising that Arkansas has a case. Most patients require hospitalization for their illness but fully recover. One patient has died. The Arkansas patient has recovered fully.

Arkansas has some of the highest rates in the nation for tick-borne diseases such as Rocky Mountain Spotted Fever (RMSF), Ehrlichiosis, and Tularemia. Anaplasmosis and Lyme Disease may also occur. People who work or do activities outside, where they are exposed to ticks or insects, are more likely to be infected.

Preventing bites from ticks and mosquitoes are the best way to prevent these and other infections:

-Use insect repellents

-Wear long sleeves and pants

-Avoid bushy and wooded areas

-Perform thorough tick checks after spending time outdoors

For more information, visit healthy.arkansas.gov.

**Comment**

I’m sure those in Arkansas are relieved to finally be officially recognized.  Just last year two children were denied Lyme treatment due to it not being on the map:  https://madisonarealymesupportgroup.com/2016/09/24/arkansas-kids-denied-lyme-treatment/  Thanks to a mom who wouldn’t take no for an answer, Lyme Disease is finally recognized.

Arkansas officials ended up eating their words:  https://madisonarealymesupportgroup.com/2017/03/02/hold-the-press-arkansas-has-lyme/