Archive for the ‘Ticks’ Category

Established Populations of Rickettsia Parkeri-Infected Amblyomma Maculatum Ticks in New York City, NY, USA

https://www.liebertpub.com/doi/abs/10.1089/vbz.2021.0085?journalCode=vbz

Established Populations of Rickettsia parkeri-Infected Amblyomma maculatum Ticks in New York City, New York, USA

Published Online:24 Dec 2021https://doi.org/10.1089/vbz.2021.0085

Abstract

Objectives: We sought to determine the habitat associations and pathogen status of Amblyomma maculatum (Gulf Coast tick) ticks in New York City (NYC), New York, USA, a newly expanded portion of their range.

Methods: We collected 88 ticks from two NYC parks on Staten Island, one of the five boroughs of NYC, and compared our findings with similar habitat in Brooklyn, New York during the same time period (April 30–September 1). We tested 76 for pathogens.

Results: We found adult and immature ticks in native and invasive grasses at Freshkills and Brookfield parks on Staten Island. No A. maculatum ticks were found in Brooklyn.

  • 52.6% of ticks tested were infected with Rickettsia parkeri—the etiological agent of R. parkeri rickettsiosis.

Conclusions: This high rate of R. parkeri in a dense urban center is of concern to the medical community, who should be aware of this species’ presence and the symptoms of R. parkeri rickettsiosis.

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Category:

research, Rickettsia, Ticks

“Unusually High” Levels of Deer Tick Virus Found in Pennsylvania Park

https://www.lymedisease.org/deer-tick-virus-pennsylvania/

“Unusually high” levels of deer tick virus found in Pennsylvania park

Officials report an “unusually high” infection rate of deer tick virus (DTV) detected in a Pennsylvania park.

Out of 25 ticks recently collected from Lawrence Township Recreational Park in Clearfield County, 23 carried the dangerous virus. That’s a 92% infection rate.

The previous highest DTV infection rate found at a single location in Pennsylvania was 11 percent. The highest infection rate reported nationally in scientific literature is about 25 percent.

The Pennsylvania Department of Environmental Protection’s (DEP) Vector Management Program strongly advises the public to take protective measures to reduce risk of exposure to ticks.

“Deer tick virus transfers very quickly through the bite from an infected tick, and the health outcomes from the deer tick virus are more severe than other tick-borne illnesses typically seen in Pennsylvania,” said DEP Secretary Patrick McDonnell.

The deer tick virus, which is a type of Powassan virus, is rare in the United States, but positive cases have increased in recent years. It is spread to people primarily by bites from infected ticks.

Initial symptoms of a DTV infection may include fever, headache, vomiting, and weakness. Some people who are infected with DTV experience no symptoms, and therefore infection may go undetected. However, according to the CDC, 91 percent of patients treated for DTV infections develop severe neuroinvasive disease.

Those who exhibit severe disease from deer tick virus may experience encephalitis or meningitis and require hospitalization, with symptoms including confusion, loss of coordination, difficulty speaking, or seizures.

About 12 percent of people with severe disease have died, and approximately half of survivors of severe disease have suffered long-term health impacts.

SOURCE: Pennsylvania Department of Environmental Protection

Category:

Ticks, Viruses

Bannwarth Syndrome in Early Disseminated Lyme Disease

https://danielcameronmd.com/bannwarth-syndrome-lyme-disease/  Video Here

Bannwarth syndrome in early disseminated Lyme disease

Man with Bannwarth syndrome and lyme disease huntched over and holding his lower back.

Welcome to another Inside Lyme Podcast with your host Dr. Daniel Cameron. In this episode, Dr. Cameron will be discussing the case of a 66-year-old man with Bannwarth syndrome with urinary retention in early Lyme disease.

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Omotosho and colleagues described this case in an article entitled “A Unique Case of Bannwarth Syndrome in Early Disseminated Lyme Disease.”¹

The man presented to the emergency room with generalized myalgia, fatigue, and severe neck pain. The symptoms had been occurring for two weeks and began shortly after he was bitten by two ticks while performing yard work.

The patient reported having dull mid-back pain, intermittent headaches, and neck stiffness. His doctor initially suspected he had pneumonia and prescribed an antibiotic. But his symptoms worsened.

“His pain then radiated down his entire spine into his upper and lower extremities, leading to right arm weakness and new urine retention onset,” the authors wrote.

“His paraspinal tenderness and diminished deep tendon reflexes bilaterally.” His pain score was 8 out of 10. The ESR rate was 100 and C-reactive protein of 8.8 mg/L.

“Physicians need to be aware of the rare neurological manifestations of [Lyme neuroborreliosis] … Prompt diagnosis and treatment with antibiotics can reduce unnecessary imaging, patient anxiety, and, most importantly, avert debilitating complications.”

Test results indicated a white blood cell count of 12 k/uL, C-reactive protein of 8.8 mg/L, sedimentation rate of 100 mm/h, and creatinine kinase of 27 units/L.

Western blot and ELISA Lyme disease tests were positive and confirmed an early stage infection with Borrelia burgdorferi. In addition, a spinal tap showed lymphocytic pleocytosis and a positive Lyme disease titer.

The man was diagnosed with Bannwarth syndrome (BWS) based on his severe radiculopathy, upper extremity weakness, and urinary dysfunction. “All of these findings are pathognomonic for [Bannwarth syndrome],” wrote the authors.

Typically, Bannwarth syndrome affects a person’s limbs. In this case, Lyme disease induced sacral radiculitis leading to neurogenic urinary dysfunction.

The authors were not sure why the patient’s urinary tract was affected. They suggested, “the influence of the radiculitis on innervating fibers” and “direct invasion of the spirochetes into the bladder wall” might have played a role.

“Early recognition of this rare presentation associated with Lyme disease and treatment with antibiotics can prevent disease progression and detrimental neurological sequelae.”

The man was treated with a 21-day course of IV ceftriaxone and “his symptoms improved with complete resolution of his urinary retention,” the authors wrote.

About Bannwarth syndrome

Bannwarth syndrome has been reported most often in Europe. And despite disputes over its incidence in the United States, “the condition does occur but is often misdiagnosed.”

BWS is characterized by a wide range of symptoms including:

  • radicular pain (100%)
  • sleep disturbances (75.3%)
  • headache (46.8%)
  • fatigue (44.2%)
  • malaise (39%)
  • paresthesia (32.5%)
  • peripheral nerve palsy (36.4%)
  • meningeal signs (19.5%)
  • paresis (7.8%)

The syndrome can cause severe pain. “BWS typically manifests itself with severe zoster-like segmental pain that is worse at night,” the authors wrote. “The pain has a burning, stabbing, biting, or tearing character and usually responds poorly to all common analgesics.”

Author’s Conclusion:

“The constellation of neurological symptoms, particularly when associated with a recent or suspected tick bite in an endemic region, should prompt thorough evaluation for [Lyme neuroborreliosis] and assessment for BWS,” the authors wrote.

The following questions are addressed in this Podcast episode:

  1. What is Bannwarth syndrome?
  2. How is BWS diagnosed and treated?
  3. What is radicular pain?
  4. What is the significance of the spinal tap findings?
  5. What is the significance of an elevated sedimentation rate and c-reactive protein?
  6. Why is BWS rarely diagnosed in the USA?
  7. What can we learn from this case?

Thanks for listening to another Inside Lyme Podcast. Please remember that the advice given is general and not intended as specific advice to any particular patient. If you require specific advice, please seek that advice from an experienced professional.

Inside Lyme Podcast Series

This Inside Lyme case series will be discussed on my Facebook page 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.

References:
  1. Omotosho YB, Sherchan R, Ying GW, Shayuk M. A Unique Case of Bannwarth Syndrome in Early Disseminated Lyme Disease. Cureus. Apr 25 2021;13(4):e14680. doi:10.7759/cureus.14680

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Category:

Lyme, Pain Management, research, Testing, Ticks, Treatment

STARI & Lyme Disease

https://danielcameronmd.com/southern-tick-associated-rash-illness-stari-and-lyme-disease/

Southern Tick-Associated Rash Illness (STARI) and Lyme disease

Welcome to another Inside Lyme Podcast with your host Dr. Daniel Cameron. In this episode, Dr. Cameron will be discussing the case of a 63-year-old woman who was diagnosed with Southern Tick-Associated Rash Illness (STARI).

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In their article “Southern Tick-Associated Rash Illness: Florida’s Lyme Disease” Abdelmaseih and colleagues describe the woman’s case, highlighting the differences between STARI and Lyme disease.¹

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The patient was bitten by a lone-star tick on her right leg while camping in Gainesville, Florida. She noticed a pruritic target erythematous lesion after removing the tick.

Two weeks later she was evaluated and reported having a persistent fever, headache, and diffuse myalgias for 4 days following the tick bite. On presentation, she had a fever of 100.5 F and a tachycardia of 127 BPM, low white count, anemia, low platelet count and elevated liver function tests.

Fortunately, the patient’s symptoms resolved with a 14-day course of doxycycline.

The authors discuss the differences and similarities of STARI and Lyme disease:

  • “The associated rash is similar if not indistinguishable from Lyme disease erythema migrans, with lymphocytic dermal infiltrate.”
  • Both the diagnosis of STARI and Lyme disease are based on clinical evidence. “At the present time, there is no approved diagnostic modality to identify STARI; thus, the diagnosis must be made on clinical evidence including erythema migrans and tick exposure.”
  • The diagnosis of STARI and Lyme disease often rely on geography. “Diagnosis usually relies on geographic association (STARI from central Texas and Oklahoma eastward across the southern states and along the Atlantic coast as far north as Maine, versus Lyme disease in northeast, mid-Atlantic, and upper mid-west).”

However, the authors did not address reports documenting the presence of lone-star ticks in the Northeast, mid-Atlantic, and upper Midwest and of deer ticks in the South.

It has been assumed that STARI does not have any long-term sequelae.

“A recent study has suggested that STARI is transmitted by the lone-star tick Amblyoma americanum; however, it may take some time before all the necessary data can be collected, since much is still unknown about STARI.”

The treatment of STARI is also uncertain. “STARI is often treated as Lyme disease with doxycycline twice daily for 14 days; however, there is no approved treatment yet.”

The authors conclude, “STARI is an emerging Lyme-like illness that causes the characteristic rash, erythema migrans. The current incidence of STARI remains unknown as it is not nationally reportable.”

The following questions are addressed in this Podcast episode:

  1. What is STARI?
  2. Are there differences between STARI and Lyme disease rashes?
  3. Are there differences in the ticks?
  4. How is STARI diagnosed, compared to Lyme disease?
  5. What clinical evidence does one need to diagnose STARI?
  6. What are the consequences if Lyme disease or co-infections is overlooked?
  7. What do we know about ticks in the South?

Thanks for listening to another Inside Lyme Podcast. Please remember that the advice given is general and not intended as specific advice to any particular patient. If you require specific advice, please seek that advice from an experienced professional.

Inside Lyme Podcast Series

This Inside Lyme case series will be discussed on my Facebook page 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.

References:
  1. Abdelmaseih R, Ashraf B, Abdelmasih R, Dunn S, Nasser H. Southern Tick-Associated Rash Illness: Florida’s Lyme Disease Variant. Cureus. May 28 2021;13(5):e15306. doi:10.7759/cureus.15306

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**Comment**

When I speak with experts they state STARI IS LYME.  Southerners have fought to be heard.  Patients have been turned away undiagnosed and untreated and are told, “You can’t have Lyme because Lyme doesn’t exist here,” which of course is asinine.  Until the birds quit flying, rodents quit crawling, lizards and humans quit moving, and transporting ticks everywhere they go, ticks will continue to travel.

Category:

Lyme, research, Testing, Ticks, Treatment

Houston, We Have a Problem: Doctors Can’t Identify Ticks

https://danielcameronmd.com/clinicians-difficulty-identifying-ticks/

Clinicians have difficulty identifying ticks

identifying-ticks

Welcome to another Inside Lyme Podcast with your host Dr. Daniel Cameron. In this episode, Dr. Cameron discusses findings from a recent study which examined the proficiency of clinicians at identifying ticks in the northeastern region of the United States.

By

The study by Laga and colleagues entitled “Proficiency at Tick Identification by Pathologists and Clinicians Is Poor” was published in The American Journal of Dermatopathology.¹

Using high-resolution photographs of ticks, the authors surveyed 115 health care providers, which included primarily medical students, medical residents, and physicians.

CLICK HERE TO WATCH A VIDEO DISCUSSING TICK IDENTIFICATION WITH DR. CAMERON

The survey was simple. Each health care provider was asked to look at high-resolution color pictures of ticks provided by the University of Rhode Island Tick Encounter Resource Center.  (The dimensions of each image were 1 5/8 inches by 2 inches.)

The participants were asked to select one of 5 possible answers for each photograph:

  1. American dog tick
  2. Deer/ blacklegged tick
  3. Lone Star tick
  4. Brown dog tick
  5. “I do not know”

Only 1 in 3 ticks were correctly identified.

The survey participants correctly identified 60% of the non-engorged black-legged ticks but only 34% correctly identified a partially engorged black-legged tick.

“Likely explanations are that texts and media rarely show partially engorged ticks,” the authors explain.

Additionally, “the color contrast seen between the scutum and abdomen in the blacklegged tick, for example, is lost after 2.5–3 days of engorgement.”

Participants had more difficulty identifying the other tick species:

  • 1 in 2 participants identified a non-engorged Lone Star tick;
  • 1 in 3 identified a non-engorged American dog tick;
  • 1 in 4 identified a non-engorged adult Brown dog tick.

The number of ticks correctly identified was worse for partially engorged ticks.

Medical students and non-physician health care providers (i.e., nurses, physician assistants) fared the worse with only about 1 in 4 correctly identifying the ticks.

In everyday practice, health care providers do not view high-resolution photographs of ticks. Their experience, instead, is with actual ticks which appear much smaller.

“In addition to choosing the easier-to-identify female ticks for our test, we also chose adult rather than nymphal ticks for the quiz,” the authors explain.

“Nymphal ticks, in addition to be being smaller, tend to have more muted colors and less distinctive markings on their scutums.”

In actual practice, it’s important that health care providers can identify engorged ticks. Yet, the survey shows that engorged ticks were more difficult for providers to identify.

The following questions are addressed in this podcast episode:

  1. How often is the tick seen?
  2. Have you found it difficult to identify a tick?
  3. What are a few tips to identifying ticks?
  4. What diseases does each tick carry?
  5. Why is it important to be able to identify an engorged tick?
  6. What is the risk of an engorged tick?
  7. What educational information should clinicians receive?
  8. What do Lyme disease patients know?
  9. What are treatment options for a tick bite?
  10. What are the risks and benefits of a single 200 mg dose of doxycycline for a tick bite?
  11. How effective is testing of ticks for diseases?

Please remember that the advice given is general and not intended as specific advice as to any particular patient. If you require specific advice, then please seek that advice from an experienced professional.

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.

References:
  1. Laga AC, Granter SR, Mather TN. Proficiency at Tick Identification by Pathologists and Clinicians Is Poor. Am J Dermatopathol. May 11 2021.

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**Comment**

As they say, “There’s no such thing as a good tick.”

That said, doctors are woefully educated on ticks, the diseases they spread, how to diagnose, treat, and recognize not just various ticks but the wide variety of symptoms patients struggle with.

This study partially reveals the many problems in Lyme-land.

Yesterday, I posted an article proposing guidelines by supposed ‘experts’ that call themselves the ‘Wilderness Medical Society.’  In the comment section I break down the various continually regurgitated myths used as talking points and the basis for all research and clinical guidelines. One of the things discussed is how the “wait and see” approach has been dooming patients for decades. This essentially means that rather than quickly treating known tick bites prophylactically, they simply wait and see if the person develops symptoms.

They also continue to push the one-dose doxy prophylactic treatment which doesn’t work. Neither does two pills. Unfortunately, researchers still believe the EM rash is some magical symbol.  The EM rash comes and goes at will and should never be a marker for effectiveness of treatment.

The catch with all of this is doctors can’t identify the ticks involved.

Ironically, if the doctor can’t identify the tick, or if attachment time is unknown, they still recommend the “wait and see” approach, even though that particular refrain has caused untold damage.

Category:

Activism, research, Ticks