Archive for the ‘Ticks’ Category

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.

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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

The Unusual Cell Wall of the Lyme Disease Spirochete Borrelia Burgdorferi is Shaped by a Tick Sugar

https://www.nature.com/articles/s41564-021-01003-w

The unusual cell wall of the Lyme disease spirochaete Borrelia burgdorferi is shaped by a tick sugar

Tanner G. DeHart, Mara R. Kushelman, Sherry B. Hildreth, Richard F. Helm & Brandon L. Jutras

Nature Microbiology volume 6, pages 1583–1592 (2021)Cite this article

Published Nov. 24, 2021

Abstract

Peptidoglycan—a mesh sac of glycans that are linked by peptides—is the main component of bacterial cell walls. Peptidoglycan provides structural strength, protects cells from osmotic pressure and contributes to shape. All bacterial glycans are repeating disaccharides of N-acetylglucosamine (GlcNAc) β-(1–4)-linked to N-acetylmuramic acid (MurNAc). Borrelia burgdorferi, the tick-borne Lyme disease pathogen, produces glycan chains in which MurNAc is occasionally replaced with an unknown sugar. Nuclear magnetic resonance, liquid chromatography–mass spectroscopy and genetic analyses show that B. burgdorferi produces glycans that contain GlcNAc–GlcNAc. This unusual disaccharide is chitobiose, a component of its chitinous tick vector. Mutant bacteria that are auxotrophic for chitobiose have altered morphology, reduced motility and cell envelope defects that probably result from producing peptidoglycan that is stiffer than that in wild-type bacteria. We propose that the peptidoglycan of B. burgdorferi probably evolved by adaptation to obligate parasitization of a tick vector, resulting in a biophysical cell-wall alteration to withstand the atypical torque associated with twisting motility.

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**Comment**

Evidently this change is unprecedented and has not occurred in any other known organism.  The modification, which comes from the tick itself, allows for elasticity which supports motility of borrelia to move through tissue and cartilage.  A carbohydrate unique to ticks is absorbed by borrelia.

This finding could lead to potential diagnostic tests and treatments that target this unique sugar.

Category:

research, Ticks

Nebraska Wakes up From Long Coma. Admits Lyme Disease Exists There

https://dhhs.ne.gov/Pages/Joint-Release—Bacteria-That-Causes-Lyme-Disease-Detected.aspx

Joint Release – Bacteria That Causes Lyme Disease Detected

For Immediate Release: 12/10/2021
 

MEDIA CONTACT

Jeff Powell, (402) 471-6223, jeff.powell@nebraska.gov

Emilee Longuski, (402) 385-4770, Emilee.Longuski@WinnebagoTribe.com

Julie Rother, (402) 375-2200, Julie@nnphd.org

Logos

Lincoln, Neb. – Recently, the Department of Health and Human Services (DHHS) was notified by the Northeast Nebraska Public Health Department of two cases of Lyme disease locally acquired within their jurisdiction. Both patients reported likely exposure around the same time frame at sites located near one another in Thurston County.

Due to the association between both cases, a coordinated environmental investigation involving DHHS, the Northeast Nebraska Public Health Department, and the Winnebago Public Health Department was completed at the suspected exposure sites. Ixodes scapularis (commonly called deer tick or the blacklegged tick) were collected from the sites of likely exposure.

Thurston County is now the fourth known county (Douglas, Sarpy, and Saunders were identified in 2019) in the state to have established black-legged tick populations. A subset of the ticks collected was sent to the CDC’s Division of Vector-Borne Disease and Creighton University for testing in an attempt to detect pathogens vectored by the tick including the bacteria (Borrelia burgdorferi) responsible for causing Lyme disease.

Ticks submitted to Creighton University and CDC came back positive for Borrelia burgdorferi indicating that the bacteria that causes Lyme disease is circulating in the tick population in the area. These results mark the first ever detection of Borrelia burgdorferi in Nebraska’s blacklegged tick populations and the first definitive evidence of Lyme disease cases acquired locally in the state.

The detection of an established population of black-legged ticks in Nebraska with evidence of detectable pathogens heightens concern of further establishment of the tick vector and its associated pathogens in other areas of the state. DHHS will continue to work with the Northeast Nebraska Public Health Department, the Winnebago Public Health Department, and other state public health partners on surveillance efforts for blacklegged and other medically important ticks.

While tick activity may be slowing down with colder weather, blacklegged ticks can be active year-round. There are simple steps people can take to protect themselves against tick bites.

Prevention steps include:

  • Use an EPA approved insect repellent containing DEET, picaridin, IR3535, oil of lemon eucalyptus, para-menthane-diol, or 2-undecanone.
  • Treat clothing and gear such as boots, pants, socks, and tents with products containing 0.5% permethrin.
  • Dress in long-sleeved shirts, pants, and socks when outside.
  • Do frequent tick checks after being outdoors and remove attached ticks promptly with fine-tipped tweezers. Don’t forget to check pets for ticks after being outdoors as well.
  • Shower as soon as possible after being outdoors.

Ticks are generally found near the ground, in brushy or wooded areas. They cannot jump or fly. Instead, they climb grasses or shrubs and wait for you to brush against them. This is called “questing”. When this happens, they hang on to you with small claws and then find a spot to attach and take a blood meal.

What to do if you find an attached tick:

  • Remove the attached tick as soon as you notice it by grasping with fine-tipped tweezers, as close to the skin as possible, and pull it straight out. Early removal can minimize and often eliminate the chance of infection. After removing the tick, thoroughly clean the bite area and your hands with rubbing alcohol or soap and water.
  • Avoid using nail polish, petroleum jelly, or heat to make the tick detach from the skin. These methods are not effective and may increase the risk of disease transmission.
  • Watch for signs of illness such as rash or fever in the days and weeks following the bite, and see a healthcare provider if these develop. Be sure to let your healthcare provider know you were recently bitten by a tick.

For more information visit the following links:

CDC Ticks Website: https://www.cdc.gov/ticks/index.html

CDC Lyme Disease Website: https://www.cdc.gov/lyme/index.html

CDC Preventing Ticks on Pets Website: https://www.cdc.gov/ticks/avoid/on_pets.html

DHHS Press Release, “Blacklegged Tick Identified in Nebraska: https://dhhs.ne.gov/Pages/Blacklegged-Tick-Identified-in-Nebraska.aspx

Placeholder text for an image.To be replaced by appropriate text
Image. Four (3 female; 1 male) Ixodes scapularis (black-legged ticks) collected from two exposure sites. The male Ixodes scapularis is located at the top of the image with the three other ticks being female Ixodes scapularis. Photo courtesy of Jeff Hamik (DHHS).


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**Comment**

And you thought Rip Van Winkle was a myth.

Category:

Activism, Lyme, Ticks

Deer Ticks Parasitizing Big Brown Bats in NY

https://academic.oup.com/jme/advance-article-abstract/doi/10.1093/jme/tjab174/6425286?redirectedFrom=fulltext

Ixodes scapularis (Ixodida: Ixodidae) Parasitizing an Unlikely Host: Big Brown Bats, Eptesicus fuscus (Chiroptera: Vespertilionidae), in New York State, USA

James L Occi, Victoria M Campbell, Dina M Fonseca, Richard G Robbins
Journal of Medical Entomology, tjab174, https://doi.org/10.1093/jme/tjab174
Published:  11 November 2021

Abstract

Ixodes scapularis Say is a three-host tick that has been recorded feeding on over 150 different species of terrestrial vertebrates (mammals, birds, and reptiles). This tick is found throughout the northeastern, coastal southeastern, and upper midwestern United States and is considered the most significant vector of tick-borne pathogens to humans in North America. Despite its ubiquity and broad host range, I. scapularis previously has not been reported feeding on bats (Chiroptera). However, during 2019 and 2020, larvae and nymphs of I. scapularis were recovered from big brown bats, Eptesicus fuscus (Palisot de Beauvois), at four locations in rural New York State, USA. All Ixodes infested bats were injured and found on the ground; therefore, parasitism by I. scapularis was likely opportunistic. Nonetheless, the large number of pathogens known to be associated with bats and the frequency with which I. scapularis bites people suggest that this host–tick relationship is of at least potential epidemiological significance.

Category:

research, Ticks, Transmission