Archive for the ‘Ticks’ Category

16-Year-Old Boy With Lyme Disease Presenting as Depression

https://danielcameronmd.com/16-year-old-boy-lyme-disease-presenting-depression/

16-YEAR-OLD BOY WITH LYME DISEASE PRESENTING AS DEPRESSION

Adolescent with Lyme disease and depression holding his head

There has been increasing research linking COVID-19 with the development of neuropsychiatric symptoms, including depression and anxiety. But multiple studies have already found an association between other infections, such as Lyme disease, and the onset of depression.

By
 

One study found a high prevalence of depression in Lyme disease patients. Between January 2008 and December 2014, 1 in 5 patients treated at the Lyme Center Apeldoorn in the Netherlands was diagnosed with depression and Lyme disease. ¹

Meanwhile, Dr. Robert Bransfield, a psychiatrist specializing in the diagnosis and treatment of tick-borne illnesses, reports “In my database, depression is the most common psychiatric syndrome associated with late-stage Lyme dis­ease.”

“I estimate that there are at least 1,200 people per year who commit suicide as the result of Lyme disease,”  Bransfield writes in his article “Suicide, Lyme and Associated Diseases.” ²

Borrelia burgdorferi, the causative agent of Lyme disease, “may be diagnosed as a persistent infection with immune suppressant and evasive capabilities or there may be a postinfectious process,” Bransfield writes. “In either case, the psychiatric symptoms are associated with an immune-mediated process.”

Brian Fallon, MD, director of the Lyme and Tick-Borne Diseases Research Center at Columbia University, describes the case of a 16-year-old adolescent who presented with long-standing depression, which suddenly worsened.³

Neuropsychiatric symptoms

He reported anger, frustration, insomnia, poor appetite, mild weight loss, and passive suicidal ideation. He would say, “I wish I could just die in my sleep.”

The boy complained of brain fog and had a steep decline in cognitive abilities. His symptoms were initially presumed to be caused by “either laziness or mild depression.” He suffered from ongoing knee pain and was forced to quit sports.

His grades dropped from “A’s” in 7th grade to nearly failing by 10th grade. He suffered from fatigue and forgetfulness. “He appeared lazy because he found it hard to get out of bed in the morning,” Fallon writes.

The boy’s symptoms were extensive and included:

• severe headaches
• facial fasciculations, myalgias
• stiff neck
• hyperacusis
• episodic paresthesias of his face and hands
• sudden sweating
• painful joints
• sore throats
• palpitations
• electric shock-like pains
• word-finding problems, such that it was hard to finish sentences
• semantic paraphasias
• short-term memory problems, such that he could not recall conversations
• testicular pain

Since he reported having embedded ticks in the past, Lyme disease was clinically diagnosed “given the suspicious clinical history.”

His Lyme ELISA results were negative twice in the prior 3 months, but his IgG Western blot revealed 4 of the 5 requisite CDC specific bands. A brain SPECT revealed findings consistent with encephalitis, vasculitis, and Lyme disease.

Treatment response

The boy was diagnosed with probable Lyme encephalopathy and treated with 12 weeks of intravenous ceftriaxone.

He improved on sleep, appetite, headaches, joint pains, numbness, distractibility, short-term memory, and emotional behavior. His depression cleared without the need for antidepressant medications. His IQ improved by 22 points, and his school performance markedly improved.

Related Articles:

Don’t confuse somatic symptoms with depression in early Lyme disease

Chronic neurological Lyme disease or co-morbid conditions?

Oppositional behavior in children with Lyme disease

References:
  1. Zomer, T.P., et al., Depressive Symptoms in Patients Referred to a Tertiary Lyme Center: High Prevalence in Those Without Evidence of Lyme Borreliosis. Clin Infect Dis, 2017. 65(10): p. 1689-1694.
  2. Bransfield RC. Suicide and Lyme and associated diseases. Neuropsychiatr Dis Treat. 2017;13:1575-1587. Published 2017 Jun 16. doi:10.2147/NDT.S136137.
  3. Fallon BA, Kochevar JM, Gaito A, Nields JA. The underdiagnosis of neuropsychiatric Lyme disease in children and adults. Psychiatr Clin North Am. 1998;21(3):693-703, viii.

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**Comment**

If there was ever a great example of the importance of Lyme/MSIDS being clinically diagnosed, this is it!

This poor teenager would have continued spiraling down until he might just have achieved his wish of dying.  

This study points out a number of things parents and doctors should be considering:

  1. The plethora of symptoms that suggest a systemic infection(s)
  2. The drop in grades
  3. The stiff neck (few things cause this – but it’s hallmark for Lyme)
  4. The fact antibiotics helped so many of the symptoms – including the depression – without any antidepressants
  5. He was seronegative – and so many are.  Doctors have to stop relying upon testing to diagnose this and must become more educated on tick-borne illness.
The CDC just upped numbers again from 300,000 to 476,000 new cases of Lyme diseases per year – highlighting the fact this plague is serious, isn’t going away, and something needs to be done about it.

For more:

We can be thankful he fell into the hands of Dr. Fallon or this young man would most probably not had a favorable outcome.

Category:

Lyme, Psychological Aspects, research, Ticks

Spatial and Temporal Patterns of Borrelia Miyamotoi in NY Deer Ticks

https://parasitesandvectors.biomedcentral.com/articles/10.1186/s13071-020-04569-2

Spatial and temporal patterns of the emerging tick-borne pathogen Borrelia miyamotoi in blacklegged ticks (Ixodes scapularis) in New York

Parasites & Vectors volume 14, Article number: 51 (2021) Cite this article

Abstract

Borrelia miyamotoi, a bacterium that causes relapsing fever, is found in ixodid ticks throughout the northern hemisphere. The first cases of human infection with B. miyamotoi were identified in 2011. In the eastern USA, blacklegged ticks (Ixodes scapularis) become infected by feeding on an infected vertebrate host, or through transovarial transmission. We surveyed B. miyamotoi prevalence in ticks within forested habitats in Dutchess County, New York, and identified possible reservoir hosts. To assess spatial variation in infection, we collected questing nymphal ticks at > 150 sites. To assess temporal variation in infection, we collected questing nymphs for 8 years at a single study site. We collected questing larval ticks from nine plots to estimate the amount of transovarial transmission. To evaluate potential reservoir hosts, we captured 14 species of mammal and bird hosts naturally infested with larval blacklegged ticks and held these hosts in the laboratory until ticks fed to repletion and molted to nymphs. We determined infection for all ticks using quantitative polymerase chain reaction.

  • The overall infection prevalence of questing nymphal ticks across all sites was ~ 1%, but prevalence at individual sites was as high as 9.1%.
  • We detected no significant increase in infection through time.
  • Only 0.4% of questing larval ticks were infected.
  • Ticks having fed as larvae from short-tailed shrews, red squirrels, and opossums tended to have higher infection prevalence than did ticks having fed on other hosts.

Further studies of the role of hosts in transmission are warranted. The locally high prevalence of B. miyamotoi in the New York/New England landscape suggests the importance of vigilance by health practitioners and the public.

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**Comment**

A perfect example of how there can be high infection rates in humans but low infection rates in ticks.

Category:

Borrelia Miyamotoi (Relapsing Fever Group), research, Testing, Ticks

New Study Identifies Bird Species That Could Spread Ticks & Lyme Disease

https://phys.org/news/2021-01-bird-species-lyme-disease.html

New study identifies bird species that could spread ticks and Lyme disease

by Cary Institute of Ecosystem Studies

New study identifies bird species that could spread ticks and Lyme disease

Birds play an underrecognized role in spreading tickborne disease due to their capacity for long-distance travel and tendency to split their time in different parts of the world—patterns that are shifting due to climate change. Knowing which bird species are able to infect ticks with pathogens can help scientists predict where tickborne diseases might emerge and pose a health risk to people.

A new study published in the journal Global Ecology and Biogeography used machine learning to identify bird species with the potential to transmit the Lyme disease bacterium (Borrelia burgdorferi) to feeding ticks. The team developed a model that identified birds known to spread Lyme disease with 80% accuracy and flagged 21 new species that should be prioritized for surveillance.

Lead author Daniel Becker, a Postdoctoral Fellow at Indiana University, says, “We know birds can infect ticks with the Lyme bacterium; however, until now, no one has systematically studied the ecological and evolutionary drivers that influence which bird species are most likely to host and spread Borrelia burgdorferi on a global scale. We set out to fill this gap by identifying traits of bird species that are most likely to pass Lyme to feeding ticks.”

Senior author Barbara Han, a disease ecologist at Cary Institute of Ecosystem Studies, says, “To predict and monitor species that could spread tickborne diseases to people, we first need to know which traits make certain animals good pathogen hosts. Here, we used machine learning to assess bird species traits, paired with Lyme infection data from ticks found on birds, to predict bird species that have the potential to spread Lyme.”

In this study, the team searched published literature to locate studies reporting Lyme infection of ticks found feeding on birds. The global search yielded 102 studies, including data from ticks found on 183 bird species; of these, 91 carried ticks that tested positive for Borrelia burgdorferi. These bird species are considered ‘competent’ reservoir species because they are known to infect feeding ticks with Borrelia burgdorferi. Species flagged have a broad range, reaching across the Americas, Africa, Asia, and Oceania.

Next, machine learning was used to compare traits of competent bird species with 4691 other bird species. Data included information on life history features like diet composition, foraging location, body size, lifespan, reproductive rate, and fledgling age, as well as geographical information like migration distance, global dispersal, and maximum elevation. They also looked at baseline corticosterone—the stress hormone in birds—which can influence susceptibility to infection.

New study identifies bird species that could spread ticks and Lyme disease

The model identified birds that were known to spread Lyme to ticks with 80% accuracy, and revealed 21 that should be prioritized for surveillance based on sharing traits with known competent species. High-risk species tend to have low baseline corticosterone, breed and winter at high latitudes and low elevations, are broadly distributed, and occur on either extreme of the pace-of-life continuum (species that breed early and die young, or breed late and are longer lived).

Species from the genus Turdus, commonly known as true thrushes, were found to have a significantly greater likelihood of competence compared to other taxa. This finding suggests that thrushes might be the riskiest bird species for Lyme transmission. Passerines, or perching birds, also tended to have higher competence, as did birds that primarily eat seeds and those that forage on the ground—a behavior that would put them in reach of questing ticks.

Identifying Lyme-competent bird species could have direct implications for our health. Tickborne diseases, especially Lyme disease, can be difficult to diagnose. Knowing where ticks and the diseases they carry are spreading can help medical practitioners prepare for diagnosis and treatment, improving health outcomes for patients.

Due to climate change, the breeding ranges of many birds are shifting north. As spread into higher latitudes, so do ticks and pathogens. Some have taken up full or part-time residence in cities and suburbs. Birds that can succeed in developed environments, especially those that are overwintering in these new places in close proximity to people, increase residents’ risk of contracting a tickborne disease.

Becker says, “Birds don’t spread Lyme directly to people, but they can carry infected ticks to new locations with no history of Lyme occurrence. A could drop off a bird and into a garden or yard, where it could later bite and infect a person. If local medical practitioners are unfamiliar with Lyme symptoms, proper diagnosis could be delayed. Identifying where ticks are spreading could improve medical response to Lyme and other tickborne diseases.”

Han concludes, “These findings remind us that pathogen competence varies tremendously, even among animals of the same family. Machine learning techniques allow us to analyze animal traits and help us predict risky species on a global scale—not only for Lyme, but for other tickborne and zoonotic diseases that involve multiple host . These predictions could provide crucial information to guide early interventions, prevent disease spillover, and protect our health.”

Explore further:  Model predicts where ticks, Lyme disease will appear next in Midwest states

More information: Daniel J. Becker et al, The macroecology and evolution of avian competence for Borrelia burgdorferi, (2020). DOI: 10.1101/2020.04.15.040352

Journal information: Global Ecology and Biogeography

Provided by Cary Institute of Ecosystem Studies

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For more:  https://madisonarealymesupportgroup.com/2018/11/07/ticks-on-the-move-due-to-migrating-birds-and-photoperiod-not-climate-change/

https://madisonarealymesupportgroup.com/2021/01/07/predicting-current-future-distribution-of-western-black-legged-tick-across-the-western-us/

https://madisonarealymesupportgroup.com/2021/01/26/mapping-lyme-cdc-reveals-distribution-of-lyme-disease-causing-bacteria-by-county/

https://madisonarealymesupportgroup.com/2021/01/14/cdc-updates-annual-estimate-of-those-diagnosed-treated-for-lyme-disease-from-300000-to-476000/

https://madisonarealymesupportgroup.com/2021/01/18/lyme-disease-much-more-common-than-previously-thought-study-shows/

Category:

Lyme, research, Ticks

Pediatric Lyme Disease Biobank, USA, 2015–2020: An Innovative Approach to Understanding Pediatric Lyme Disease

https://wwwnc.cdc.gov/eid/article/26/12/20-0920_article

Pediatric Lyme Disease Biobank, United States, 2015–2020

Lise E. NigrovicComments to Author , Desire N. Neville, Fran Balamuth, Michael N. Levas, Jonathan E. Bennett, Anupam B. Kharbanda, Amy D. Thompson, John A. Branda, Aris C. Garro, and the Pedi Lyme Net Working Group
Author affiliations: Boston Children’s Hospital, Boston, Massachussetts, USA (L.E. Nigrovic); Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA (D.N. Neville); Milwaukee Children’s Hospital, Milwaukee, Wisonsin, USA (F. Balamuth); Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA (M.N. Levas); Nemours/Alfred I. duPont Children’s Hospital, Wilmington, Delaware, USA (J.E. Bennett, A.D. Thompson); Children’s Minnesota, Minneapolis, Minnesota, USA (A.B. Kharbanda); Massachusetts General Hospital, Boston (J.A. Branda); Rhode Island Hospital, Providence, Rhode Island, USA (A.C. Garro)

Abstract

In 2015, we founded Pedi Lyme Net, a pediatric Lyme disease research network comprising 8 emergency departments in the United States. Of 2,497 children evaluated at 1 of these sites for Lyme disease, 515 (20.6%) were infected. This network is a unique resource for evaluating new approaches for diagnosing Lyme disease in children.

https://globallymealliance.org/an-innovative-approach-to-understanding-pediatric-lyme-disease/

An Innovative Approach to Understanding Pediatric Lyme Disease

by Mayla Hsu, Ph.D., Director of Research and Science, GLA

In the late 1970s, children presenting with arthritic symptoms were among the first cases of what is now known to be Lyme disease. Almost 50 years later, the incidence among kids remains high. Despite an estimated 400,000 new cases of Lyme disease annually in the U.S., with more than half being children, focused research to develop accurate diagnostics and improved treatments for them is lacking.

Global Lyme Alliance (GLA) funded the Pedi Lyme Net led by Lise Nigrovic, M.D., M.P.H., of the Division of Emergency Medicine at Boston Children’s Hospital.

To address this critical need, Global Lyme Alliance (GLA) funded the Pedi Lyme Net led by Lise Nigrovic, M.D., M.P.H., of the Division of Emergency Medicine at Boston Children’s Hospital. Dr. Nigrovic established Pedi Lyme Net, a network of seven children’s hospital emergency departments in five Lyme-endemic states. After obtaining informed parental consent, this network of pediatricians collects patient specimens from children suspected of having Lyme disease, or their clinical mimics, for testing and further research within Pedi Lyme Net.

Currently, the standard Lyme disease diagnostic blood test is problematic. Besides its inaccuracy in detecting early disease, the test also cannot distinguish new or persistent infections. Developing better diagnostic tests relies on having patient samples, alongside careful patient histories. An added feature of Pedi Lyme Net is that samples are also collected from control patients who visit the emergency room for non-Lyme related conditions, such as accidental fractures or lacerations. Altogether, the goal is to build a comprehensive data set for research.

Dr. Nigrovic recently published an article that describes Pedi Lyme Net’s Lyme disease screening results. Between June 2015 to January 2020, blood samples were obtained from 2,497 Lyme disease symptomatic patients and 377 asymptomatic control patients. All were analyzed with the C6 Lyme disease enzyme immunoassay, and those that were positive or equivocal were further tested with Western immunoblot, the standard Lyme disease test.

Among the 515 patients who tested positive for Lyme disease, the median age was 8, and 67% were boys, which correlates with national Lyme disease incidence statistics. The most common symptoms of those diagnosed with Lyme disease were fever, headache, facial palsy, and arthritis. These symptoms were used to classify Lyme patients into early, early disseminated, and late stage disease.

Among the Lyme-positive patients:

  • 8.9% had erythema migrans (EM) skin rashes alone
  • 89.5% had positive blood test results
  • 1.6% had both

These results show that the classic EM rash was only present in a minority of Lyme disease patients, and indicates that blood test results identify many more patients than skin rash alone. It also shows that many patients who are positive by blood test lack the skin rash.

Interestingly, only 15.6% of Lyme disease patients and their parents recalled a tick bite in the past year.

This is further evidence that tick bites are often missed, and reinforces that tick bite prevention is an important first step to reduce infections. A more in-depth study led by Dr. Nigrovic addressing this question shows the unreliability of tick bite history at predicting Lyme disease in children.

Pedi Lyme Net is a unique resource for advancing Lyme disease research. Besides being exclusively composed of pediatric samples, it also includes control pediatric samples, which are more appropriate as comparators than adults. Children’s bodies and physiology are not merely small versions of those of adults. Also, because the Pedi Lyme Net enrolls patients from emergency rooms, the samples are from symptomatic individuals, whose specific clinical presentations may be important information in understanding the basic science of disease. Finally, patient samples are from Lyme-endemic areas across the U.S., ensuring broad representation of pediatric Lyme patients.

Further studies of samples collected in the Pedi Lyme Net may involve understanding how different disease stages manifest in children, along with varied inflammatory biomarkers or immune correlates. One limitation of this study is the Western immunoblotting blood test may have given false negative results to some individuals who, early in disease, might not have developed the antibodies detected by this test. Follow-up calls to test later time points were done by Pedi Lyme Net researchers. And, since samples were banked, they can be tested with newly emerging diagnostic technologies in pursuit of designing tests with higher accuracy. Eventually, other tick-borne co-infections may also be studied in this population, since ticks frequently transmit not only Borrelia burgdorferi, the bacteria that cause Lyme disease, but other pathogens as well.

GLA is proud to support Pedi Lyme Net as it expands under the leadership of Dr. Nigrovic. This is an important research initiative that will lead to improved patient diagnostics and care. To date, Pedi Lyme Net data has led to over 10 peer-reviewed publications and scientific presentations.

Learn more about preventing Lyme in kids.
Blog: Kids and Lyme Disease: Cognitive Symptoms and School

Category:

Lyme, research, Testing, Ticks

Mapping Lyme: CDC Reveals Distribution of Lyme Disease-Causing Bacteria by County

https://entomologytoday.org/2021/01/22/mapping-lyme-cdc-reveals-distribution-of-lyme-disease-causing-bacteria-county-ticks/

Mapping Lyme: CDC Reveals Distribution of Lyme Disease-Causing Bacteria by County

U.S. distribution of Lyme disease-causing bacteria in ticks

A new study by CDC researchers maps the distribution of Lyme disease spirochetes, Borrelia burgdorferi sensu stricto and Borrelia mayonii, in host-seeking blacklegged ticks (Ixodes scapularis, in the eastern U.S.) or western blacklegged ticks (I. pacificus, in the western U.S.), relative to the previously reported distribution of these vector species. Ticks were considered present in a county if at least one tick was recorded. Counties where ticks have been reported without records of infection may be reported as such either if ticks were not tested or if the pathogen was not detected in tested samples. (Image originally published Fleshman et al 2021, Journal of Medical Entomology)

By Melissa Mayer

Excerpts from article (See link for article):

The team limited their search to data reported after 2000 that used advanced detection methods to identify spirochetes, since only B. burgdorferi s.s. or B. mayonii are confirmed to cause Lyme disease in the U.S.—and data that included related species could skew the map.

It turns out that, while vector ticks are distributed broadly, ticks carrying Lyme disease spirochetes have a more limited range. The ticks are established in 41 states (35 eastern and 6 western), but mapping revealed spirochetes in three-quarters of those eastern states and one-third of those western states. At a more local level, about 26 percent of counties where the ticks are established have records for Lyme disease spirochetes.

That news comes with some caveats, the researchers say. These numbers are a baseline and probably low. One reason is that surveillance efforts vary, with more monitoring happening in regions with more reports of Lyme disease cases. And, the team excluded records that didn’t adequately identify the spirochetes or list the county of collection.

Of course, Lyme disease isn’t the only tickborne illness in the country. “Tickborne diseases are becoming increasingly more common and widespread in the U.S.,” says Eisen. She points out that blacklegged ticks also carry pathogens that cause the relapsing fever Borrelia miyamotoi disease, anaplasmosis, babesiosis, one form of ehrlichiosis, and Powassan virus.

Reported County-Level Distribution of Lyme Disease Spirochetes, Borrelia burgdorferi sensu stricto and Borrelia mayonii (Spirochaetales: Spirochaetaceae), in Host-Seeking Ixodes scapularis and Ixodes pacificus Ticks (Acari: Ixodidae) in the Contiguous United States”

Category:

Activism, Lyme, research, Testing, Ticks