Archive for the ‘Ticks’ Category

Powassan Virus in Children

https://danielcameronmd.com/powassan-virus-in-children/

CASE REPORTS: POWASSAN VIRUS IN CHILDREN

powassan-virus-in-children

Powassan virus (POWV) is a tick-borne illness that can cause severe encephalitis. Animal studies have shown the virus can be transmitted to humans following a tick bite within 15 minutes. However, the cases described in a recent article “Powassan Virus Encephalitis Following Brief Attachment of Connecticut Deer Ticks” by Feder et al. “strongly suggest that infected ticks may also rapidly transmit POWV to people.” [1]

Powassan virus in children is not often reported. In this article, the authors describe two cases involving infants with tick bites who developed Powassan virus encephalitis. As the authors point out, their case report not only demonstrates that rapid transmission of POWV can occur, but it highlights the importance for parents/caregivers to follow tick bite prevention methods. In these cases, adults unknowingly exposed their children to ticks infected with Powassan virus.

Powassan virus encephalitis in two children

A 5-month-old child was hospitalized after experiencing fevers for two days, along with vomiting and facial twitching which progressed to seizures. Two weeks prior to the onset of symptoms, a tick was removed from the infant’s forehead. Test results for the Powassan virus were positive.

The second case involved a 2-month-old child who presented with a fever and listlessness for one day. “He then developed left sided focal seizures (rhythmic left arm twitching, facial deviation to the left, and tongue thrusting with lip smacking),” the authors write.

A tick was removed from the infant’s arm approximately two weeks before he was hospitalized. The parents believed the father or dog had brought a tick into the house following a walk outside. The tick was not engorged and had not fed for more than 24 hours, the authors report.

READ MORE: No neurologic damage in 3 children with Lyme disease and Powassan virus

“POWV infection was confirmed by a positive PRNT on both serum and CSF,” the authors explain.

“POWV infection of humans has been notable for the severity of both the acute disease and the long-term sequelae.”  In fact, chronic illness occurs in approximately 50% of patients, the authors report, with symptoms including hemiplegia [paralysis on one side of the body], wasting, personality changes, and headaches.

Adults unknowingly expose children

“The circumstances under which the 2 children reported here acquired infection require some comments that are pertinent to prevention of future cases,” the authors write.

Infants typically would not be exposed to tick bites. These cases demonstrate the importance in adopting tick bite prevention methods. Feder points out, “in both of our cases, parents presumably brought ticks into their homes after outdoor activities.”

In the first case, the father had been out walking in the woods and brushed off multiple ticks outside. He presumably brought a tick into the home. In the second case, a father had been walking outside with a dog. The family believed either the father or dog had brought the tick into the house.

Parents/caregivers should be educated about several preventative measures:

  • “Outdoor clothing may prevent access to skin, but the ticks may remain undetected and will crawl off the person when body heat is reduced, such as when a coat is removed.”
  • Parents should check for ticks more than once. “Because of searching for an optimal skin site, ticks will not immediately attach to a person.”
  • “Parents should be educated about the need to treat outdoor clothing with Permethrin, an effective mode of preventing tick bites … Contact with treated fabric will kill all ticks within 2 hours.”
  • “Parents should also be educated about the possibility that dogs could bring ticks into homes, and that these animals should be inspected after every outdoor exposure.”
  • “Most anti-tick preventives only work after a tick has attached to a dog [the tick needs to ingest the chemical], although there are collars that are impregnated with Permethrin or similar products that might repel or kill ticks.”

Editor’s Note:  Although the authors did not discuss treatment of the two infants, both recovered.

References:
  1. Feder HM, Telford S, Goethert HK, Wormser GP. Powassan Virus Encephalitis Following Brief Attachment of Connecticut Deer Ticks. Clin Infect Dis. 2020.

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**Comment**

Despite being told that all of this is “rare,” please remember that Powassan, along with numerous other tick-borne infections are not reportable illnesses; therefore, nobody has a clue about prevalence. Coppe Lab out of Wisconsin emphatically states Powassan is NOT rare:

For the last two years, Coppe Laboratories has dedicated a significant amount of time and resources to dispelling the myth that infection with Powassan virus, a virus transmitted by tick bite, is rare. The Centers for Disease Prevention and Control (CDC) reports only 100 cases of Powassan virus infection in the United States in the last 10 years. Indeed, that statistic gives the illusion that Powassan infection is rare. However, did you know that the only infections reported to CDC are those that are life-threatening, particularly cases causing severe inflammation of the brain like the case reported in LiveScience? Coppe has published three new papers in the last year that clearly show Powassan virus infection is not rare are at all,and until testing for this virus is included as part of tick-borne disease screening panels infections will continue to be underreported. Coppe’s Powassan Guide, which can be downloaded from the website, summarizes the findings from both tick and human Powassan prevalence studies, as well as defining the patient populations that would benefit most from Powassan testing.

For more:

Tick prevention:

https://madisonarealymesupportgroup.com/2019/04/12/tick-prevention-2019/

https://madisonarealymesupportgroup.com/2020/07/20/ticks-lyme-disease-information-for-families/

Remember, pets are called “Tick taxies” for a reason:  https://madisonarealymesupportgroup.com/2017/08/12/pet-owners-have-nearly-2-times-the-risk-of-finding-ticks/

Ticks Produce Antibiotic That Protects Them From Human Skin Bacteria

https://www.ucsf.edu/news/2020/12/419216/lyme-disease-ticks-produce-antibiotic-protects-them-human-skin-bacteria

Lyme Disease Ticks Produce Antibiotic That Protects Them From Human Skin Bacteria 

Gene Provides Protection During the ‘Really Risky Sport’ of Feeding on Blood

By Vicky Stein

Dec. 10, 2020

Ticks live dangerous lives, spending most of their time questing for a host across wildly different habitats and seasons. Once they encounter a reptile, bird, or a mammal like us, they become intimately connected with it – and all of its bacteria and viruses – for days on end. Though ticks are notorious for transmitting pathogens such as the Lyme disease bacterium, how does their immune system keep them safe from contracting pathogens themselves?

In a study published in Cell on Dec. 10, 2020, a research team led by UC San Francisco’s Seemay Chou, PhD, provides an answer to this mystery. The work, Chou said, reveals that ticks are exquisitely constructed blood-sucking machines, with immune systems specially tailored for this unique lifestyle. Their defense strategies are carried out both inside and outside their bodies, she said, killing even our resident microbes as they feed on us.

Five years ago, in work published in Nature, Chou and colleagues found a gene in tick DNA that produces a microbe-killing protein. In the new study, senior author Chou leveraged that discovery to show that, without the protection offered by this gene, ticks are vulnerable to infection with Staphylococcus, one of the most common types of “commensal” bacteria. These bacterial species carpet our skin surface, but generally don’t harm us.

“This is the first time anybody’s identified a natural pathogen of ticks, and established a mechanism for it,” said Chou, an assistant professor of biochemistry and biophysics at UCSF and Chan Zuckerberg Biohub Investigator whose work is supported by a Sanghvi-Agarwal Innovator Award. “Ticks pass more microbes to humans, livestock, and other animals than any other known arthropod, but now their own vulnerabilities are on the table.”

The tick gene in question, known as dae2, originally evolved in bacteria, where the protein it encoded worked as an offensive agent against other bacteria. Several hundred million years ago, right around the time that the ancestors of some of today’s ticks began feeding on blood, those ticks “stole” the gene, making it a part of their own genomes.

According to Chou, dae2 represents a rare example of so-called horizontal transfer of a gene from a bacterium to an animal, and the fact that this transfer occurred as blood feeding evolved might not be a coincidence.

“I’ve always wondered why blood-feeding is even a thing,” said Chou. Not only does blood take a lot of energy to process into useful food, but biting on and attaching to much larger animals “seems inherently like a really risky sport.” With a strong, dae2-enhanced immune system, she said, tick species could have flourished, expanding to fill their bloody ecological niche.

When she first began working with dae2 in Ixodes scapularis, the deer tick, Chou thought ticks’ acquisition of the gene must have something to do protection against tick-dwelling bacteria like B. burgdorferi, which causes Lyme disease in humans and other animals. In experiment after experiment, she and members of her lab tried to find a mechanism for the gene to inhibit this bacterium, until they had an epiphany.

It makes no sense for ticks to have acquired this immune effector to kill off the bacteria that it’s most notoriously known to stably associate with,” she said. So instead, the lab began the much more complicated process of looking for bacteria that ticks are not known to live with peaceably. When members of the lab, including co-first authors Beth M. Hayes, PhD, and Atanas D. Radkov, PhD, proposed exploring the idea that dae2 might protect against Staphylococcus bacteria, “I actually pooh-poohed the idea – I bet a beer against it,” said Chou.

But after the dae2 protein was introduced to a cloudy vial of cultured staph bacteria, Chou was shocked. “The tube went from murky to clear in like, a second,” she said. “I was kind of glad to have lost this bet. After two years of trying to figure out what was going on, it all started falling together.”

Now the team had a direction. As detailed in the Cell paper, the researchers embarked on a series of wide-ranging experiments, first comparing dae genes in a range of tick species with the bacterial tae genes from which they were originally derived. With these comparisons and high-resolution protein structures in hand, they used computer models of these proteins to compare their shape and orientation when they came in contact with molecules found in bacterial cell walls.

Next, they moved on to testing the proteins directly against actual molecules extracted from bacterial cell walls. While dae2 protein could quickly degrade this material, taken from common skin bacteria, Tae2 could not. Dae2 also killed a wide a range of bacteria, notably three very common species that are symbiotic partners of human skin.

The researchers then investigated whether dae2 could reach our skin. They found dae2 protein in tick salivary glands and saliva, and observed that, from there, the protein was transferred to the ticks’ blood meal hosts.

When Chou and the team cancelled out the effects of dae2 in a group of blood-fed ticks, using a technique known as RNA interference in some mice and immunizing other mice to the protein, they found higher levels of Staphylococcus bacteria than in ticks with the functioning protein. These ticks also stayed smaller and gained less weight than ticks with dae2.

“This is a new way of thinking about how ticks interact with microbes,” said Chou. Microbes borne by ticks cause disease in humans and animals worldwide, but that’s only half the story, she said. “Their commensal is our pathogen, and our commensal is their pathogen.”

Authors: Joining Chou, Hayes, and Radkov were Fauna Yarza, Sebastian Flores, Jungyun Kim, Ziyi Zhao, and Victoria Bowcut, all of UCSF; Katrina W. Lexa, of Denali Therapeutics, Liron Marnin and Joao H.F. Pedra of the University of Maryland School of Medicine; and Jacob Biboy and Waldemar Vollmer of Newcastle University.

Funding: The research was funded in part by grants from the NIH (R01AI132851, R01AI134696, R01AI116523), Research Councils UK (EP/T002778/1), the UCSF Program for Breakthrough Biomedical Research, and the Sandler Foundation. Additional support came from the Chan Zuckerberg Biohub, the Johnson & Johnson WiSTEM2D Award, the Pew Biomedical Research Foundation, and the Sangvhi-Agarwal Innovation Award. Yarza was supported by the National Science Foundation (1650113) and a grant to UCSF from the Howard Hughes Medical Institute through the James H. Gilliam Fellowships for Advanced Study program.

Disclosures: The authors declare no competing interests.

The University of California, San Francisco (UCSF) is exclusively focused on the health sciences and is dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. UCSF Health, which serves as UCSF’s primary academic medical center, includes top-ranked specialty hospitalsand other clinical programs, and has affiliations throughout the Bay Area.

Diagnosing and Treating Lyme: Podcast

https://canlyme.com/2020/09/02/new-podcast-dr-ralph-hawkins-shares-his-medical-expertise-and-hands-on-experience-diagnosing-and-treating-lyme-disease/

New Podcast: Dr. Ralph Hawkins shares his medical expertise and hands on experience diagnosing and treating Lyme disease

https://www.lookingatlyme.ca/2020/09/dr-ralph-hawkins-explains-the-challenges-of-detecting-lyme-disease-through-testing/  Podcast here

September 1st, 2020

In this episode of Looking at Lyme, Sarah speaks with Internal Medicine Specialist and Canadian Lyme expert, Dr. Ralph Hawkins. Dr. Hawkins has been treating Lyme patients in Canada for many years, gaining a wealth of knowledge about the disease. He recounts his introduction to the shortcomings of Lyme disease testing in Canada while treating a patient with a history of multiple previous tick bites, many common symptoms of Lyme disease, but a negative Canadian Lyme test. Dr. Hawkins had the patient’s blood tested at a University Lab in New York, revealing test band patterns consistent with Lyme disease. He referred this patient to Infectious Diseases colleagues for treatment, but quickly found out that the diagnosis of late stage Lyme disease is not generally recognized by the Infectious Diseases community. He was advised to not only drop this case, but to avoid other similar cases. The recommendation to avoid such patients sparked Dr. Hawkins’ curiosity and interest, inspiring him to dive deeply into the research and history of Lyme disease.

Dr. Hawkins walks us through the current testing protocols for Lyme disease in Canada, explaining why some patients with Lyme disease receive a negative test result. He explains the difference between current testing in Canada and tests done in other parts of the world, highlighting a test done in Germany that he often relies on when diagnosing patients, and touching on the approval process for such tests by Health Canada. Without better testing, Canadians with Lyme disease continue to fall through the cracks of the healthcare system. Dr. Hawkins refers to a recent analysis of Lyme diagnosis in Canada in which researchers speculate that in some areas, two thirds of Lyme cases go unreported. With this in mind he points out that, in light of the severity of untreated Lyme disease, a trial period of treatment for Lyme disease would be valid for certain patients with negative Canadian serology. Thank you Dr. Hawkins for walking with us down the bumpy road of Lyme disease testing and treatment in Canada!

Resources and notes

For more:  

Putting Lyme Disease on the Map

https://thetyee.ca/News/2020/08/31/Putting-Lyme-Disease-Map/

Putting Lyme Disease on the Map

BC says the debilitating disease isn’t a risk in much of the province. Advocates say that’s a myth and it’s putting people at risk.
Amanda Follett Hosgood 31 Aug 2020 | TheTyee.ca

On the BC Centre for Disease Control’s website, a map shows where Lyme disease exists in the province. It highlights isolated areas in the south, mostly focused around Vancouver Island and the Lower Mainland, extending as far north as Clearwater. In the north, there are pockets of “potential” around Williams Lake and in coastal areas.*

But the map, dated 2019, leaves vast swaths unmarked and the impression that Lyme disease is not a risk from tick bites in most of the province.** As a result, it can be hard to get your doctor to listen if you have Lyme symptoms and even harder to get a conclusive diagnosis.

Officially, Lyme, spread by bites from infected ticks, has only been positively diagnosed a handful of times in the northern three-quarters of the province.*** But some experts say that’s because its myriad symptoms — everything from joint pain to facial paralysis — are often misdiagnosed as illnesses like chronic fatigue, fibromyalgia, multiple sclerosis and early dementia. (See link for article)

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**Comment**

Great article highlighting how tick maps have only served to hurt patients for over 40 years.  It is high time researchers and doctors understand the limitations of these maps and while interesting, should NEVER be used to diagnose patients.  

But Muhammad Morshed, a clinical microbiologist with the BCCDC, says private labs are notorious for inaccurate results, with false positives reported up to 50 per cent of the time.

This belief is a HUGE problem.  The CDC used to have a blurb right on their website calling CLIA-certified labs “home-brewed.”  From the top down, our public health ‘authorities’, which by the way own patients on Lyme tests, are educating doctors that these smaller specialty labs, which have to jump through the toughest lab standards on the planet to be certified, are substandard.  Please see:  https://madisonarealymesupportgroup.com/2019/06/28/who-owns-the-elisa-patents/

As to ticks – the idea they only exist in certain areas needs to die.  Perhaps that used to be the case, but migrating birds and rodents are taking them everywhere.  Not to mention :  https://madisonarealymesupportgroup.com/2018/11/07/ticks-on-the-move-due-to-migrating-birds-and-photoperiod-not-climate-change/

Not to mention ticks have been dropped from airplanes:  https://madisonarealymesupportgroup.com/2019/07/31/tick-expert-admits-to-working-on-ticks-dropping-them-out-of-airplanes/

Tick Bite – Letter to the Editor

https://www.bmj.com/content/370/bmj.m3029/rr-3

Tick bite

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3029 (Published 13 August 2020)Cite this as: BMJ 2020;370:m3029

21 August 2020
Habib ur Rehman
Physician
Saskatchewan Health Authority
Suite 100, 2550 12th Ave, Regina, SK, S4P 3X1, Canada

Rapid Response:

Re: Tick bite

Dear Editor

Razai et al, in their consultation on tick bite, missed an important message to learners (1).

  • As the incidence of Lyme disease increases, there is also greater likelihood of co-transmission of other pathogens carried by I scapularis and I pacificus ticks.
  • Since symptoms of these co infections are non-specific and may overlap with Lyme’s disease, accurate diagnosis becomes more difficult. It is therefore important that a high level of suspicion is maintained for these co-infections so patients receive accurate diagnosis and adequate treatment.

The most common infectious agents transmitted by Ixodes species ticks in North America that have the potential for co-infection with B burgdorferi are Anaplasma phagocytophilum, Babesia species, deer tick (Powassan) virus, Borrelia miyamotoi, and the Ehrlichia muris–like agent (2).

A phagocytophilum is transmitted by the same Ixodes ticks as B burgdorferi in the United States and causes fever, chills, headache, myalgia, and fatigue arising 1 to 3 weeks following tick exposure. Most cases are mild and self-limited. However, severe manifestations may include respiratory failure, adult respiratory distress syndrome, peripheral neuropathy, rhabdomyolysis, acute renal failure, pancreatitis, and coagulopathies.

It has been found that in Wisconsin, approximately 3% of I scapularis ticks examined were co-infected with B burgdorferi and A phagocytophilum (3). A similar study in 11,000 ticks in public parks of New York State’s Hudson Valley Region found that co-infection rates of nymphs and adults were 0.5% and 6.3%, respectively (4).

The frequency of humans with Lyme disease simultaneously co-infected with A phagocytophilum from various studies ranges from 2% to 10% (5,6). Similirly, Babesiosis is transmitted through the bite of infected I scapularis and I pacificus ticks. Most patients are asymptomatic or have mild, self-limited disease but may be complicated by renal failure, acute respiratory distress, and shock.

In a study of patients with Lyme disease from southern New England, approximately 10% were co-infected with babesiosis (7).

Unlike Lyme disease and Anaplasmosis, doxycycline is not an effective treatment of babesiosis and requires atovaquone and azithromycin or combination of clindamycin with quinine, making it imperitive to consider this diagnosis in mind in patients with tick bite.

Of the 3 species of Ehrlichia in United States, only E muris–like (EML) agent is transmitted by I scapularis is the vector of this emerging pathogen(8).

Possible co-infections should be considered in any patients who are diagnosed with tick bite or Lyme disease, especially those who have unexplained leukopenia, thrombocytopenia, or anemia, or who fail to respond to treatment for Lyme’s disease.

References:
1- Razai MS, Doerholt K, Galiza E, Oakeshott P. Tick bite. BMJ 2020;370:m3029
2- Caulfield AJ, Pritt BS. Lyme disease Coinfections in the United States. Clin Lab Med 2015;35:827–846.
3- Lee, X, Coyle DR, Johnson DK, et al. Prevalence of Borrelia burgdorferi and Anaplasma phagocytophilum in Ixodes scapularis (Acari: Ixodidae) nymphs collected in managed red pine forests in Wisconsin. J Med Entomol 2014;51:694-701.
4- Prusinski MA, Kokas JE, Hukey KT, et al. Prevalence of Borrelia burgdorferi (Spoirochets: Spirochaetaceae), Anaplasma phagocytophilum (Rickettsiales: Anaplasmataceae), and Babesia microti (Piroplasmida: Babesiidae) in Ixodes scapularis (Acari: Ixodidae) collected from recreational lands in the Hudson Valley Region, New York State. J Med Entomol 2014;51:226-36.
5- Horowitz HW, Aguero-Rosenfeld ME, Holmgren D, et al. Lyme disease and human granulocytic anaplasmosis coinfection: impact of case definition on coinfection rates and illness severity. Clin Infect Dis 2013;56;93-9.
6- Steere AC, McHugh G, Suarez C, et al. Prospective study of coinfection in patients with erythema migrans. Clin Infect Dis 2003;36:1078-81.
7- Krause PJ, Telford SR, Spielman A, et al. Concurrent Lyme disease and babesiosis – evidence for increased severity and duration of illness. JAMA 1996;275:1657-60.
8- Pritt BS, McFadden JD, Stromdah E, et al. Emergence of a novel Ehrlichia sp. agent
pathogenic for humans in the Midwestern United States. 6th International Meeting
on Rickettsiae and Rickettsial Diseases. Heraklion (Greece), June 5–7, 2011.

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**Comment**

This important letter to the editor highlights many contentious issues Lyme/MSIDS patients have to muddle through.  From where I sit, I disagree with the author’s statements that these infections are ‘mild and self-limited’, but I deal with sick people – not healthy.  If there’s one thing I DO know, it’s that these infections have been downplayed for far too long, and it’s been a real problem.  Patients haven’t been taken seriously for over 40 years!

The consideration of coinfections; unfortunately, is not common in mainstream medicine regarding Lyme/MSIDS.  They still treat this as a one germ disease with doxycycline curing it, when nothing could be further from the truth:  https://madisonarealymesupportgroup.com/2018/10/30/study-shows-lyme-msids-patients-infected-with-many-pathogens-and-explains-why-we-are-so-sick/