Archive for the ‘Ticks’ Category

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.

_______________________

**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/

Dogs Are Testing Positive For New Tick-Borne Bacteria

https://thebark.com/content/dogs-are-testing-positive-new-tick-borne-bacteria

New species of bacteria identified that may cause disease in dogs and humans.
By Tracey Peake, November 2020

Researchers have identified a new species of Rickettsia bacteria that may cause significant disease in dogs and humans.

This new, yet-unnamed species, initially identified in three dogs, is part of the spotted-fever group Rickettsia which includes Rickettsia rickettsii, the bacteria that cause Rocky Mountain Spotted Fever (RMSF).

(See link for article)

_______________________

**Comment**

These poor dogs suffered from loss of appetite, lethargy, lameness, painful elbows, fever, dehydration, thrombocytopenia, and abdominal tenderness among other symptoms.  While I appreciate the authors’ desire to determine tick species and geography, these details have often been used against patients by hampering diagnosis and treatment.  We must stop trying to put this into a four-cornered box.  

Ticks and animals, including birds travel everywhere taking ticks with them.  You can get infected anytime, anywhere.

Study here:  https://madisonarealymesupportgroup.com/2020/11/17/novel-rickettsia-species-infecting-dogs-united-states/

Importantly, https://madisonarealymesupportgroup.com/2019/11/14/study-shows-ticks-can-transmit-rickettsia-immediately/ ..ticks can transmit infectious Rickettsia virtually as soon as they attach to the host.

Interactions Between Borrelia Burgdorferi & Ticks

https://pubmed.ncbi.nlm.nih.gov/32651470/

Interactions between Borrelia burgdorferi and ticks

    Free PMC article

    Abstract

    Borrelia burgdorferi is the causative agent of Lyme disease and is transmitted to vertebrate hosts by Ixodes spp. ticks. The spirochaete relies heavily on its arthropod host for basic metabolic functions and has developed complex interactions with ticks to successfully colonize, persist and, at the optimal time, exit the tick. For example, proteins shield spirochaetes from immune factors in the bloodmeal and facilitate the transition between vertebrate and arthropod environments. On infection, B. burgdorferi induces selected tick proteins that modulate the vector gut microbiota towards an environment that favours colonization by the spirochaete. Additionally, the recent sequencing of the Ixodes scapularis genome and characterization of tick immune defence pathways, such as the JAK-STAT, immune deficiency and cross-species interferon-γ pathways, have advanced our understanding of factors that are important for B. burgdorferi persistence in the tick. In this Review, we summarize interactions between B. burgdorferi and I. scapularis during infection, as well as interactions with tick gut and salivary gland proteins important for establishing infection and transmission to the vertebrate host.

    What Makes Ticks Tick: Researcher Studies Their Every Move

    https://www.lymedisease.org/what-makes-ticks-tick/

    What makes ticks tick: researcher studies their every move

    Weaponized Ticks/Human Experiments/The Lyme Disease Truth With Kris Newby

    http://  Approx. 55 Min

    Dec. 14, 2020

    Weaponized Ticks/Human Experiments/The Lyme Disease Truth with Kris Newby

    With Chris Mathieu

    Forbidden Knowledge News

    The censorship mentioned is very real.  I was just kicked off LinkedIn.  It’s going to be harder to find information that does not follow the accepted narrative spun out by our public ‘authorities’ and main stream media whom have severe conflicts of interest.

    We are indebted to all of Newby’s work.  She is behind the documentaries “Under Our Skin”and “Emergence” which accurately portray what Lyme/MSIDS patients experience.  I diagnosed myself and my husband by watching these.  

    We are still waiting to hear the results of an investigation into all of this (don’t hold your breath – you will pass out first):  https://madisonarealymesupportgroup.com/2020/07/22/house-passes-chris-smith-measure-to-probe-if-government-turned-ticks-into-bioweapons/

    For more:  

    Lastly, here’s a short piece of Willy Burgdorfer shortly before he died where he candidly explains Lyme/MSIDS is far from a simple illness and is nearly impossible to find.

    http://

    Dec. 1914

    There’s many similarities between how Lyme/MSIDS AND COVID-19 have been mishandled.

    For more:  

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