Archive for the ‘Transmission’ Category

2018 Review of Previous Pathogen Transmission Time Studies in Deer Ticks

https://www.ncbi.nlm.nih.gov/pubmed/29398603

2018 Mar;9(3):535-542. doi: 10.1016/j.ttbdis.2018.01.002. Epub 2018 Jan 31.

Pathogen transmission in relation to duration of attachment by Ixodes scapularis ticks.

Abstract

The blacklegged tick, Ixodes scapularis, is the primary vector to humans in the eastern United States of the deer tick virus lineage of Powassan virus (Powassan virus disease); the protozoan parasite Babesia microti (babesiosis); and multiple bacterial disease agents including Anaplasma phagocytophilum (anaplasmosis), Borrelia burgdorferi and Borrelia mayonii (Lyme disease), Borrelia miyamotoi (relapsing fever-like illness, named Borrelia miyamotoi disease), and Ehrlichia muris eauclairensis (a minor causative agent of ehrlichiosis).

With the notable exception of Powassan virus, which can be transmitted within minutes after attachment by an infected tick, there is no doubt that the risk of transmission of other I. scapularis-borne pathogens, including Lyme disease spirochetes, increases with the length of time (number of days) infected ticks are allowed to remain attached. This review summarizes data from experimental transmission studies to reinforce the important disease-prevention message that regular (at least daily) tick checks and prompt tick removal has strong potential to reduce the risk of transmission of I. scapularis-borne bacterial and parasitic pathogens from infected attached ticks.

The most likely scenario for human exposure to an I. scapularis-borne pathogen is the bite by a single infected tick. However, recent reviews have failed to make a clear distinction between data based on transmission studies where experimental hosts were fed upon by a single versus multiple infected ticks. A summary of data from experimental studies on transmission of Lyme disease spirochetes (Bo. burgdorferi and Bo. mayonii) by I. scapularis nymphs indicates that the probability of transmission resulting in host infection, at time points from 24 to 72 h after nymphal attachment, is higher when multiple infected ticks feed together as compared to feeding by a single infected tick.

In the specific context of risk for human infection, the most relevant experimental studies therefore are those where the probability of pathogen transmission at a given point in time after attachment was determined using a single infected tick. The minimum duration of attachment by single infected I. scapularis nymphs required for transmission to result in host infection is poorly defined for most pathogens, but experimental studies have shown that Powassan virus can be transmitted within 15 min of tick attachment and both A. phagocytophilum and Bo. miyamotoi within the first 24 h of attachment. There is no experimental evidence for transmission of Lyme disease spirochetes by single infected I. scapularis nymphs to result in host infection when ticks are attached for only 24 h (despite exposure of nearly 90 experimental rodent hosts across multiple studies) but the probability of transmission resulting in host infection appears to increase to approximately 10% by 48 h and reach 70% by 72 h for Bo. burgdorferi. Caveats to the results from experimental transmission studies, including specific circumstances (such as re-attachment of previously partially fed infected ticks) that may lead to more rapid transmission are discussed.

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**Comment**

There are a number of problematic issues with this study:

  1. This is a review of previous studies.  There is nothing NEW here.  
  2. It’s important to note that ticks typically carry more than just borrelia and transmission times have not taken this fact into account: https://madisonarealymesupportgroup.com/2017/05/01/co-infection-of-ticks-the-rule-rather-than-the-exception/ and https://www.lymedisease.org/lyme-basics/co-infections/about-co-infections/  Infection with more than one pathogen is associated with more severe illness.https://madisonarealymesupportgroup.com/2018/10/30/study-shows-lyme-msids-patients-infected-with-many-pathogens-and-explains-why-we-are-so-sick/  For the first time, Garg et al. show a 85% probability for multiple infections including not only tick-borne pathogens but also opportunistic microbes such as EBV and other viruses.  This is a BIG DEAL.  Finally, a study showing what we face as patients in the real world.  They also never take into account nematodes (worms), mycoplasma, tularemia, and/or Bartonella.  These are infections many if not most patients have to contend with.  Some have been bioweaponized.
  3. They assume that the most likely scenario is for a person to be bitten by one tick.  Assuming makes an ass out of u and me.  When you take into account the latest information on the Asian tick, you quickly realize the probability of coming into contact with hundreds if not thousands of ticks at one time:  https://madisonarealymesupportgroup.com/2018/09/12/three-surprising-things-i-learned-about-asian-longhorned-ticks-the-tick-guy-tom-mather/  While human infection has yet to be found in the U.S., this tick is responsible for plenty of misery in Asia:  https://madisonarealymesupportgroup.com/2018/06/12/first-longhorned-tick-confirmed-in-arkansas/  It spreads SFTS (sever fever with thrombocytopenia syndrome), “an emerging hemorrhagic fever,” but the potential impact of this tick on tickborne illness is not yet known. In other parts of the world, it has been associated with several tickborne diseases, such as spotted fever rickettsioses, Anaplasma, Ehrlichia, and Borrelia, the causative agent of Lyme Disease.
  4. While they discuss the probability of multiple tick attachment, they never discuss the issue of partially fed ticks, where spirochetes would be in the salivary glands – leading to quicker transmission: http://iai.asm.org/content/61/6/2396.full.pdf  Ticks can spontaneously detach – and the authors of this study found that they did so 15% of the time in mice.  They also state that about a tenth of questing nymphs appear distended with partially fed sub-adult ticks being common.
  5. While the current review states, “There is no experimental evidence for transmission of Lyme disease spirochetes by single infected I. scapularis nymphs to result in host infection when ticks are attached for only 24 h (despite exposure of nearly 90 experimental rodent hosts across multiple studies), this study shows transmission can occur in under 16 hours:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4278789/
  6. https://madisonarealymesupportgroup.com/2017/04/14/transmission-time-for-lymemsids-infection/  Within this video, microbiologist Holly Ahern discusses the numerous problems with animal Bb transmission studies.  Transmission Time:  Only one study done on Mice. At 24 hours every tick had transmitted borrelia to the mice; however, animal studies have proven that transmission can occur in under 16 hours and it occurs frequently in under 24 hours.  No human studies have been done and https://www.dovepress.com/lyme-borreliosis-a-review-of-data-on-transmission-time-after-tick-atta-peer-reviewed-article-IJGM  no studies have determined the minimum time it takes for transmission.  And, never forget the case of the little girl who couldn’t walk or talk after a tick bite attachment of 4-6 hours:  https://madisonarealymesupportgroup.com/2016/12/07/igenex-presentation/
  7. They continue to blame Lyme/MSIDS on the black legged tick as the sole perp when experience and studies show there’s more potential transmitters at play:  https://madisonarealymesupportgroup.com/2018/11/07/are-mosquitoes-transmitting-lyme-disease/https://madisonarealymesupportgroup.com/2016/07/23/german-study-finds-borrelia-in-mosquitos/https://madisonarealymesupportgroup.com/2019/01/17/remember-deer-keds-study-shows-bartonella-causing-deer-ked-dermatitis-in-humans/
Please, quit doing reviews of previous data and do something new using better laboratory techniques!  We don’t need MORE of the same thing.

Remember Deer Keds? Study Shows Bartonella Causing Deer Ked Dermatitis in Humans

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC525279/

. 2004 Nov; 42(11): 5320–5323.
PMCID: PMC525279
PMID: 15528732

Isolation of Bartonella schoenbuchensis from Lipoptena cervi, a Blood-Sucking Arthropod Causing Deer Ked Dermatitis

ABSTRACT

Bartonella schoenbuchensis, which commonly causes bacteremia in ruminants, was isolated from the deer ked Lipoptena cervi and was shown to localize to the midgut of this blood-sucking arthropod, causing deer ked dermatitis in humans. The role of B. schoenbuchensis in the etiology of deer ked dermatitis should be further investigated.

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**Important Take-aways**

  • Deer Ked incidental infestation in humans is well documented
  • Skin tests with deer red whole-body extracts were positive in ALL patients
  • Testing showed both immediate & delayed reactions
  • 57% of patients had elevated serum immunoglobulin E (IgE) levels
  • Deer keds appear to be an ideal vector for efficient transmission
  • The risk for transmission to humans is apparent
  • B. schoenbuchensis is most closely related to B bacilliformis, an important human pathogen also transmitted by a fly (Lutzomyia verrucarum)
  • Five variants were found – some of which may pose a larger risk than others
  • Clinical scenario of deer led dermatitis resembles a primary manifestation of Cat Scratch disease caused by B. henselae.
  • A positive delayed-type hypersensitivity skin test, like that characteristically observed for B. henselae antigens in cat scratch disease (), was also reported for all cases of deer ked dermatitis when whole deer ked extracts were used for the skin test (). Also, C3 deposits in dermal vessels like those described for deer ked dermatitis () are consistent with infection by vasculotropic bartonellae (). Taken together, certain clinical and histological characteristics of deer ked dermatitis are reminiscent of human infection by bartonellae, indicating that these pathogens should be considered possible etiological agents of deer ked dermatitis.

In summary, our study has provided evidence that deer keds collected from roe deer and red deer in Germany are commonly infected by B. schoenbuchensis. Furthermore, we have shown that B. schoenbuchensis colonizes the midgut of these arthropods and that this pathogen can be cultured at high titers from surface-sterilized arthropods. Our data suggest an important risk for the transmission of B. schoenbuchensis or related bartonellae to humans by the bite of an infected deer ked and suggest that a potential role of bartonellae in the etiology of deer ked dermatitis should be investigated further.

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**Comment**

Some of you will remember this: http://danielcameronmd.com/swarming-deer-flies-quickly-expose-people-lyme-disease-anaplasmosis/  Entomologists corrected Dr. Cameron and he published, “RETRACTION: STILL NO EVIDENCE THAT DEER FLIES OR DEER KEDS TRANSMIT B. BURGDORFERI OR A. PHAGOCYTOPHILUM.”

Yet, this 2018 study shows the deer ked does carry Bb and Anaplasma:  https://madisonarealymesupportgroup.com/2018/10/04/deer-fly-lyme-carrying-ectoparasite-on-the-move/  Although rarely reported in the United States, this vector (Lipoptena cervi, i.e. deer ked), recently has been shown to carry Borrelia burgdorferi and Anaplasma phagocytophylum from specimens collected domestically.

In 2016, Bb and Anaplasma was found via PCR in a Pennsylvanian deer led:  https://www.ncbi.nlm.nih.gov/pubmed/27860010

In 2017, Bartonella spp. was found in Polish deer ked:  https://www.ncbi.nlm.nih.gov/pubmed/29037227

Besides, Bb and Anaplasma, Bartonella has also been found in Norwegian Deer Flies: https://madisonarealymesupportgroup.com/2018/10/02/bartonella-found-in-deer-flies-deer-moose/  Bartonella, a huge player in Lyme/MSIDS, was found in 85% pools of adult wingless deer ked (n = 59). Two Bartonella lineages were identified based on phylogenetic analysis of the gltA gene and ITS region sequences.

Research is now desperately needed to connect these potential dots of how Lyme/MSIDS patients are acquiring Bartonella and other TBI’s.  We need transmission studies done on many, many vectors.  The one used by entomologists to downplay other vectors is 30 years old:  https://www.ncbi.nlm.nih.gov/pubmed/?term=3170711

And even it shows Bb infection or antibodies in various horse flies & mosquitoes.

https://madisonarealymesupportgroup.com/2017/04/18/bartonella-vectors/

https://madisonarealymesupportgroup.com/2018/11/07/are-mosquitoes-transmitting-lyme-disease/

https://madisonarealymesupportgroup.com/2016/07/23/german-study-finds-borrelia-in-mosquitos/

 

 

 

 

 

 

 

 

 

 

 

Study Shows Diminished Pathogen-specific Antibody Production in Coinfected Mice Contributing to Persistent Infection

https://www.ncbi.nlm.nih.gov/pubmed/30619263

Age-Related Differential Stimulation of Immune Response by Babesia microti and Borrelia burgdorferi During Acute Phase of Infection Affects Disease Severity.

Abstract

Lyme disease is the most prominent tick-borne disease with 300,000 cases estimated by CDC every year while ~2,000 cases of babesiosis occur per year in the United States. Simultaneous infection with Babesia microti and Borrelia burgdorferi are now the most common tick-transmitted coinfections in the U.S.A., and they are a serious health problem because coinfected patients show more intense and persisting disease symptoms. B. burgdorferi is an extracellular spirochete responsible for systemic Lyme disease while B. microti is a protozoan that infects erythrocytes and causes babesiosis. Immune status and spleen health are important for resolution of babesiosis, which is more severe and even fatal in the elderly and splenectomized patients.

Therefore, we investigated the effect of each pathogen on host immune response and consequently on severity of disease manifestations in both young, and 30 weeks old C3H mice.

At the acute stage of infection, Th1 polarization in young mice spleen was associated with increased IFN-γ and TNF-α producing T cells and a high Tregs/Th17 ratio. Together, these changes could help in the resolution of both infections in young mice and also prevent fatality by B. microti infection as observed with WA-1 strain of Babesia. In older mature mice, Th2 polarization at acute phase of B. burgdorferi infection could play a more effective role in preventing Lyme disease symptoms. As a result, enhanced B. burgdorferi survival and increased tissue colonization results in severe Lyme arthritis only in young coinfected mice. At 3 weeks post-infection, diminished pathogen-specific antibody production in coinfected young, but not older mice, as compared to mice infected with each pathogen individually may also contribute to increased inflammation observed due to B. burgdorferi infection, thus causing persistent Lyme disease observed in coinfected mice and reported in patients.

Thus, higher combined proinflammatory response to B. burgdorferi due to Th1 and Th17 cells likely reduced B. microti parasitemia significantly only in young mice later in infection, while the presence of B. microti reduced humoral immunity later in infection and enhanced tissue colonization by Lyme spirochetes in these mice even at the acute stage, thereby increasing inflammatory arthritis.

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**Comment**
Glad to see more work done on the polymicrobial nature of Lyme/MSIDS as most of us out here in Lyme-land struggle with numerous pathogens, not just Lyme (borrelia).

Key Quote:  Our findings recognize that microbial infections in patients suffering from TBDs do not follow the one microbe, one disease Germ Theory as 65% of the TBD patients produce immune responses to various microbes.”

Another problem:  

83% of all commercial tests focus only on Lyme (borrelia), despite the fact we are infected with more than one microbe.

https://madisonarealymesupportgroup.com/2018/11/17/investigating-disease-severity-in-an-animal-model-of-concurrent-babesiosis-lyme-disease/  These findings suggest that B. Burgdorferi coinfection attenuates parasite growth while B. Microti presence exacerbates Lyme Disease-like symptoms in mice.

https://madisonarealymesupportgroup.com/2018/10/02/1st-documented-case-of-girl-with-blood-stream-infection-with-bartonella-with-coinfection-of-another-bartonella-strain/

https://madisonarealymesupportgroup.com/2017/05/01/co-infection-of-ticks-the-rule-rather-than-the-exception/  Our study reveals high pathogen co-infection rates in ticks, raising questions about possible co-transmission of these agents to humans or animals, and their consequences to human and animal health. We also demonstrated high prevalence rates of symbionts co-existing with pathogens, opening new avenues of enquiry regarding their effects on pathogen transmission and vector competence.

https://madisonarealymesupportgroup.com/2018/10/11/babesia-found-in-patient-with-persistent-symptoms-following-lyme-treatment/  Because the Ixodes scapularis tick can harbour and transmit multiple parasites simultaneously, the possibility of coinfection should be considered in any patient not responding to appropriate initial medical therapy.

To date, ticks can transmit 18 and counting pathogens – ALL as devastating as Lyme: https://madisonarealymesupportgroup.com/2017/07/01/one-tick-bite-could-put-you-at-risk-for-at-least-6-different-diseases/

https://madisonarealymesupportgroup.com/2017/10/28/lyme-wars-part-5-coinfections/  (Click on NBC link for new story.  Approx 5 Min.)  All tests came back negative.  Don’t be fooled.  This stuff ISN’T RARE!  Dr. Phillips discusses how Bartonella isn’t even on the radar and is often confused with Lyme as symptoms overlap greatly.

 

Multistate Infestation with the Exotic Disease Vector Tick Haemaphysalis Longhornis – U.S., Aug. 2017- Sept. 2018

https://www.cdc.gov/mmwr/volumes/67/wr/mm6747a3.htm

Multistate Infestation with the Exotic Disease–Vector Tick Haemaphysalis longicornis — United States, August 2017–September 2018

C. Ben Beard, PhD1; James Occi, MA, MS2; Denise L. Bonilla, MS3; Andrea M. Egizi, PhD4; Dina M. Fonseca, PhD2; James W. Mertins, PhD3; Bryon P. Backenson, MS5; Waheed I. Bajwa, PhD6; Alexis M. Barbarin, PhD7; Matthew A. Bertone, PhD8; Justin Brown, DVM, PhD9; Neeta P. Connally, PhD10; Nancy D. Connell, PhD11; Rebecca J. Eisen, PhD1; Richard C. Falco, PhD5; Angela M. James, PhD3; Rayda K. Krell, PhD10; Kevin Lahmers, DVM, PhD12; Nicole Lewis, DVM13; Susan E. Little, DVM, PhD14; Michael Neault, DVM15; Adalberto A. Pérez de León, DVM, PhD16; Adam R. Randall, PhD17; Mark G. Ruder, DVM, PhD18; Meriam N. Saleh, PhD14; Brittany L. Schappach10; Betsy A. Schroeder, DVM19; Leslie L. Seraphin, DVM3; Morgan Wehtje, PhD3; Gary P. Wormser, MD20; Michael J. Yabsley, PhD21; William Halperin, MD, DrPH22 (View author affiliations)

Summary

What is already known about this topic?

Haemaphysalis longicornis is a tick indigenous to Asia, where it is an important vector of human and animal disease agents, which can result in human hemorrhagic fever and substantive reduction in dairy production.

What is added by this report?

During 2017–2018, H. longicornis has been detected in Arkansas, Connecticut, Maryland, New Jersey, New York, North Carolina, Pennsylvania, Virginia, and West Virginia on various species of domestic animals and wildlife, and from two humans.

What are the implications for public health practice?

The presence of H. longicornis in the United States represents a new and emerging disease threat. Characterization of the tick’s biology and ecology are needed, and surveillance efforts should include testing for potential indigenous and exotic pathogens.

Haemaphysalis longicornis is a tick indigenous to eastern Asia and an important vector of human and animal disease agents, resulting in such outcomes as human hemorrhagic fever and reduction of production in dairy cattle by 25%. H. longicornis was discovered on a sheep in New Jersey in August 2017 (1). This was the first detection in the United States outside of quarantine. In the spring of 2018, the tick was again detected at the index site, and later, in other counties in New Jersey, in seven other states in the eastern United States, and in Arkansas. The hosts included six species of domestic animals, six species of wildlife, and humans. To forestall adverse consequences in humans, pets, livestock, and wildlife, several critical actions are indicated, including expanded surveillance to determine the evolving distribution of H. longicornis, detection of pathogens that H. longicornis currently harbors, determination of the capacity of H. longicornis to serve as a vector for a range of potential pathogens, and evaluation of effective agents and methods for the control of H. longicornis.

H. longicornis is native to eastern China, Japan, the Russian Far East, and Korea. It is an introduced, and now established, exotic species in Australia, New Zealand, and several island nations in the western Pacific Region. Where this tick exists, it is an important vector of human and animal disease agents. In China and Japan, it transmits the severe fever with thrombocytopenia syndrome virus (SFTSV), which causes a human hemorrhagic fever (2), and Rickettsia japonica, which causes Japanese spotted fever (3). Studies in Asia identified ticks infected with various species of Anaplasma, Babesia, Borrelia, Ehrlichia, and Rickettsia, and all of these pathogen groups circulate zoonotically in the United States (4,5). In addition, parthenogenetic reproduction, a biologic characteristic of this species, allows a single introduced female tick to generate progeny without mating, thus resulting in massive host infestations. In some regions of New Zealand and Australia, this tick can reduce production in dairy cattle by 25% (6). Before 2017, H. longicornis ticks were intercepted at U.S. ports of entry at least 15 times on imported animals and materials (James W. Mertins, U.S. Department of Agriculture [USDA], personal communication).

The USDA Animal and Plant Inspection Service coordinated cooperative efforts through telephone conference calls with various local, state, and federal agricultural and public health agencies. Through these efforts, enhanced vector and animal surveillance were implemented to detect additional tick infestations. Suspect archival specimens that were available among previously collected ticks were also examined. Ticks were identified definitively by morphology at the USDA National Veterinary Services Laboratories or by DNA sequence analysis (molecular barcoding) at Rutgers University Center for Vector Biology, Monmouth County (New Jersey) Mosquito Control Division; College of Veterinary Medicine, University of Georgia; and Center for Veterinary Health Sciences, Oklahoma State University. By definition, a “report” is any new morphologic or molecular identification of H. longicornis ticks with a new county or host species from that county, identified from August 2017 through September 2018. Subsequent repeat collections are not reported here.

From August 2017 through September 2018, vector and animal surveillance efforts resulted in 53 reports of H. longicornis in the United States, including 38 (72%) from animal species (23 [61%] from domestic animals, 13 [34%] from wildlife, and two [5%] from humans), and 15 (28%) from environmental sampling of grass or other vegetation using cloth drags or flags* or carbon dioxide–baited tick traps. With the exception of one report from Arkansas, the remaining reports of positively identified ticks are from eight eastern states: New Jersey (16; 30%), Virginia (15; 28%), West Virginia (11; 21%), New York (three; 6%), North Carolina (three; 6%), Pennsylvania (two; 4%), Connecticut (one; 2%), and Maryland (one; 2%) (Figure). Among the 546 counties or county equivalents in the nine states, ticks were reported from 45 (8%) counties (1.4% of all 3,109 U.S. counties and county equivalents) (Table 1). Excluding 15 reports of positive environmental sampling using flagging, dragging, or carbon dioxide traps, the remaining 38 reports reflect collection of ticks from infested host species (Table 2). Surveillance efforts did not include testing the ticks or hosts for pathogens. No cases of illness in humans or other species were reported. Concurrent reexamination of archived historical samples showed that invasion occurred years earlier. Most importantly, ticks collected from a deer in West Virginia in 2010 and a dog in New Jersey in 2013 were retrospectively identified as H. longicornis.

Discussion

Cooperative efforts among federal, state, and local experts from agricultural, public health, and academic institutions during the last year have documented that a tick indigenous to Asia is currently resident in several U.S. states. The public health and agricultural impacts of the multistate introduction and subsequent domestic establishment of H. longicornis are not known. At present, there is no evidence that H. longicornis has transmitted pathogens to humans, domestic animals, or wildlife in the United States. This species, however, is a potential vector of a number of important agents of human and animal diseases in the United States, including Rickettsia, Borrelia, Ehrlichia, Anaplasma, Theileria, and several important viral agents such as Heartland and Powassan viruses. Consequently, increased tick surveillance is warranted, using standardized animal and environmental sampling methods.

The findings in this report are subject to at least two limitations. First, the findings are limited by the variable surveillance methods used to identify the geographic and host distribution of H. longicornis. These methods included both passive and active surveillance. Conclusions about the geographic and host distribution might reflect the biases in the collection and submission of samples to states and USDA and the paucity of available information. Second, the data in this report reflect the collection of specimens that were positively identified by morphology or molecular barcoding. These represent sentinels that H. longicornis is present in different U.S. states and regions, and not a comprehensive assessment of the distribution of H. longicornis in the United States. The absence of positive samples from many states and counties might reflect the absence of infestation, absence of sampling, or failure to recover the tick. Even in states where H. longicornis has been found, the available data do not describe the actual extent or intensity of infestation.

The biology and ecology of H. longicornis as an exotic species in the United States should be characterized in terms of its vector competence (ability to transmit a pathogen) and vectorial capacity (feeding habits, host preference, climatic sensitivity, population density, and other factors that can affect the risk for pathogen transmission to humans) for tickborne pathogens known to be present in the United States (5). Surveillance for H. longicornis should include adequate sampling of companion animals, commercial animals, wildlife, and the environment. Where H. longicornis is detected, there should be testing for a range of indigenous and exotic viral, bacterial, and protozoan tickborne pathogens potentially transmitted by H. longicornis. Given the similarity between SFTSV and Heartland virus, a tickborne phlebovirus (https://www.cdc.gov/heartland-virus/index.html), further evaluation of the potential role of H. longicornis in transmission of this disease agent among animal reservoirs and possibly to humans is warranted. A broad range of interventions should be evaluated, including insecticide and acaricide sensitivity testing. Many state and federal agencies are developing and disseminating information for stakeholders, including development of hotlines, and some states are identifying ticks submitted by the public. The recently documented occurrence of H. longicornis in the United States presents an opportunity for collaboration among governmental, agricultural, public health agencies and partners in academic public health, veterinary sciences, and agricultural sciences to prevent diseases of potential national importance before onset in humans and other animal species.

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Acknowledgments

Wes Watson, Andrew D. Haddow, Naomi Drexler, Gleeson Murphy, Harry Savage, Howard Ginsberg, Kim Cervantes, field and laboratory personnel.

Corresponding author: C. Ben Beard, cbeard@cdc.gov, 970-221-6418.


* Drags consist of white cloth (usually 1 m2) that have a wooden leading frame and are dragged by a cord through grass or a leafy forest floor. Flags are similar but are used to brush uneven surfaces such as small bushes in wooded areas. Drags and flags are used to sample the environment for ticks trying to locate a host.

Carbon dioxide traps consist of dry ice–filled small boxes with holes that allow the CO2 to escape which are placed on a white cloth or mat in a grassy area or forest floor. Ticks, attracted by the CO2, crawl on to the cloth or mat surface, which is inspected for ticks after a period of time.

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References

  1. Rainey T, Occi JL, Robbins RG, Egizi A. Discovery of Haemaphysalis longicornis (Ixodida: Ixodidae) parasitizing a sheep in New Jersey, United States. J Med Entomol 2018;55:757–9. CrossRef PubMed
  2. Luo L-M, Zhao L, Wen H-L, et al. Haemaphysalis longicornis ticks as reservoir and vector of severe fever with thrombocytopenia syndrome virus in China. Emerg Infect Dis 2015;21:1770–6. CrossRef PubMed
  3. Mahara F. Japanese spotted fever: report of 31 cases and review of the literature. Emerg Infect Dis 1997;3:105–11. CrossRef PubMed
  4. Kang J-G, Ko S, Smith WB, Kim H-C, Lee I-Y, Chae J-S. Prevalence of Anaplasma, Bartonella and Borrelia species in Haemaphysalis longicornis collected from goats in North Korea. J Vet Sci 2016;17:207–16. CrossRef PubMed
  5. Rosenberg R, Lindsey NP, Fischer M, et al. Vital signs: trends in reported vectorborne disease cases—United States and territories, 2004–2016. MMWR Morb Mortal Wkly Rep 2018;67:496–501. CrossRef PubMed
  6. Heath A. Biology, ecology and distribution of the tick, Haemaphysalis longicornis Neumann (Acari: Ixodidae) in New Zealand. N Z Vet J 2016;64:10–20. CrossRef PubMed
Return to your place in the textFIGURE. Counties and county equivalents* where Haemaphysalis longicornis has been reported (N = 45) — United States, August 2017–September 2018

The figure is a map showing the counties and county equivalents where Haemaphysalis longicornis has been reported (N = 45), in the United States, during August 2017–September 2018.* Benton County, Arkansas; Fairfield County, Connecticut; Washington County, Maryland; Bergen, Hunterdon, Mercer, Middlesex, Monmouth, Somerset, and Union Counties, New Jersey; Davidson, Polk, and Rutherford Counties, North Carolina; Richmond, Rockland, and Westchester Counties, New York; Bucks and Centre Counties, Pennsylvania; Albemarle, Augusta, Carroll, Fairfax, Giles, Grayson, Louisa, Page, Pulaski, Rockbridge, Russell, Scott, Smyth, Staunton City, Warren, and Wythe Counties, Virginia; Cabell, Hardy, Lincoln, Mason, Marion, Monroe, Putnam, Ritchie, Taylor, Tyler, Upshur Counties, West Virginia.

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TABLE 1. Percentage of Haemaphysalis longicornis–infested counties or county equivalents in infested states — nine states, August 2017–September 2018Return to your place in the text
State No. of counties* per state No. (%) of counties* with H. longicornis on host or in environment
Arkansas 75 1 (1)
Connecticut 8 1 (13)
Maryland 24 1 (4)
New Jersey 21 7 (33)
New York 62 3 (5)
North Carolina 100 3 (3)
Pennsylvania 67 2 (3)
Virginia 134 16 (12)
West Virginia 55 11 (20)
Total 546 45 (8)

* Counties or county equivalents

TABLE 2. Distribution of Haemaphysalis longicornis, by host and species — nine states, August 2017–September 2018Return to your place in the text
Host category, no. (% of total)/Species No. (% of host category)
Domestic animal, 23 (61)
Cat 1 (4)
Cow 4 (17)
Dog 12 (52)
Goat 2 (9)
Horse 2 (9)
Sheep 2 (9)
Total 23 (100)
Wildlife, 13 (34)
Coyote 1 (8)
White-tailed deer 7 (54)
Gray fox 1 (8)
Groundhog 1 (8)
Virginia opossum 2 (15)
Raccoon 1 (8)
Total 13 (100)
Human, 2 (5) 2 (100)
Total 38 (100)

Beard CB, Occi J, Bonilla DL, et al. Multistate Infestation with the Exotic Disease–Vector Tick Haemaphysalis longicornis — United States, August 2017–September 2018. MMWR Morb Mortal Wkly Rep 2018;67:1310–1313. DOI: http://dx.doi.org/10.15585/mmwr.mm6747a3.

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**Comment**

In the section discussing the species and the other pathogens it’s been known to transmit, Theileria was mentioned. Theileria is a malarial-like pathogen similar to Babesia:

https://en.wikipedia.org/wiki/Theileria_microti

Babesia IS also spread by ticks and is a frequent coinfection with Lyme.

An important difference from malaria is that T. microti does not infect liver cells. Additionally, the piroplasm is spread by tick bites (Ixodes scapularis, the same tick that spreads Lyme disease), while the malaria protozoans are spread via mosquito. Finally, under the microscope, the merozoite form of the T. microti life cycle in red blood cells forms a cross-shaped structure, often referred to as a “Maltese cross“, whereas malaria forms more of a diamond ring structure in red blood cells.[3]

Much is yet to be discovered about the Asian tick that clones itself and can drain cattle of its blood.  For more:  https://madisonarealymesupportgroup.com/2018/09/12/three-surprising-things-i-learned-about-asian-longhorned-ticks-the-tick-guy-tom-mather/

One of the biggest discoveries by Mather was how the ticks line up on stalks of grass resembling grains of wheat.  When anything touches this, it’s like a tick cluster bomb and ticks go everywhere.  Not just one or two, mind you, but hundreds at one time.  See link for pictures.

https://madisonarealymesupportgroup.com/2018/03/01/asian-ticks-mysteriously-turn-up-in-new-jersey/

https://madisonarealymesupportgroup.com/2018/10/03/1st-person-bitten-by-east-asian-longhorned-tick/

https://madisonarealymesupportgroup.com/2018/11/05/hawk-found-carrying-asian-long-horned-tick-the-one-that-drains-cattle-of-all-their-blood/

 

 

 

22 With Babesia, 8 Develop Acute Respiratory Distress Syndrome – 3 Die

https://www.ncbi.nlm.nih.gov/pubmed/30585748

2018 Dec 26:1-6. doi: 10.1080/00325481.2019.1558910. [Epub ahead of print]

Babesiosis as a cause of acute respiratory distress syndrome: a series of eight cases.

Abstract

OBJECTIVES:

The characteristics of patients with Acute Respiratory Distress Syndrome (ARDS) as a complication of Babesia microti infection have not been systematically described.

METHODS:

Adult patients admitted to the medical intensive care unit (MICU) of a tertiary care hospital in the Lower Hudson Valley of New York from 1/1/2008 to 8/1/2016 were evaluated for ARDS complicating babesiosis.

RESULTS:

Of 22 patients with babesiosis in the MICU, eight (36.4%; 95% CI: 19.7-57.0%) had ARDS. Six patients (75%) developed ARDS following initiation of anti-babesia drug therapy; however, the mean duration of symptoms in these patients exceeded that of patients who developed ARDS prior to initiation of treatment (7.50 ± 3.83d vs. 4.50 ± 0.71d, p = 0.34). Three patients (37.5%; 95% CI: 13.7-69.4%) expired without recovery from ARDS. In comparison, the mortality rate for the 14 MICU babesiosis patients without ARDS was 14.3% (p = 0.31). There was a trend toward younger age in survivors relative to non-survivors (mean age 54.6 ± 13.8y vs. 74.0 ± 6.24y, p = 0.07). Three of the five survivors did not require mechanical ventilation. The mean sequential organ failure assessment score of non-survivors was significantly higher than that of survivors (12.3 ± 1.15 vs. 6.0 ± 1.4, p = 0.0006).

CONCLUSION:

Among 22 critically ill adult patients with B. microti infection, ARDS developed in eight (35.4%), and three (37.5%) expired without resolution of the ARDS. ARDS often followed the initiation of anti-babesia drug therapy, raising the question of whether the death of the parasite per se contributed to its development. However, this observation was confounded by the longer duration of symptoms preceding initiation of drug therapy.

________________

More on Babesia:  https://madisonarealymesupportgroup.com/2016/01/16/babesia-treatment/ According to Dr. Horowitz ARDS is often worsened in hospitalized patients who were given steroids (which suppress the immune system) which can cause death.

The number of symptoms and duration of illness in patients with concurrent Lyme disease and babesiosis are greater than in patients with either infection alone:  http://www.lymepa.org/c07%20Lyme%20disease%20and%20Babesiosis%20coinfection.pdf

This finding implies the presence of living spirochetes, because spirochete DNA in blood is amplifiable only when these pathogens remain viable.  It also suggests a synergistic inflammatory response to both a parasitemia and an increased spirochetemia. In addition, babesial infection enhances Lyme disease myocarditis in mice, which suggests that coinfection might also synergize spirochete-induced lesions in human joints, heart, and nerves.

The same was found in animals:  https://www.sciencedirect.com/science/article/abs/pii/S0020751918302406

Similar to humans, B. microti coinfection appears to enhance the severity of Lyme disease-like symptoms in mice. Coinfected mice have lower peak B. microti parasitaemia compared to mice infected with B. microti alone, which may reflect attenuation of babesiosis symptoms reported in some human coinfections. These findings suggest that B. burgdorferi coinfection attenuates parasite growth while B. microti presence exacerbates Lyme disease-like symptoms in mice.

https://www.sciencedirect.com/science/article/pii/S1877959X18302978  Our findings suggest that Babesia infections may indeed be quite common among individuals who have been exposed to tick bites.

Authorities and mainstream doctors to this day are not considering Lyme/MSIDS a polymicrobial illness, but it usually is:  https://madisonarealymesupportgroup.com/2018/10/30/study-shows-lyme-msids-patients-infected-with-many-pathogens-and-explains-why-we-are-so-sick/

https://madisonarealymesupportgroup.com/2018/12/11/babesia-widespread-in-canada-its-high-tolerance-to-therapy/

https://madisonarealymesupportgroup.com/2018/10/06/case-of-recurrent-fever-multiple-splenic-infarcts-why-short-treatment-duration-often-doesnt-work-for-babesia/

https://madisonarealymesupportgroup.com/2018/03/22/what-is-air-hunger-anyway/

https://madisonarealymesupportgroup.com/2018/02/20/babesia-and-heart-issues/

https://madisonarealymesupportgroup.com/2018/10/11/babesia-found-in-patient-with-persistent-symptoms-following-lyme-treatment/

https://madisonarealymesupportgroup.com/2018/02/20/babesia-and-heart-issues/

Transmitted in the Womb – Children Battle Lyme Disease From Birth

https://www.newscentermaine.com/article/news/health/transmitted-in-the-womb-kids-battle-lyme-disease-from-birth/97-612998682  (News Video within link – Approx. 5.5 Min)

Transmitted in the womb -Kids battle Lyme disease from birth

Author: Vivien Leigh
Published:  November 9, 2018
Shortly after birth, these kids started suffering from debilitating symptoms doctors could not diagnose or explain. Out of desperation, their families were forced to seek treatment out of state.

BRUNSWICK (NEWS CENTER Maine) – The CDC says every year about 300-thousand people in the U.S. are diagnosed with Lyme Disease, which is transmitted by deer ticks. Experts say a quarter of those cases are children — the highest infection rates are happening in kids ages 5 to 14.

But a small number of kids in Maine didn’t contract Lyme through a tick bite. Instead, doctors believe the disease was passed to them in the womb through their moms living with undiagnosed Lyme for years.

Celeste Zelasko was five months pregnant when she discovered a rash on her body. ‘I definitely had a bulls eye rash we thought it was a spider or another bug.,’

9 months after her son was born he started losing weight, broke out in rashes and his hair fell out. But it didn’t stop there.

‘Miles was constantly getting ear infections, respiratory problems, asthma trips to the ER.’

Doctors blamed germs from day care — but couldn’t figure out what was wrong with Miles. Celeste was also experiencing joint pain, extreme fatigue, memory loss an, brain fog.

Celeste and Miles underwent testing for Lyme disease, but they were negative. The two step blood test recommended by the CDC checks for antibodies against Lyme bacteria. But some experts say the test is unreliable — failing up to 40 percent of the time even within 30 days of a tick bite. She and her son — now 6-years old were diagnosed with Lyme disease based on their symptoms. A provider recommended treatment out of state. Celeste found a doctor for herself in New York and a pediatrician for Miles in New Haven, Connecticut.

The only pediatric Lyme specialist in the country and he was in his 80’s and it would be a four hour drive.

Pediatrician Dr. Charles Jones practices outside the CDC guidelines. He has treated more than 15-thousand children across the Us and from around the world. He says is cure rate is at 98 percent.

Those guidelines recommend treatment as one dose of antibiotics for children over 8 years old would include twice daily for 2-4 weeks.

“What’s important,” he says, “is to treat continuously, not stopping until all symptoms are gone.” said Dr. Jones.

Angela and Aaron Gilbert say after their son Noah was born, he experienced medical problems no doctors could explain. Besides rashes and stomach problems their son was rarely awake.

‘The fatigue was unbelievable, he would sometimes sleep 22 to 23 hours a day,’ said Angela.

After multiple trips to the emergency room to treat her son’s many fevers doctors still couldn’t figure out what was wrong with Noah. A friend suggested Lyme disease, but the family couldn’t get a medical provider even to consider the possibility. But Angela then heard about Dr. Jones.  At this point, her son Noah was a little more than a year old.

‘There were no options for us to get medical treatment and he was getting sick and sicker and sicker,’ said Angela.

Dr. Jones treated Noah multiple doses of antibiotics at the same time over more extended periods of time. After Noah’s younger brother Elijah because experiencing similar symptoms, the family knew they had to make a drastic decision. They sold their house in Maine and moved to Connecticut so both boys could be treated for Lyme disease and other co-infections by Dr. Jones.

“What’s important,” he says, “is to treat continuously, not stopping until all symptoms are gone.”

Dr. Jones believes both Celeste and Angela were living with undiagnosed Lyme Disease when they had their children and passed the disease to them in the womb.

Angela ended up getting diagnosed with late stage Lyme and a number of co-infections. After several months of treatment, Gilbert says she and her sons started getting better. The joint pain subsided and the severe fatigue improved. The family returned to Maine 9 months later and found a Lyme literate provider familiar with the vast range of symptoms that may indicate infection at various stages of the disease, as well as potential co-infections and other complexities. But Angela says families should not have to make extreme sacrifices to get their kids treated for Lyme. She says if CDC revised its guidelines for pediatricians on antibiotic treatment for Lyme disease, more doctors in Maine would be willing to treat children who may have undiagnosed Lyme.

‘They are in fear of losing their license that is the bottom line.’

— For information about Lyme Disease, Diagnosis and Treatment https://www.cdc.gov

— Maine Medical Center Research Institute www.ticksinmaine.com

— Information on finding a provider to treat late-stage Lyme disease. Midcoast Lyme Disease Support & Education, www.mldse.org

— International Lyme & Associated Diseases Society, www.ilads.org

— Information about Dr. Charles Jones https://health.usnews.com/doctors/charles-jones-115055

— Information on prevention, testing, treatment guidelines, support groups and other resources

Lyme Resource Card/Nelson Family Project

For real-time data on Lyme Disease rates compiled by the Maine CDC go to https://data.mainepublichealth.gov/tracking/home or www.maine.gov/lyme

NEWS CENTER Maine’s Vivien Leigh is joined by Dr. Sean McCloy, Integrative Health Center of Maine and Dr. Jacob Aguiar, Scarborough Integrative Health discussing the topic on Facebook.

________________

**Comment**

Mainstream medicine is still in denial, but congenital Lyme/MSIDS is real and more prevalent than realized.  While I’m thankful for this story, please note that they couldn’t conjure up ONE pediatrician to speak on congenital Lyme.  If it wasn’t for Dr. Jones, kids would be dead.  Everyone STILL is cowering behind the antiquated and unscientific CDC guidelines.

This has to stop.

The research on Lyme is ancient and poorly done.  We need new research and new laboratory techniques as borrelia is extremely fastidious and hard to culture and study.  Many coinfections are just as difficult to study and aren’t even on the radar for most doctors.  The combined effect of these pathogens is what is making us so ill:  https://madisonarealymesupportgroup.com/2018/10/30/study-shows-lyme-msids-patients-infected-with-many-pathogens-and-explains-why-we-are-so-sick/

For the first time, Garg et al. show a 85% probability for multiple infections including not only tick-borne pathogens but also opportunistic microbes such as EBV and other viruses.  Also, 83% of all commercial tests focus only on Lyme (borrelia), despite the fact we are infected with more than one microbe.

Key Quote: “Our findings recognize that microbial infections in patients suffering from TBDs do not follow the one microbe, one disease Germ Theory as 65% of the TBD patients produce immune responses to various microbes.”

More on Congenital Lyme:  https://madisonarealymesupportgroup.com/2018/06/19/33-years-of-documentation-of-maternal-child-transmission-of-lyme-disease-and-congenital-lyme-borreliosis-a-review/

https://madisonarealymesupportgroup.com/2018/12/14/scientists-weigh-in-on-the-seriousness-of-tick-borne-illness-video/

https://madisonarealymesupportgroup.com/2018/12/22/doctors-public-left-in-the-dark-on-danger-to-babies-from-lyme/

https://madisonarealymesupportgroup.com/2018/11/11/gestational-lyme-other-tick-borne-diseases-dr-jones/

Tick Bite in Ear Gave UK Teacher Rickettsial Typhus Infection

https://www.foxnews.com/health/rare-tick-infection-leaves-teacher-with-memory-loss-fatigue

Rare tick infection leaves teacher with memory loss, fatigue

tick1-solent-news
Keith Poultney was teaching English in Nepal when he was bitten by a tick, which spread a rare infection throughout his body leaving him with memory loss and fatigue. (Solent News)

A 40-year-old English teacher from the U.K. who was bitten by a tick in his ear while volunteering in Nepal two years ago said he still has trouble with his memory and coordination after the infection left him suffering from hallucinations and brain swelling.

Keith Poultney, who said he didn’t realize he had been bitten by the tick during his 2017 trip until a few days after developing discomfort in his ear, initially wasn’t concerned about his illness while in Nepal because others in his group had developed colds or the flu, according to The Sun.

“They treated me with antibiotics, but what they didn’t know was that the type of infection I had developed was resistant,” he said of his treatment in Nepal. “I flew home as planned, but the flight, a 12-hour flight via the Middle East, was the worst experience of my life.”

tick2-solent-newsPoultney initially wasn’t concerned about his symptoms because others in his group had been dealing with colds, but then he developed hallucinations and severe head pain. (Solent News)

He said at one point his temperature reached 104.9 and he developed severe head pain. He was rushed to Queen Alexandra Hospital in Portsmouth, where he was eventually diagnosed with encephalitis and a rickettsial typhus infection, which is typically transmitted by fleas, ticks, mites and lice and in some cases can be fatal.

According to the Centers for Disease Control and Prevention (CDC), immediate treatment should be started in a patient with a suspected case of rickettsioses before confirmation is complete due to the rapid progression of the infection.

Transmission is most common during outdoor activities in the spring or summer months when ticks and fleas are most active, with a 5-14 day incubation period for most rickettsial diseases, meaning symptoms often don’t start until after the trip as ended. The most common rickettsial diseases found in travelers are in the spotted fever or typhus groups.

“I felt different in myself,” Poultney, who is still dealing with fatigue, told The Sun. “I had real problems with my balance and was unable to walk in a straight line. I physically felt as though I was impaired or drunk. I could not gauge space or distance and would often walk into door frames or knock things such as drinks over.”

Nearly two years after his diagnosis and treatment, Poultney said he still has issues with his memory, and has started working with Headway, an organization that provides support to brain injury patients.

“Without Headway’s help, I know my recovery would have been slower and more frustrating,” he told The Sun. “They were there to pick me up from a very low point in my life. I know my brain has been altered and that will most likely never change. But I also know that I shouldn’t try to deal with this on my own.”

____________________

**Comment**

In this article, a treatment resistant Rickettsial Typhus is obviously transmitted by a tick.  This is important to acknowledge.  In the following CDC information, there are numerous types of typhus but not many commonly thought to be transmitted by ticks.  

Tick-associated reservoirs of R. prowazekii (epidemic typhus) have been described in Ethiopia, Mexico, and Brazil, but the role of ticks in the natural transmission of R. prowazekii has not been characterized.

Unfortunately, the article does not mention what typhus strain caused this.

https://wwwnc.cdc.gov/travel/yellowbook/2018/infectious-diseases-related-to-travel/rickettsial-spotted-and-typhus-fevers-and-related-infections-including-anaplasmosis-and-ehrlichiosis  Excerpt below:

Rickettsial infections are caused by various bacterial species from the genera Rickettsia, Orientia, Ehrlichia, Neorickettsia, Neoehrlichia, and Anaplasma.  Rickettsia spp. are classically divided into the typhus group and spotted fever group (SFG).

Most rickettsial pathogens are transmitted by ectoparasites such as fleas, lice, mites, and ticks. It can also be transmitted by inoculating infectious fluids or feces from the ectoparasites into the skin. Inhaling or inoculating conjunctiva with infectious material may also cause infection.  Transmission after transfusion or organ transplantation is rare but has been reported.

Clinical presentations vary with the causative agent and patient; however, common symptoms that typically develop within 1–2 weeks of infection include fever, headache, malaise, rash, nausea, and vomiting. Many rickettsioses are accompanied by a maculopapular, vesicular, or petechial rash or sometimes an eschar at the site of the tick bite.

Treatment of patients with possible rickettsioses should be started when disease is suspected and should never await confirmatory testing, as certain infections can be rapidly progressive. Immediate empiric treatment with a tetracycline, most commonly doxycycline, is recommended for all ages. Almost all other broad-spectrum antibiotics are not helpful. Chloramphenicol may be an alternative in some cases, but its use is associated with more deaths, particularly for R. rickettsii. In some areas, tetracycline-resistant scrub typhus has been reported. Azithromycin may be an effective alternative. Anaplasma phagocytophilum infections may respond to rifampin, which may be an alternate drug for pregnant patients. Expert advice should be sought if alternative agents are being considered.

Doxycycline is the front-line drug for typhus and broad-spectrum antibiotics aren’t helpful.

Fact sheet on typhus: https://www.health.nsw.gov.au/Infectious/factsheets/Factsheets/typhus.PDF   The perps are typically lice, fleas, mites, and ticks.
https://madisonarealymesupportgroup.com/2018/08/19/monster-ticks-found-in-germany-threaten-europe-with-deadly-disease-crimean-congo-fever/ In this article, they found a tropical form of tick typhus in tropical ticks found in Germany. Typhus is making a comeback, particularly in the southern U.S. Migrating birds are transporting ticks as well as the diseases they carry worldwide.

Remember:  There’s no such thing as a “good” or “insignificant” tick.

All ticks are suspect until proven otherwise.