Archive for the ‘Tularemia’ Category

Ulceroglandular Tularemia

https://www.nejm.org/doi/full/10.1056/NEJMicm2031676?query=WB

Ulceroglandular Tularemia

April 8, 2021
N Engl J Med 2021; 384:1349
DOI: 10.1056/NEJMicm2031676

List of authors.

  • Michael Buettcher, M.D.,
  • and Chiara Imbimbo, B.M.


A 5-year-old girl presented to the pediatric emergency department with a 4-week history of painful swelling on both sides of her lower abdomen. Pets that she had regular contact with included a cat and a dog. Six weeks before presentation, her parents had noticed a tick buried in her umbilicus and had removed it with tweezers. Five days later, the patient had fever, loss of appetite, fatigue, and redness around the umbilicus (Panel A). These symptoms abated after 4 days. At the time of this presentation, examination showed marked inguinal lymphadenopathy on both sides (Panel B). Treatment with oral ciprofloxacin was initiated for suspected ulceroglandular tularemia. Serologic testing supported the diagnosis; the Francisella tularensis antibody titer was 1:1280. Two weeks after the completion of treatment, there was a reduction in the lymphadenopathy. After an additional 2 weeks, the swelling had completely resolved.


For more:

According to DHS, tularemia in Wisconsin is rare, with less than one case per year since 1980.  In 2016, a tularemia alert was given for La Crosse due to the death of three infected cats.  And according to this report, while rabbits are the main source of transmission in Wisconsin, aquatic mammals (muskrat, beaver), woodticks, upland game birds: (partridge, pheasant, prairie chicken), cats, squirrels, deer-fly bites, skunks horses, sick dogs which killed rabbits, foxes, possible skunk, mink, muskrat or raccoon are also responsible.  One case was recorded from exposure to a contaminated stream.  It’s been called “Deer-fly Fever.”

Mechanisms Affecting the Acquisition, Persistence & Transmission of Francisella Turlarensis in Ticks

Mechanisms Affecting the Acquisition, Persistence and Transmission of Francisella tularensis in Ticks

 
 
Department of Medical Microbiology and Immunology, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43614, USA
*
Author to whom correspondence should be addressed.
Microorganisms 2020, 8(11), 1639; https://doi.org/10.3390/microorganisms8111639
Received: 29 September 2020 / Revised: 15 October 2020 / Accepted: 21 October 2020 / Published: 23 October 2020
(This article belongs to the Special Issue Epidemiology of Tularemia and Francisella tularensis)

Abstract

Over 600,000 vector-borne disease cases were reported in the United States (U.S.) in the past 13 years, of which more than three-quarters were tick-borne diseases. Although Lyme disease accounts for the majority of tick-borne disease cases in the U.S., tularemia cases have been increasing over the past decade, with >220 cases reported yearly. However, when comparing Borrelia burgdorferi (causative agent of Lyme disease) and Francisella tularensis (causative agent of tularemia), the low infectious dose (<10 bacteria), high morbidity and mortality rates, and potential transmission of tularemia by multiple tick vectors have raised national concerns about future tularemia outbreaks. Despite these concerns, little is known about how F. tularensis is acquired by, persists in, or is transmitted by ticks. Moreover, the role of one or more tick vectors in transmitting F. tularensis to humans remains a major question. Finally, virtually no studies have examined how F. tularensis adapts to life in the tick (vs. the mammalian host), how tick endosymbionts affect F. tularensis infections, or whether other factors (e.g., tick immunity) impact the ability of F. tularensis to infect ticks. This review will assess our current understanding of each of these issues and will offer a framework for future studies, which could help us better understand tularemia and other tick-borne diseases.
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**Comment**
About half of US tularemia cases are associated with tick bite, and annual cases are slowly increasing. 
 
 
 
 
 
 
http://www.siumed.edu/medicine/id/tularemia.htm
Tularemia, in aerosol form, is considered a possible bioterrorist agent that if inhaled would cause severe respiratory illness. It was studied in Japan through 1945, the USA through the 60’s, and Russia is believed to have strains resistant to antibiotics and vaccines. An aerosol release in a high population would result in febrile illness in 3-5 days followed by pleuropneumonitis and systemic infection with illness persisting for weeks with relapses. The WHO estimates that an aerosol dispersal of 50 kg of F. tularensis over an area with 5 million people would result in 25,000 incapacitating casualties including 19,000 deaths.
 
 
 
 
 
 
 

Two Exotic Disease-Carrying Ticks Identified in Rhode Island & First Case of Parasitic Soft Ticks Reported in New Jersey

https://www.sciencetimes.com/articles/27511/20200929/two-exotic-disease-carrying-ticks-identified-rhode-island.

Two Exotic Disease-Carrying Ticks Have Just Been Identified in Rhode Island

Sep 29, 2020

Local authorities in Rhode Island announced that two new tick species were identified on Block Island. The tick species were traced back to Eurasia and Asia origins.

Dr. Danielle Tufts from Columbia University identified the two species Haemaphysalis longicornis (Asian long-horned tick) and Haemaphysalis punctata (red sheep tick), reported the state’s Department of Environmental Management (DEM). (See link for article) 

Two Exotic Disease-Carrying Ticks Had Just Been Identified in Rhode Island

(Photo: Asian long-horned tick, adult female dorsal view climbing on a blade of grass – Photo by James Gathany; CDC)

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**Comment**

Both ticks are considered live-stock pests but they can and do bite humans, transmitting diseases.  Farmers, hunters, and hikes are at greater risk.

  • The red sheep tick is identified with Tick paralysis, Tick Borne Encephalitis virus, Tribec virus, Bhanja virus, Crimean-Congo haemorrhagic fever virus, Babesia bovis, Theileria recondita, Coxiella burneti, Francisella tularensis.  http://www.bristoluniversitytickid.uk/page/Haemaphysalis+punctata/17/#.X3S-TS2ZOWgCattle: Babesia major, Babesia bigemina, Theileria mutans, Anaplasma marginale and Anaplasma centrale

    Sheep: Babesia motasi, Theileria ovis

H.-punctata-female-dorsal-0-300x225

Red sheep tick, Adult female dorsal view

https://medicalxpress.com/news/2020-09-jersey-1.html

Bat tick found for the first time in New Jersey

Bat tick found for the first time in New Jersey

A tick species associated with bats has been reported for the first time in New Jersey and could pose health risks to people, pets and livestock, according to a Rutgers-led study in the Journal of Medical Entomology.

This species (Carios kelleyi) is a “soft” . Deer ticks, which carry Lyme disease, are an example of “hard” ticks.

“All ticks feed on blood and may transmit pathogens (disease-causing microbes) during feeding,” said lead author James L. Occi, a doctoral student in the Rutgers Center for Vector Biology at Rutgers University-New Brunswick. “We need to be aware that if you remove from your belfry, attic or elsewhere indoors, ticks that fed on those bats may stay behind and come looking for a new source of blood. There are records of C. kelleyi biting humans.”  (See link for article)

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**Comment**

A few important points:

  1. A related species, Carios jersey, was found in amber 2001
  2. C. kelleyi has been found in 29 states so far
  3. Public health risk remains unknown, but it has been found to be infected with harmful pathogens in other states
  4. There are reports of this tick feeding on humans
  5. The bat it feeds on regularly roosts in attics and barns
  6. It has been identified with rickettsia and borrelia (Lyme):  https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/carios
I can’t help but notice the bat connection, as well as the following:

https://www.newsbreak.com/news/2058858379813/first-case-of-parasitic-soft-ticks-reported-in-new-jersey  The current pandemic has been accompanied by cases of other illnesses and diseases such as African Swine Flu, Ebola, Bubonic Plague, West Nile Virus, Dengue outbreaks around the world.

Health Officials Warn Lone Star Ticks Multiplying In Connecticut

https://www.newtownbee.com/06282020/health-officials-warn-lone-star-ticks-multiplying-in-state/

Health Officials Warn Lone Star Ticks Multiplying In State

280px-Lone-star-tick-stages-cdc CDChttp://www.cidrap.umn.edu/news-perspective/2013/07/researchers-trace-novel-heartland-virus-missouri-ticks Public Domain

As if Newtown Health District Director Donna Culbert was not busy enough handling coronavirus issues, she is now grappling with the news that the aggressive lone star tick is proliferating in the region.

Culbert, who has made tickborne disease education a hallmark of her administration, told The Newtown Bee this week that the latest news from colleague Goudarz Molaei, PhD, at the Connecticut Agricultural Experiment Station (CAES) is disturbing considering how many local residents are already suffering from related illnesses.

“The Newtown Health District is always concerned about tick bites and tick-borne disease, and news of the lone star tick becoming established in the region adds to the concern,” Culbert said. “Although our office has not yet received a lone star tick submitted to our office for identification yet this year, I am not naive enough to think that they aren’t out there.”

Review Connecticut’s latest information about the lone star tick by CLICKING HERE  (See link for article)

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**Comment**

Key Quote:  

Previously limited to the southeastern US, lone star ticks have been detected in areas with no previous record of activity….

And that includes Wisconsin:

Excerpt:

….he diagnoses approximately 1 patient per month with Alpha-gal allergy and that the reactions can be severe, from passing out to life-threatening reactions.

The lone star tick is an aggressive biter that gives highly irritating bites.  It’s known to transmit:

 

 

 

 

 

 

 

Serendipitous Treatment of Tularemia in Pregnancy

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6804751/

Serendipitous Treatment of Tularemia in Pregnancy

Published online 2019 Sep 24. doi: 10.1093/ofid/ofz413

Abstract

We present a young pregnant woman who developed ulceroglandular tularaemia following a bite wound from a kitten. She grew Francisella tularensis from the ulcer. While awaiting bacterial culture results and serology for Bartonella, she was treated with azithromycin, with resolution of fever and axillary tenderness. Treatment recommendations for tularemia are either gentamicin or doxycycline, both of which can be perilous to the fetus. A Centers for Disease Control and Prevention report on the macrolide susceptibility of North American isolates of this organism has been underappreciated. The unanticipated result from this patient may give another potential option for treatment of tularemia in pregnancy.

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Please know ticks transmit Tularemia:  https://madisonarealymesupportgroup.com/2019/02/18/tularemia-in-minnesotan-ticks/

https://madisonarealymesupportgroup.com/2016/10/25/of-rabbits-and-men/

It also kills: https://madisonarealymesupportgroup.com/2018/09/28/after-tularemia-death-experts-stress-education/

Now, Dr. Brown said an increasing number of cases of tularemia that were transmitted by a tick bite are being seen. Tularemia is transmitted by dog ticks, which also can transmit Rocky Mountain spotted fever. Lyme disease, babesiosis and erlichiosis, which are transmitted by tiny deer ticks, also occur on the Vineyard.

And with the relatively recent spread on the Island of lone star ticks, a new species, Dr. Brown said there is added concern about the potential for more disease transmission.