EYE PROBLEMS IN TICK-BORNE DISEASES OTHER THAN LYME
“Why should an ophthalmologist have a good understanding of Lyme diagnosis and treatment?” asks Sathiamoorthi , from the Mayo Clinic, in an article published in the Current Opinion in Ophthalmology. “Vision-threatening ophthalmic manifestations are relatively common in Lyme disease (LD) and Rocky Mountain spotted fever.”
by Daniel J. Cameron, MD MPH
“Knowledge of systemic and ophthalmic manifestations combined with an understanding of the epidemiology of disease vectors is crucial for the diagnosis of tick-borne diseases,” she explains.
While manifestations may be present with LD and Rocky Mountain spotted fever, ocular involvement is rare in other tick-borne diseases such as babesiosis, tick-borne relapsing fever, Powassan encephalitis, ehrlichiosis, anaplasmosis, and Colorado tick fever, Sathiamoorthi points out.
However, the true prevalence of ocular involvement due to tick-borne illnesses is unknown. Limitations with testing can make it difficult to identify patients. “It is crucial to know who is appropriate to test in order to avoid false positive results.” If an individual has been symptomatic for only a short period of time, they “may not have detectable serum IgM antibodies to the causative organism because it takes time for this immune response to develop.”
It can also be difficult to determine the cause of the ocular complaints if there is evidence of more than one tick-borne illness.
“One case report  describes a patient with optic neuritis and orbital myositis who had serologic evidence of HME [Human Monocytic Ehrlichioisis], Borrelia burgdorferi, and Babesia,” cites Sathiamoorthi.
There are more than one species of ticks associated with ocular findings, as well. According to Sathiamoorthi, those include Ornithodoros genus, Dermacentor variabilis Ambylomma americanum, Ixodes scapularis, and Dermacentor andersonii.
Sathiamoorthi advises doctors to “carefully generate a reasonable differential based on clues in the medical and social history regarding exposures and risks.”
“Patients who are most likely to have ophthalmic Lyme disease,” explains Sathiamoorthi, “are those with ocular manifestations commonly associated with Lyme disease (i.e. Bells palsy, cranial nerve palsies and keratitis); tick exposure in Lyme endemic regions; other signs/symptoms of late Lyme disease (i.e. inflammatory arthritis, carditis, acrodermatitis chronica atrophicans rash, encephalopathy and meningitis); and negative syphilis testing.”
1. Sathiamoorthi S, Smith WM. The eye and tick-borne disease in the United States. Curr Opin Ophthalmol. 2016;27(6):530-537.
2. Pendse S, Bilyk JR, Lee MS. The ticking time bomb. Surv Ophthalmol. 2006;51(3):274-279.
Medical Diagnostic Laboratories, L.L.C., Fights Tick- and Mosquito-borne Epidemic with New Comprehensive Testing for Vector-borne Disease.
Hamilton, NJ., March 18, 2019 –Medical Diagnostic Laboratories, L.L.C., (MDL), a Genesis Biotechnology Group® (GBG) company and CLIA-certified, CAP-accredited laboratory specializing in high-complexity, state-of-the-art, automated DNA-based molecular analyses, has expanded its testing to include a comprehensive program for the detection of vector-borne diseases.
Unfortunately, new tick- and mosquito-borne diseases continue to emerge, increasing in prevalence year after year. The Centers for Disease Control and Prevention (CDC) has reported that the number of disease cases from mosquitoes, ticks, and fleas has tripled from 2004 to 2016. Ticks and mosquitos that carry bacterial, parasitic, and viral pathogens continue to increase in number, species, and geographic range. Currently, tick-borne diseases are widely distributed throughout the United States, with major concentrations in the Northeast, Upper Midwest, and across the middle of the Midwest and Atlantic states.
To combat this growing medical issue, MDL has renewed their efforts to provide the most comprehensive vector-borne disease test menu. Their multi-phase implementation will offer a comprehensive platform blending direct (molecular testing) and indirect (serological) testing methods. This important information helps providers determine their patients’ exposure risk, the pathogen(s) associated with often-overlapping symptomatology, the most effective antimicrobial treatment for active infections, and appropriate prophylactic treatment for exposure. Phase Two, expected to launch in Q2 2019, will feature tick identification. MDL will also offer immune status testing using flow cytometry to evaluate CD3-/CD8-/CD57+ natural killer cells and other immune markers to help assess treatment response for acute and Post-treatment Lyme disease Syndrome patients.
Testing will detect a variety of pathogens associated with tick-borne disease including:
Borrelia species (US and European strains of Lyme disease and Relapsing fever)
Rickettsia species (Spotted Fever and Typhus Fever)
Ehrlichia species (Ehrlichiosis)
Francisella tularensis (Tularemia)
Babesia species (Babesiosis)
Powassan virus and Bourbon virus
Mosquito-borne viruses will include Zika virus, Chikungunya virus, Dengue virus, Japanese Encephalitis virus, and Usutu virus.
This is not the first time that MDL has been on cutting-edge of clinical diagnostic testing for vector-borne disease. In 2001 they were the first lab to identify and report, in peer-reviewed scientific journals, co-infections of Ixodes scapularis (deer tick) with Borrelia burgdorferi and Bartonella henselae. According to Dr. Eli Mordechai, Chief Executive Officer (CEO),
“Our laboratory has always poured resources into vector-borne research by developing and enhancing tests in concert with our national and international clinician clients. We’re committed to leading the way in vector-borne diagnostics and partnering with healthcare providers to offer patients the best care possible”.
MDL is a CLIA-certified infectious disease laboratory specializing in high-complexity, state-of-the-art, automated, DNA-based molecular analyses. Using unique molecular techniques, MDL provides clinicians from many specialties valuable information to assist in the diagnosis, evaluation, and treatment of viral, fungal, and bacterial infections. MDL is a member of the Genesis Biotechnology Group located in Hamilton, New Jersey, in “Einstein’s Alley”, the research and technology corridor of New Jersey.
GBG is a consortium of vertically-integrated corporate research entities, which facilitates the overall market implementation and delivery of biomedical science products and services related to diagnostics and drug discovery. Through the consolidation of research activities, and the collaboration of diverse groups of scientists with expertise in molecular biology, genetics, high throughput screening (HTS), pharmacology, molecular modeling, and medicinal chemistry, GBG is well-positioned to create and sustain complex research platforms in drug discovery and the design of surrogate biomarkers for chronic diseases.
There are 17 human-biting ticks known in Australia. The bites of Ixodes holocyclus, Ornithodoros capensis, and Ornithodoros gurneyi can cause paralysis, inflammation, and severe local and systemic reactions in humans, respectively. Six ticks, including Amblyomma triguttatum, Bothriocroton hydrosauri, Haemaphysalis novaeguineae, Ixodes cornuatus, Ixodes holocyclus, and Ixodes tasmani may transmit Coxiella burnetii, Rickettsia australis, Rickettsia honei, or Rickettsia honei subsp. marmionii. These bacterial pathogens cause Q fever, Queensland tick typhus (QTT), Flinders Island spotted fever (FISF), and Australian spotted fever (ASF). It is also believed that babesiosis can be transmitted by ticks to humans in Australia.
In addition, Argas robertsi, Haemaphysalis bancrofti, Haemaphysalis longicornis, Ixodes hirsti, Rhipicephalus australis, and Rhipicephalus sanguineus ticks may play active roles in transmission of other pathogens that already exist or could potentially be introduced into Australia. These pathogens include Anaplasma spp., Bartonella spp., Burkholderia spp., Francisella spp., Dera Ghazi Khan virus (DGKV), tick-borne encephalitis virus (TBEV), Lake Clarendon virus (LCV), Saumarez Reef virus (SREV), Upolu virus (UPOV), or Vinegar Hill virus (VINHV).
It is important to regularly update clinicians’ knowledge about tick-borne infections because these bacteria and arboviruses are pathogens of humans that may cause fatal illness. An increase in the incidence of tick-borne infections of human may be observed in the future due to changes in demography, climate change, and increase in travel and shipments and even migratory patterns of birds or other animals. Moreover, the geographical conditions of Australia are favorable for many exotic ticks, which may become endemic to Australia given an opportunity. There are some human pathogens, such as Rickettsia conorii and Rickettsia rickettsii that are not currently present in Australia, but can be transmitted by some human-biting ticks found in Australia, such as Rhipicephalus sanguineus, if they enter and establish in this country.
Despite these threats, our knowledge of Australian ticks and tick-borne diseases is in its infancy.
I appreciate the way the researchers wrote about the possibility of infection even though there are not recorded cases yet. This open-mindedness is imperative if we are to move forward. Gone are the days where tick-borne illness is presented as if the information were akin to the 10 commandments.
Tick-borne illness has become a true pandemic and is found virtually everywhere.
While Lyme is not mentioned (please note further down that autopsy results showed Lyme all over a man from Sydney) the following infections are on record:
Queensland tick typhus (QTT)
Flinders Island spotted fever (FISF)
Australian spotted fever (ASF)
Francisella spp. (Tularemia)
Dera Ghazi Khan virus (DGKV)
tick-borne encephalitis virus (TBEV)
Lake Clarendon virus (LCV)
Saumarez Reef virus (SREV)
Upolu virus (UPOV)
Vinegar Hill virus (VINHV)
I would say that is quite enough to make our Aussie friends quite sick.
You probably try to protect yourself and your children from ticks and the diseases they carry with insect repellents. But new federal legislation would add resources to the battle against Lyme disease and other tick-borne diseases.
The Centers for Disease Control estimates 300,000 people are diagnosed with Lyme disease each year in the U.S. The proposed legislation would crate a new national strategy to combat tick-borne diseases.
The bill would create an office of oversight and coordination for tick-borne diseases in the Department of Health and Human Services.
It would expand and enhance research, develop new and better diagnostic tests and seek safe and effective vaccines.
Lori Geurin, who lives near Bolivar, hopes more resources are put toward exploring tick-borne diseases. She started having flu like symptoms and severe fatigue about seven years ago.
“My whole body was in pain, and I couldn’t sleep at all,” says Geurin. “I would have night after night of no sleep at all, and I was teaching and a mom of four children and a wife. And it was just all I could do to get up in the morning and get out of bed.”
A year and a half later, Geurin says she tested positive for Lyme disease in one test from a private company, one from her doctor, plus another tick borne disease called tularemia.
“He said that my symptoms, if I had been to the northeast, that he would diagnose me with Lyme because my symptoms were consistent with Lyme,” says Geurin.
“But because I hadn’t been to the northeast, I didn’t have Lyme disease.”
Her long search for answers is one reason she believes more research is needed on Lyme disease and other tick borne illnesses.
“I’ve read a lot that there isn’t enough funding for Lyme, and there’s so many people out there that I hear from every week have the same symptoms and they’ve been told the same things,” says Geurin.
Congresswoman Vicky Hartzler is one of many co-sponsors to the bill, House Resolution 220. It’s been introduced in the house and referred to the House Committee on Energy and Commerce.
Another patient told they can’t have Lyme because it doesn’t show up on a man-made map. This is 2019, with information coming out on a daily basis on the spread of ticks and tick borne illness, yet doctors STILL have their heads in the sand.
This, right here, is a very real reason why thousands go undiagnosed.
These maps are outdated and do not explain the whole story. Doctors, please use your God-given brains. Do not smugly rely on outdated information. Be informed. Do your homework.
Quit looking at maps and start listening to patients!
Introduction: The prevalence of Francisella tularensis in Minnesota ticks is unknown. Ticks collected at seven sites were tested to determine the infection prevalence of F. tularensis in Dermacentor variabilis in Minnesota.
Materials and Methods: Ticks were collected from two properties at an epizootic site and at five long-term tick research sites. Ticks were pooled by species, sex, date, and site with a maximum of 10 ticks per pool. Ticks were bisected and homogenized; DNA from supernatant was extracted and tested by real-time PCR (RT-PCR). Twice, additional ticks were collected for bacterial culture and isolation of F. tularensis. Proportion of positive pools and minimum infection rate (MIR) were calculated.
Results: A total of 3527 ticks were tested for F. tularensis including 1601 male D. variabilis and 1926 female D. variabilis. Across all sites, 128 (34%) of 378 pools were RT-PCR positive for F. tularensis. Of 128 positive pools, F. tularensis from 96 (75%) was identified as type A; F. tularensis from 32 pools was unable to be subtyped. The overall MIR was 3.6%. The MIR was significantly lower at the epizootic site compared with Morrison County 1 (3.9% vs. 7.2%; p = 0.02) but did not differ between the epizootic site and Pine County 1 (3.9% vs. 2.1%; p = 0.49). Within the epizootic site, the MIR was significantly higher at Washington County 2 compared with the adjacent property (5.7% vs. 2.3%; p < 0.001). F. tularensis was cultured from 6 (15%) of 40 pools.
Conclusions: F. tularensis was found in ticks at a majority of sites tested. The MIR of F. tularensis in D. variabilis ticks in Minnesota varied geographically. Our findings support the hypothesis that D. variabilis plays an important role in the natural history of tularemia in Minnesota. Further ecologic studies are needed to fully understand the importance of tick species in the maintenance and transmission of F. tularensis in Minnesota.
The Dermacentor variabilis tick is a hard bodied tick, also known as the American Dog tick or Wood tick and is widely known. It transmits Rocky Mountain spotted fever (RMSF) and tularemia to humans as well as canine tick paralysis to dogs. http://edis.ifas.ufl.edu/in781
Dorsal view of American dog ticks, Dermacentor variabilis (Say), with male on left, and female on right.Credit: J.F. Butler, University of Florida
It was been suggested that adult ticks move to the edge of the roads and trails in an attempt to find a host, or “quest.” Some have hypothesized that because many animals typically follow trails, they leave an odor that attracts these ticks causing them to move toward and quest alongside trails in attempts to find a host (Mcnemee et al. 2003).
Normally thought of as inhabiting areas east of the Rocky Mountains, the Wood tick is obviously defying entomology maps and traipsing all over – from Minnesota to Missouri, California, and most probably everywhere in-between.
I remember hearing Timothy Lepore, MD, FACS, surgeon at Nantucket Cottage Hospital, at a Lyme conference. He explained that Tularemia is also a disease of those who work with the land such as landscapers and farmers, as well as those who get bit by a tick. There are cases reported in every state but Hawaii, and many other wild and domestic animals can be infected. The highest rates of infection are in Arkansas. Please see this link for more details but know that this is a bioweaponized pathogen: https://madisonarealymesupportgroup.com/2016/10/25/of-rabbits-and-men/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.
Transmission: Transmission can occur through the skin or mucous membranes when handling infected animals as well as through tick bite, contact with fluids from infected deer flies, mosquitoes or ticks, handling or eating undercooked rabbit, drinking contaminated water, inhaling dust from contaminated soil, and handling contaminated pelts or paws of animals. It can also be inhaled from infected hay, grain, or soil. Dr. Lepore had patients who contracted it from their pet dog who shook rain water on them after chewing on a dead rabbit, as well as from folks eating road kill, a person who held sick animals, and a gentleman who slept with his pet bunny.
Another reminder – don’t sleep with pets!
The fact that 35% of Minnesotan ticks are infected with Tularemia is concerning. Spread the word.
In December of 2018, the Tick-Borne Disease Working Group released its first report to Congress regarding the epidemic of emerging disease. This article gives a basic rundown of relevant statements contained in the first of three TBDWG reports to Congress.
What is the Tick-Borne Disease Working Group?
The TBDWG is a fourteen-member panel of infectious disease professionals called together in light of the 21st Century Cures Act and organized by the Department of Health and Human Services. This group is tasked with reviewing the current science and treatment progress of the various tick-borne diseases and reporting their findings to Congress every two years in December. December 2018 saw the first report, there will be a second report in December 2020 followed by final recommendations at the end of 2022.
So what does this first report detail regarding Morgellons disease? Let’s dive in and find out!
Chronic Lyme Disease
At the start of the first TBDWG report it is stated,
“While most Lyme disease patients who are diagnosed and treated early can fully recover, 10 to 20% of patients suffer from persistent symptoms, which for some are chronic and disabling. Studies indicate that Lyme disease costs approximately $1.3 billion each year in direct medical costs alone in the United States.”
Sounds promising, but what about the insensitive testing methods? What does the report say about early diagnosis and why there are so many false negatives? Amazingly the report addresses these concerns directly, “Today, available diagnostic tests can be inaccurate and complex to interpret, especially during the earliest stage of infection when treatment is most effective. Unlike in other infectious disease settings, tests to directly measure the presence of the infecting organism, such as cultures or tissue biopsies, are not available for some tick-borne diseases such as Lyme disease. This leaves physicians without the tools needed to diagnose; and without an accurate diagnosis, it is challenging for physicians to provide early treatment.”
Wow! With that kind of admission about standard Lyme testing, you would expect similar honesty regarding other controversial aspects of Lyme disease. What about congenital transmission then, what does this report state about Lyme infecting unborn children?
Lyme Congenital Transmission
From the report, the sole instance of recognition appears on page 53 in the chapter titled “Treatment”. It states,
“Pregnancy: Transplacental infection of the human fetus has been recognized for relapsing fever borreliosis, as well as Lyme disease, babesiosis, and certain arthropodborne flaviviruses. Pregnancy poses particular challenges for treatment because few antimicrobials have been approved and are safe to use during pregnancy. Additional research into appropriate treatment options are needed.”
It’s right there in black and white and from the red, white and blue state of American Freedom and Democracy! Why then would the World Health Organization remove such an apparent consideration from its medical coding system?
But what about Morgellons specifically? What does this report elicit about those afflicted with this particular skin manifestation that’s been thoroughly associated with tick-borne disease?
What’s in the report for Morgellons?
Keyword analysis of the report reveals seventeen instances of the term “skin” speckled throughout. The first instance is regarding frequent skin lesions that occur early in the infectious process. It continues to state that with early treatment the better prognosis can be achieved. While that’s great and everything, what else does it say about skin lesions that may be particularly relevant?
The next two instances of “skin” in the report occur regarding utilizing skin agents to deter ticks from attaching to the skin. The following six instances regard the characteristic erythema migrans bullseye rash and that relates to early diagnosis. This section is interesting in that it elaborates on the many kinds of erythema migrans that can occur and gives a visual presentation of each. Still, none of these erythema migrans look anything at all like Morgellons ulcerations.
The tenth and eleventh occurrence of the term “skin” in the first of three TBDWG reports to Congress are of interest as they describe Figure 10 in the report, “Skin Rashes of Tick-Borne Diseases”. Figure 10.a depicts Tularemia which is a Tick-Borne Infection (TBI) that produces lesions in the skin. The difference between Tularemia and Morgellons, however, is Tularemia does not produce collagenous fibers, which are the defining characteristic of Morgellons disease.
Occurrence twelve describes how skin rashes present early in dissemination and appears alongside a figure that demonstrates how the IgM response falls off over time, leaving a patient with primarily elevated IgG antibodies.
“Skin” appears for the thirteenth and fourteenth time in the report regarding the challenges of diagnosing skin rashes in individuals with darker skin tone. This section stresses the importance of TBI education in areas where Lyme is not considered endemic, as a lapse in diagnosis can result in severe patient complications.
The fifteenth and sixteenth use of the term “skin” appear alongside information regarding how the disease disseminates from the skin to other organs of the body in the sixth chapter which details treatment. This section is completely fascinating, eliciting how infected patients are more susceptible to re-infection and how mice vaccinated against influenza produced a suppressed immune response to the flu in light of their infection with Borrelia burgdorferi.
If Lyme disease can suppress the immune response for diseases other than itself, what else can it accomplish?
The final instance of the term “skin” in the TBDWG report to Congress is alongside recognition of NIAMS, the National Institute of Arthritis and Musculoskeletal and Skin Diseases. We went to the NIAMS website and was not at all surprised to produce a lack of search results for the term “Morgellons“.
Is the TBDWG Report Good?
The first TBDWG Report is surprising. It’s not at all littered with propaganda and falsehoods that plague our esteemed medical establishments. Besides not directly addressing Morgellons the report does reveal several controversial facts about Lyme disease that many in official health agencies currently disagree about. This is a refreshing move in what could be considered a positive direction.
This report did not try to appease the establishment, but at the same time, it doesn’t explore the full extent of the Lyme pandemic. The fact is the fourteen members of the TBDWG have two more reports to produce, and we know for certain many of them are aware of the significance Morgellons has relating to their efforts.
If a grade was to be applied to the first report it feels like this initial effort deserves a solid B+.
HHS Working Group Calls for Tick-Borne Disease Strategic Plan
The Tick-Borne Disease Working Group, a federal advisory committee established by Congress in the 21st Century Cures Act, issued its first report Nov. 14.
Nov 15, 2018
The Tick-Borne Disease Working Group, an HHS advisory committee established by Congress in the 21st Century Cures Act, issued its first report Nov. 14. The document recommends that the National Institutes of Health create an NIH tick-borne disease strategic plan to address these diseases, including all stages of Lyme disease; that funding be dedicated within CDC to study babesiosis incidence; that the Department of Defense begin a study of tick-borne disease incidence among active-duty service members and their dependents; and that the Veterans Administration begin a study of tick-borne disease incidence and prevalence among veterans and eligible family members.
The DoD recommendation says the department should compile data on the impact of tick-borne diseases on military readiness and should create education and preparedness programs that address the unique risks service members face during training and on deployment and by their families.
The working group consists of 14 people appointed by the HHS secretary in December 2017. They include scientists, physicians, patients, patient advocates, and representatives of HHS, DoD, and the Office of Management and Budget.
Their report calls Lyme disease a growing public health threat, with about 300,000 new cases reported in the United States every year. A map of U.S. states in the report indicates the hardest-hit states, those reporting more than 12,856 cases each in 2004-2016, include Minnesota, Wisconsin, Pennsylvania, Maryland, Virginia, New York, New Jersey, Massachusetts, and Maine.
Most Lyme disease patients who are diagnosed and treated early can fully recover, but 10-20 percent of patients suffer from persistent symptoms, which for some are chronic and disabling. The report says while studies indicate Lyme disease costs approximately $1.3 billion annually in direct medical costs in the United States,
“a comprehensive understanding of the full economic and societal cost remains unknown. It is likely orders of magnitude higher and potentially a $50- to $100-billion-dollar problem for the United States, although more research is needed.”
On Nov. 14, CDC reported that new data show tick-borne diseases are again on the rise, and that in 2017, state and local health departments reported a record number of cases of tick-borne disease to CDC. Cases of Lyme disease, anaplasmosis/ehrlichiosis, spotted fever rickettsiosis (including Rocky Mountain spotted fever), babesiosis, tularemia, and Powassan virus disease all increased—from 48,610 cases in 2016 to 59,349 cases in 2017. However, the 2017 data capture only a fraction of the number of people with tick-borne illnesses, according to CDC. According to the agency, between 2004 and 2016, the number of reported cases of tick-borne disease doubled and researchers discovered seven new tick-borne pathogens that infect people. The new data are from the Notifiable Disease Surveillance System.
“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.”