Archive for the ‘Viruses’ Category

Misdiagnosed: How Children With Treatable Medical Issues Are Mistakenly Labeled as Mentally Ill

https://www.huffingtonpost.com/entry/misdiagnosed-how-children-with-treatable-medical-issues_us_59d6b302e4b0705dc79aa68f by A. Elizabeth Washington, Writer, Advocate, Mother

Misdiagnosed: How Children With Treatable Medical Issues Are Mistakenly Labeled as Mentally Ill

10/05/2017 

In the fall of 2015, eleven-year-old Sophia Cahill* began blinking her eyes. Though an eye doctor dismissed the blinking as a symptom of dry eyes, her parents would look back later and realize the blinking was a tic. Sophia was otherwise healthy and unbothered by the blinking so life carried on as usual. The simple tic would unfortunately foreshadow much darker days to come.

As Sophia entered seventh grade the following year, she enjoyed spending time with friends and family, performed well academically, and excelled in several sports. She played softball and skied black-diamond slopes with ease. With a love of horseback riding, she had spent two weeks the prior summer at an overnight riding camp. Independent and responsible, she had flown alone across the country to see her cousins and was a trustworthy babysitter for her siblings. Sophia was happy and healthy, with a precocious sense of humor and an easygoing demeanor. Sophia’s parents, both medical doctors, had no concerns about her behavior or health that could have predicted that her life would soon be dramatically and abruptly turned upside down.

Shortly after the school year started, Sophia became sick with a virus and then pneumonia. The illnesses would have been easily forgotten were it not for the troubling episodes that began the following month. Out of the blue and generally in the evenings, Sophia would become extremely distressed and inconsolable, crying for hours at a time. In a state of extreme anguish, she’d rip up boxes of Kleenex, pound her fists on the bed, and repeat bizarre and senseless phrases. Her pupils would dilate and with sheer terror in her eyes and panic on her face, she would scream “Mommy! Mommy, help me!” but no amount of consoling could ease her suffering. Eventually, her hysterical sobbing was punctuated with the disturbing sight and sound of the usually calm twelve-year-old banging her head against the wall. By the wee hours of the morning, she would collapse from utter exhaustion and fall sleep.

The morning after each episode, Sophia would awake in good spirits showing no signs of the turmoil that had transpired the night before. A few nights would pass before another episode would occur. Gradually the episodes became more frequent and began lasting longer. Within three months, she had racked up a number of mental health diagnoses from several different doctors and had started an SSRI, yet her mental health continued to deteriorate.

Shortly after the New Year, the distressing symptoms that Sophia had exhibited only intermittently in the prior months turned into an around-the-clock nightmare for her and her family. With the addition of peculiar involuntary movements and constant moaning that would later be recognized as a vocal tic, Sophia was admitted into the hospital.

While hospitalized, her mother received a call from the pediatrician. The strep titers that she had asked the pediatrician to order were positive. This indicated that Sophia had likely had a fairly recent strep infection. Coupled with her dramatic neuropsychiatric deterioration, the pediatrician believed her mother’s suggestion that Sophia might have pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, commonly referred to as PANDAS, was likely accurate. She asked that Sophia’s mother discuss the possibility with the doctors at the hospital. Because Sophia also had a virus and pneumonia in the month before her symptoms began, pediatric acute-onset neuropsychiatric syndrome, or PANS, was also a consideration. PANDAS, a subset of PANS, requires documentation of previous strep infection. Diagnosis of PANS does not require identification of a specific trigger.

Sophia’s parents shared the labs and their suspicions with the hospital, but the attending physicians were adamant that Sophia did not have PANS. Relentlessly symptomatic, Sophia was transferred to an inpatient child and adolescent unit at another hospital with a diagnosis of anxiety. Here too, her symptoms continued to worsen and she developed an extreme startle response, jerking violently at the slightest sound. One week passed and high doses of anti-psychotics, beta-blockers, and other medications as well as additional investigation into medical causes produced no relief. Desperate for help, Sophia’s parents brought her back to the first hospital.

An MRI, EEG, and lumbar puncture provided no insight into what might be wrong and a neurologist reported she could find nothing amiss neurologically. After seeing another psychiatrist, Sophia picked up yet another diagnosis. This time her parents were told she had a conversion disorder and that they were to bring her home and behave as though nothing was wrong with her. With that, Sophia was discharged from the hospital.

At home, she continued to moan around the clock, jerked her arms uncontrollably, screamed hysterically, and was frequently catatonic. Frantic for answers, Sophia’s parents took her to yet another psychiatrist. This time she was diagnosed with a panic disorder, and though the psychiatrist admitted he honestly was not sure what was wrong with her, he prescribed two different anti-psychotics in an effort to stabilize her.

The attempt failed and by February, Sophia had refused to eat or drink for a full week. Treated for dehydration and released by the hospital, she was sent to an in-patient psychiatric facility. She was initially placed on an eating disorder unit and then moved to the OCD and anxiety unit. The two psychiatrists who evaluated her quickly encouraged her parents to have Sophia evaluated by a doctor who specialized in PANS and PANDAS. Sophia and her parents traveled out of state to see a specialist. With a virus and pneumonia preceding her initial neuropsychiatric symptoms, as well as positive streptococcus titers, the specialist confidently diagnosed Sophia with PANS and its subset PANDAS. Returning to the psychiatric facility with a proper diagnosis and treatment plan in place, Sophia was discharged.

Still suffering horrifically, Sophia tried to end her own life two days later. She was rushed back to the same hospital that had encouraged her parents to take her home and behave as though nothing was wrong the month before.

Now open to the possibility of PANS, hospital physicians agreed to treat her with intravenous immunoglobulin, or IVIG. Derived from the plasma of over a thousand donors, IVIG is used to treat a number of serious and life threatening medical conditions, including PANS. Sophia also underwent plasmapheresis, a procedure in which the plasma is separated from the blood cells, treated to remove auto-antibodies that may be attacking the body, and then returned to the body. Next she received Rituximab, a medication that halts autoimmune disorders by targeting and destroying B-cells, a type of blood cell responsible for antibody production

Though patients receiving these treatments often wait eight or more weeks for relief, Sophia was well enough to leave the hospital by the end of the month. Just as she was beginning to resume a few normal activities, pharyngitis caused relapse and she was readmitted to the hospital for an additional six weeks of aggressive immunomodulatory therapies, antibiotics, tonsillectomy and adenoidectomy. This time, the treatment would provide complete remission.

Four months after her final release from the hospital, Sophia is functioning just as well today as she had been prior to the onset of PANS. She is content, doing well academically, and on the school volleyball team. Surrounded by friends to celebrate her thirteenth birthday last month, Sophia showed no evidence of the year-long nightmare she had endured.

To understand how the physicians of a highly regarded hospital system could repeatedly misdiagnose Sophia, it is helpful to understand the history of PANS and PANDAS. National Institute of Mental Health researcher, Dr. Susan Swedo, first recognized what would come to be called PANDAS more than 25 years ago. While researching Sydenham’s chorea and obsessive-compulsive disorder (OCD), the mother of a patient with severe OCD and tics mentioned that her son had strep throat less than two weeks before his onset of symptoms. She had also noticed her older son’s tics would worsen a couple days before the start of a sore throat and positive strep test. As Dr. Swedo investigated further, she became aware that other infections also triggered OCD, tics, psychiatric issues, and behavioral problems in certain children.

Focusing early research on strep-triggered cases of obsessive-compulsive and tic disorders, Dr. Swedo published a paper in 1998 that provided clinical description of the first 50 children she had observed with PANDAS. All cases were characterized by an abrupt onset of OCD or tics following a strep infection. Many of the children also suffered from emotional lability, changes in school performance, personality changes, bedtime fears, separation anxiety, irritability, sensory defensiveness, impulsivity, distractibility, deterioration in handwriting and math skills, oppositional defiant behaviors, and nightmares (1).

A small handful of neurologists were swift to criticize the research. Quickly labeled as controversial, Dr. Swedo and other researchers would find themselves defending the concept of PANS for decades to come. Ruthless in their attack of PANS and PANDAS, several critics published a paper in 2012 in the Journal of Pediatrics titled “Moving From PANDAS to CANS (2).” Despite a large body of evidence to the contrary, they again called into question the scientific evidence for its existence. They also criticized the use of antibiotics to treat children with abrupt onset OCD and tics despite evidence that the health of many children with PANS was restored with antibiotic treatment.

After the paper was published, it was revealed that three of the authors, Dr. Roger Kurlan, Dr. Harvey Singer, and Dr. Donald Gilbert, failed to disclose that they had received financial support from the pharmaceutical company Psyadon (3). The company manufactures a medication for tics, providing a possible motive for their persistent criticism of the concept of PANS and use of inexpensive antibiotics to treat it.

Despite the frequent negative publicity, significant progress has been made in the understanding and treatment of PANS. In 2012, Lucile Packard Children’s Hospital at Stanford started a program treating children with PANS. In 2013, they hosted a conference with a number of experts from prestigious medical institutions and published a paper with clear diagnostic guidelines (4). In February 2015, an entire edition of the Journal of Child and Adolescent Psychopharmacology (5) was dedicated to PANS and PANDAS and in 2017, the same journal published three articles detailing full treatment guidelines (6). The articles were co-authored by an incredible team of experts like Dr. James Leckman, Professor of Child Psychiatry at Yale University, who served as the Director of Research for the Yale Child Study Center for more than twenty years; Dr. Mark Pasternack, infectious disease doctor and Associate Professor of Pediatrics at Harvard University; Dr. Jennifer Frankovich, PANS rheumatologist and Director of the PANS Program at Stanford; and more than two dozen other experts from prominent institutions.

Though experts consider the controversy to be resolved, the vast majority of pediatricians, child psychiatrists, and neurologists are unapprised of the latest research and continue to misdiagnose children who have PANS with any number of mental health disorders. The PANDAS Physician Network, an organization that educates medical professionals and sponsors research of the disorder, lists only one or two physicians who treat PANS in many states. Considering that by National Institute of Mental Health estimates, at least 350,000 children in the United States have PANS, the number of doctors who recognize and treat it is woefully inadequate to meet the needs of suffering children.

For now, many children with PANS continue to wait for the medical community to catch up to what experts have known for decades. We can only hope they’ll be as lucky as Sophia and receive proper medical attention before it’s too late.

 

*Name has been changed to protect privacy.

 

References

1. Swedo, Susan E., et al. “Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases.” American Journal of Psychiatry 155.2 (1998): 264-271.

2. Singer, Harvey S., et al. “Moving from PANDAS to CANS.” The Journal of pediatrics 160.5 (2012): 725-731.

3. Singer, Harvey S., et al. “Moving from PANDAS to CANS.” The Journal of pediatrics 160.5 (2012): 725-731. (see correction)

4. Chang, Kiki, et al. “Clinical evaluation of youth with pediatric acute-onset neuropsychiatric syndrome (PANS): Recommendations from the 2013 PANS Consensus Conference.” Journal of Child and Adolescent Psychopharmacology 25.1 (2015): 3-13.

5. Chang, Kiki, Harold S. Koplewicz, and Ron Steingard. “Special issue on pediatric acute-onset neuropsychiatric syndrome.” Journal of child and adolescent psychopharmacology 25.1 (2015): 1-2.

Second Jamestown Canyon Virus Case in New Hampshire

http://outbreaknewstoday.com/new-hampshire-reports-2nd-jamestown-canyon-virus-case-27643/  Sept. 2017

New Hampshire health officials have recorded the second human Jamestown Canyon virus (JCV) case of the year in an adult from Goffstown. This follows a case confirmed in mid-August in Hanover.

Image/Elionas
Image/Elionas

It is likely that this case was acquired in New Hampshire, but due to recent travel, location of exposure is not certain.

“As we head into the fall, it’s important for people to remember that mosquito-borne diseases like Jamestown Canyon Virus are still a risk in New Hampshire,” said State Epidemiologist Dr. Benjamin Chan. “We want residents and visitors to continue to enjoy the outdoors, but they should take steps to protect themselves from mosquito bites as long as mosquitoes are still around.”

LISTEN: Powassan virus: The spread is inevitable

Until the second hard frost of the season, residents and visitors to New Hampshire should continue to protect themselves and their family members from mosquito-borne diseases by using an effective mosquito repellant that contains 30% DEET, wearing long sleeves and pants at dawn and dusk when mosquitoes are most active, and removing standing water from around your home so mosquitoes do not have a place to breed. Repellents with picaridin, IR3535 and some oil of lemon eucalyptus and para-menthane-diol products also provide protection against mosquito bites. A hard frost is defined as two consecutive hours of temperatures below 28 degrees Fahrenheit.

Related: Iowa reports 1st West Nile virus death of 2017

Initially described in the early 1970s, JCV is a mosquito-borne pathogen that circulates widely in North America primarily between deer and a variety of mosquito species, but it can also infect humans. Reports of JCV in humans are rare (Since 2000, more than 50 cases of JCV have been identified nationally. The cases have primarily been in the Midwest and Northeast) and most reported illnesses caused by Jamestown Canyon virus have been mild, but moderate-to-severe central nervous system involvement has been reported.

 

Of Birds and Ticks

http://mainepublic.org/post/battle-against-ticks-and-lyme-disease-scientists-look-skies#stream/0

In the Battle Against Ticks and Lyme Disease, Scientists Look to the Skies

  JUL 3, 2017

As we head into the Maine outdoors this summer, the all-too-familiar warnings about how to avoid ticks reverberate in many of our heads.

Stay on the trail. Steer clear of wooded and brushy areas where ticks congregate.

But while most of us take pains to dodge the eight-legged pests, Chuck Lubelczyk heads straight for them.

As a field biologist at the Maine Medical Center Research Institute’s Lyme and Vector-Borne Disease Laboratory, he studies the spread of diseases carried by ticks, as well as by mosquitoes. That means venturing out into the fields, forests and coastlines of Maine to collect the bugs and evaluate where they pose the most risk to humans.

On a recent June day, Lubelczyk trudged into the greenery of the Wells Reserve, a 2,250-acre spread in York County headquartered at a restored saltwater farm. He partnered with researchers from the Biodiversity Research Institute in Portland to collect ticks from creatures less often associated with them: birds.

The team, assisted by several interns, set up wide nets to ensnare the birds as they flew through the area. They then delicately extricated them, tucked the birds into breathable collection bags, and toted them to a shady picnic table for easier handling. Using tweezers, the team plucked off each tick — typically feasting around the birds’ eyes, bills, and throats — and preserved the bugs for later testing at the lab.

Lubelczyk held up a vial containing at least 50 tiny nymphal deer ticks swirling in a preservative solution. They’d been tweezed off a single bird, a towhee, that morning.

Once free of ticks, the birds were then safely released to continue on their way.

https://bangordailynews.com/video/ticks-on-migratory-birds/ (Video here)

While mice, chipmunks and deer get most of the attention as hosts for ticks, “Not a lot of people talk about the bird issue,” he said. “They’re understudied in a big way, I think. They do have a real role to play.”

Ticks are an annoyance to birds, but they don’t transmit disease to them or slowly and lethally drain them of blood, as researchers have seen among moose calves in Maine. But birds facilitate the spread of ticks, picking them up in Maryland, Connecticut and other eastern states as they fly north in the spring, Lubelczyk explained.

“As they’re migrating, they’re either dropping the ticks off as they fly or when they land. They’re kind of seeding them along migration patterns.”

Emerging diseases

By tracking the birds and the ticks they carry, researchers hope to predict where Lyme and other tick-borne diseases are most likely to accelerate. Lyme is now present in every county in the state, after hitting a record of 1,488 cases in 2016, but ticks are just getting established in areas such as Aroostook and Washington counties, Lubelczyk said.

Along with Lyme, Lubelczyk tested the ticks for other two other emerging diseases, anaplasmosis and the rare but potentially devastating Powassan virus. Powassan, carried by both the deer tick and the groundhog or woodchuck tick, recently sickened two people in midcoast Maine, following the death in 2013 of a Rockland-area woman.

A recent survey Lubelczyk led found the virus in ticks crawling around southern Maine, Augusta and on Swan’s Island in Hancock County.

In the modest Scarborough lab, medical entomologist Rebecca Robich furthered the findings of that survey. Clad in a white coat and blue gloves, she cloned a tiny band of the Powassan virus’ inactivated RNA, using a sample derived from the ticks that tested positive in the survey. Robich began the work, designed to confirm the earlier test results, last winter.

She expects to know conclusively within the next month what percentage of the sampled ticks were infected with Powassan, she said.

“We’re this close to finishing,” Robich said.

Growing exposure

Ticks have become so prevalent in Maine that Lubelcyzk and his colleagues are increasingly called upon to educate the public about the health risks the arachnids pose. That includes speaking at community forums, town meetings, garden clubs and even to groups of employees.

“They’re widespread enough now that DOT, CMP, people like that are bumping into them on a regular basis,” he said. “Even people like law enforcement. The warden service, regular police with police dogs, they’re exposed.”

Their outreach also includes plenty of phone calls to the lab, fielded by its small staff of four, not counting summer interns.

“If somebody calls, we never really turn them down,” he said.

Many people don’t realize that the lab no longer identifies ticks for the public, Lubelczyk said. Now located in Scarborough along with MMC’s medical and psychiatric research centers, the lab formerly operated in South Portland, where it identified a tick’s species for anyone who walked in the door or mailed a sample. The University of Maine Cooperative Extension in Orono has since taken over that service (it does not test ticks for disease).

“It’s very hard to say no to someone when they’re really frantic because they found a tick on themselves, or their child, or even their pet,” he said. “And they’re sitting out in the parking lot.”

So far this season, the lab has fielded numerous calls from worried residents only to discover after viewing a photograph that the tick in question is a dog tick, not a deer tick. Maine is home to 15 species of ticks, and the dog tick is not among those that transmit disease to humans, at least in this region.

Through its outreach work, the lab has also found itself at the center of debates about how to manage ticks. Lubelczyk recalled a town forum on Long Island a couple of years ago that grew tense as residents discussed the use of pesticides.

“As soon as the topic of any kind of spray was brought up, not even by us, by somebody else, the fishing community was dead set against it,” he said. “Understandably, they’re worried about the stock. It really makes that difficult because you start to have divisions in how to control the ticks.”

The lab’s research on the role of birds in spreading tick-borne disease is similarly delicate, because many birds are under threat ecologically, Lubelczyk said.

“No one really cares if you try to target mice. Birds are federally protected in a lot of cases,” he said.

That other biting pest

Educating the public represents a large part of the lab’s mission but only a small part of its budget. Its outreach work is funded largely through small grants from foundations, Lubelczyk said.

Most of its research funding is targeted toward mosquitoes rather than ticks, boosted by the federal government’s initiative to combat the Zika virus, he said. While Zika hasn’t appeared in Maine, warming temperatures due to future climate change could make the state habitable for one of the mosquito species that carries it.

Lubelczyk explained this as he stood in the lab’s testing area, next to a large freezer storing petri dishes packed with frozen mosquitoes. A piece of yellow tape affixed to the door warned, “Not for food.”

While Lyme is far more prevalent, diseases carried by mosquitoes, such as West Nile virus and Eastern Equine Encephalitis, can lead to more acute illness. Both can cause inflammation of the brain and other serious complications.

Funding for tick research is generally less reliable, Lubelczyk said. The recent Powassan survey, for example, was funded by the Maine Outdoor Heritage Fund, which collects money through the sale of instant scratch lottery tickets.

A continuing threat

The lab’s role in helping to prevent tick-borne diseases has only grown as the tick population and the diseases they carry spread. The incidence of Lyme in Maine is among the highest rates in the country, averaging 82.5 cases per 100,000 people between 2013 and 2015.

Anaplasmosis and babesiosis are less common but becoming increasingly worrisome.

Lubelczyk understands the illnesses on both a professional and personal level. He contracted Lyme several years ago, after a deer tick latched onto him while he made a pitstop on the way home from work one steamy July day, he said. He had just changed into shorts and sandals and jumped out of his car for 30 seconds to hang a mosquito trap in Wells, he recalled.

A day and a half later, he spotted the tick bite. After a round of antibiotics, he recovered, Lubelczyk said.

His usual garb for field work includes long sleeves and pants treated with permethrin, along with gaiters over his boots.

“It’s embarrassing,” he said, wincing. “We always talk about wearing appropriate clothing.”

 

**Comment**

I’m thankful someone is dealing with the bird issue in relation to tick propagation as I believe it will be found to be much more of an issue than previously thought.  It would help explain why folks insist they’ve been infected while near trees as birds would drop them onto trees (as well as various rodents).  Like deer, birds serve primarily as transits that can spread ticks far and wide.

While Lubelczyk doesn’t feel dog ticks are important carriers (at least in his area) – he’s mistaken.  Every tick should be suspect until proven otherwise.  Think about it:  they all exchange bodily fluids with their hosts.  Dog ticks are known to carry Tularemia, https://www.cdc.gov/ticks/diseases/index.html Rocky Mountain Spotted Fever, Ehrlichia, Mediterranean Spotted Fever, Babesia in dogs (which should also make it suspect for humans), and potentially Bartonella.  http://labs.russell.wisc.edu/wisconsin-ticks/rhipicephalus-sangineus/  No, it would not be wise to think of the Dog Tick in friendly terms.  Remember that ticks are moving all over the place defying commonly held beliefs about geography.  And while folks fighting for research grants want to promote and blame the supposed “global warming” mentioned in this article, there are many who disagree for good reasons:  https://madisonarealymesupportgroup.com/2017/07/08/global-warming-numbers-fudged/

https://madisonarealymesupportgroup.com/2017/08/14/canadian-tick-expert-climate-change-is-not-behind-lyme-disease/  John explains, “The climate change range expansion model is what the authorities have been using to rationalize how they have done nothing for more than thirty years. It’s a huge cover-up scheme that goes back to the 1980’s. The grandiose scheme was a nefarious plot to let doctors off the hook from having to deal with this debilitating disease. I caught onto it very quickly. Most people have been victims of it ever since.”
“This climate change ‘theory’ is all part of a well-planned scheme. Even the ticks are smarter than the people who’ve concocted this thing,” he says.
“Climate change has nothing to do with tick movement. Blacklegged ticks are ecoadaptive, and tolerate wide temperature fluctuations. On hot summer days, these ticks descend into the cool, moist leaf litter and rehydrate. In winter, they descend into the leaf litter, and are comfortable under an insulating blanket of snow. Ticks have antifreeze-like compounds in their bodies, and can tolerate a wide range of temperatures. For instance, at Kenora, Ontario, the air temperature peaks at 36°C and dips to –44°C, and blacklegged ticks survive successfully.

Also, please note that although there has only been one Zika death in an elderly man with a preexisting health condition the continental U.S., all the funding is going to it and mosquito research.  This is causing untold harm here where Lyme is causing around 400,000 new cases per year.  There is no official tally on all the other coinfections they often come with Lyme as they aren’t even reportable in many states but are a crucial detail in understanding the complexity of Lyme/MSIDS.  People are often infected with numerous pathogens.  https://madisonarealymesupportgroup.com/2017/07/01/one-tick-bite-could-put-you-at-risk-for-at-least-6-different-diseases/

To treat this complex as a one organism/one disease would be folly.  

Also, he claims that West Nile virus and Eastern Equine Encephalitis, can lead to more acute illness, I would disagree again.  Lyme (borrelia), Babesia, Bartonella, Mycoplasma, and numerous other viruses, and funguses have killed people outright.  Heart block, encephalitis, meningitis, and other serious illnesses are caused by TBI’s. Powassan can be transmitted in under 15 minutes and can kill. Rocky Mountain Spotted Fever is another killer.  There is much to show that if the non-cell wall and biofilm formation of borrelia isn’t successfully dealt with, it could lead to dementia or Alzheimer’s in the future:  https://madisonarealymesupportgroup.com/2017/06/10/the-coming-pandemic-of-lyme-dementia/https://madisonarealymesupportgroup.com/2016/06/03/borrelia-hiding-in-worms-causing-chronic-brain-diseases/https://madisonarealymesupportgroup.com/2016/08/09/dr-paul-duray-research-fellowship-foundation-some-great-research-being-done-on-lyme-disease/https://madisonarealymesupportgroup.com/2016/06/09/alzheimers-byproduct-of-infection/https://madisonarealymesupportgroup.com/2017/01/18/a-bug-for-alzheimers/

And of course, while many cases of Lyme (borrelia) don’t kill immediately, it can make you want to die and disrupt life in such a way people commit suicide.  https://madisonarealymesupportgroup.com/2017/06/20/suicide-lyme-and-associated-diseases/https://madisonarealymesupportgroup.com/2017/07/26/can-lyme-steal-your-mind/

If that isn’t serious, I don’t know what is.

 

 

 

Death from Tick-borne Virus (SFTS)

http://www.bbc.com/news/world-asia-40713172  July 25, 2017  BBC News

A Japanese woman died last year of a tick-borne disease after being bitten by a stray cat, Japan’s health ministry says, in what could be the first such mammal-to-human transmission.

The unnamed woman in her 50s had been helping the apparently sick cat.

Ten days later she died of Severe Fever with Thrombocytopenia Syndrome (SFTS), which is carried by ticks.

With no tick bite detected, doctors assume the illness could have been contracted via the cat.

“No reports on animal-to-human transmission cases have been made so far,” a Japanese health ministry official told the AFP news agency.

“It’s still not confirmed the virus came from the cat, but it’s possible that it is the first case,” the official added.

SFTS is a relatively new infectious disease emerging in China, Korea and Japan.

The virus is said to have fatality rates of up to 30% and is especially severe in people over 50.

According to Japanese media, SFTS first occurred in the country in 2013.

Japan’s health ministry said last year’s death was still a rare case but warned people to be careful when in contact with animals in poor physical condition.

Globally, tick bites are widely associated with transmitting Lyme disease which can lead to severe illness and death if left untreated.

 

**For more on Thrombocytopenia Syndrome** https://wwwnc.cdc.gov/eid/article/20/11/14-0888_article

Severe fever with thrombocytopenia syndrome (SFTS) is a newly emerging infectious disease. Symptoms and laboratory abnormalities are fever, thrombocytopenia (low platelet count), leukocytopenia (low white blood cell count), and elevated liver serum enzyme levels. Multiorgan failure occurs in severe cases, and 6%–30% of case-patients die. The syndrome is caused by the SFTS virus (SFTSV) (genus Phlebovirus, family Bunyaviridae). SFTS case-patients were first reported in China (1) and more recently were reported in Japan (2) and South Korea (3). Two case-patients with symptoms consistent with a similar virus, Heartland virus, were reported in the United States (4).

Ixodid tick species are implicated as vectors of SFTSV (1,5,6). One study described a SFTSV prevalence in Haemaphysalis longicornis ticks, a major vector of SFTSV, of 0.46% minimum infection rate in South Korea (7); in another study, SFTSV was detected in ticks that had bitten humans (6). From these studies, we realized that SFTSV was common throughout the country. We aimed to evaluate the prevalence of SFTS in South Korea and isolate the SFTSV to analyze its phylogenetic properties.  

The major signs and symptoms of the 35 case-patients, including fever (100%), gastrointestinal symptoms (74%), fatigue (74%), thrombocytopenia (100%), and leukocytopenia (100%), were similar to those of case-patients in China and Japan (9).

For more on Bunyaviridae viruses:  https://en.wikipedia.org/wiki/Bunyaviridae

*The enveloped RNA viruses are found in hematophagous arthropods (blood sucking) and include mosquitos, ticks, midges, flies, or sandflies as well as rodents except for Hantaviruses which are transmitted through contact with deer mice feces – even in the air.  In the advanced stage, of Hantaviruses, there is shortness of breath due to the lungs willing with fluid.

*Examples of Bunyaviridae viruses:  Crimean Congo hemorrhagic fever virus, Hanta Virus or Hantavirus Hemorrhagic Fever, California encephalitis virus, Rift Valley fever, Bwamba Fever, Cache Valley Virus, and La Crosse Virus (Wisconsin).  According to the CDC, between 2004 and 2013 there were 787 total cases of La Crosse encephalitis and 11 deaths in the U.S.[7]  Looking at the distribution of cases across the United States by state, between 2004 and 2013 the most cases of La Crosse encephalitis was in North Carolina. North Carolina had 184 total cases, followed by Ohio with 178 total cases.[8]  https://en.wikipedia.org/wiki/La_Crosse_encephalitis

*There was a Hantavirus outbreak at Yosemite in 2012 and put a 22 year old in intensive care for 10 days. http://www.wral.com/22-year-old-contracted-the-often-fatal-hantavirus-at-state-park/16850141/  The CDC states it has a mortality rate of 38% and that cotton and rice rats, and white-footed and deer mice carry it.

http://www.medicalnewstoday.com/articles/318645.php?utm_source=newsletter&utm_medium=email&utm_campaign=weekly-us  Arboviruses:  Types, symptoms, and transmission  By Jenna Fletcher

*There are over 130 different arboviruses that affect humans.

*The three main genera are:  flavivirus (yellow fever, West Nile virus, Zika virus, dengue fever, Japanese encephalitis), togavirus (Ross River virus, Eastern equine virus, Western equine virus), and bunyavirus (California encephalitis, La Crosse Virus, Jamestown Canyon virus).

*The viruses can be transmitted through insect bites, blood transfusion, organ transplant, sexual contact, congenitally.

 

Heartland Virus in Arkansas

http://www.thv11.com/mb/news/local/case-of-tick-borne-illness-heartland-virus-found-in-arkansas-resident/454950576

Case of tick-borne illness, Heartland virus, found in Arkansas resident

26 days ago

Lone star tick, Thinkstock

LITTLE ROCK, Ark. (July 7, 2017) — Arkansas has identified its first case of Heartland virus, a relatively new tick-borne disease, in an individual living in the northwest part of the state.

People become infected with Heartland virus through the bite of the Lone Star tick. Patients are most likely to be diagnosed with Heartland virus from May to September. Heartland virus causes a flu-like illness, including fever, headache, muscle aches, diarrhea, appetite loss, and feeling very tired. Most cases have low numbers of cells that fight infection and low numbers of cells that help blood clot. There is no vaccine or drug to prevent or treat the disease.

“It’s a flu-like illness where you’re stiff, you’re achy, you run a fever, you’ve got headaches, this one often has diarrhea, which isn’t always the case with some of the others, loss of appetite,” said Dr. Sue Weinstein, the state public health veterinarian. “It can get quite serious.  A lot of patients with this are hospitalized, but most recover.  There’s only been one death in the nation and that was in someone who was quite elderly and other medical issues at the time.”

In 2009, two people admitted to Heartland Hospital in Missouri were later found to be infected with this virus. Both recovered, but the Missouri Department of Health and Senior Services began working with the Centers for Disease Control and Prevention (CDC) to learn more about the virus.

To date, more than 20 cases of Heartland virus disease have been identified in several states in Southeast and South Central United States, so it is not surprising that Arkansas has a case. Most patients require hospitalization for their illness but fully recover. One patient has died. The Arkansas patient has recovered fully.

Arkansas has some of the highest rates in the nation for tick-borne diseases such as Rocky Mountain Spotted Fever (RMSF), Ehrlichiosis, and Tularemia. Anaplasmosis and Lyme Disease may also occur. People who work or do activities outside, where they are exposed to ticks or insects, are more likely to be infected.

Preventing bites from ticks and mosquitoes are the best way to prevent these and other infections:

-Use insect repellents

-Wear long sleeves and pants

-Avoid bushy and wooded areas

-Perform thorough tick checks after spending time outdoors

For more information, visit healthy.arkansas.gov.

**Comment**

I’m sure those in Arkansas are relieved to finally be officially recognized.  Just last year two children were denied Lyme treatment due to it not being on the map:  https://madisonarealymesupportgroup.com/2016/09/24/arkansas-kids-denied-lyme-treatment/  Thanks to a mom who wouldn’t take no for an answer, Lyme Disease is finally recognized.

Arkansas officials ended up eating their words:  https://madisonarealymesupportgroup.com/2017/03/02/hold-the-press-arkansas-has-lyme/

Ticks Found on Eyeball, Buttocks, and Penis

https://mobile.nytimes.com/2017/07/24/health/ticks-disease-united-states.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=second-column-region&region=top-news&WT.nav=top-news&_r=0&referer=http%3A%2F%2Fm.facebook.com

It’s High Time for Ticks, Which Are Spreading Diseases Farther
LINDSAY MORRIS FOR THE NEW YORK TIMES
By ANERI PATTANI
JULY 24, 2017

SOUTHAMPTON, N.Y. — This town is under siege from tiny invaders.

A doctor at Southampton Hospital recently pulled a tick off a woman’s eyeball. After a 10-minute walk outside, a mother reported finding a tick affixed to her 7-year-old daughter’s buttocks.

Another mother called the hospital in a “hysterical state,” according to the nurse who answered, because a tick had attached itself to her son’s penis.

Like many towns across the country, Southampton is seeing a tick population that is growing both in numbers and variety — at a time when ticks are emerging as a significant public health danger.

“Tick-borne diseases are a very serious problem, and they’re on the rise,” said Rebecca Eisen, a research biologist at the Centers for Disease Control and Prevention.

“Even though you may live in an area where you didn’t have ticks in the past or your parents don’t remember having ticks, the distribution is changing,” she added. “More and more people are at risk.”

With the expansion of the suburbs and a push to conserve wooded areas, deer and mice populations are thriving. They provide ample blood meals for ticks and help spread the pests to new regions.

Originally from the Southeast, the lone star tick, for example, is heading north; it can now be found in 1,300 counties in 39 states. The blacklegged tick, also called the deer tick, is expanding its territory, too. In a recent study, Dr. Eisen reported a nearly 45 percent increase since 1998 in the number of counties with blacklegged ticks.

Thomas Mather, director of the University of Rhode Island’s TickEncounter Resource Center, said it used to get reports of three or four lone star ticks in the greater Chicago area each year. Now, it is receiving up to 15.

When a tick species marches into a new region, it poses a double-barreled threat, said Jerome Goddard, extension professor of medical and veterinary entomology at Mississippi State University.

First, the species brings diseases from its original location. Second, the ticks pick up new pathogens from animals in their new ecosystem.

Physicians and patients in a tick’s new home may be less familiar with the diseases it carries. They can overlook symptoms or attribute them to a different cause, delaying effective treatment.

The best known threat is Lyme disease. Cases in the United States increased from about 12,000 annually in 1995 to nearly 40,000 in 2015. Experts say the real number of infections is likely closer to 300,000.

But scientists are finding ticks carry more than just Lyme: At least a third of known tick-borne pathogens were found in the last 20 years. Heartland virus and Bourbon virus, which can prove fatal, were discovered in just the last five years.

Powassan virus, a rare but dangerous pathogen that can cause permanent brain damage or death, can be passed from tick to human in just 15 minutes. It was discovered in 1958, and an average of seven cases are reported each year. Earlier this month, a resident of Saratoga County, N.Y., who had Powassan disease died.

Dr. Gary Wormser, founder of the Lyme Disease Diagnostic Center at New York Medical College, said the most worrisome tick-borne contagion he sees is babesiosis, which can cause malaria-like symptoms and require hospitalization. A few of his patients have died from it; several required intensive care.

Before 2001, babesiosis was not found in Westchester, N.Y. But Westchester Medical Center has diagnosed at least 21 cases in the past year.

A study of babesiosis in Wisconsin found a 26-fold increase in the number of cases between 2001 to 2003, and 2012 to 2015.

In places where the lone star tick is gaining prevalence, doctors also are seeing an increase in cases of alpha-gal syndrome, a strange allergy to red meat induced by tick bites.

Alpha-gal is a sugar molecule carried by the lone star tick. When the tick bites a human, it activates the immune system, which starts producing alpha-gal antibodies.

The body becomes wired to fight alpha-gal sugar molecules, which are abundant in red meat. Eating meat can trigger allergic reactions, from an itchy rash to anaphylactic shock.

Dr. Erin McGintee, an allergist and immunologist at ENT and Allergy Associates in Southampton, sees two to three cases of alpha-gal syndrome per week during tick season. Since diagnosing her first case in October 2010, she has seen more than 380 patients.

“The cases are definitely increasing over time,” she said.

That is no surprise to Karen Wulffraat, administrative director of Southampton Hospital’s Tick-Borne Disease Resource Center.

“The calls about lone star tick bites are increasing in number, even overtaking the blacklegged tick,” which is native to the Northeast, she said.

Cathy Ward and her husband bought a summer home in Southampton in 1984, and moved there permanently eight years ago.

Ms. Ward remembers taking her son Bill to the nearby wildlife refuge as a child, where he would fill his hands with birdseed and stand with his arms outstretched until birds came and perched on them.

Now when Bill Ward visits with his young daughter, Taylor, his mother tells them the refuge is off limits — it is a breeding ground for ticks.

“It wasn’t a concern when Bill was young,” Ms. Ward said. “Now you have to protect yourself all the time. You don’t know where you’re going to pick up a tick.”

She will not garden in the yard anymore, and has it sprayed for ticks annually. Despite that, her granddaughter got a tick while visiting during the Fourth of July weekend. The family found it before it had bitten her, but it was a shock nonetheless.

“It’s scary, because we don’t know which diseases they carry,” said Mr. Ward.

Brian Kelly, owner of East End Tick and Mosquito Control, has noticed the change, too. His company now sprays people’s lawns instead of just their bushes because lone star ticks are more aggressive than the native blacklegged ticks, and tend to venture further from the woods.

“People can walk across their lawn barefoot to get the newspaper and get a tick,” he said.

As human exposure to ticks continues to increase, it’s likely that even the rarest infections they carry will become more common, Dr. Goddard said.

“This really has a human toll that a lot of people don’t recognize,” he said.

 

Clinical Association: Lyme Disease and Guillain-Barre

According to this abstract in The American Journal of Emergency Medicine, http://www.ajemjournal.com/article/S0735-6757(17)30559-4/fulltext  the authors state an association between GBS and Lyme is rare; however, the following article states that Epstein-Barr, also known as Mono, is an infection that triggers Guillain-Barre as well as mycoplasma and cytomegalovirus.  http://www.webmd.com/brain/tc/guillain-barre-syndrome-topic-overview#1

Dr. Garth Nicolson states that Mycoplasma is the most common co-infection with Lyme (borrelia).  https://madisonarealymesupportgroup.com/2016/02/07/mycoplasma-treatment/  Cytomegalovirus (herpes virus family) is also a coinfection to LD.  https://www.envita.com/lyme-disease/cytomegalovirus-a-chronic-lyme-disease-coinfection-and-cancer-causing-agent

Which leaves EBV.

In Dr. Waisbren’s book, Treatment of Chronic Lyme Disease, the majority of his 51 cases of chronic Lyme had high EBV titers.  He also states,

“As will be seen in other cases, the Epstein-Barr virus may be a candidate for a co-infection associated with LD.”  

Waisbren often treated this co-infected patients that had EBV with 1000mg of Valtrex three times a day with good success.  He also used gamma globulin (4cc twice a week).

I think this is another great example of proclaiming something is rare when little research has been done.  Until Lyme patients are routinely tested for GB, I think it unwise to assume a connection is rare.  Researchers need to tread carefully in all things related to TBI’s, understanding that their words have been used against patients for decades.

Time to admit there’s a lot we frankly just don’t know.