HOST: Dr. Daniel Cameron
DATE: Tuesday, June 5, 2018
TIME: 8 PM EST
http://danielcameronmd.com/lyme-disease-science-conversations-registration/
A report published in Infection and Drug Resistance reviews the case of a 44-year-old woman who visited a neurological outpatient clinic in Japan complaining of fatigue and partial mouth paralysis. (She was unable to open her mouth.) The symptoms had persisted for 2 months.
by Daniel J. Cameron, MD, MPH
The patient had been living in New York for the past 10 years and only recently returned to Japan to visit family. “The neurologist initially suspected mild tetanus with lockjaw caused by Clostridium tetani infection, which is relatively common in our area,” writes Seki from the division of Infectious Diseases and Infection Control, Tohoku Medical and Pharmaceutical University Hospital in Japan. [1]
However, “She could open her mouth about 1.5 cm, but her left side of the mouth sagged unilaterally, and she could hardly close her left eye,” writes Seki. So, infectious disease physicians diagnosed her with facial paralysis rather than lockjaw.
When questioned further, the woman recalled being bitten by a tick while camping in Pennsylvania 3 months earlier. She described having “skin changes [flat red rash] with slight itching and pain on her right limb about 1 week after camping,” explains Seki. The rash persisted for 1 to 2 weeks.
She also had a slight fever of 37.2°C (99°F). A fever of unknown origin (FUO) typically includes infectious, rheumatologic and cancer causes. “Lyme disease is not generally considered a common cause of fever of unknown origin (FUO) in Japan,” writes Seki, “although it is very common in North America and Europe.”
The woman was tested and found to be positive for Lyme disease. After 2 weeks of oral minocycline, her symptoms of fatigue, mouth sagging, and a slight inability in opening the eye disappeared.
The patient was treated successfully with antibiotics despite the doctors’ reservations about the legitimacy of chronic Lyme disease. “She had a relatively mild, chronic status,” writes Seki, “suggested of the chronic type of Lyme diseases, which is a poorly defined term that describes the attribution of various atypical syndromes to protracted B.burgdorferi infection.”
Given that there are sporadic and transported cases of Lyme disease in mainland Japan, the authors recommend that clinicians consider Lyme disease in their differential diagnosis when a patient presents with a fever of unknown origin (FUO).
“Thus, Japanese ID [infectious disease] physicians should consider this disease as one of the possible causes of FUO and carefully ask patients about their living conditions and past histories,” notes Seki, particularly when presenting with a combination of FUO and facial palsy.
References:
The Tick App is a free app for your smartphone conceived to allow the participation of people living in high-risk areas for Lyme disease in our tick exposure behavioral study.
Who are we?
This study is conducted by researchers from Columbia University and the University of Wisconsin – Madison, members of the CDC Regional Centers for Excellence in Vector-Borne diseases. Funding for this study is provided by the Centers for Disease Control.
In two words, Lyme disease. Lyme disease can be transmitted to humans after a tick bite. This study is designed to help us understand more about how people’s practices and activities impact their exposure to ticks. This research is being done because Lyme disease is the most common vector-borne disease (infections transmitted by the bite of infected arthropod species, such as mosquitoes, ticks, sandflies, etc) in the United States. The information provided will help us design integrated control strategies to prevent diseases transmitted by ticks.
If you live in a high-risk area, sharing your experience and perspective with us will help us learn about the risk factors for tick borne disease and design better methods that prevent tick bites and tick-borne disease. We really appreciate your input!
We are also including information that will help you identify the different tick species, ways to prevent tick exposure and other information that will help you understand more about ticks and the diseases they transmit.
Once you download the app and register for an account, you will be asked to take one enrollment survey that will help us capture your baseline risk of exposure to ticks.
You will then receive a weekly to monthly message to start your tick diary during the high risk months (May to September). The tick diary, or activity report, should take less than a minute to complete. It asks if you or a household member encountered a tick and what you did that day. When you start the tick diary, you will receive a daily reminder until you complete 15 reports.
Also, you can help us by reporting any tick through a quick form built in the app.
You can sign-up in our website and the surveys will be sent to your email. The informational material can also be found in this website
Anybody over 18 years old is welcome to join the Tick App project! This year the in-person part of the study is also available in Wisconsin. We will be focused on Eau Claire, Madison, Baraboo and Minoqua areas.
Tick Chat: We like to learn about your thoughts about ticks, tick-borne disease and what our research can do about it. We will be hosting conversations about ticks and the Tick App project in:
The conversations are about one hour and limited to 10-15 people. Therefore we request you to sign up and we will confirm with you.
Backyard tick collections: Residential sampling, i.e. collecting ticks in back yards, will be done in:
If you live near these parks and would like to enroll in the Tick App and have your backyard sampled for ticks, please contact us via email (tickapp @ wisc.edu) or flag us down during our visit to your neighborhood.
Several universities, public health agencies, commercial companies and other entities offer tick identification and pathogen testing of your tick.
Different tick species transmit different pathogens, so it helps to know which species bit you. You can send the image of your tick or tick to us, but we are not testing them. Even if a tick is tested for pathogens and none were detected, that does not mean that there is zero chance of you developing a disease. There is the chance that other ticks might have been attached to you and gone unnoticed (they are very small!).
Submit a picture:
The actual tick for identification and testing:
Know of any other places where ticks can be submitted for identification or testing, let us know (tickapp@wisc.edu).
https://www.thevaccinereaction.org/2018/05/has-a-new-organ-in-the-human-body-been-discovered/
STORY HIGHLIGHTS
Pathologist Neil Theise, MD of New York University and endoscopy experts David Carr-Locke, MD and Petros Benias, MD of New York’s Mount Sinai Beth Israel recently announced the results of a study in which they discovered a previously unrecognized “organ” of the human body, and they say it might be the biggest one of them all.1
Dubbed “the Interstitia,” the structure the scientists identified is a network of fluid-filled collagen and connective tissue that is present throughout the body. They described it as “the anatomy and histology of a previously unrecognized, though widespread, macroscopic, fluid-filled space within and between tissues.”1
Knowledge that the interstitium exists is not new, but its interconnectedness and potential for transporting harmful substances like cancer cells throughout the human body is a new discovery.
The word interstitial means “Pertaining to being between things, especially between things that are normally closely spaced.”2 In non-medical terms, it can refer for example to a sub-ceiling that houses the mechanical structures for a building. In medicine, it is used to describe the cells, fluids and spaces between tissues and parts of organs in the body.
Interstitial cells and fluid are found in the spaces around cells of a given organ (like the spaces between the air sacs of the lungs) and help transport oxygen and nutrients and waste products into or out of the cells. It drains into the lymph system, which plays an important role in immunity. Previously, the interstitiumit was thought to be specific to a particular tissue or area of the body rather than functioning as a system-wide superhighway that connects all parts of the body.
The revolutionary change in understanding of the interstitium was made possible because of a new technology called “probe-based confocal laser endomicroscopy,” which allows researchers to examine living tissue instead of relying on traditional prepared microscope slides.3 It was during such an examination of a patient’s bile duct to check for cancer spread that the doctors noticed a series of “interconnected cavities in this submucosal tissue level that [did] not match any known anatomy.”4
Drs. Theise, Carr-Locke, and Benias suspected that the “densely-packed barrier-like walls of collagen,” as the interstitial space was previously understood, only looked that way because tissue-sampling techniques involved removing all of the fluid from the slide samples, forcing the collagen framework to collapse and stick together into what seemed like a dense layer. They hypothesized that the interstitium, instead, is a complex of fluid-filled interstitial spaces held by a lattice-like network of collagen. Thus, the whole is flexible and can be compressed and distended, acting as a sort of shock absorber that “keep tissues from tearing as organs, muscles, and vessels squeeze, pump, and pulse as part of daily function.”5 It is also subject to directional flow caused by the alternating contraction and relaxation of the body.6
First observed in the human extra-hepatic (liver) bile duct, similar structures were subsequently confirmed in many other parts of the body, including the skin, gastrointestinal tract, urinary tract, lungs, musculoskeletal system, blood vessels and fat tissue… anywhere “tissues moved or were compressed by force.”
Drs. Theise, Carr-Locke and Benias explained that the interstitial space may actually comprise a system of “dynamically compressible and distensible sinuses through which interstitial fluid flows around the body,” potentially acting as a “conduit for movement of injurious agents, pro-fibrogenic signaling molecules, and tumor cells.”7 It was previously recognized that permeation of the interstitial space is a necessary first step in the spread of cancer metastasis.
Its status as a new organ is not being embraced universally. The study’s authors contend that it should be considered an organ, as the skin is, because it has both a “unitary structure” and a “unitary function.” According to co-senior investigator Theise, “This has both…This structure is the same wherever you look at it, and so are the functions that we’re starting to elucidate.”8
Michael Nathanson, MD, professor of medicine and cell biology and chief of the section of digestive diseases at Yale University School of Medicine, however, disagrees. He says, “I would think of this as a new component that is common among a variety of organs, rather than a new organ in and of itself… It would be analogous to discovering blood vessels for the first time, in that they are in every organ but they aren’t an organ themselves.”9
What there seems to be a consensus on is that Theise, Carr-Locke and Beniashave have “identified a previously unknown feature of human anatomy with implications for the function of all organs, most tissues, and the mechanisms of most major diseases.”10
References:
1 Benias PC, et al. Structure and Distribution of an Unrecognized Interstitium in Human Tissues. Scientific Reports Mar. 27, 2018.
2 Interstitial defininition. MedicineNet.
3 Press Release. Researchers Find New ‘Organ’ Missed by Gold Standard Methods for Visualizing Anatomy & Disease. Mar. 27, 2018.
4 Ibid.
5 Ibid.
6 See Footnote 1.
7 Ibid.
8 Howard J. Newfound ‘Organ’ Could Be the Biggest in Your Body. CNN Mar. 31, 2018.
9 Ibid.
10 See Footnote 3.
Join Dr. Bill Rawls, along with special guest Dr. Neil Spector, for a new live webinar
Dr. Rawls, author of the best-selling book Unlocking Lyme, and Dr. Spector, author of Gone in A Heartbeat: A Physician’s Search for True Healing, will share how misdiagnosed Lyme disease was devastating to their health and careers, and even led to Dr. Spector requiring a heart transplant.
Plus, they’ll discuss how they were ultimately able to take control of their health — and how you can, too.
Topics covered during the webinar will include:
Join us, and bring your questions. Dr. Rawls and Dr. Spector will host a LIVE Q&A immediately after their presentation.
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