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Lyme Carditis and Heart Block Can Strike Kids Too

A new case study from the Masonic Children’s Hospital in Minneapolis and University of Minnesota Medical School shows that a 16-year-old boy with Lyme carditis suffered from palpitations and a significant heart block. The patient recovered with antibiotic treatment. According to the study, the “take-away” lesson is that “carditis can be the presenting manifestation of B. burgdorferi infection in pediatric patients.”

Abstract

Background

The incidence of Lyme disease (LD) in North America has increased substantially in the past two decades. Concomitant with the increased incidence of infection has been an enhancement in the recognition of LD complications. Here, we report a case of Lyme carditis complicated by heart block in a pediatric patient admitted to our children’s hospital. What is unique about this case is that the complaint of chest palpitations is an infrequent presentation of LD, and what it adds to the scientific literature is an improved understanding of LD in the pediatric population.

Case presentation

The patient was a 16-year-old male who presented with the main concerns of acute onset of palpitations and chest pain. An important clinical finding was Erythema migrans (EM) on physical exam. The primary diagnoses were LD with associated Lyme carditis, based on the finding of 1st degree atrioventricular heart block (AVB) and positive IgM and IgG antibodies to Borrelia burgdorferi. Interventions included echocardiography, electrocardiography (EKG), and intravenous antibiotics. The hospital course was further remarkable for transition to 2nd degree heart block and transient episodes of complete heart block. A normal sinus rhythm and PR interval were restored after antibiotic therapy and the primary outcome was that of an uneventful recovery.

Conclusions

Lyme carditis occurs in < 5% of LD cases, but the “take-away” lesson of this case is that carditis can be the presenting manifestation of B. burgdorferi infection in pediatric patients. Any patient with suspected Lyme carditis manifesting cardiac symptoms such as syncope, chest pain, or EKG changes should be admitted for parenteral antibiotic therapy and cardiac monitoring. The most common manifestation of Lyme carditis is AVB. AVB may manifest as first-degree block, or may present as high-grade second or third-degree block. Other manifestations of Lyme carditis may include myopericarditis, left ventricular dysfunction, and cardiomegaly. Resolution of carditis is typically achieved through antibiotic administration, although pacemaker placement should be considered if the PR interval fails to normalize or if higher degrees of heart block, with accompanying symptoms, are encountered. With the rising incidence of LD, providers must maintain a high level of suspicion in order to promptly diagnose and treat Lyme carditis.

Read the entire study here.

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Can Google Identify Tick-borne Trends?

A new study from the Department of Dermatology and Allergy at the Technical University of Munich analyzed over 200 million Google searches in Germany. The data showed a high correlation between temperature, tick bite, and tick-borne illness, as well as between Google searches for Lyme and registered Lyme cases. More connections and trends might be waiting to be uncovered. 

ABSTRACT

Background: Borreliosis is the most frequently transmitted tick-borne disease in Europe. It is difficult to estimate the incidence of tick bites and associated diseases in the German population due to the lack of an obligation to register across all 16 federal states of Germany.

Objective: The aim of this study is to show that Google data can be used to generate general trends of infectious diseases on the basis of borreliosis and tick bites. In addition, the possibility of using Google AdWord data to estimate incidences of infectious diseases, where there is inconsistency in the obligation to notify authorities, is investigated with the perspective to facilitate public health studies.

Methods: Google AdWords Keyword Planner was used to identify search terms related to ticks and borreliosis in Germany from January 2015 to December 2018. The search volume data from the identified search terms was assessed using Excel version 15.23. In addition, SPSS version 24.0 was used to calculate the correlation between search volumes, registered cases, and temperature.

Results: A total of 1999 tick-related and 542 borreliosis-related search terms were identified, with a total of 209,679,640 Google searches in all 16 German federal states in the period under review. The analysis showed a high correlation between temperature and borreliosis (r=0.88), and temperature and tick bite (r=0.83), and a very high correlation between borreliosis and tick bite (r=0.94). Furthermore, a high to very high correlation between Google searches and registered cases in each federal state was observed (Brandenburg r=0.80, Mecklenburg-West Pomerania r= 0.77, Saxony r= 0.74, and Saxony-Anhalt r=0.90; all P<.001).

Conclusions: Our study provides insight into annual trends concerning interest in ticks and borreliosis that are relevant to the German population exemplary in the data of a large internet search engine. Public health studies collecting incidence data may benefit from the results indicating a significant correlation between internet search data and incidences of infectious diseases.

Read the full case study here.

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Lone Star Ticks Have Swarmed Aquinnah, Biologist Says

“Lone star ticks – and thousands of their larvae — have overrun the town of Aquinnah, biologist and tick expert Richard Johnson told Aquinnah selectmen at their meeting Wednesday, following reports that showed a high incidence of tick-borne disease in the town this year.

In a letter that went out last week, the town board of health reported 13 new cases of tick-borne illnesses since April of this year, including cases of Lyme disease, ehrlichiosis, babeosis and Rocky Mountain spotted fever. At the meeting, Mr. Johnson said he was in Aquinnah on Tuesday surveying yards for ticks and found lone star larvae in every location he visited.

“I was horrified,” Mr. Johnson said. “I’ve looked at a lot of ticks over the past 10 years and the number of lone star larvae I found was just astonishing,”

Mr. Johnson is director of the Martha’s Vineyard tick-borne illness reduction program. He said he receives at least one call or email a day alerting him to newly discovered clusters of lone star ticks on the Island.

“They’re everywhere,” Mr. Johnson said. “Every property that we have gone to in Aquinnah to do a survey we’ve found lone star ticks. They’re literally every place in the town except maybe the [Gay Head] Cliffs.”

Read the entire article here.

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HHS and the Steven & Alexandra Cohen Foundation Announce $25 Million “LymeX” Innovation Accelerator

Today, at the virtual LymeMIND exit disclaimer icon conference, the U.S. Department of Health and Human Services (HHS) and the Steven & Alexandra Cohen Foundation announced a new $25 million-dollar, public-private partnership — the LymeX Innovation Accelerator (LymeX). This is the largest Lyme disease public-private partnership in history. This partnership will be a force multiplier to expedite progress and catalyze change faster than government or other sectors can do on their own.

Our LymeX mission is to strategically advance Lyme and tickborne disease solutions in direct collaboration with Lyme patients, patient advocates, and diverse stakeholders across academia, nonprofits, industry, and government. LymeX will include up to $25 million for Lyme innovation and competition prize awards. The LymeX partnership will prioritize a series of diagnostics prize challenges for Lyme disease to move the next generation of diagnostic tools to market for better patient care.

“Lyme disease is exactly the kind of neglected public health issue that the Trump Administration has made a priority, including by strategic efforts to drive private sector innovation,” says HHS Secretary Alex Azar. “The new $25 million LymeX effort is the largest Lyme disease public-private partnership ever and will help support next-generation science and innovation to address the disease’s growing burden.”

LymeX does not in any way replace or supersede other government programs focused on ticks or tickborne diseases. Rather, it augments federally funded science, disease control and prevention, and regulatory approvals for next-generation diagnostics, treatments, vaccines, and technologies for Lyme and tickborne diseases.

Lyme disease affects more than 300,000 people in the United States each year. Tickborne diseases, including Lyme disease, are increasing in number; they are spreading to new areas; and new tickborne diseases are being discovered. According to the Centers for Disease Control and Prevention (CDC), domestic cases of tickborne diseases more than doubled from 2004 to 2018.

To reverse these current trends, the Steven & Alexandra Cohen Foundation partnered with HHS on LymeX for transformative impact. The Steven & Alexandra Cohen Foundation is the largest private funder of Lyme and tickborne disease research in the United States. Their philanthropy is inspired by Alex Cohen’s personal journey with Lyme disease.

U.S. government is prioritizing Lyme disease, as exemplified by the LymeX partnership and demonstrated by increasing government budget, leadership, and action for tickborne diseases. In December 2019, President Trump signed the Kay Hagan Tick Act. This authorized an additional $150 million for Lyme and vector-borne diseases over five years. In early 2020, the President’s 2021 Budget requested an increase of $58 million in one year — from $131 million to $189 million for tickborne diseases. Just last month, the HHS Deputy Secretary Eric Hargan and HHS Assistant Secretary for Health, Admiral Brett Giroir, committed $2 million to support LymeX stakeholder engagement, patient-centered innovation, and lab-to-market technologies for Lyme disease.

Challenges with Lyme disease are too big and complex for any one entity or one discipline to solve. Therefore, the LymeX partnership will bring together diverse stakeholders for a holistic approach with crosscutting collaborations for interdisciplinary solutions. Similar to the methods and success of the HHS KidneyX exit disclaimer icon Innovation Accelerator, LymeX will include patients in every step of its innovation process. Three focus areas of LymeX will advance tickborne disease innovation through:

(1) Stakeholder engagement to facilitate patient-centered innovations, using the Health+ model with HHS.

(2) Education and awareness through “open innovation” like crowdsourcing to raise awareness about risk and prevention.

(3) Next-generation diagnostics incentivized with a series of multi-million-dollar grand prize challenges, so prize winners who meet diagnostic performance benchmarks will receive cash prizes for delivering solutions. The first LymeX diagnostics prize will launch in 2021. These diagnostics prizes will be open to U.S. universities, non-profit organizations, private-sector companies, and domestic organizations, per the America COMPETES Reauthorization Act of 2010 – PDF, to improve diagnostics at all stages of Lyme disease.

The LymeX partnership fits within the broader, big-tent Lyme Innovation initiative that HHS launched in 2018. The LymeX partnership and program will reside within the HHS Office of the Assistant Secretary for Health (OASH), which manages the TickBorne Disease Working Group. OASH is also leading and coordinating interagency efforts to implement the U.S. national framework on vector-borne diseases including Lyme and tickborne diseases.

The entire original article can be found here.

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A Distinct Microbiome Signature in Posttreatment Lyme Disease Patients

ABSTRACT

Lyme disease is the most common vector-borne disease in the United States, with an estimated incidence of 300,000 infections annually. Antibiotic intervention cures Lyme disease in the majority of cases; however, 10 to 20% of patients develop posttreatment Lyme disease syndrome (PTLDS), a debilitating condition characterized by chronic fatigue, pain, and cognitive difficulties. The underlying mechanism responsible for PTLDS symptoms, as well as a reliable diagnostic tool, has remained elusive. We reasoned that the gut microbiome may play an important role in PTLDS given that the symptoms overlap considerably with conditions in which a dysbiotic microbiome has been observed, including mood, cognition, and autoimmune disorders. Analysis of sequencing data from a rigorously curated cohort of patients with PTLDS revealed a gut microbiome signature distinct from that of healthy control subjects, as well as from that of intensive care unit (ICU) patients. Notably, microbiome sequencing data alone were indicative of PTLDS, which presents a potential, novel diagnostic tool for PTLDS.

IMPORTANCE Most patients with acute Lyme disease are cured with antibiotic intervention, but 10 to 20% endure debilitating symptoms such as fatigue, neurological complications, and myalgias after treatment, a condition known as posttreatment Lyme disease syndrome (PTLDS). The etiology of PTLDS is not understood, and objective diagnostic tools are lacking. PTLDS symptoms overlap several diseases in which patients exhibit alterations in their microbiome. We found that patients with PTLDS have a distinct microbiome signature, allowing for an accurate classification of over 80% of analyzed cases. The signature is characterized by an increase in Blautia, a decrease in Bacteroides, and other changes. Importantly, this signature supports the validity of PTLDS and is the first potential biological diagnostic tool for the disease.

You can read the entire study at American Society for Microbiology.

Word of caution: In its research definition, the published study uses the term “PTLDS,” or post-treatment Lyme disease syndrome, a term we object to because it suggests infection is completely gone and is often used to argue against further antimicrobial treatment. Project Lyme uses the term Persistent Lyme.

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Effects of Dapsone & Intracellular Antibiotics on B. Burgdorferi

Objective

Lyme disease is a tick-borne, multisystemic disease caused by Borrelia burgdorferi. Standard treatments for early Lyme disease include short courses of oral antibiotics but relapses often occur after discontinuation of treatment. Several studies have suggested that ongoing symptoms may be due to a highly antibiotic resistant form of B. burgdorferi called biofilms. Our recent clinical study reported the successful use of an intracellular mycobacterium persister drug used in treating leprosy, diaminodiphenyl sulfone (dapsone), in combination therapy for the treatment of Lyme disease. In this in vitro study, we evaluated the effectiveness of dapsone individually and in combination with cefuroxime and/or other antibiotics with intracellular activity including doxycycline, rifampin, and azithromycin against Borrelia biofilm forms utilizing crystal violet biofilm mass, and dimethyl methylene blue glycosaminoglycan assays combined with Live/Dead fluorescent microscopy analyses.

Results

Dapsone, alone or in various combinations with doxycycline, rifampin and azithromycin produced a significant reduction in the mass and protective glycosaminoglycan layer and overall viability of B. burgdorferi biofilm forms. This in vitro study strongly suggests that dapsone combination therapy could represent a novel and effective treatment option against the biofilm form of B. burgdorferi.

You can read the entire study on BMC Research Notes. 

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Lyme in the Arctic?

In the latest sign of climate change, Bartonella henselae, a coinfection of Lyme usually found in more temperate regions, has been detected in the blood of arctic foxes. Research suggests that migratory geese have given Bart-infected fleas a ride north, where the bacterium can now survive. Below we share the abstract of the study. You can read the entire @BioMedCentral post here. 

Abstract
Background
In a warmer and more globally connected Arctic, vector-borne pathogens of zoonotic importance may be increasing in prevalence in native wildlife. Recently, Bartonella henselae, the causative agent of cat scratch fever, was detected in blood collected from arctic foxes (Vulpes lagopus) that were captured and released in the large goose colony at Karrak Lake, Nunavut, Canada. This bacterium is generally associated with cats and cat fleas, which are absent from Arctic ecosystems. Arctic foxes in this region feed extensively on migratory geese, their eggs, and their goslings. Thus, we hypothesized that a nest flea, Ceratophyllus vagabundus vagabundus (Boheman, 1865), may serve as a vector for transmission of Bartonella spp.

Methods
We determined the prevalence of Bartonella spp. in (i) nest fleas collected from 5 arctic fox dens and (ii) 37 surrounding goose nests, (iii) fleas collected from 20 geese harvested during arrival at the nesting grounds and (iv) blood clots from 57 adult live-captured arctic foxes. A subsample of fleas were identified morphologically as C. v. vagabundus. Remaining fleas were pooled for each nest, den, or host. DNA was extracted from flea pools and blood clots and analyzed with conventional and real-time polymerase chain reactions targeting the 16S-23S rRNA intergenic transcribed spacer region.

Results
Bartonella henselae was identified in 43% of pooled flea samples from nests and 40% of pooled flea samples from fox dens. Bartonella vinsonii berkhoffii was identified in 30% of pooled flea samples collected from 20 geese. Both B. vinsonii berkhoffii (n = 2) and B. rochalimae (n = 1) were identified in the blood of foxes.

Conclusions
We confirm that B. henselae, B. vinsonii berkhoffii and B. rochalimae circulate in the Karrak Lake ecosystem and that nest fleas contain B. vinsonii and B. henselae DNA, suggesting that this flea may serve as a potential vector for transmission among Arctic wildlife.

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The CDC Unveils New Prevention Framework

This week the CDC unveiled its new ‘National Public Health Framework for the Prevention and Control of Vector-Borne Diseases’. It included a lofty yet admiral vision of eliminating the threat of vector borne diseases from humanity. Some goals include better understanding of when, where and how people are exposed, getting sick and dying.

In order to achieve their goals they need to effectively engage with “a multidisciplinary set of stakeholders must be engaged, activated, and resourced. The stakeholders include the federal government; state, tribal, local, and territorial health departments; vector control agencies; healthcare providers; academic and industry partners; policy and decision-makers, including Congress and elected community leaders; public health partners, such as nonprofit organizations and associations of medical, entomological, and vector control professionals; and the public, including patients.”

Project Lyme is skeptical of these efforts because of the history between CDC and vector-borne illnesses, but hopeful nonetheless.

Read the entire CDC framework here.   

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“Living Well With Lyme Disease”

Despite being the most common vector-borne disease in America, myths about Lyme disease abound. So when we caught a U.S. News & World Report article with the somewhat provocative title “Living Well With Lyme Disease,” we simply had to take a look at the facts. And while the article deserves some credit for acknowledging the existence of chronic Lyme, which many sources refuse to do, the misinformation is legion.

  1. Transmission Time

The article claims, “If the tick latches on to a human host, it usually takes anywhere from 48 to 72 hours for the bacteria to travel from the tick’s gut to where it makes contact with human blood and results in transmission, and in turn causes Lyme disease.” This false but surprisingly resilient myth has been circulating the internet and even repeated by doctors for decades. The truth is that no one knows the minimum time it takes for Lyme to be transmitted by a tick bite under a range of circumstances.

The CDC reports 36 to 48 hours as the average transmission time for Lyme, and that gives a false sense of security as well. Other peer review says Lyme disease risk is low, but possible, if ticks are attached for at least 24 hours. But other experts point out that no minimum time has ever been established for transmission of Borrelia burgdorferi. In fact, a number of circumstances mean risk of rapid transmission could be high: For instance, if you accidentally squeeze a tick while trying to remove it, spirochetes can be inadvertently injected. And if a tick has partially bitten an animal but fallen off, spirochetes can remain in the mouth parts and salivary glands, creating the potential for efficient transmission upon a second bite. 

Finally, the microorganism matters. Different genospecies of Borrelia take more or less time to travel from the midgut to the mouth, and the deadly Powassan virus, though rare, can be transmitted by a deer tick in 15 minutes. Bottom line: Do not treat any tick attachment casually. Have the tick removed by someone who understands tick-removal techniques. And do consult with a Lyme literate M.D.

2.  Number of Annual Cases

The article cites statistics from the CDC, which acknowledges that while state health departments report approximately 30,000 cases of Lyme disease in the U.S. each year, the true number of cases is closer to ten times that amount (approximately 300,000 per year). However, a survey of large commercial laboratories using 2008 data revealed that the number of annual cases was closer to 444,000. Since Lyme rates have increased in following years, we can extrapolate that the number of annual cases has too. In other words, Lyme is more widespread than the CDC reports.

3. Lingering and Persistent Symptoms

The article calls Lyme disease in its acute form “very easily treatable” and in its chronic form “manageable.” This attitude overlooks the experiences of many actual Lyme patients, some of whom see their health crater and lives derail for years. Evidence is hardly just anecdotal. A study from Johns Hopkins (which still uses the unfortunate term “post-Lyme syndrome” to describe patients still sick with Lyme) found disturbing inflammation in the brain scans of those who were chronically ill. The New England Journal of Medicine found patients who stayed sick were as impaired as those with congestive heart failure and sicker than those with type two diabetes. A patient-run study, called My Lyme Data, has documented patient financial hardship, late diagnoses, and devastating ongoing symptoms from pain to confusion for the chronic group.  

4. The Bull’s-Eye Rash

The article claims that the erythema migrans bull’s-eye rash occurs in “70% to 80% of patients,”  but this is wildly misleading. According to some studies, as few as 27% ever see or exhibit a Lyme rash.  Depending on the study, estimates range widely. Even the CDC reports rashes in anywhere from 51%-87% of patients; in short, studies by a range of researchers fall all over the map—43% were said to have rashes in the state of Maine and less than 50% of children in Vermont. As to the famous bull’s-eye rash, it is even rarer, appearing in less than 20% of patients, studies show.  

As long as readers keep in mind these missteps, there’s a lot of information in “Living Well With Lyme Disease” that may prove useful, particularly to those who are less familiar with this common tick-borne disease. 

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Rabies To The Rescue

Utpal Pal, PhD, professor in Veterinary Medicine at the University of Maryland (UMD) will be partnering with Matthias Schnell, director of the Jefferson Vaccine Center at Thomas Jefferson University to develop a novel “next-generation” Lyme disease vaccine.

Pal, a tick immunobiologist, and Schnell, whose lab studies rabies virus as a platform for vaccination, will adapt the rabies virus platform to fight Lyme disease.  The inactivated rabies virus, which helps the body produce antibodies to fight rabies, will be repurposed to produce other types of proteins that can fight Borrelia burgdorferi, the Lyme disease bacteria, a technique found effective for other viral vaccinations.

This study will test the four already identified vaccine candidate proteins, as well as the three major types of rabies vaccine platforms– using live attenuated virus, inactivated virus, and the shell of a virus with viral proteins on the outside but no virus inside to trick the body.  Pal is also studying both Borrelia proteins and the tick proteins that keep the Borrelia alive so it can be tramsmitted to humans.

Read more here.

Based on the track records of Lyme vaccines, Project Lyme will monitor the studies progress closely for safety and efficacy. 

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