Thursday, January 21, 2016

Not your father's Lyme disease


Lone star ticks, (Amblyoma americanum). are taking over. They now comprise more than 80% of the small black legged, hard bodied ticks found in the D.C metro area and elsewhere. These guys are very aggressive. They may be hard to distinguish from their deer tick (Ixodes scapularis) colleagues. Adult females are easy to spot: white spot on top. The shape and coloration is somewhat different. Take a careful look with a magnifying glass and compare to pix on google images. The CDC party line is: Lone stars do not transmit Lyme; they transmit STARI which is a mild disease and easy to treat. The CDC website states it is unknown wich bacteria causes the syndrome. The CDC website says Borrelia lonstari was a suspect but “further research” showed this not to be the case. This “definitive” research is the product of a small study published by Gary Wormser (name familiar) in 2005. Thirty EM rashes were examined for B. burdorferi (classic Lyme) and B. lonestari. Wormser did not find the genetic signature of B. burgdorferi or B. lonstari (or any Borrelia species) Therefore, the case is closed. Incidentally, all cases were from the Cape Girardeau are of Missouri (along the Mississippi river). I leave it to the reader to make sense of this research.  It is said that an inhibitor in lone star tick saliva makes them an inhospitable host for B. burdorferi. Perhaps. Nonethess, multiple studies have shown that B. burdorferi can be found in lone stars.  A patient in my practice with PCR (blood) proven B. lonestari was amongst the sickest patients I have seen. The only lab that I know of that does this test is Clongen. What about Western Blots? This patient was negative except for band 41 at two reference labs.
The Western Blot (as we currently know it) may soon be obsolete as the mix of Borrelia pathogens changes. Clongen found many Babesia organisms in these ticks, species unknown. Laboratory testing for unknown species of Babesia is impossible, except for fresh, properly stained blood smears. Bartonella is already a complete mystery: I say no more here.

Diverse ticks (Ixodes species) around the globe are known to transmit Borrelia species causing a Lyme-like illness, referred to as Borrelia burgdorferi sensu lato. Rapid changes are occurring in the US. The spirochetes live in an expanded reservoir, beyond white footed mice; the species are different; the strains are different and of course the vectors are different.

The coinfections are different and may be complete unknowns.

Here are a few clues: Ehrichia antibodies equal lone star tick. Only Anaplasma in deer ticks. RMSF antibodies show up a lot. I am not sure what this means. Cross reacting Rickettsia sp?  RMSF occurs only in lone stars not deer ticks. Meat allergies (anti-gal) only from lone stars: can be devastating.

The Lyme disease and associated tickborne pathogens paradigm is changing dramatically and very quickly. Be cognizant as we move forward.

7 comments:

Christian said...

I think the wyss institute fcmbl filter will change the landscape for chronic illnes with pathogen suspects. A primary problem is that a blood sample does not generate enough material for PCR. The result is abmysal sensitivity. The fcmbl filter can act as a pathogen capture (pre concentrator) and the filtered slurry becomes the new base to do PCR on. It has the potential to change the PCR landscape completely.

This could make low grade/load and unknown infections more readily detectable.
http://wyss.harvard.edu/viewpressrelease/221/

Christian said...

I think the wyss institute fcmbl filter will change the landscape for chronic illnes with pathogen suspects. A primary problem is that a blood sample does not generate enough material for PCR. The result is abmysal sensitivity. The fcmbl filter can act as a pathogen capture (pre concentrator) and the filtered slurry becomes the new base to do PCR on. It has the potential to change the PCR landscape completely.

This could make low grade/load and unknown infections more readily detectable.
http://wyss.harvard.edu/viewpressrelease/221/

Justin Macdonald said...

MDL also offers testing for other borrelia species by PCR including B. lonestarii and the two european species B. afzelii and B. garinii. Not sure how sensitive PCR testing is for any borrelia species but my guess would be extremely low. Some people do get lucky and when you get a positive PCR for any borrelia specie, you can be sure its pretty darn specific. If the patient had the money or insurance will pay for MDL which many do, it may we worthwhile to throw some of these tests in just to see, you never know. I would imagine a lot of you reading this blog and lymemd himself are all well aware with the incredible work Kerry Clark at UNF has been doing with lonestar ticks. This blog has been such a gift to the lyme community and can help keep so many people informed and updated about whats new on the horizon. Thanks for all you do doc.

anita b. said...

Hello Dr. Jaller,
How are you? I just found your blog. I hope the lawsuit/case against you was dropped. I really need your help. Are you accepting new patients?
I tested very low on CD 57 and igenex tested positive for band 41 a few years ago after a tick bite with quasi bull rash. Doctor did nothing. Instead he treated me for Candida instead. Then he quit the practice.
My symptoms got significantly worse to the point where I couldn't function. I was a shell of a human. It was all a blur and I nearly lost my job from brain fog and hpoor performance. I couldn't even remember what you asked me 2 mins ago. Since then I have gotten a little better but it comes and goes. I can go on and on but I would love an appt. how much are your visits? I'm sure you do not accept insurance but is there any way to provide receipt with diagnosis or medical codes to attempt to claim out of network benefits with my insurance?
I'm tired of being tired and I'm tired of being sick. I'm only 34 and I've wasted my entire 30s with mysterious illness. I do not recognize the face that's staring at me in the mirror I'm a shell of a person and I don't think I'll ever be able to have a healthy baby. I haven't slept in two years or more, my sleep is constantly disrupted I wake up probably over 20 times. I can't sleep for more than one hour.
Thank you for reading,

max den said...

Amazing post.

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Bev Clearly said...

Just when I thought I knew everything about Lyme disease, I came upon your blog. :) This is incredible. Thank you so much for your information. I'm not sure where else to post this or ask, but what about Lyme disease and pregnancy and breast feeding? What's the latest on that?