Fourteen more last minute fluff filled articles published on Lyme and tick borne diseases to support the IDSA & CDC theories. These new guidelines are gonna be a doozy!
Infect Dis Clin North Am. 2015 Jun;29(2):325-340. doi: 10.1016/j.idc.2015.02.006.
Chronic Lyme Disease.
1Divisions of Pediatric Infectious Diseases and General Internal Medicine, Duke University School of Medicine, DUMC 100800, Durham, NC 27710, USA. Electronic address: paul.lantos@duke.edu.
Abstract
Chronic Lyme disease is a poorly defined diagnosis that is usually given to patients with prolonged, unexplained symptoms or with alternative medical diagnoses.
Data do not support the proposition that chronic, treatment-refractory infection with Borrelia burgdorferi is responsible for the many conditions that get labeled as chronic Lyme disease.
Prolonged symptoms after successful treatment of Lyme disease are uncommon, but in rare cases may be severe.
Prolonged courses of antibiotics neither prevent nor ameliorate these symptoms and are associated with considerable harm.
http://www.ncbi.nlm.nih.gov/pubmed/25999227
Infect Dis Clin North Am. 2015 Jun;29(2):xi-xvi. doi: 10.1016/j.idc.2015.03.001.
Lyme disease: knowing good evidence to help inform practice.
1Johns Hopkins University School of Medicine, Sherrilyn and Ken Fisher Professor of Medicine, Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, 725 North Wolfe Street, Room # 231, Baltimore, MD 21205, USA. Electronic address: pauwaert@jhmi.edu.
NO ABSTRACT.
PMID:
25999231
[PubMed - in process]
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Infect Dis Clin North Am. 2015 Jun;29(2):281-294. doi: 10.1016/j.idc.2015.02.011.
Lyme Disease in Children.
Sood SK1.
1Hofstra North Shore-LIJ School of Medicine, Hempstead, NY 11549, USA; Department of Pediatrics, Southside Hospital, 301 East Main Street, Bay Shore, NY 11706, USA; Pediatric Infectious Diseases, Cohen Children's Medical Center, New Hyde Park, NY 11040, USA. Electronic address: SSood@nshs.edu.
Abstract
The diagnosis and management of Lyme disease in children is similar to that in adults with a few clinically relevant exceptions. The use of doxycycline as an initial empiric choice is to be avoided for children 8 years old and younger.
Children may present with insidious onset of elevated intracranial pressure during acute disseminated Lyme disease; prompt diagnosis and treatment of this condition is important to prevent loss of vision.
Children who acquire Lyme disease have an excellent prognosis even when they present with the late disseminated manifestation of Lyme arthritis.
Guidance on the judicious use of serologic tests is provided.
Pediatricians and family practitioners should be familiar with the prevention and management of tick bites, which are common in children.
Copyright © 2015 Elsevier Inc. All rights reserved.
Infect Dis Clin North Am. 2015 Jun;29(2):269-280. doi: 10.1016/j.idc.2015.02.004.
Diagnosis and Treatment of Lyme Arthritis.
Arvikar SL1, Steere AC2.
1Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
2Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: asteere@mgh.harvard.edu.
Abstract
In the United States, Lyme arthritis is the most common feature of late-stage Borrelia burgdorferi infection, usually beginning months after the initial bite. In some, earlier phases are asymptomatic and arthritis is the presenting manifestation.
Patients with Lyme arthritis have intermittent or persistent attacks of joint swelling and pain in 1 or a few large joints.
Serologic testing is the mainstay of diagnosis.
Synovial fluid polymerase chain reaction for B burgdorferi DNA is often positive before treatment, but is not a reliable marker of spirochetal eradication after therapy.
This article reviews the clinical manifestations, diagnosis, and management of Lyme arthritis.
Copyright © 2015 Elsevier Inc. All rights reserved.
http://www.ncbi.nlm.nih.gov/pubmed/25999223
Infect Dis Clin North Am. 2015 Jun;29(2):255-268. doi: 10.1016/j.idc.2015.02.003.
Lyme Carditis.
Robinson ML1, Kobayashi T2, Higgins Y2, Calkins H3, Melia MT4.
1Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, 1830 East Monument Street, Room 448, Baltimore, MD 21287, USA.
2The Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, 725 North Wolfe Street, PTCB - Room 231, Baltimore, MD 21287, USA.
3Division of Cardiology, Department of Medicine, Johns Hopkins University, 600 North Wolfe Street, Sheikh Zayed Tower, Room 7125R, Baltimore, MD 21287, USA.
4Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, 1830 East Monument Street, Room 448, Baltimore, MD 21287, USA. Electronic address: mmelia4@jhmi.edu.
Abstract
Lyme disease is a common disease that uncommonly affects the heart. Because of the rarity of this diagnosis and the frequent absence of other concurrent clinical manifestations of early Lyme disease, consideration of Lyme carditis demands a high level of suspicion when patients in endemic areas come to attention with cardiovascular symptoms and evidence of higher-order heart block.
A majority of cases manifest as atrioventricular block. A minority of Lyme carditis cases are associated with myopericarditis.
Like other manifestations of Lyme disease, carditis can readily be managed with antibiotic therapy and supportive care measures, such that affected patients almost always completely recover.
Copyright © 2015 Elsevier Inc. All rights reserved.
KEYWORDS:
AV block; Heart block; Lyme carditis; Lyme disease; Pericarditis
http://www.ncbi.nlm.nih.gov/pubmed/25999222
Infect Dis Clin North Am. 2015 Jun;29(2):241-253. doi: 10.1016/j.idc.2015.02.002.
Nervous System Lyme Disease.
1Department of Neurosciences, Overlook Medical Center, 99 Beauvoir Avenue, Summit, NJ 07902, USA; Department of Neurology and Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA. Electronic address: john.halperin@atlantichealth.org.
Abstract
Lymphocytic meningitis, cranial neuritis or radiculoneuritis occur in up to 15% of patients with untreated Borrelia burgdorferi infection. Presentations of multifocal PNS involvement can range from painful monoradiculitis to confluent mononeuropathy multiplex.
Serologic testing is highly accurate after 4 to 6 weeks of infection.
In CNS infection, production of anti-Bburgdorferi antibody is often demonstrable in CSF. Oral antimicrobials are microbiologically curative in virtually all patients, including acute European neuroborreliosis. Severe cases may require parenteral treatment.
The fatigue and cognitive symptoms seen in some patients with extra-neurological disease are neither evidence of CNS infection nor specific to Lyme disease.
Copyright © 2015 Elsevier Inc. All rights reserved.
http://www.ncbi.nlm.nih.gov/pubmed/25999221
Infect Dis Clin North Am. 2015 Jun;29(2):211-239. doi: 10.1016/j.idc.2015.02.001.
Erythema Migrans.
1Division of Infectious Diseases, Department of Medicine, New York Medical College, Skyline Office #2NC20, 40 Sunshine Cottage Road, Valhalla, NY 10595, USA. Electronic address: robert_nadelman@nymc.edu.
Abstract
Erythema migrans (EM) is the most common objective manifestation of Borrelia burgdorferi infection. Systemic symptoms are usually present. Most patients do not recall a preceding tick bite.
Despite a characteristic appearance, EM is not pathognomonic for Lyme disease and must be distinguished from other similar appearing skin lesions.
EM is a clinical diagnosis; serologic and PCR assays are unnecessary. Leukopenia and thrombocytopenia are indicative of either an alternative diagnosis, or coinfection with another tick-borne pathogen.
When EM is promptly treated with appropriate antimicrobial agents, the prognosis is excellent. Persons in endemic areas should take measures to prevent tick bites.
Copyright © 2015 Elsevier Inc. All rights reserved.
http://www.ncbi.nlm.nih.gov/pubmed/25999220
Infect Dis Clin North Am. 2015 Jun;29(2):187-210. doi: 10.1016/j.idc.2015.02.010.
Epidemiology of Lyme Disease.
Mead PS1.
1Epidemiology and Surveillance Activity, Bacterial Diseases Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), 3156 Rampart Road, Fort Collins, CO 80521, USA. Electronic address: pfm0@CDC.GOV.
Abstract
Lyme disease is the most common vector-borne illness in North America and Europe. The etiologic agent, Borrelia burgdorferi sensu lato, is transmitted to humans by certain species of Ixodes ticks, which are found widely in temperate regions of the Northern hemisphere.
Clinical features are diverse, but death is rare.
The risk of human infection is determined by the geographic distribution of vector tick species, ecologic factors that influence tick infection rates, and human behaviors that promote tick bite.
Rates of infection are highest among children 5 to 15 years old and adults older than 50 years.
Published by Elsevier Inc.
http://www.ncbi.nlm.nih.gov/pubmed/25999219
The following abstracts include 2 new surveys by the CDC, and an update on four tick borne diseases by Wormser. All are authored by current or previous IDSA Lyme disease guidelines authors and or the CDC. Fluff, fluff, fluff, pad, pad, pad, the guidelines are gonna be bad, bad, bad.
Infect Dis Clin North Am. 2015 Jun;29(2):341-355. doi: 10.1016/j.idc.2015.02.007.
Human Granulocytic Anaplasmosis.
1Department of Family Medicine, University of Minnesota School of Medicine, Duluth, MN, USA; St. Luke's Infectious Disease Associates, 1001 East Superior Street, Suite L201, Duluth, MN 55802, USA.
2Department of Pathology, University of Maryland School of Medicine, 685 West Baltimore Street, HSF1 322D, Baltimore, MD 21201, USA; Department of Microbiology & Immunology, University of Maryland School of Medicine, Baltimore, MD 21201, USA. Electronic address: sdumler@som.umaryland.edu.
Abstract
Human granulocytic anaplasmosis, a deer tick-transmitted rickettsial infection caused by Anaplasma phagocytophilum, is a common cause of undifferentiated fever in the northeast and upper Midwest United States.
Patients are often initially diagnosed with a mild viral infection, and illness readily resolves in most cases. However, as many as 3% develop life-threatening complications and nearly 1% die from the infection.
Although coinfections with Borrelia burgdorferi and Babesia microti occur, there is little evidence to suggest synergism of disease or a role for A phagocytophilum in chronic illness.
No vaccine is available.
Copyright © 2015 Elsevier Inc. All rights reserved.
KEYWORDS:
Infect Dis Clin North Am. 2015 Jun;29(2):357-370. doi: 10.1016/j.idc.2015.02.008.
Babesiosis.
Vannier EG1, Diuk-Wasser MA2, Ben Mamoun C3, Krause PJ4.
1Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Tufts University School of Medicine, 800 Washington Street Box #041, Boston, MA 02111, USA.
2Department of Ecology, Evolution, and Environmental Biology, Columbia University, 1200 Amsterdam Avenue, New York, NY 10027, USA.
3Department of Internal Medicine, Yale School of Medicine, 15 York Street, New Haven, CT 06520, USA.
4Department of Epidemiology of Microbial Diseases, Yale School of Public Health, 60 College Street, New Haven, CT 06520, USA; Departments of Internal Medicine and Pediatrics, Yale School of Medicine, 15 York Street, New Haven, CT 06520, USA. Electronic address: peter.krause@yale.edu.
Abstract
Babesiosis is caused by intraerythrocytic protozoan parasites that are transmitted by ticks, or less commonly through blood transfusion or transplacentally. Human babesiosis was first recognized in a splenectomized patient in Europe but most cases have been reported from the northeastern and upper midwestern United States in people with an intact spleen and no history of immune impairment. Cases are reported in Asia, Africa, Australia, Europe, and South America. Babesiosis shares many clinical features with malaria and can be fatal, particularly in the elderly and the immunocompromised.
Copyright © 2015 Elsevier Inc. All rights reserved.
KEYWORDS:
Apicomplexa; Babesia microti; Babesiosis; Erythrocyte; Protozoan; Tick; Transfusion
PMID:
25999229
[PubMed - as supplied by publisher]
Ticks Tick Borne Dis. 2015 Apr 14. pii: S1877-959X(15)00054-0. doi: 10.1016/j.ttbdis.2015.03.017. [Epub ahead of print]
U.S. public's experience with ticks and tick-borne diseases: Results from national HealthStyles surveys.
Hook SA1, Nelson CA2, Mead PS3.
1Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, 3156 Rampart Road, Fort Collins, CO 80521, USA. Electronic address: shook@cdc.gov.
2Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, 3156 Rampart Road, Fort Collins, CO 80521, USA. Electronic address: cnelson2@cdc.gov.
3Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, 3156 Rampart Road, Fort Collins, CO 80521, USA. Electronic address: pmead@cdc.gov.
Abstract
Surveillance data indicate that tick-borne diseases (TBDs) are a substantial public health problem in the United States, yet information on the frequency of tick exposure and TBD awareness and prevention practices among the general population is limited. The objective of this study was to gain a more complete understanding of the U.S. public's experience with TBDs using data from annual, nationally representative HealthStyles surveys. There were 4728 respondents in 2009, 4050 in 2011, and 3503 in 2012.
Twenty-one percent of respondents reported that a household member found a tick on his or her body during the previous year; of these, 10.1% reported consultation with a health care provider as a result. Overall, 63.7% of respondents reported that Lyme disease (LD) occurs in the area where they live, including 49.4% of respondents from the West South Central and 51.1% from the Mountain regions where LD does not occur.
Conversely, in the New England and Mid-Atlantic regions where LD, anaplasmosis, and babesiosis are common, 13.9% and 20.8% of respondents, respectively, reported either that no TBDs occur in their area or that they had not heard of any of these diseases. The majority of respondents (51.2%) reported that they did not routinely take any personal prevention steps against tick bites during warm weather.
Results from these surveys indicate that exposure to ticks is common and awareness of LD is widespread. Nevertheless, use of TBD prevention measures is relatively infrequent among the U.S. public, highlighting the need to better understand barriers to use of prevention measures.
Published by Elsevier GmbH.
KEYWORDS:
Lyme disease; Prevention; Tick exposure; Tick-borne disease
http://www.ncbi.nlm.nih.gov/pubmed/25887156
Am J Trop Med Hyg. 2015 Apr 13. pii: 15-0122. [Epub ahead of print]
Human Granulocytic Anaplasmosis in the United States from 2008 to 2012: A Summary of National Surveillance Data.
Dahlgren FS1, Heitman KN2, Drexler NA2, Massung RF2, Behravesh CB2.
1Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, Tennessee iot0@cdc.gov.
2Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, Tennessee.
Abstract
Human granulocytic anaplasmosis is an acute, febrile illness transmitted by the ticks Ixodes scapularis and Ixodes pacificus in the United States. We present a summary of passive surveillance data for cases of anaplasmosis with onset during 2008-2012. \
The overall reported incidence rate (IR) was 6.3 cases per million person-years. Cases were reported from 38 states and from New York City, with the highest incidence in Minnesota (IR = 97), Wisconsin (IR = 79), and Rhode Island (IR = 51). Thirty-seven percent of cases were classified as confirmed, almost exclusively by polymerase chain reaction (PCR).
The reported case fatality rate was 0.3% and the reported hospitalization rate was 31%. IRs, hospitalization rates, life-threatening complications, and case fatality rates increased with age group.
The IR increased from 2008 to 2012 and the geographic range of reported cases of anaplasmosis appears to have increased since 2000-2007. Our findings are consistent with previous case series and recent reports of the expanding range of the tick vector I. scapularis.
© The American Society of Tropical Medicine and Hygiene.
http://www.ncbi.nlm.nih.gov/pubmed/25870428
NG
Infect Dis Clin North Am. 2015 Jun;29(2):371-381. doi: 10.1016/j.idc.2015.02.009.
Update and Commentary on Four Emerging Tick-Borne Infections: Ehrlichia muris-like Agent, Borrelia miyamotoi, Deer Tick Virus, Heartland Virus, and Whether Ticks Play a Role in Transmission of Bartonella henselae.
Wormser GP1, Pritt B2.
1Division of Infectious Diseases, New York Medical College, 40 Sunshine Cottage Road, Skyline Office #2N-C20, Valhalla, NY 10595, USA. Electronic address: gwormser@nymc.edu.
2Division of Clinical Microbiology, Department of Pathology and Laboratory Medicine, Mayo Clinic, 200 1st Street, SW, Rochester, MN 55905, USA.
Abstract
Emerging tick-borne infections continue to be observed in the United States and elsewhere.
Current information on the epidemiology, clinical and laboratory features, and treatment of infections due to Ehrlichia muris-like agent, deer tick virus, Borrelia miyamotoi sensu lato, and Heartland virus was provided and critically reviewed.
More research is needed to define the incidence and to understand the clinical and the laboratory features of these infections.
There is also a growing need for the development of sensitive and specific serologic and molecular assays for these infections that are easily accessible to clinicians.
Copyright © 2015 Elsevier Inc. All rights reserved.
KEYWORDS:
Front Public Health. 2015 Apr 21;3:55. doi: 10.3389/fpubh.2015.00055. eCollection 2015.
Challenges posed by tick-borne rickettsiae: eco-epidemiology and public health implications.
Eremeeva ME1, Dasch GA2.
1Jiann-Ping Hsu College of Public Health, Georgia Southern University , Statesboro, GA , USA.
2Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention , Atlanta, GA , USA.
Abstract
Rickettsiae are obligately intracellular bacteria that are transmitted to vertebrates by a variety of arthropod vectors, primarily by fleas and ticks. Once transmitted or experimentally inoculated into susceptible mammals, some rickettsiae may cause febrile illness of different morbidity and mortality, and which can manifest with different types of exhanthems in humans. However, most rickettsiae circulate in diverse sylvatic or peridomestic reservoirs without having obvious impacts on their vertebrate hosts or affecting humans.
We have analyzed the key features of tick-borne maintenance of rickettsiae, which may provide a deeper basis for understanding those complex invertebrate interactions and strategies that have permitted survival and circulation of divergent rickettsiae in nature.
Rickettsiae are found in association with a wide range of hard and soft ticks, which feed on very different species of large and small animals. Maintenance of rickettsiae in these vector systems is driven by both vertical and horizontal transmission strategies, but some species of Rickettsia are also known to cause detrimental effects on their arthropod vectors.
Contrary to common belief, the role of vertebrate animal hosts in maintenance of rickettsiae is very incompletely understood. Some clearly play only the essential role of providing a blood meal to the tick while other hosts may supply crucial supplemental functions for effective agent transmission by the vectors.
This review summarizes the importance of some recent findings with known and new vectors that afford an improved understanding of the eco-epidemiology of rickettsiae; the public health implications of that information for rickettsial diseases are also described.
Special attention is paid to the co-circulation of different species and genotypes of rickettsiae within the same endemic areas and how these observations may influence, correctly or incorrectly, trends, and conclusions drawn from the surveillance of rickettsial diseases in humans.
KEYWORDS:
Rickettsia; acquisition feeding; co-feeding transmission; eco-epidemiology; molecular epidemiology; spotted fever rickettsioses; ticks; transovarial maintenance
PMID:
25954738
[PubMed]
PMCID:
PMC4404743