Post by Admin on May 5, 2015 13:27:37 GMT -5
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About Vector-borne Diseases
Traditionally in medicine, a vector is an organism that does not cause disease itself, but which spreads infection by conveying pathogens from one host to another. This sense of “biological vector” is the primary one in epidemiology and in common speech. Lyme borreliosis or Lyme disease is one of the most common among vector-borne diseases and the carriers are often ticks. However, as a tick can transmit up to 100 different infections, it shares common traits with other hosts transmitting some of the same infections – hence the name “vector-borne”. Examples of other vectors are lice, fleas, mice, mosquitos etc. They carry bacteria, viruses, multicellular microscopical parasites and other pathogens that may transmit a disease through feeding activity. In the following, a general outline on tick-borne diseases such as Lyme Borreliosis and other associated infections will be presented.
Lyme Borreliosis
Infections transmitted by ticks are well known. Lyme borreliosis is one of the most known illnesses to be transmitted by ticks. It is a multi-system infectious disease caused by a bacterial spirochete, Borrelia burgdorferi (hereafter Bb). The name Lyme disease originated in 1975 when the town Old Lyme in Connecticut experienced an outbreak of rheumatoid arthritis, which one eventually (1978) discovered was caused by ticks. The cause of Lyme disease remained unknown until 1982 when an American scientist, Dr. Willy Burgdorfer, identified a Borrelia- spirochete to be the cause, hence the name Borrelia burgdorferi. Although the illness received it’s name a few decades back, recent discoveries found that the 5300 year old Ötzi indeed had been infected with Bb.
Bb is the most common species in the United States; there are 100 strains in the US alone and 300 strains worldwide. There are at least 15 species that are infectious to man, including B. garinii, B. afzelii, B. japonica, B miyamoto, B lonestari, and B andersonii. Bb is the most genetically complex bacteria identified to date. Bb contains 132 functional genes, compared to the syphilis spirochete Treponema pallidum (often called the Bb’s “cousin”) with mere twenty-two. Ninety percent of these genes are novel to all bacteria. Bb’s genome is 2/3 the size of the human genome. Bb contains 21 plasmids, more than any other bacteria. This characteristic allows the organism to be highly adaptive to its environment, with the ability to survive in a number of different hosts.
Bb appears to survive even when the host has an intact immune system. Bb is not commonly found in body fluids, but rather has an affinity for collagenous tissue, such as the bladder wall, synovium, myelin sheath of nerve fibers, and the meninges. The bacteria can, in the early stage of the disease, disseminate to distant areas, it can hide in niches, it can be intracellular, and it can express multi-drug resistance. Further, it can hide in biofilms both in the blood and in anoxic, remote parts of the body, and camouflage itself with proteins from the host. It may perform antigenic changes, manipulate the immune system of the host, and change into inactive (dormant) cyst-forms. All these properties make specific Borrelia spirochetes unique, and some could potentially develop disease of epidemic proportions. Bb is called “The Great Imitator”, and seems to be the cause of a tremendous amount of misdiagnoses worldwide.
Lyme Borreliosis offers a complex symptom picture for the clinician. Infection with Bb may be overlooked due to common misperceptions about disease presentation and pervasiveness. Lyme Borreliosis can be misdiagnosed as Fibromyalgia, ME/CFS, Multiple Sclerosis, Lupus, Parkinson’s, Alzheimer’s, Rheumatoid Arthritis, ALS, and a number of neuropsychiatric disorders. Lyme Borreliosis has often been referred to having three stages. Stage 1 (3-30 days post-tick bite) is called early localized Lyme Borreliosis, as the infection has not yet spread throughout the body. Symptoms include, but are not limited to a red, expanding rash called erythema migrans (EM), fatigue, chills, fever, headache, muscle and joint aches, and swollen lymph nodes. Studies have shown that only half of the infected patients develop an EM. Also, several patients do not even recall ever having a rash. Stage 2 is called early disseminated Lyme Borreliosis (days to weeks post-tick bite). Untreated, the infection may spread from the site of the bite to other parts of the body, producing an array of specific symptoms that may come and go, including; addditional EM lesions in other areas of the body; facial or Bell’s palsy (loss of muscle tone on one or both sides of the face); severe headaches and neck stiffness due to meningitis (inflammation of the spinal cord); pain and swelling in the large joints (such as knees); shooting pains that may interfere with sleep; heart palpitations and dizziness due to changes in heartbeat. Stage 3 is called late disseminated Lyme borreliosis, where the bacteria have spread throughout the body (months-to-years post-tick bite). Approximately 60% of patients with untreated infection may begin to have intermittent bouts of arthritis, with severe joint pain and swelling. Large joints are most often affected, particularly the knees. Untreated or undertreated patients may also develop chronic neurological complaints months to years after infection. These include shooting pains, numbness or tingling in the hands or feet, and problems with short-term memory.
Today, there are few, if any, highly sensitive and reliable tests for detecting Bb, and there is an assumption of a high number of zero negative (“false negative”) patients suffering from this infection. Studies have shown an average of 56% sensitivity to Bb with a two-tiered testing (Elisa and Western Blot). This would be the same as flipping a coin. Some studies show as low as 29% sensitivity. According to a recent report from CDC (Centers for Disease Control and Prevention), the annual number of humans infected with Lyme Borreliosis is 10 times higher than previously estimated – 300.000 Americans per year. It becomes clear that this is a worldwide epidemic, with official numbers revealing an annual frequency that is six times higher than HIV/AIDS.
There is a discrepancy in the medical community regarding which approach to take regarding diagnostics and treatment. This originates from the US where the two organizations IDSA and ILADS have two very differing views. IDSA (The Infectious Diseases Society of America) stipulates that it is an easy disease to diagnose and treat. The diagnostics rely mainly on a two-tiered testing regime (of Elisa and Western Blot). Treatment should not exceed 14- 28 days with antibiotics. After this maximum treatment of one month, IDSA states that the infection is treated, and what the patient experiences beyond this point, is a Post-Treatment Lyme Disease Syndrome (PTLDS), not related to an active infection. ILADS (International Lyme and Associated Diseases Society) was founded by medical doctors (1999), who realized that the official treatment guidelines were not making the patients better. ILADS also puts a stronger emphasis on the clinical presentation, as the current diagnostics still are too uncertain. ILADS claims that an untreated infection of Bb may go chronic. Longer treatment regimens and a combination of several types of antibiotics is important to get well. ILADS arranges several times a year knowledge leading conferences to bring together respected international researchers and clinicians to share cutting-edge research and diagnostic and treatment modalities that will enhance the lives of those suffering from these diseases. Increasingly more doctors now treat according to the ILADS guidelines. A total of 56% of American doctors follow the ILADS guidelines, and increasingly more states have passed doctor protection laws that let their physicians treat according to the ILADS guidelines. A recent example is the Vermont legislature that just passed Lyme bill H123, which acknowledges the severity of chronic Lyme disease, the role of co-infections in chronic illness, and the need for individualized treatment according to ILADS guidelines. The bill also contains language that protects health care practitioners from disciplinary action from the Vermont board of medical practice for diagnosing and treating tick-borne diseases according to ILADS guidelines, allowing practitioners to treat according to their best clinical judgement. This is a huge political step forward, and Vermont now joins a growing number of other states that have passed doctor protection laws.
This fundamental dispute has played out, not only in the universities, research communities or in the doctor’s office, it has also been taken to court as well as to the Senate and the Congress. Attorney General, Blumenthal waded into the Lyme disease controversy in 2006 when he launched an antitrust investigation into guidelines for treating Lyme developed by IDSA. The guidelines, which advised against long-term antibiotic therapy, had been used by insurers to restrict coverage for long-term treatment. Blumenthal alleged that some members of the panel that developed the guidelines had conflicts of interest, including financial stakes in drug companies or diagnostic tests. In April 2008, IDSA entered into an agreement with Connecticut Attorney General Richard Blumenthal to voluntarily undertake a special review of its 2006 Lyme disease guidelines. The outcome of the investigation was that 9 out of 14 of the IDSA authors had some kind of commercial stake (insurance, lyme vaccine etc.), however the guidelines were not revised. A study from 2011, also showed that 50% of random IDSA guidelines from 1994-2010 were based on low scientific quality and the authors warned that physicians should remain cautious when using current guidelines as the sole source guiding patient care decisions. Despite this fundamental disagreement, there is still a common understanding, that we still have a long way ahead when it comes to filling in the unknowns in biology and epidemiology of this disease. Whilst waiting for more research to be conducted, there are unfortunately a significant number of patients that suffer tremendously.
Lyme Borreliosis may be transmitted together with other vector-borne infections. The most common co-infectious organisms are Bartonella spp (Bartonellosis), Babesia microti (Babesiosis), Ehrlichia spp & Anaplasma phagocytophila (Ehrlichiosis). A growing number of studies report the importance of identifying co-infections as additional infections next to Lyme Borreliosis. DeMartino, Carlyon et al. found that every fifth individual who was seropositive for Bb also showed immunological evidence of exposure to Ehrlichiosis (2001). Prevalance of Babesiosis can range from 10% to 60% in individuals who are seropositive for Bb. In a random selection of Ixodes scapularis ticks in New Jersey, 33.6% were positive for Borrelia burgdorferi, 8.4% for Babesia, 1.9% Anaplasma, and 34.5% Bartonella. Please see an outline of different co-infections outlined below.
norvect.no/vector-borne-diseases/
About Vector-borne Diseases
Traditionally in medicine, a vector is an organism that does not cause disease itself, but which spreads infection by conveying pathogens from one host to another. This sense of “biological vector” is the primary one in epidemiology and in common speech. Lyme borreliosis or Lyme disease is one of the most common among vector-borne diseases and the carriers are often ticks. However, as a tick can transmit up to 100 different infections, it shares common traits with other hosts transmitting some of the same infections – hence the name “vector-borne”. Examples of other vectors are lice, fleas, mice, mosquitos etc. They carry bacteria, viruses, multicellular microscopical parasites and other pathogens that may transmit a disease through feeding activity. In the following, a general outline on tick-borne diseases such as Lyme Borreliosis and other associated infections will be presented.
Lyme Borreliosis
Infections transmitted by ticks are well known. Lyme borreliosis is one of the most known illnesses to be transmitted by ticks. It is a multi-system infectious disease caused by a bacterial spirochete, Borrelia burgdorferi (hereafter Bb). The name Lyme disease originated in 1975 when the town Old Lyme in Connecticut experienced an outbreak of rheumatoid arthritis, which one eventually (1978) discovered was caused by ticks. The cause of Lyme disease remained unknown until 1982 when an American scientist, Dr. Willy Burgdorfer, identified a Borrelia- spirochete to be the cause, hence the name Borrelia burgdorferi. Although the illness received it’s name a few decades back, recent discoveries found that the 5300 year old Ötzi indeed had been infected with Bb.
Bb is the most common species in the United States; there are 100 strains in the US alone and 300 strains worldwide. There are at least 15 species that are infectious to man, including B. garinii, B. afzelii, B. japonica, B miyamoto, B lonestari, and B andersonii. Bb is the most genetically complex bacteria identified to date. Bb contains 132 functional genes, compared to the syphilis spirochete Treponema pallidum (often called the Bb’s “cousin”) with mere twenty-two. Ninety percent of these genes are novel to all bacteria. Bb’s genome is 2/3 the size of the human genome. Bb contains 21 plasmids, more than any other bacteria. This characteristic allows the organism to be highly adaptive to its environment, with the ability to survive in a number of different hosts.
Bb appears to survive even when the host has an intact immune system. Bb is not commonly found in body fluids, but rather has an affinity for collagenous tissue, such as the bladder wall, synovium, myelin sheath of nerve fibers, and the meninges. The bacteria can, in the early stage of the disease, disseminate to distant areas, it can hide in niches, it can be intracellular, and it can express multi-drug resistance. Further, it can hide in biofilms both in the blood and in anoxic, remote parts of the body, and camouflage itself with proteins from the host. It may perform antigenic changes, manipulate the immune system of the host, and change into inactive (dormant) cyst-forms. All these properties make specific Borrelia spirochetes unique, and some could potentially develop disease of epidemic proportions. Bb is called “The Great Imitator”, and seems to be the cause of a tremendous amount of misdiagnoses worldwide.
Lyme Borreliosis offers a complex symptom picture for the clinician. Infection with Bb may be overlooked due to common misperceptions about disease presentation and pervasiveness. Lyme Borreliosis can be misdiagnosed as Fibromyalgia, ME/CFS, Multiple Sclerosis, Lupus, Parkinson’s, Alzheimer’s, Rheumatoid Arthritis, ALS, and a number of neuropsychiatric disorders. Lyme Borreliosis has often been referred to having three stages. Stage 1 (3-30 days post-tick bite) is called early localized Lyme Borreliosis, as the infection has not yet spread throughout the body. Symptoms include, but are not limited to a red, expanding rash called erythema migrans (EM), fatigue, chills, fever, headache, muscle and joint aches, and swollen lymph nodes. Studies have shown that only half of the infected patients develop an EM. Also, several patients do not even recall ever having a rash. Stage 2 is called early disseminated Lyme Borreliosis (days to weeks post-tick bite). Untreated, the infection may spread from the site of the bite to other parts of the body, producing an array of specific symptoms that may come and go, including; addditional EM lesions in other areas of the body; facial or Bell’s palsy (loss of muscle tone on one or both sides of the face); severe headaches and neck stiffness due to meningitis (inflammation of the spinal cord); pain and swelling in the large joints (such as knees); shooting pains that may interfere with sleep; heart palpitations and dizziness due to changes in heartbeat. Stage 3 is called late disseminated Lyme borreliosis, where the bacteria have spread throughout the body (months-to-years post-tick bite). Approximately 60% of patients with untreated infection may begin to have intermittent bouts of arthritis, with severe joint pain and swelling. Large joints are most often affected, particularly the knees. Untreated or undertreated patients may also develop chronic neurological complaints months to years after infection. These include shooting pains, numbness or tingling in the hands or feet, and problems with short-term memory.
Today, there are few, if any, highly sensitive and reliable tests for detecting Bb, and there is an assumption of a high number of zero negative (“false negative”) patients suffering from this infection. Studies have shown an average of 56% sensitivity to Bb with a two-tiered testing (Elisa and Western Blot). This would be the same as flipping a coin. Some studies show as low as 29% sensitivity. According to a recent report from CDC (Centers for Disease Control and Prevention), the annual number of humans infected with Lyme Borreliosis is 10 times higher than previously estimated – 300.000 Americans per year. It becomes clear that this is a worldwide epidemic, with official numbers revealing an annual frequency that is six times higher than HIV/AIDS.
There is a discrepancy in the medical community regarding which approach to take regarding diagnostics and treatment. This originates from the US where the two organizations IDSA and ILADS have two very differing views. IDSA (The Infectious Diseases Society of America) stipulates that it is an easy disease to diagnose and treat. The diagnostics rely mainly on a two-tiered testing regime (of Elisa and Western Blot). Treatment should not exceed 14- 28 days with antibiotics. After this maximum treatment of one month, IDSA states that the infection is treated, and what the patient experiences beyond this point, is a Post-Treatment Lyme Disease Syndrome (PTLDS), not related to an active infection. ILADS (International Lyme and Associated Diseases Society) was founded by medical doctors (1999), who realized that the official treatment guidelines were not making the patients better. ILADS also puts a stronger emphasis on the clinical presentation, as the current diagnostics still are too uncertain. ILADS claims that an untreated infection of Bb may go chronic. Longer treatment regimens and a combination of several types of antibiotics is important to get well. ILADS arranges several times a year knowledge leading conferences to bring together respected international researchers and clinicians to share cutting-edge research and diagnostic and treatment modalities that will enhance the lives of those suffering from these diseases. Increasingly more doctors now treat according to the ILADS guidelines. A total of 56% of American doctors follow the ILADS guidelines, and increasingly more states have passed doctor protection laws that let their physicians treat according to the ILADS guidelines. A recent example is the Vermont legislature that just passed Lyme bill H123, which acknowledges the severity of chronic Lyme disease, the role of co-infections in chronic illness, and the need for individualized treatment according to ILADS guidelines. The bill also contains language that protects health care practitioners from disciplinary action from the Vermont board of medical practice for diagnosing and treating tick-borne diseases according to ILADS guidelines, allowing practitioners to treat according to their best clinical judgement. This is a huge political step forward, and Vermont now joins a growing number of other states that have passed doctor protection laws.
This fundamental dispute has played out, not only in the universities, research communities or in the doctor’s office, it has also been taken to court as well as to the Senate and the Congress. Attorney General, Blumenthal waded into the Lyme disease controversy in 2006 when he launched an antitrust investigation into guidelines for treating Lyme developed by IDSA. The guidelines, which advised against long-term antibiotic therapy, had been used by insurers to restrict coverage for long-term treatment. Blumenthal alleged that some members of the panel that developed the guidelines had conflicts of interest, including financial stakes in drug companies or diagnostic tests. In April 2008, IDSA entered into an agreement with Connecticut Attorney General Richard Blumenthal to voluntarily undertake a special review of its 2006 Lyme disease guidelines. The outcome of the investigation was that 9 out of 14 of the IDSA authors had some kind of commercial stake (insurance, lyme vaccine etc.), however the guidelines were not revised. A study from 2011, also showed that 50% of random IDSA guidelines from 1994-2010 were based on low scientific quality and the authors warned that physicians should remain cautious when using current guidelines as the sole source guiding patient care decisions. Despite this fundamental disagreement, there is still a common understanding, that we still have a long way ahead when it comes to filling in the unknowns in biology and epidemiology of this disease. Whilst waiting for more research to be conducted, there are unfortunately a significant number of patients that suffer tremendously.
Lyme Borreliosis may be transmitted together with other vector-borne infections. The most common co-infectious organisms are Bartonella spp (Bartonellosis), Babesia microti (Babesiosis), Ehrlichia spp & Anaplasma phagocytophila (Ehrlichiosis). A growing number of studies report the importance of identifying co-infections as additional infections next to Lyme Borreliosis. DeMartino, Carlyon et al. found that every fifth individual who was seropositive for Bb also showed immunological evidence of exposure to Ehrlichiosis (2001). Prevalance of Babesiosis can range from 10% to 60% in individuals who are seropositive for Bb. In a random selection of Ixodes scapularis ticks in New Jersey, 33.6% were positive for Borrelia burgdorferi, 8.4% for Babesia, 1.9% Anaplasma, and 34.5% Bartonella. Please see an outline of different co-infections outlined below.