Tick-Borne Diseases and

Associated Diseases

Jack Dunham, DVM

Kathy White, BA Ed.; MSW

Representing the Lyme Association of

Greater Kansas City, Inc.

A non-profit, all-volunteer organization

P.O. Box 25853, Overland Park, KS 66225

Phone: (913) 438-5963 (GET-LYME)

Email: Lymefight @aol.com Website: www. lymefight.info

Our Mission

1)To provide services to people who have Lyme disease.

2)To cooperate with the medical community.

3)To promote public awareness and prevention education.

Presentation Purpose

To increase awareness of...

tick-borne diseases in Kansas

associated diseases

To present information about...

symptoms

tests and treatments being used by Lyme disease doctors who are members of ILADS (International Lyme and Associated Diseases Society)

This presentation is for information only and should not be used as diagnostic or treatment advice.

Jack Dunham's Story

Tick bite in 2006

In Bonner Springs in Wyandotte County, KS

Developed Lyme rash and symptoms

Began treatment but didn't get well

Later was diagnosed with WA-1 babesia

Still have symptoms

Still on treatment

2007 Kansas Research Study

A researcher from Kansas State U. collected ticks and mice from four counties in NE Kansas in 2007.

Results from a farm:

10 Acres in Western Wyandotte County

Lyme and WA-1 Babesia were found in

All of the mice

Most of the ticks (all Lone Star ticks)

It is not widely known that Lone Star ticks

are carrying these diseases.

2007 - Research on aJefferson County, KS Farm

Lyme found in:

Some of the ticks collected.

All four family members who live there have been infected with Lyme disease and have been treated.

This research has not been published.

We do not have information concerning the testing done in the other two counties.

Kathy White's Story

Tick bite in April, 1998

In Wyandotte County, KS

Bull's-eye rash and illness

Developed Lyme, babesia, and what was probably a spotted fever group rickettsial disease

Treatment began 4 ½ weeks after tick bite.

Three weeks of 200 mg. of doxycycline per day was not enough. The disease became much worse when treatment stopped.

Handouts

Green folder containing:

Handbook

ILADS "Basic Information"

Brochure

References (Primary sources of information for this presentation):

(1) Dr. Joseph Burrascano's "Diagnostic Hints and Treatment Guidelines" (www. ilads.org)

(1)The CDC (www. cdc.gov)

(1)ILADS "Basic Information" (www. ilads.org)

ILADS (International Lyme and Associated Diseases Society) is an organization of doctors who are interested in treating tick-borne diseases. They offer a physician training program and have an annual scientific conference.

Ticks

Are arachnids, related to spiders, mites, and chiggers.

Have 8 legs, except the larvae have 6.

Feed on the blood of animals and humans.

Adult female drops off and lays several thousand eggs.

Larvae hatch in late spring or summer.

Nymphs emerge in spring.

Adults are active year-round, even in winter.

Some adults are active even when it's below freezing.

Tick-Borne Diseases General Information

Ticks carry many diseases, some fatal.

Ticks commonly transmit 3 or more diseases at once.

It can take years to diagnose them all.

There are no reliable tests for many tick-borne diseases.

There are no tests for some strains of some of these diseases.

About half of patients are unaware of having had a tick bite.

The tick can be too tiny to be noticed.

Diagnosis may need to be clinical, based on symptoms and history of tick exposure during the past month.

Symptoms resemble many other diseases.

If a patient is still ill after being treated for a tick-borne disease, consider co-infections.

Types of TicksArgasidae (soft ticks) Live in animal nests Feed many times during their lives Feed for a few minutes during the night

and then drop off Example: relapsing fever tick

Ixodidae (hard ticks): Feed 3 times during their lives Once as larvae, once as nymphs, once as adults Remain attached for several days and then drop

off Genera: Ixodes, Amblyomma, Dermacentor,

Rhipicephalus

Types of Ticks

1. Ixodes (black-legged ticks) ex.: Ixodes scapularis (deer tick)

Western Black- Legged Tick

Deer Tick

2. Amblyommaex.: Amblyomma americanum (lone star tick)

Amblyomma maculatum (Gulf Coast tick)

Types of Ticks3. Dermacentor

ex: Dermacentor variabilis (American dog tick)

Dermacentor andersoni (wood tick)

4. Rhipicephalus – ex.: Rhipicephalus sanguineus (brown dog tick)

Female Male

Ticks Change Size And Color As They Feed

Female, Deer Tick

Female, Lone Star Tick Female, Lone Star Tick

Tick Anatomy

Female American dog tick (ventral view)

Tick Drawings from CDCLeft to Right:

Adult Female, Adult Male, Nymph, Larva

Black-Legged Tick, Deer Tick(Ixodes Scapularis)

American Dog Tick, Wood Tick(Dermacentor)

Lone Star Tick(Amblyomma americanum)

Lone Star Tick

American Dog Tick

Gulf Coast Tick

Rocky Mountain Wood Tick

Brown Dog Tick

Black-Legged Ticks

Lyme Disease

Anaplasma Erlichia

Reported Cases in Dogs in Kansaswww. dogsandticks.com

Kansas Counties Endemic for LymeThe CDC definition of a Lyme disease endemic county: Two or more

confirmed cases contracted in the county and reported since 1986.

The following counties are endemic:

Johnson Sedgwick Wyandotte Jefferson

Butler Shawnee Leavenworth

Riley Atchison Douglas

Many other counties may be endemic.

The EM (erythema migrans) rash is reportable in endemic counties as a confirmed case if the patient is known to have been in a wooded, brushy, or grassy area in the county during the past 30 days. A positive test is not required to report these cases.

The EM rash must be at least 5 centimeters (about 3") in diameter to be reportable. It can just be a red spot. Central clearing or rings are not required for reporting purposes.

Herxheimer Reaction

Dr. Adolph Jarisch and Dr. Karl Herxheimer first discovered this reaction in syphilis patients.

A Jarisch-Herxheimer reaction is...

Common when Lyme patients begin antibiotics.

Often called a "Herx."

A temporary worsening of symptoms.

Caused by toxins released by dying bacteria.

Can last several days or longer.

Herxheimer Reaction

Symptoms can include:

Severe headache

Profound fatigue

Insomnia

Depression

Suicidal thoughts

Increased pain

Heart problems

Exacerbation of previous symptoms

New symptoms

Herxheimer Reaction

Severity and duration depend on how long a person has had untreated Lyme and the quantity of bacteria.

Detoxifying the body helps to reduce the severity and duration of this reaction.

If symptoms are severe or life-threatening, doctors often temporarily stop treatment and resume it later, often starting with a lower dose and gradually increasing it.

Supplements and vitamins can boost the immune system and also cause a Herx.

Tick-Borne Diseases in Kansas

Lyme Disease

STARI

Babesia

Ehrlichiosis

Anaplasma

Rocky Mountain Spotted Fever

Other Rickettsial diseases (Spotted fever group Rickettsia, SFGR)

Mycoplasma

Bartonella

Tularemia

Q Fever

Tick Paralysis

BabesiaBabesia is caused by a protozoan, closely related

to the protozoan that causes malaria.

Symptoms

At onset of Lyme (8 days or more after tick bite): High fever and chills in some patients

Later:

Severe fatigueGlobal headaches, like a hat is

too tightBody aches, muscle painFevers of up to 104 degreesChills, sweats, especially night

sweats

Eye painBreathing problems,

"air hunger"Occasional dry coughPoor balanceEncephalopathyHemolytic anemiaHypercoagulation

Babesia Facts

Babesia & malaria are both caused by protozoans that reproduce inside red blood cells and destroy them.

A very common co-infection with Lyme. Many members of our Lyme Association have babesia.

Nationally reportable as of January, 2011.

Reporting criteria can be found at www.cdc.gov.

Found in Cattle in Miami County forty years ago.

Not known to affect humans in this area of the country until recently.

Babesia Blood Smear

A blood smear can show protozoans in red blood cells. However, a person may be ill with only a few red blood cells infected, and there may be none visible in the sample being viewed.

A negative test does not rule out babesia.

Babesia and Lyme

A combination of babesia and Lyme makes both diseases much worse.

Both diseases suppress the immune system and make it more difficult to recover.

Babesia enables the Lyme bacteria to survive Lyme treatment.

Lyme disease spirochetes cycle and cause a Herx every 4 to 6 weeks.

Babesia cycles every 4 to 6 days.

Babesia Blood Transfusion Risk Many people infected are healthy and don't know they carry

babesia.

Babesia is unknowingly being transmitted through blood transfusions.

At least 9 people in the U.S. have died after receiving babesia-infected blood.

There are no tests to screen donated blood for babesia.

CDC recommends babesia patients not donate blood.

Wise for people who get a lot of tick bites to refrain from donating blood.

Lyme disease can also survive in stored blood, as can agents of some other tick-borne diseases.

Babesia Testing

Quest Diagnostics, LabCorp, and Igenex (www. igenex.com, 1-800-832-3200) have tests for Babesia microti and Babesia duncani (WA-1).

There are no specific tests for Babesia MO-1 (Missouri strain) or the other strains. There are at least 13 strains of babesia carried by ticks.

Quest Diagnostics has an ECP (Eosinophil Cationic Protein) test. It can indicate a protozoan infection without identifying the species – useful for species for which we don't have tests.

Babesia Treatment(According to Dr. J. Burrascano's Guidelines, pp. 23-24)

Mepron (atovaquone) or Malarone (atovaquone + proguanil)

+Azithromycin (Zithromax) or Clarithromycin (Biaxin)

or Telithromycin (Ketek)

+Artemisia (a non-prescription herb)

(It increases the effectiveness of the medications.)

Babesia Treatment(According to Dr. J. Burrascano's Guidelines, pp. 23-24)

Research is showing atovaquone does not get absorbed well unless taken with food containing fat.

Treatment for acute illness should be 3 weeks, and at least 4 months for chronic cases. Relapses occur. Re-treatment may be needed.

Dr. Burrascano no longer recommends the clindamycin and quinine protocol. Almost half of patients had to abandon treatment because of side effects, and there was a failure rate of almost 50%. Some doctors find it helpful.

Can cause a terrible Herx when beginning treatment, which can cause profound fatigue, headache, profuse sweating, and other symptoms that last a few days or longer.

Tick-Borne Bartonella

A very common co-infection with Lyme disease.

Ticks carry Bartonella henselae (cat scratch disease).

Ticks also carry other bartonella strains.

There are no tests for most strains of bartonella.

Consider bartonella if a person remains ill after Lyme disease treatment.

Symptoms of Bartonella

Swollen lymph nodes, can be the size of golf ballsFever HeadacheFatiguePoor appetiteAbdominal painEndocarditis Uveitis, retinitis, other eye problemsRed papular rashesParallel lines resembling stretch marksInsomniaSeizures, in some patients

Bartonella Symptom Pictures

Swollen Lymp Node

Bartonella Symptom Pictures

Bartonella Treatment(Burrascano, pp. 24-25)

For Bartonella henselae:

– erythromycin or doxcycline

For other strains:

– levofloxacin for adults over age 18

– various other drugs

For children:

– azithromycin

Mycoplasma

Common co-infection with Lyme disease

Bacterial infection

Treated with certain antibiotics that are effective for cell-wall deficient bacteria

Several species found in ticks, most commonly mycoplasma fermentans.

Difficult to diagnose.

Mycoplasma fermentans can disrupt the immune system.

Mycoplasma

Multitude of symptoms that can resemble other diseases.

Found in patients with:

Lyme disease Gulf War syndrome Chronic fatigue syndrome Fibromyalgia Rheumatoid arthritis MS ALS Chronic asthma Crohn's disease Autism Other inflammatory bowel diseases

Very common co-infection with Lyme disease, but many doctors are not looking for it.

MDL Laboratories has a PCR test for mycoplasma (1-877-269-0090, www. mdlab.com).

Some Diseases Caused by Rickettsia Bacteria

(Source: www. cdc.gov)

Ehrlichiosis (HME, human monocytic ehrlichiosis)

Anaplasmosis (HGA, human granulocytic anaplasmosis, formerly called HGE)

Rocky Mountain spotted fever (RMSF)

Spotted fever group rickettsias (SFGR) (R. parkeri, R. amblyommii, etc.)

These diseases share similar symptoms

Fever

Chills

Severe headache

Muscle aches or pain

Malaise

Confusion

Abdominal pain

Nausea

Vomiting (sometimes)

Diarrhea (sometimes)

Additional Symptoms

Maculopapular and/or petechial rash (rare in anaplasmosis and ehrlichiosis)

Black, crusty eschar at site of tick bite is typical of RSFG but rare in Rocky Mountain spotted fever

Rash: Doesn't appear until a person has been ill with one of these diseases for several days. Many patients don't get a rash.

The RMSF rash typically begins at the wrists and ankles and moves up the limbs. May also occur on the palms of the hands and soles of the feet. A petechial rash can occur later, and the toes may turn black.

There is some evidence that spotted fever group rickettsias may usually cause a milder illness than RMSF.

Rocky Mountain Spotted Fever Picture

Diagnosis Issues

May not get diagnosed until the rash appears.

Specific tests can be ordered, but treatment must not wait until test results come back.

Antibody tests for anaplasma are likely to be negative during the first week or two of infection.

These diseases can be transmitted along with Lyme or other tick-borne diseases.

Symptoms from co-infections complicate diagnosis.

Meningitis

Can be caused by ehrlichiosis, anaplasmosis, and Rocky Mountain spotted fever.

If a person is hospitalized with meningitis, try to determine whether there has been recent tick exposure.

Don't assume it is viral.

If it is one of these diseases, doxycyline may save a life.

Checking the blood for low platelets, low leukocyte count, and elevated liver enzymes may be helpful.

Early Diagnosis of Rickettsial Diseases

Ask patient if he/she was exposed to ticks during the two weeks prior to illness.

Patient may not have noticed a tick bite.

A CBC panel and liver enzyme test can indicate the possibility of a rickettsial disease.

These diseases cause leukopenia (low white blood cell count), thrombocytopenia (low platelet count), and elevated liver enzymes.

Treatment of Rickettsial Diseases

Treatment is most successful if begun promptly (before the 5th day of illness).

Don't wait for test results.

Tests are usually negative early in the illness.

Begin treatment as soon as a rickettsial disease is suspected.

These diseases can be fatal if treatment is delayed.

Medication Recommendations(Source: www. cdc.gov)

Doxycycline: Ehrlichiosis, Anaplasmosis, RMSF, and SFGR

For adults and children of all ages Other drugs don't work as well, not even other tetracyclines. Sulfa drugs make these diseases worse. Children under 8 can take up to 5 two-week courses at CDC

recommended dose without harming their permanent teeth.

For pregnant women and people with a life-threatening allergy to doxycycline: Chloramphenicol is effective for RMSF. Causes grey baby syndrome, which can be fatal for baby. Not effective for anaplasma or ehrlichia.

Rifampin works for anaplasma and ehrlichia. Not effective for RMSF.

Treatment Duration for These Diseases:

(www. cdc.gov)

The CDC says to treat for at least 3 days after the fever subsides and the patient is better.

Treatment should last for 7-14 days.

For Ehrlichiosis and Anaplasmosis, Dr. Burrascano Suggests: (Burrascano, p. 25)

Doxycycline, 200 mg. daily for adults, for 2-4 weeks

Higher doses, parenteral therapy, and longer duration may be needed, based on severity and duration of illness, immune suppression, and advanced age.

If treatment fails, consider adding rifampin, 600 mg. daily.

Tick Paralysis A rare allergic reaction to a tick bite

Caused by a neurotoxin in saliva of a female tick

Begins with weakness in legs

Paralysis begins in the lower legs and moves up the body

Lungs become paralyzed

Can be fatal unless the tick is found and removed in time

Once the tick is removed, the patient recovers

The tick is often on the head, usually at the back, at the hairline

The tick can be on the neck, back or other location

Lyme Disease Definition

The CDC (Centers for Disease Control) definition:

Lyme disease is caused by Borrelia burgdorferi (Bb) bacteria and is transmitted by the bite of an infected black-legged tick.

Black-legged ticks are also known as “deer ticks” and “Ixodes pacificus ticks.” Bb bacteria are called “spirochetes” because of their spiral shape.

Problems with the CDC definition:

It excludes most cases in the central states.

Some people in this area get Lyme disease from deer ticks.

Most in Missouri and Kansas get infected by lone star ticks.

Researchers have found Bb bacteria in

Lone star ticks, wood ticks, American dog ticks, and brown dog ticks.

People have tested positive after bites by all these ticks.

Bb bacteria have also been found in Gulf Coast Ticks.

It does not include the variations of borrelia bacteria.

Problems with the CDC definition:

Variant strains often don’t get diagnosed and treated.

The CDC calls the disease "Lyme-like" or STARI when caused by a lone star tick, although the rash, symptoms, severity, and treatment are the same as for Lyme disease.

This causes many doctors to ignore the illness and not treat it.

This often causes the disease to become chronic and debilitating, sometimes leading to death.

Prompt treatment of Lyme disease and STARI with 4 to 6 weeks of antibiotics can often prevent it from becoming chronic.

Lyme Disease General Information

One of the fastest growing infectious diseases in the US. It is increasing much faster than HIV or AIDS. It has infected more Americans than HIV. The number of cases is increasing as the number of deer and

ticks increases. Lyme disease is world-wide. It has been reported in all 50 states and has been found on

every continent except Antarctica. Ticks carrying Lyme disease have been found on migrating

birds on sub-antarctic islands. Infected ticks on migrating birds continue to take the disease

to new areas.

Lyme Disease General Information

Some people die from Lyme disease, usually after years of illness.

We know of 14 people who have died in Kansas since 1991 because of Lyme disease.

They include an unborn baby and a girl aged 17. Only one was over age 62.

Many others die undiagnosed.

Lyme disease is causing disability in many more people than West Nile Virus.

Government funding for West Nile Virus and AIDS is much higher than funding for Lyme disease.

# Lyme Cases # WNV Cases0

5000

10000

15000

20000

25000

19804

2539

Reported Cases of Lyme Disease vs West Nile Virus 2004

Disparity in Funding: Lyme versus West Nile Virus

From California Lyme Disease Association 2004

Lyme Disease West Nile Virus$0

$10,000,000

$20,000,000

$30,000,000

$40,000,000

$50,000,000

$60,000,000

$70,000,000

$80,000,000

$90,000,000

Federal Funding for Vector Borne Diseases 2004

CDC $$

NIH $$

Disparity in Funding: Lyme versus West Nile Virus

History of Lyme Disease

1883 – the ACA (acrodermatitis chronica atrophicans) Lyme disease skin condition was described in Germany.

1894 – A researcher stored mice in a Massachusetts museum. About 100 years later, Bb bacteria were found on the mouse pelts.

1960's – Polly Murray in Old Lyme, Connecticut began documenting symptoms in her family of what later became known as Lyme disease.

History of Lyme Disease

1967 – A doctor in Germany reported that, although most Lyme disease is caused by ticks, about 10% of patients were getting the disease from horseflies.

1975 – Polly Murray and another mother contacted Yale to report an unusual illness that was affecting their families and neighbors in and near Lyme and Old Lyme, Connecticut. A Yale doctor investigated. This led to the discovery of Lyme disease.

1981 – While doing research on ticks, Willy Burgdorfer discovered the Borrelia burgdorferi bacteria that causes Lyme disease.

Early Lyme Disease Symptoms

People may get an illness with some of these symptoms 1 to 32 days after a tick bite. These early symptoms resemble the flu. Some people don’t get these early symptoms.

A red spot. It may grow, may clear in the center, and may or may not develop rings like a bull’s-eye. Many people don’t get a red spot or rash. The red spot is called an erythema migrans (EM) rash.

Lyme Disease Rashes

Lyme Disease Rashes

Lyme Disease Rashes

Lyme Disease Rashes

Lyme Disease Rashes

Lyme Disease Rashes

Early Lyme Disease Symptoms

EM rash, other rashes

Chills, with or without fever; sweating

Fatigue, sleepiness

Sore or aching muscles

Sore throat, cough

Runny nose, sinus infection

Swollen glands

Stomach and digestive problems

Joint pains

Severe headache

Eyes hurt in sunlight

Stiff neck

Meningitis

Late Lyme Disease Symptoms

Arthritis, or joint pains that move from joint to joint, with or without swelling

Muscle pains that move around

Headache that may last for days or years

Chronic nausea, vomiting that lasts for months or years

Diarrhea, constipation

Skin rashes; spots that resemble bruises but may clear in center

Irregular heartbeat and other heart problems

The early symptoms may last about a week and then go away. If not diagnosed and treated promptly with at least 6 weeks of antibiotics, the following symptoms may develop weeks, months, or years later:

Late Lyme Disease Symptoms

Blurry vision, other vision problems, red eye(s)

Ringing in ears; hearing loss

Numbness, tingling, or burning sensations

Paralysis; tremors; dizziness; seizures

Post sleep paralysis: temporary paralysis of arms or body after awakening

Problems with thinking, concentration, and memory; confusion; brain fog; sleep problems

Mood swings, depression, psychiatric illnesses

Lyme Disease and SyphilisLyme disease is caused by a bacterium called a spirochete,

closely related to the spirochete that causes syphilis.

Both diseases:

are treated with antibiotics. have similar symptoms. Have an early stage and a late stage.can cause arthritis, movement disorders, psychiatric illness,

heart problems, and blindness.Are called "the great imitator" because they imitate many other

diseases. Cause a Jarisch-Herxheimer reaction when treatment begins.Can cause miscarriages, stillbirths, and children born with the

illness.

Lyme Disease Can Cause Fibromyalgia Chronic Fatigue Syndrome Lupus Multiple Sclerosis ALS (Lou Gehrig's Disease) Rheumatoid Arthritis Parkinson’s Guillain-Barre Syndrome Bell's Palsy Sjogren’s Syndrome Hypercoagulation

Thyroid Disorders, too high or low Alzheimer’s Attention Deficit Disorder Autism, Asperger's Syndrome Autism Spectrum Disorders Tourette's Syndrome Depression Bipolar Disorder Obssesive-Compulsive Disorder Other psychiatric disorders Other diseases

When these are caused by Lyme disease, patients often improve with antibiotic treatment. Many improve dramatically, but it can take a year of treatment or more. The patients may never be totally well. Patients may relapse if treatment is stopped.

Lyme Disease and Autism

When autism is caused by Lyme disease, antibiotics may cause a sudden change in behavior.

It may become bizarre at first, as the bacteria die off.

A few days later, behavior may be normal, but autisic behavior may return after the antibiotic treatment ends.

Whenever there is an unusual response to antibiotics, the possibility of Lyme disease should be considered.

Thinking Problems Associated with Lyme

Concentration

Memory

Thinking

Making decisions

Mood and Psychiatric SymptomsAssociated with Lyme

Lyme disease can cause:

Personality changes

Mood swings

Violent outbursts

Visual and/or auditory hallucinations

Panic attacks

Sudden suicidal impulses

Depression

Insomnia

Obsessive-compulsive disorder

Bipolar disorder

A wide variety of psychiatric disorders

When these conditions are caused by Lyme disease, antibiotic treatment often helps tremendously.

Lyme Disease Diagnosis

Diagnosing Lyme disease can be extremely difficult, because:

The early stage symptoms resemble the flu.

The late stage resembles many other diseases.

Many people never saw the tick and didn't know they had a tick bite.

Many people with Lyme disease have negative test results.

Many doctors are unaware of the Lyme disease epidemic here and don't consider the diagnosis.

Many doctors are unaware that a person with a negative test can still have Lyme disease.

Testing for Tick-Borne Diseases

Blood must be fresh for the most accurate results.

When blood is being sent out-of-state, it should be drawn Mon., Tues., or Wednesday, and sent overnight by Federal Express.

Lyme Disease Tests

The CDC says Lyme disease is a clinical diagnosis, but testing can be used to confirm a diagnosis.

The CDC doesn't recommend testing in the early stage, because treatment needs to begin immediately, and it can take 4-6 weeks for antibodies to develop.

Antibody Tests

The ELISA and Western blot are antibody tests.

Many Lyme patients never develop a detectable level of antibodies.

The ELISA is a titer test used as a screening test.

It misses at least 35% of culture proven cases.

A screening test should be able to detect at least 95% of cases.

Most Lyme disease specialists don't use the ELISA.

Western Blot Test

Medical Diagnostic Labs (MDL)2439 Kuser Rd.Hamilton, New Jersey 08690Phone 877-269-0090www. mdlab.com

MDL has a Western blot test which is somewhat better than local labs but misses many cases. MDL works with insurance companies.

IGeneX Labs795 San Antonio Rd.Palo Alto, California 94303Phone 800-832-3200www. igenex.com

IGeneX has the best Western blot (WB) test for Lyme. It detects 95-97% of cases, with fewer than 4% false positives. They don’t work with insurance companies, but many people get some out-of-network coverage. Their WB costs about $200 for both IgM and IgG, or $100 for either one.

The Western blot (WB) also misses many cases.

About 36% of culture-proven Lyme cases remain WB negative throughout the illness.

Interpreting the Western Blot

The CDC has very strict reporting criteria for the Lyme disease Western blot.

Many patients don't get enough positive bands to meet the criteria.

The CDC says not to use the reporting criteria for diagnosis.

Dr. Burrascano says the following are specific for Lyme disease: Bands 18, 23-25, 31, 34, 37, 39, 83, and 93.

No other disease is known to cause these to be positive.

CD-57 Test

The CD-57 NK test can be used to diagnose Lyme and monitor treatment progress.

Lyme patients typically have an absolute CD-57 NK count below 60. (Normal is over 200.)

Dr. Burrascano says that, if treatment ends before the score is above 200, a relapse will probably occur.

The lab may not report the absolute count.

To determine the absolute count, multiply the percent of CD-57 NK lymphocytes by the absolute total lymphocyte count.

LabCorp's CD-57 test is called the HNK1 (CD-57) Panel, code # 505026. It's done at their lab in Burlington, NC.

Quest Diagnostics has a CD-57 test in San Juan Capistrano, CA, phone 1-800-642-4657.

Culture

Culture tests fail to detect many cases of Lyme disease.

The Lyme disease bacterium, Borrelia burdorferi Bb), has a 4-week growth cycle. This slow growth rate makes it extremely difficult to grow in culture.

Also, the Bb bacteria don't thrive well outside the body, so they may die in a lab before growing.

LUAT Test

LUAT Test – IGeneX has a Lyme Urine Antigen Test (LUAT).

It measures pieces of dead Lyme bacteria in the urine.

It is most likely to be positive a few days after treatment begins, after the bacteria start to die. For best results, the sample should be collected as soon as the patient wakes up in the morning.

PCR-DNA Test

This test is more sensitive than antibody tests.

Spiro Stat Technologies does PCR and DNA testing for Lyme and other spirochetal diseases.

They also have tests for some other tick-borne diseases.

Tests include: Borrelia burgdorferi, Borrelia lonestari, some other species of borrelia, Babesia microti, Bartonella henselae, ehrlichia, anaplasma, 9 species of rickettsia, tularemia, and other diseases.

Their panel of tests costs $500 (or more).

They do not currently have tests for Babesia duncani (WA-1) or other strains of babesia or bartonella.

Spiro Stat Technologies, Lubbock, TX Phone 877-767-7476 www. spirostattech.com.

Reasons for False Negative Lyme Antibody Tests

The ELISA and Western blot tests are blood (serum) tests used to detect antibodies. A false negative test gives negative results even though the patient really has Lyme disease.

This can occur because:

The testing is done too soon after the tick bite. It often takes 4-6 weeks for a detectable level of antibodies to develop.

The patient has a poorly functioning immune system that is not producing enough antibodies to be detected.

The patient is or has recently been on steroids or anti-cancer drugs which suppress the immune system.

The patient is or has recently been on antibiotics, which can reduce the production of antibodies.

Reasons for False Negative Lyme Antibody Tests

The antibodies may be bound to the bacteria, with not enough free-floating to be detected. (Some of the sickest patients test negative, because their antibodies are busy fighting numerous bacteria.)

The bacteria have changed their antigenic make-up, evading recognition by the immune system.

The patient has a variant strain of the disease that the test fails to detect.

The lab has such a high cut-off point that a positive test is determined to be equivocal or negative.

The patient has positive bands, but the test is interpreted based on strict reporting criteria and not on criteria for diagnosis.

Why Don’t Most Cases of Lyme Disease Get Reported?

Support groups have helped thousands of people with Lyme and Lyme-like illnesses in central, southern, and western states. Only a very few of these cases were reported.

1. Many doctors, unaware that it is in all 50 states, don't suspect it.

2. Diagnosis is difficult:

a. Symptoms resemble other diseases.

b.Tests are not very sensitive.

c. Many, perhaps most, cases don't get diagnosed.

3. Most diagnosed cases don't meet reporting criteria. The CDC revised their reporting criteria in 1996, 2008, and 2011 so that fewer cases could be reported.

4. Most cases that do meet reporting criteria don't get reported. The CDC estimates that only about 10% of cases that meet reporting criteria are actually getting reported.

Why don't cases that meet reporting criteria get reported?

The reporting criteria are complicated.

Doctors may be confused by the criteria, too busy to fill out the forms, and tired of having their reports rejected.

Many Lyme patients see doctors in other states.

The doctor may not have the reporting form for the state where the patient lives nor the time to obtain it.

The Lyme Association of Greater Kansas City has helped about 2,000 people who have Lyme disease. Almost none of these cases was reported.

Many doctors think Lyme disease is rare and don’t diagnose it.

Undiagnosed cases aren't reported.

A low number of reports makes doctors continue to think it’s rare.

This is a vicious circle.

Lyme Disease Treatmentwww.cdc.gov; Burrascano

Treatment is most successful if begun promptly.

Do not wait for test results, which are usually negative early in the illness.

Lyme disease is a bacterial infection treated with antibiotics.

Doxycycline is the usual treatment for adults.

Children are often given amoxicillin.

If children have a high fever, there could be a coinfection with ehrlichiosis or spotted fever, in which case doxycycline is given.

Lyme disease specialists recommend at least 4 to 6 weeks of treatment.

Lyme Disease Treatment

Dr. Burrascano recommends treatment for at least 4 weeks after all symptoms are gone, to prevent a relapse.

If the disease is not treated promptly and adequately in the early stage, the disease can become chronic.

Chronic Lyme disease may require years of antibiotics, changing to different antibiotics from time to time.

People who have neurological symptoms or who don't respond to oral treatment may benefit from months or even a year or more of IV treatment.

A healthy diet and vitamins & supplements are helpful.

Lyme Disease Transmission

Not transmitted via casual contact. Usually transmitted by a tick bite. Can be transmitted through bites by fleas, horseflies, deerflies, and

occasionally mosquitoes. Can pass through the placenta to an unborn baby if a pregnant

mother has Lyme disease. Has been found in breast milk, tears, sweat, semen, vaginal fluid,

and stored blood. Possibly sexually transmitted; research is needed. Can survive in stored blood. We don't yet know whether it is being

transmitted via blood transfusion. People with Lyme disease should not donate blood or organs.

Lyme Disease TransmissionLyme disease Borrelia burgdorferi (Bb) bacteria have been found in:

blacklegged ticks brown dog ticks fleas

lone star ticks horse flies mites

American dog ticks deer flies mosquitoes

wood ticks

A study found that a mosquito did transmit Lyme disease bacteria to a hamster. Some people have been diagnosed with Lyme disease after a mosquito bite.

References to some of the research studies are at the end of this presentation.

Please Consider the Possibility of Lyme Disease even if:

The patient lives in a less endemic part of the state

The patient was bitten by the “wrong” kind of tick

The patient was bitten by an insect instead of a tick

The patient did not get a rash

The red spot or rash was too small for reporting criteria

The test was negative

Diseases Associated with Tick-Borne Diseases

Re-Activated Dormant Herpes Viruses:

HHV-6A

HHV-6B

Epstein Barr virus

Varicella-Zoster (chickenpox)

Cytomegalovirus (CMV)

Other herpes viruses

Morgellons

Possibly, XMRV Virus

Tularemia(rabbit fever)

A red, open sore that last a long time, at the bite site

Swollen lymph nodes near the bite site, often in the armpit or groin

Fever, up to 104 degrees

Transmitted by a tick bite or by handling rabbits

Usually treated with doxycycline

The CDC also recommends Streptomycin, Gentamycin, Doxycycline, Ciprofloxacin

Symptoms Chills

Headache

Fatigue

Pneumonia, sometimes

Tularemia Symptom Picture

A Tularemia lesion on the dorsal skin of right hand. Tularemia is caused by the bacterium, Francisella tularensis. Symptoms vary depending on how the person was exposed to the disease, and as is shown here, can include skin ulcers.

Colorado Tick FeverCause: a virus

Transmission: a tick, usually a wood tick (D. andersoni)

Where: Mostly in the mountains of Colorado and Idaho, at elevations above 4,000 feet. (The disease is mentioned in this presentation because many Kansans travel to Colorado.)

Symptom onset: 4 or 5 days after tick bite

Symptoms: Fever, chills, malaise, severe headache, pain behind eyes, muscle pain, abdominal pain, nausea, vomiting, sometimes flat or pimply rash.

Colorado Tick Fever.

Progression: Fever goes away after about 3 days but returns 1-3 days later and lasts a few more days.

Treatment: pain relievers. Children should not be given aspirin because of risk for Reye's Syndrome.

Blood transfusion risk: A few people have contracted the disease from blood transfusions. The virus can remain in the blood for up to 4 weeks, so patients should be advised not to donate blood during that time.

Tick-Borne Relapsing Fever

Cause: Several species of borrelia spirochetes

Transmitted by: Soft ticks (Lice also transmit relapsing fever)

The disease can cross the placenta if a woman is infected during pregnancy.

Where: Western states; southwest Kansas; caves in Texas; rustic mountain cabins in Colorado that have rodent nests.

Soft ticks live in: caves, rodent burrows, and nests of rodents, birds, and bats.

Unlike hard ticks, they feed on a host for about an hour during the night and then drop off. They can transmit relapsing fever within a few minutes after biting. They take many blood meals during their lives.

Tick-Borne Relapsing Fever

Symptoms: high fever, chills, excessive sweating, rapid heartbeat, rapid breathing, headache, muscle pain, weakness, dry cough, nausea, vomiting, petechial or maculopapular rash

Symptom Onset: 3-18 days after tick bite

Progression: Initial illness lasts about 3-6 days and ends with a crisis that can cause fatal shock. A relapse occurs about 7-10 days later. Future relapses are milder. There are usually 3-10 relapses.

Treatment: (according to emedicine.medscape.com) Tetraycycline, Doxycycline, Erythromycin (for children and pregnant women), Chloramphenicol (for adults allergic to tetracyclines)

Tick-Borne Relapsing Fever

Fatality rate: less than 1% in treated patients.

Herxheimer reaction: Many patients, when starting treatment, have a Herx reaction which can be fatal, with high fever, excessive sweating, tachycardia, rapid breathing, and hypotension. Researchers reported that intravenous meptazinol reduces this reaction in louse-borne relapsing fever.

(The Lancet, Apr. 16, 1983. 1(8329) 835-9, "Meptazinol Diminishes the Jarisch-Herxheimer Reaction of Relapsing Fever: by Baya Teklu, et. al.)

Q FeverCause: Coxiella burnetii bacteria

Contracted on farms and ranches that have infected cattle, sheep, or goats

Usually contracted from contact with: Placenta or birth fluids while assisting in the birth of the young from infected animals

Also contracted by:

Inhaling dust contaminated with feces, the placenta, or amniotic fluid of infected animals

Drinking unpasturized milk from infected animals

Contact with urine of infected animals

A bite from an infected tick

Q Fever

Most infected animals show no symptoms

The disease may be discovered by an outbreak of animal stillbirths on the ranch or farm

Symptoms of Q Fever in humans:

High fever, 104 or 105 degrees

Severe headache

Malaise

Myalgia

Chills, sweats

Dry cough

Nausea, vomiting

Abdominal pain

Chest pain

Q Fever Can Cause

Pneumonia Meningitis Encephalitis Endocarditis Myocarditis Pericarditis

Aortic aneuryism Hepatitis Cirrhosis

Q Fever Treatment(www.cdc.gov)

Most successful if begun promptly. Don't wait for test results, which are usually negative early in the illness.

Acute Stage: Treat 2 to 3 weeks with

Doxycycline

Chronic Illness: Treat 18 months with

Doxycycline, 100 mg. 2 times a day plus Hydroxychloroquine, 200 mg. 3 times a day

Children:

Doxycycline if severely ill Co-trimoxazole for mild illness in children under age 8

Pregnancy: Treat for duration of pregnancy

Co-trimoxazole, 1 time per day

XMRV (HGRV) Virus – Linked with Chronic Fatigue Syndrome or Lyme Disease?

A study published in 2006 reported a link between the XMRV virus and prostate cancer. ("Identification of a novel Gammaretrovirus in prostate tumors of patients homozygous for R462Q RNASEL variant." PloS Pathog 2006 Mar;2(3):e25. Epub 2006 Mar 31. A. Urisman, et al., Dept. of Biochemistry and Biophysics, University of California San Francisco.)

A study published in 2009 reported a link between XMRV and chronic fatigue syndrome (CFS). ("Retrovirus Might be Culprit in Chronic Fatigue Syndrome." Science News vol. 176, no. 10, p.13. Judy Mikovits, PhD, et al., Whittemore Peterson Institute, Reno, NV.)

XMRV was found in 67% of 101 patients with chronic fatigue syndrome (CFS).

XMRV was found in only 8 of 218 (3.7%) healthy controls. Additional tests found XMRV in almost 98% of about 300 CFS patients.

Other studies have failed to find a link between XMRV and prostate cancer or CFS, so findings of both studies are being disputed.

Retroviruses XMRV (xenotropic murine leukemia virus-related virus) is a

retrovirus, similar to the HIV retrovirus that causes AIDS.

Retroviruses remain in the host for life.

Retroviruses suppress the immune system and activate other dormant viruses.

Many CFS patients have chronic viruses, and some have chronic Lyme disease.

XMRV is also called HGRV virus, for Human Gamma Retro Virus, since it infects humans.

Some CFS patients with XMRV/HGRV are being treated with anti-retroviral drugs used for HIV.

XMRV Transmission

According to the Mikovitz study, XMRV is much more prevalent than HIV.

Therefore, it must have additional ways to be transmitted.

Some doctors suspect ticks and/or fleas may transmit it.

XMRV is closely related to a retrovirus that infects mice.

Ticks and fleas pass diseases from mice to people.

Risk for Blood Supply?

The Mikovitz study found XMRV in almost 4% of healthy people in the control group.

This means 10 million healthy people in the U.S. may unknowingly carry the disease.

It could pose a risk for people receiving blood transfusions.

There is currently no screening test for XMRV.

It is not yet known whether XMRV is being transmitted through blood transfusions.

Research on BloodAug., 2010 – Scientists from the NIH, FDA, and Harvard Medical

School released a study of XMRV in blood.

Blood from 37 CFS patients had been stored since about 1995. Mouse leukemia retroviruses related to XMRV were in stored blood of 32 of

37 CFS patients, 86.5%. The viruses were detected in only 3 of 44 healthy blood donors, 6.8%. Fresh blood was drawn from 8 of the CFS patients whose stored blood had

been tested. The viruses were found in 7 of them, indicating that the patients are still

infected. As a result of this study, the Red Cross stopped accepting blood donations

from CFS patients. VIP Diagnostics in Reno has culture and PCR tests for XMRV (HGRV).

See www. vipdx.com for more information. They recently stopped the testing.

A Family Story of XMRV

Test Results

Treatment

Morgellons Disease

Causes painful open sores that last for months or don't heal.

Causes black granules and white clear, red, blue, black, or green fibers to emerge from the skin.

Fibers can be removed from sores or intact skin with tweezers.

Fibers don't match any known fibers.

Calcium and other minerals have been found in some fibers.

Many fibers are hard and feel like splinters.

Causes stinging and crawling sensations under the skin and intense itching.

These symptoms interfere with sleep.

Morgellons Fibers

Long fiber emerging from woman's arm.Notice the two bumps, it's obviously not a hair.

Morgellons Fibers

Two white fibers emerging from thumb knuckle.

Fibers emerging from under and around thumb nail.

Morgellons Sores

Morgellons Sores & Black Specks

Black specks emerging from skin under eye.

Morgellons Infected Dog

Morgellons Disease

Reported in all 50 states and in Canada, Europe and world-wide.

Appears to be an emerging disease; incidence is on the increase.

Almost all Morgellons patients have Lyme disease or another tick-borne disease.

Most people with Lyme do NOT have Morgellons.

Some Lyme specialists are treating Morgellons.

Lyme support groups can help people find a Lyme specialist.

It is unknown whether Morgellons may be transmitted by ticks.

Another possibility is contact with soil.

Many Morgellons patients develop the disease after contact with soil, as in gardening.

Morgellons Disease

Antibotics helps many patients.

Many also need antiparasitic and/or antifungal drugs.

Some have improved by taking NutraSilver colloidal silver internally. (See stories at www.nutrasilver.com)

When starting treatment, patients typically have a temporary worsening of symptoms (a Herx reaction), with a mass exodus of fibers.

May be somewhat contagious.

Many patients have family and close friends with the disease.

Some patients have dogs or cats with it.

However, many families just have one person infected.

Morgellons Disease

The CDC is investigating the cause.

Some possible causes include an unknown fungus, nematodes, other parasites, and/or Agrobacterium.

Agrobacterium is a plant bacterium found in the soil.

It has been genetically modified. It gets into the cells of plants and changes their genetic structure.

Agrobacterium has been found in the skin of Morgellons patients but not in controls.

Agrobacterium creates cellulose, a plant material which appears to be in some of the fibers.

Morgellons Disease

People can have the fibers without the sores. Some people have sores without fibers.

If they have fibers, they have Morgellons, because that is the definition. It's a fiber disease.

There are no tests for Morgellons.

The disease is diagnosed based on patient history and visible fibers.

A doctor who does not see any protruding fibers can look for fibers under the skin with an EyeClops BioniCam microscope.

Morgellons Patients Are Ill In addition to fibers and sores, they have insomnia, fatigue, memory

problems, mood swings, and depression which leads some to suicide.

Some have joint pain, vision problems, muscle weakness, and other symptoms.

Most (about 95%, according to Ginger Savely) also have Lyme disease. Determing to what extent Lyme is causing or exacerbating some of these symptoms can be difficult.

Some have a thick, black, oily substance that oozes out of their pores.

Some lose their hair in clumps, and their teeth may turn black, starting at the gum line, and then fall out.

Osteoporosis may develop in the bones. It is unknown whether the calcium in the fibers is coming from the

bones and teeth.

Finding Morgellons Fibers Dr. Ginger Savely, DNP advises doctors to buy an EyeClops

BioniCam magnifier to examine the skin of Morgellons patients.

Other microscopes are too powerful. She says magnification of 30 to 100 is best for viewing Morgellons fibers under the skin, with 60 giving the best view.

The BioniCam is sold as a child's toy and is available at Amazon.com and sometimes at Toys R Us.

The price is usually slightly over $100.

It has a light, and illumination is important for seeing fibers under sores and intact skin.

Digital photographs can be taken with this microscope.

Dr. Ginger Savely, DNP, is a nurse practitioner with a doctorate degree in Nursing Practice (not an M.D.) She has treated over

500 Morgellons patients, perhaps more than anyone else in the world.

To Use the BioniCam First wipe the skin with an alcohol wipe or dampened non-linty

eyeglasses paper, to remove any environmental fibers that may be on the skin.

Rubbing intact skin with the paper may bring the fibers closer to the surface for easier viewing.

The fibers that show up are usually blue or red but can be other colors.

You usually have to place the magnifier on several areas of skin before finding fibers, so this is not a quick examination.

Morgellons is on the Increase

If you have never seen a person with it, you may someday.

You may notice a person whose face or body is covered with open sores.

For more information:See www. Morgellons.org and www. thecehf.org.

Do an internet search of "Morgellons" and "Agrobacterium." Buy DVD's of Morgellons conferences at www. thecehf.org.

For consultation on treatment, contact Ginger Savely through www. gingersavely.com.

Tick HabitsTicks crawl upward, against gravity.They are attracted to carbon dioxide from people and animals.Adult ticks like to feed and mate on deer.Ticks have to stay cool and moist.

l Where are ticks?Mostly in woodsy areas, where deer roam.Hiding in damp piles of leaves, tall grass, and bushes. Sometimes in short grass, on well-watered shady lawns.Sitting at the tips of blades of grass with their legs

outstretched, ready to grab onto a passing host. Waiting in low brush or on shrubs along trails.In the bushes on golf courses.Sometimes they drop from trees.

Tick Bite PreventionWear long pants, a long-sleeved shirt, shoes that cover the feet,

and a hat.

Wear light-colored clothes to see ticks better.

Tuck your shirt in, and tuck the cuffs of pants into your socks.

Seal your socks to your pant legs with duct tape to prevent ticks from reaching skin.

Use duct tape or wide masking tape, sticky side out, around clothes below knees, to catch ticks crawling up.

Use repellent on clothes and exposed skin; wash it off when you come inside.

Tick Bite Prevention Hike in the center of trails; try not to brush against plants along trails.

Wear a roll of wide masking tape or duct tape around your arm to keep it handy, in case you get attacked by hundreds of tiny ticks at once.

Don’t stand still long on trails. Lone star ticks can crawl quickly to get on you.

Stay out of tall grass and piles of leaves.

If a golf ball gets into the bushes, don’t go in to get it. Use another ball. Don’t risk getting a tick on you.

Check yourself often for ticks when outside.

Repellents

The CDC recommends spraying permethrin (permanone) on clothing the day before an outing. Permethrin is an insecticide and must not be used on skin. It is the most effective product. Ticks drop off and die without biting.

The CDC recommends products containing DEET on skin, such as OFF and Cutter's. DEET is toxic and should be washed off when coming indoors. DEET doesn’t repel ticks but can make it difficult for them to find you.

Picaridin, which is in Cutter's Advanced, is less toxic than DEET and is used world-wide to prevent mosquito bites. It provides some protection against ticks.

RepellentsPeople have reported that repellents containing cactus

juice are more effective than DEET.

Lemon oil eucalyptus is an all-natural repellent that is somewhat effective for ticks. There is concern that it may not be safe for children.

Bounce fabric softener sheets placed in socks can help keep insects away. They haven’t been studied for ticks.

Bathing in Irish Spring soap or rubbing a dry bar of it on the cuffs of socks and pants can repel insects. It may or may not help repel ticks.

Check Yourself Thoroughly

When you come inside, bathe as soon as possible.

Using lots of soap may help remove any unattached ticks.

Check yourself all over for ticks.

Check cozy places, where skin meets skin and clothing fits tightly.

Check the waist, belly button, behind knees, private parts, armpits, neck, in and behind ears, and under the hair.

Use a mirror for your back.

Look and feel for ticks. They can be as tiny as the dot of an "i" and may feel like a tiny scab.

Check Yourself Thoroughly

If covered with ticks, take clothes off in a dry bathtub and place them immediately in the washing machine or dryer, or place them in a trash bag and spray permethrin insecticide into the bag. Close the bag tightly until ready to launder clothes.

Dry clothes an extra hour on high heat after the clothes have dried. Ticks die if thoroughly dried out. They survive the washing machine.

Check your pets for ticks before they come indoors.

Discuss ways to protect pets and farm animals with your veterinarian.

Remove Ticks Properly

If ticks are found and removed right away, they may not have time to give you Lyme disease. It often takes several hours for a tick to give you the germs.

The old ways to remove an attached tick aren’t safe now that many ticks carry Lyme disease in their guts.

DON’T USEA hot match, petroleum jelly, liquid soap, alcohol, nail

polish, nail polish remover, or other chemicals. (These may make the tick vomit germs into you.)

Your fingers, or regular tweezers. (These may squeeze the tick's gut and squirt germs into you.)

Remove Ticks ProperlyDO USE: Fine-pointed tweezers. This works for adult ticks, if you grasp

the tick at the mouth, where the tick is attached to your skin; it’s not safe for the tiny young ticks, because the gut might get squeezed and squirt germs into you.

A credit card or something else you can slide under the tick. Slide something under the tick and press upward at the mouth until the tick pulls itself out.

A tick remover that slides under the tick. The Lyme Assoc. sells a tool that slides under the tick for $4.

After removing a tick, disinfect the bite site, removal tool,

and your hands.

How to Use Tick Remover

• Slide V-shaped slit of tool under tick.

• Tilt tool up at 45 degree angle, to position tick in smallest part of the V.

• Lift tick up slowly.

Please visit our exhibit table to:

Receive a free tick remover

See our display with additional pictures of rashes and ticks

Pick up a copy of Dr. Burrascano's "Diagnostic Hints and Treatment Guidelines" (or see it at www. ilads.org)

Pick up some brochures for your office

Talk with us

Lyme Disease Neurological Symptoms

Lyme disease can cause physical, cognitive, and psychiatric symptoms.

Symptoms may come and go from week to week, day to day, or even during the day.

They can vary in intensity throughout the day.

A person can suddenly get a terrible pain in the knee. It may be fine in a few minutes, and then the elbow may suddenly hurt intensely.

Lyme Disease Neurological Symptoms

A headache may last for years but may vary in intensity throughout the day.

The ability to concentrate and to comprehend oral and written speech may vary throughout the day.

Blurry vision may come and go from day to day.

Lyme can affect the brain, heart, vision, and hearing.

People can suddenly not recognize familiar places.

Speaking and Conversation ProblemsAssociated with Lyme

Conversation problems can come and go throughout the day.

It can be difficult to:Think of the right words to say.

Put words in the right order in sentences.

Hold a thought long enough to finish a sentence.

Episodes of stuttering and jumbled speech can occur.

Lyme Disease Transmission Studies

Lyme disease Bb bacteria have been found in Texas in:

Lone Star ticks (Amblyomma americanum)

Gulf Coast ticks (Amblyomma maculatum)

Deer ticks (Ixodes scapularis)

Cat fleas (Ctenocephalides felis)

"Isolation of Borrelia burgdorferi from arthropods collected in Texas," by G.J. Teltow, P.V. Fournier, and Julie A. Rawlings; Microbiological Services Division, Bureau of Laboratories, Texas Dept. of Health, Austin. Am. J Trop Med Hyg, May 1991.

"The etiologic agent of lyme disease in deer flies, horse flies, and mosquitoes." By Magnarelli LA, Anderson JF, Barbour AG. J Infect Dis 1986; 154:355-8.

Bb Bacteria were found in deer ticks, American dog ticks, 3 species of mosquitoes, 4 species of deer flies, and 3 species of horse flies in Connecticut.

After infected mosquitoes fed on 12 uninfected hamsters, one hamster developed antibodies to Bb, proving that mosquitoes in the U.S. can transmit Lyme disease.

Bb Found in 30 Species of Arthropods

Bb bacteria were found in 30 species of arthropods (arachnids and insects), including 13 species of mites, 15 species of flies, and two species of fleas.

"Incidence of the spirochete Borrelia burgdorferi in arthropods (Arthropoda) and antibodies in vertebrates (Vertebrata)." By P.Pokorny. [Article in Czech.]

Cesk Epidemiol Mikrobiol Imunol, Jan. 1989; 38(10:52-60)