Posted 2/12/2017 10:57 PM (GMT 0)
There's more, but it was continued on the next page and I couldn't copy it all.
"Borrelia miyamotoi disease (BMD), a tick-borne infection that can cause more severe symptoms than Lyme disease, was first reported in the northeastern United States in 2013 but is becoming more common and should be considered in all areas where deer tick–transmitted infections are endemic, according to a case-series published online June 9 in the Annals of Internal Medicine.
The researchers suggest that BMD might be almost as common as human anaplasmosis among tick-exposed patients who present with fevers in the endemic areas, and they recommend that it be included in routine differential diagnosis protocols.
The timing of BMD peak incidence suggests that, unlike the transmission of Lyme disease pathogen Borrelia burgdorferi, the new infection might be transmitted by unfed larval ticks, who acquire it by transovarial transmission from the infected female tick. This has immediate clinical and public health implications.
In an accompanying editorial, Peter J. Krause, MD, from the Yale School of Public Health and Yale School of Medicine, New Haven, Connecticut, and Alan G. Barbour, MD, from the University of California, Irvine, write, "Bites from larval deer ticks have not been considered as a health threat, but this needs to be reevaluated. Larval transmission of B. miyamotoi has implications for checking for ticks and continuing tick precautions even after the risk for Lyme disease has abated."
The case series report was prepared by a research team led by Philip J. Molloy, MD, medical director of IMUGEN, a commercial laboratory that performs specialized testing of clinical specimens for tick-borne diseases. Cases were acutely febrile patients from the northeastern United States who presented to primary care offices, emergency departments, or urgent care clinics and for whom clinicians ordered testing for tick-transmitted infections. Between April 1, 2013, and October 31, 2014, the researchers identified 97 patients whose blood samples contained B miyamotoi DNA. Clinical information was available for 51 of the 97.
Patients Appeared "Toxic," Were Suspected of Having Sepsis
Presenting symptoms typically included fever, myalgia, influenza-like illness, headache, or rash. The authors write, "Patients presented with acute headache, fever, and chills and were often found to have leukopenia, thrombocytopenia, and elevated aminotransferase levels, mimicking human anaplasmosis infection. Patients were commonly described as appearing 'toxic'; more than 50% were suspected of having sepsis, and 24% required hospitalization. The headaches were most commonly described as severe, resulting in head computed tomography scans and spinal taps in 5 patients."
Initial screening used a whole-blood polymerase chain reaction for specific DNA sequences of a number of common tick-borne infections, including BMD. Because there is not yet an established test for BMD, the researchers used a recombinant B miyamotoi glycerophosphodiester phosphodiesterase enzyme-linked immunosorbent assay to detect antibody to B miyamotoi. Interestingly, only 16% of patients (8/51) had a detectably immune response to recombinant B miyamotoi glycerophosphodiester phosphodiesterase during the acute disease phase, but 86% of the case patients for whom convalescent sera (drawn 5 or more days after the beginning of treatment) were available demonstrated seroconversion."