BADAblog

Sylvia Perez and Christine TresselJuly 2, 2009 (WLS)

When it comes to summer pests, mosquitoes are not alone. Ticks are on the move in Illinois. And everyone’s urged to take precautions.

Lyme disease is not something most people associate with Illinois. But cases of this tick-spread illness are increasing and you might be surprised to learn where they are showing up. Health experts say there’s no need to panic but we need to be aware.

A couple years ago, Morgan Trajkovich would not have thought twice about being able to participate in cheerleading or tumbling.

Then something happened. he young tumbler and cheerleader started getting strange pains in her joints. She was exhausted and plagued with headaches.

“One day I was walking to class and I just started screaming cause my hip hurt so bad,” said Morgan Trajkovich.

Getting around became excruciating. Cheerleading was out.

After an exhaustive search for a cause, the Trajkovichs started to suspect their teenage daughter had Lyme disease. They think she might have gotten it in her own backyard in Naperville.

“It’s been close to two years since I first discovered the bite on her leg. We had no idea what bite her but it was this big around,” said Gloria Trajkovich, mother.

But as the Trajkovichs discovered, Lyme disease is difficult to diagnose because test results can be unreliable and they say local doctors were skeptical.

“You live in Illinois, Naperville. There’s no way your daughter has Lyme disease,” said Nick Trajkovich, father.

But Lyme disease is on the move in Illinois. And while the number of cases is considered by experts to be low they are growing.

“We’ve seen an increase in Lyme over the past decade from about 10 to 15 cases a year to over 100,” said Dr. Craig Conover, Ill. Dept. Public Health.

A bite from an infected deer tick can pass the illness on to humans. According to the Illinois Department of Public Health, these ticks are now showing up in counties such as Lake, Cook, DuPage and Will.

“You just take the drag along the rail edge and the questing ticks will brad a hold of it,” said Dr. Conover.

Jeff Nelson, a physician and biology professor at North Park University, combs local wooded areas when a case of Lyme disease or a bite is reported.

Watch an extended interview with Dr. Nelson

Deer ticks are really quite small - about the size of a gnat or a poppy seed which makes them tough to find. But Dr. Nelson says not everyone who gets bitten will get Lyme disease. It can take from 24 to 36 hours for the bug to transmit the disease so removing the tick promptly is a must. He also warns patients with vague or unexplained symptoms against rushing out for a Lyme test.

“If everyone with joint complaints or neurologic kind of illness goes to get a lyme test many will be falsely positive and then they are sent on a pathway that delays other diagnosis,” said Dr. Nelson.

The Trajkovichs say a doctor on the east coast diagnosed Morgan with Lyme disease. She’s now taking antibiotics and a medication commonly used to treat arthritis and lupus. They’re staying positive but know it will take time for Morgan to heal. The family hopes sharing their story will help others.

“You need to know it is here so watch out,” said Morgan Trajkovich.

Health experts say the growing Lyme disease problem should be an alert to Illinois doctors to start looking for it. Signs of illness include a bulls eye like rash, though some people may never develop one, fever, chills, body aches, headache and fatigue.

Obviously, most people are going to enjoy the outdoors this summer. To be safe experts recommend light colored clothing, Deet bug spray and frequent body checks for ticks.

How to protect yourself against Lyme disease:
- walk in the middle of trails
- wear light colored clothing
- wear a hat and long sleeved clothing
- wear bug repellent with DEET
- check for ticks immediately after being outside
- remove tick carefully with tweezers. Save tick in jar so it can be analyzed by lab - consult doctor

Dr. Jeff Nelson Infectious Disease Specialist
Biology Professor North Park University
Phone: (773) 244-5658
jnelson1@northpark.edu
Dr. Craig Conover
Medical Director
Office of Health Protection
Division of Infectious Diseases
Illinois Department of Public Health
122 S. Michigan
Chicago, Il
312-814-4846
www.idph.state.il.us

www.idph.state.il.us/envhealth/pccommonticks.htm

Gundersen Foundation
www.gundluth.org
Gundersen Lutheran Medical Foundation
Microbiology Research Laboratory
Health Science Center, Room 5032
1300 Badger Street
La Crosse, WI 54601
Phone (608) 775-3743
Fax (608) 775-6602
Pager 2210

http://abclocal.go.com/wls/story?section=news/health&id=6896893

Thursday, 04 June 2009 

Spring is such a beautiful time of year-the budding trees, the blossoming flowers, the new born lambs.  But are you aware of hidden dangers lurking beneath?  It is this time of year that insects and bugs come out of hiding and one of the dangerous bugs which are in the class of arachnids are ticks 
 
Ticks are initially born as small six legged larvae, less than a mm in size.  They feed on small rodents such as mice or birds.  The larva will begin to molt and develop two more legs and mature into nymphs.  These nymphs begin to search for larger animals where they will mature into adults, feed and mate.  They are able to detect carbon dioxide from passing animals and lay in wait in tall grasses, bushes and overhanging branches.  Unfortunately, humans, pets farm animals as well as wildlife are pray to the waiting tick.

The dangers with tick bites are becoming more widely known among the medical profession and local governments and politicians are being encouraged by groups of patients to become more aware of diseases they carry.  One such disease is known as Lyme disease or Borreliosis.  This is a potentially debilitating illness if not recognized during the early stages.  One of the tell tale signs of infection following a tick bite is a rash, sometimes showing as a bulls eye ring around the bite.  However this rash is not always present in all patients and the rash may even appear away from the site of the bite.  Some patients may develop flu-like symptoms and a fever which will also indicate a possible infection.  In some cases the patient may be asymptomatic, whereby they carry the Lyme disease but have no outwardly obvious symptoms.  Ill health may crop up years later following an illness or period of stress, whereby the immune system can be altered allowing the disease to overrun the body’s defences.  This leads to disseminated Lyme disease of which symptoms greatly mimic multiple sclerosis, chronic fatigue syndrome or Parkinson’s disease.  The disease can lead to joint pain, weakness, muscle aches, pelvic pain, visual problems, numbness, tingling, tremors, headaches and hear problems, and can even result in paralysis and loss of sight.

To detect Lyme disease there is a test available called “Elisa” which looks for antibodies to the borrelia bacteria in the body.  This test can show up negative during the first few weeks of infection until sufficient antibodies are produced.  Chronic Lyme sufferers may also have a false negative result, due to the depleted immune system not being able to produce antibodies in sufficient numbers for the test to show positive.  There are other tests available such as PCR analysis and LTT ( Melisa labs. in Germany) although patients often have to submit these privately.  The best method for treating Lyme disease is through antibiotics.  Lyme can be treated effectively if detected in the early stages.  If you have recently been bitten by a tick and notice a rash do not hesitate to get it checked out immediately.  Later stages of Lyme will need aggressive and long term antibiotic treatment to control the disease.  The longer the infection, the harder it is to clear.  Of course prevention is better than cure. 

To protect against ticks always:
* Carry tick repellents & spray onto outer clothing before any countryside activities
* Keep all trouser legs tucked in & wear shiny material to prevent ticks hanging onto clothes
* Stick to footpaths & avoid brushing against long grass or going under overhanging branches
* Always check clothing & body when getting home, including all the family & pets

Lyme disease is currently not a notifiable disease here in Ireland.  However, talks are underway to change this status.  This will make the illness more recognizable among Irish physicians.  There have been researches (authored by Prof. Gray of University of Dublin) showing that ticks collected in the areas of County Kerry, Galway and Connemara carry the borrelia bacteria.  It is down to us to be tick aware!

If you’d like more information there is a group on Facebook called ‘Tick Talk Ireland’ who have sections on research articles, testing, tick removal and Lyme disease symptoms.  Also, be sure to check out the eye opening documentary DVD called ‘One Tick Away’ produced by BADA UK (Borreliosis and Associated Diseases Awareness UK).  Ordering details can be found at http://www.bada-uk.org/products/dvd.php

http://www.caireland.org/our_campaigns/rural_livelihoods_campaigns/Are_You_Tick_Aware?/

By LiveScience Staff, posted: 27 June 2009 10:33 am ET

The first once-a-month pill for controlling both fleas and ticks in dogs and cats is showing promise in tests.

Peter Meinke and colleagues at Merck Research Laboratories note the need for better ways of controlling fleas and ticks, driven in part by increases in pet ownership. Estimates suggest that there were 71 million pet dogs and 81 million pet cats in the United States alone in 2007 — up from 61 million and 70 million in 2001.

Dogs and cats are the most popular pets, unless you count fish, which are thought to be in fewer homes but in greater quantities.

Although many powders, sprays and other topical agents are on the market, many pet owners prefer the convenience of pills. Products given orally can reach more parts of an animal’s body, do not wash off in rain or bath water, and don’t transfer from pets to people.

At least one existing pill fights fleas in pets, but does not appear effective for ticks.

In tests on fleas and ticks in dogs and cats, a single dose of the new pill was 100 percent effective in protecting against both fleas and ticks for a month, the scientists report in Journal of the Medicinal Chemistry.

There were no signs of toxic effects on the animals, according to a statement from the American Chemical Society.

Scientists obtained the flea and tick fighter from a substance first found in a fungus that “has the potential to usher in a new era in the treatment of ecoparasitic [ticks and fleas, for instance] infestations in companion animals,” the scientists write.

http://www.livescience.com/animals/090627-dog-cat-fleas-ticks.html

Quote:

“Altogether, these data demonstrate that mass spectrometry is an accurate and reproducible tool for rapid and inexpensive identification of Bartonella species.”

To read full article: CLICK HERE

Published Date: 11 June 2009
TICK numbers are on the increase because of climate change, but the Lyme disease they carry is not putting visitors off coming to the Borders, says VisitScotland.

The Tick Alert campaign group says there were 285 cases of Lyme disease – also known as Borreliosis – in Scotland last year, compared with only three recorded cases in 1999.

NHS Borders recorded only two cases of Lyme disease in 2008 and there are none up to March 2009 this year.

And VisitScotland say there is little concern from visitors about the disease in the Borders.

Rising tick numbers will have “little or no impact on tourism” in the region, said a VisitScotland spokesperson.

He said: “There is no evidence to suggest people are not coming to the region for fear of getting Lyme disease from ticks.

“We have checked with our visitor centre staff manager and there have so far been no enquiries of this nature as far as we are aware.”

But while the Borders is not a high-risk area for Lyme disease – unlike the Highlands – there are increasingly high numbers of the blood-sucking insects.

Borreliosis and Associated Diseases Awareness (BADA) UK director Wendy Fox told us: “As a charity we are contacted by more and more people who either have contracted Lyme disease or who are concerned about the number of ticks. People are reporting high densities of ticks where previously there appeared to be few or none at all.”

The charity Tick Alert says numbers of ticks are on the increase worldwide.

A spokeswoman said: “We are getting longer and milder summers and that gives more vegetation for tick hosts such as deer which are increasing in numbers, and hence the number of ticks is also increasing.Climate change is extending the tick season and making them live longer.”

And she said: “The traditional tick areas are changing as they are coming into towns and cities on hosts such as birds and rats.”

Changes to farming practices, too, are allowing the proliferation of ticks.

Ms Fox said: “The growing number of people involved in outdoor activities is almost certainly contributing to the rise in cases of tick-borne disease and as there are no vaccines to defend against them: awareness is the best defence.”

Tick Alert wants people to take tick bite protection as seriously as sun protection and urge people to wear insect repellent and tuck trousers into socks.

And BADA advises ticks should be pulled directly out with tweezers taking care not to squeeze the tick’s body (to avoid the tick’s stomach contents or saliva going into the bite area and possibly infecting the host) and to avoid old wives’ recommendations of using vaseline, paraffin or lit matches.

The most common symptom of Lyme disease is a slowly expanding rash, which spreads about five to 14 days after the tick bite.

Other symptoms can include fever, headache and fatigue.

Most cases can be treated with antibiotics, but if left untreated, infection can spread to joints, the heart, and the nervous system.

And often Lyme disease can be misdiagnosed.

Ms Fox said: “It is recognised that this (the published Lyme disease figures) accounts only for reported cases and there are cases that may go unreported or are left undiagnosed or misdiagnosed.”

More information can be found on www.tickalert.org and www.bada-uk.org

http://www.thesouthernreporter.co.uk/outdoors/Tick-tock–time-to.5350257.jp?articlepage=2

Now they face censure for defying conventional wisdom about antibiotics  
By Judy Benson      Published on 6/15/2009 

Supporters of a bill that would protect physicians who diagnose and treat patients with chronic Lyme disease from state censure say the measure would help both patients and doctors.

The bill, which has cleared both houses of the legislature, awaits a decision by Gov. M. Jodi Rell about whether she will sign it. Advocates, though they support the bill for different reasons, agree it would ensure doctors have the authority to use their own best judgment and make it easier for patients to find a doctor willing to treat them. Supporters of the bill include patients and others who believe chronic Lyme disease is a diagnosable condition that should be treated with long-term antibiotic use, and doctors who believe guidelines advising against the diagnoses and treatment of chronic Lyme are correct.

”This bill does not legislate treatment, but it will help patients be able to get care in their own communities,” said Maggie Shaw, chairwoman of the Newtown Lyme Disease Task Force, who worked with the Lyme Disease Association, a national patient advocacy and research group, to win passage of the bill. Shaw, a registered nurse, said she and her three sons have all had bouts with chronic Lyme disease and that finding a doctor to correctly diagnose and treat their illness was very difficult.

Pat Smith, president of the Lyme Disease Association, said doctors in Connecticut have been “under a lot of pressure not to treat people” for chronic symptoms of the tick-borne bacterial infection because of past actions by the Connecticut Medical Examining Board against physicians who did so. Doctors who diagnose and treat chronic Lyme often prescribe long-term antibiotic use for months or longer. To find a doctor willing to provide this care, patients must often travel out of state.

Smith said she began pushing for more Lyme disease research and better treatment after two of her daughters became ill with a chronic form of the infection. One of her daughters, now 21, is still suffering with serious symptoms, she said.

Guidelines from the Infectious Disease Society of America advise doctors against chronic Lyme disease diagnosis and treatment, contending that there is no scientific evidence that the disease can persist into a chronic form after a normal regimen of antibiotic treatment, and that the symptoms may be the manifestation of another condition such as an autoimmune disorder. The guidelines also warn of risks of long-term antibiotic use, such as the emergence of antibiotic-resistant infectious bacteria and serious and hard-to-treat illnesses like C-difficile colitis.

At the start of the 2009 legislative session, the infectious disease society submitted a letter to the state legislature urging rejection of the bill, which was revised from its original form to address concerns of the state Department of Public Health and the Connecticut State Medical Society.

”Our guidelines do not dictate care, but our main concern all along has been that long-term antibiotic treatment does more harm than good,” said Diana Olson, spokeswoman for the organization. “If there was solid evidence that this worked for them, we’d be the first to jump on the bandwagon.”

On July 30 in Washington, the society will conduct hearings on whether the guidelines, adopted in 2006, should be revised, rewritten or updated. Eighteen physicians, scientists and patient advocates are scheduled to testify, and 150 individuals and organizations have submitted written comments.

The hearings will be more thorough than a typical review process, she said, because of a May 1 agreement with state Attorney General Richard Blumenthal. Blumenthal had undertaken an antitrust investigation of the society that he said uncovered serious flaws in the process for writing the Lyme disease guidelines.

In a news release, Blumenthal said the society agreed after his investigation to reassess the guidelines with the assistance of an outside arbiter.

”The IDSA guidelines have sweeping and significant impacts on Lyme disease medical care,” Blumenthal said. “They are commonly applied by insurance companies in restricting coverage for long-term antibiotic treatment or other medical care and also strongly influence physician treatment decisions.”

The society, however, said the special review “is an effort to clear the air.”

”We are confident that our guidelines for the diagnoses and treatment of Lyme disease represent the best advice that medicine currently has to offer … and we look forward to the opportunity to put to rest any questions about them,” society President Dr. Donald Poretz said in a statement.

Blumenthal said this week he supported the bill because it “protects doctors from unjustified threats or retribution” if they make a specific diagnosis. He stressed that he is not taking a position on how patients who believe they have chronic Lyme disease should be diagnosed and treated.

”Medical decisions should be made by doctors and patients, not dictated by insurance companies,” he said.

The Connecticut State Medical Society supported the bill because it protects doctor autonomy in diagnoses and treatment decisions, not because it advocates that physicians disregard the infectious disease society guidelines, said Dr. Terrance Doherty, an Old Saybrook family physician and medical society member.

Doherty, who treats 10 to 25 patients per month for Lyme disease, said rarely do cases reach a chronic stage because most patients and doctors recognize symptoms early and treatment is effective. He follows with the infectious disease society guidelines against chronic Lyme diagnosis and long-term antibiotic use.

”There’s no data to support that the infection persists” after normal treatment, he said. “But this bill is important because it supports the autonomy of the provider. It supports the relationship between the doctor and patient.”

Among key supporters of the bill in the legislature was state Rep. Betsy Ritter, D-Waterford, co-chairwoman of the Public Health Committee. The committee heard testimony from dozens of bill supporters about people who’ve endured “horrible situations” due to chronic Lyme disease and inability to receive treatment, she said. Many constituents with personal experiences with the disease called to urge her to support the bill, she added.

She is convinced that the infection manifests itself differently in different people, so physicians need the flexibility to offer different treatments.

”It’s not a single disease,” she said. “This (bill) puts the power with physicians.”

http://www.theday.com/re.aspx?re=c39aa96b-716d-4304-ae96-21fc9fbd6f6c

Written by Austin Amoroso    
Friday, June 05, 2009 
Two new town surveys dispute a previous finding by the Infectious Disease Society of America that Lyme disease is not a chronic problem.

According to Kent Haydock, chairman of Deer Management Committee, the two surveys — which polled 41 Darien households after a showing of the Lyme Disease film, Under Our Skin, at the Darien Library last month — show that Lyme not only exists in great numbers, but also in debilitating, chronic and long-term cases.

In the 41 households that completed the questionnaire, 47 total Lyme disease cases were reported. In 64 percent of those cases, the patient had relapses after an initial Lyme treatment, which required additional treatment for a chronic or long-term conditions.

To read full article: CLICK HERE

Six-out-of-10 Tom Nevers households report Lyme disease infections

Nantucket, MA, June 9, 2009 - In the first broad-based study of tick-borne diseases on Nantucket, 61.3% of  the more than 220 property owners in the island’s Tom Nevers area who responded to a survey report that one or more people in their households have been infected with Lyme disease.Including family members, visiting guests and renters, an average of 2.3 people per household have been infected with Lyme disease or with one of the even more serious tick-borne diseases. Of those infected with Lyme disease, nearly 40% were diagnosed and treated off-island, with initial mis-diagnosis and ongoing health problems fairly common.

The study, just released by the Tom Nevers Civic Association, also measured the incidence of the two other major tick-borne diseasees,Babesiosis and Ehrlichiosi, and includes verbatim comments from those infected with any of these three diseases. Several report severe, debilitating, life-long health issues.

 In addition, the study also quantifies how the threat of contracting a tick-borne disease is having a serious negative impact on both the quality-of-life and future economic health of the Island. For example—

88% say they now worry more about outdoor activities like gardening, hiking, picnics, etc.—with a number cutting back or eliminating these activities.

59% say they now worry that if left unchecked, the problem will make Nantucket less attractive to their visiting family members, guests and/or renters—with a number reporting that they are already seeing both family members and renters expressing health concerns about coming to Nantucket.

51% say they now worry that the tick-borne disease problem, if left unchecked, will affect Nantucket property values—with many pleading that Town Government address the tick problem decisively and effectively before it’s too late.

The complete 18-page study report can be found on the Tom Nevers Civic Association Web site: www.tomnevers.or.

http://www.nantucketindependent.com/news/2009/0603/Front_Page/000000.html

Nicholas H. Ogden, DPhil, L. Robbin Lindsay, PhD, Muhammad Morshed, PhD, Paul N. Sockett, PhD and Harvey Artsob, PhD

Conclusions and recommendations

The number of known endemic areas of Lyme disease in Canada is increasing because the range of I. scapularis is expanding in the eastern and central provinces. National surveillance must be able to identify this changing pattern. Lyme disease is potentially preventable if people wear appropriate clothing and use N, N-diethyl-meta-toluamide (DEET) repellents. Removal of infected ticks from a person within 24 hours of attachment usually prevents transmission of B. burgdorferi, [23] and early Lyme disease is usually easily treated with antibiotics. [4,24] However, prompt treatment requires recognition of vector ticks and erythema migrans lesions by affected members of the public and prompt diagnosis by clinicians. [24] If Lyme disease is not recognized during the early stages, patients may suffer seriously debilitating disease, which may be more difficult to treat. [4] Therefore, an important function of surveillance is to inform both the public and clinicians about the local risk level and the need for prudent administration of regimens appropriate for prevention and early diagnosis of Lyme disease.

To read full article: CLICK HERE

Substitute House Bill No. 6200 - Public Act No. 09-128

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. (NEW) (Effective July 1, 2009) (a) As used in this section, (1) “long-term antibiotic therapy” means the administration of oral, intramuscular or intravenous antibiotics, singly or in combination, for periods of time in excess of four weeks; and (2) “Lyme disease” means the clinical diagnosis by a physician, licensed in accordance with chapter 370 of the general statutes, of the presence in a patient of signs or symptoms compatible with acute infection with borrelia burgdorferi; or with late stage or persistent or chronic infection with borrelia burgdorferi, or with complications related to such an infection; or such other strains of borrelia that, on and after July 1, 2009, are recognized by the National Centers for Disease Control and Prevention as a cause of Lyme disease. Lyme disease includes an infection that meets the surveillance criteria set forth by the National Centers for Disease Control and Prevention, and other acute and chronic manifestations of such an infection as determined by a physician, licensed in accordance with the provisions of chapter 370 of the general statutes, pursuant to a clinical diagnosis that is based on knowledge obtained through medical history and physical examination alone, or in conjunction with testing that provides supportive data for such clinical diagnosis.

(b) On and after July 1, 2009, a licensed physician may prescribe, administer or dispense long-term antibiotic therapy to a patient for a therapeutic purpose that eliminates such infection or controls a patient’s symptoms upon making a clinical diagnosis that such patient has Lyme disease or displays symptoms consistent with a clinical diagnosis of Lyme disease, provided such clinical diagnosis and treatment are documented in the patient’s medical record by such licensed physician. Notwithstanding the provisions of sections 20-8a and 20-13e of the general statutes, on and after said date, the Department of Public Health shall not initiate a disciplinary action against a licensed physician and such physician shall not be subject to disciplinary action by the Connecticut Medical Examining Board solely for prescribing, administering or dispensing long-term antibiotic therapy to a patient clinically diagnosed with Lyme disease, provided such clinical diagnosis and treatment has been documented in the patient’s medical record by such licensed physician.

(c) Nothing in this section shall prevent the Connecticut Medical Examining Board from taking disciplinary action for other reasons against a licensed physician, pursuant to section 19a-17 of the general statutes, or from entering into a consent order with such physician pursuant to subsection (c) of section 4-177 of the general statutes. Subject to the limitation set forth in subsection (b) of this section, for purposes of this section, the Connecticut Medical Examining Board may take disciplinary action against a licensed physician if there is any violation of the provisions of section 20-13c of the general statutes.

http://www.cga.ct.gov/2009/ACT/PA/2009PA-00128-R00HB-06200-PA.htm