Health Care Management
This section is where we post articles and medical studies to do with the management of tick-borne diseases. If you have something to say about the way that you have been treated or tips about things you have found beneficial to your recovery, please send us your comments. We’d like to hear from healthcare practitioners too about the general awareness and treatment of tick-borne diseases. If you would like something included in our blog, please contact us.
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The prompt identification of a tick-borne disease can be vital if a patient is going to make a full recovery without any lasting damage. However, getting a prompt diagnosis is often easier said than done. Awareness amongst healthcare practitioners is growing but still has a long way to go.
Dispelling misconceptions amongst doctors is something that needs to be concentrated on across the board. Many doctors still assume that the patient would have to go abroad to contract a tick-borne disease, or that it is impossible to become infected unless you have visited a recognised “hot spot” such as the highlands of Scotland or the New Forest. Many doctors cannot recognise the tell-tale rash that suggests a Borrelial infection, or they wrongly dismiss Borreliosis as a possible diagnosis in the absence of a rash, knee swelling or a facial palsy.
The blood transfusion service is crying out for donors but there could be a something that is less welcome lurking in the blood of an unwary donor.
All blood donors are informed that if they have experienced a cold, flu, or generally any form of illness recently, they should refrain from donating blood; but how many would consider mentioning being bitten by a tick? Borrelia bacteria (the cause of Lyme disease) are known to survive in human blood processed for transfusion at 4°C for up to 48 days.
And it isn’t just Lyme disease we have to be concerned about. Ticks can carry a cocktail of infective organisms, some of which can be transmitted in blood products.
In an article called ” Threats to blood safety posed by emerging protozoan pathogens”, published in Vox Sanguinis (July 2004 Volume 87 Issue s2 Page 120), the Associate Professor of the Transmissible Diseases Department of the American Red Cross, David A. Leiby Ph.D, detailed:
“Human babesiosis is caused by intraerythrocytic parasites of the genus Babesia, with B. microti and B. divergens the primary agents in the USA and Europe, respectively. Both agents are transmitted by Ixodes ticks; I. scapularis is the US vector, while I. ricinus is the European vector.
A variety of other newly described Babesia-like agents (e.g. WA-1, MO-1, EU-1) also cause human disease. Most people infected with Babesia spp. develop an asymptomatic or mild disease that can be characterized by fever, headache, night sweats and myalgia. Immunocompromised persons, including the elderly and asplenic, may experience more severe disease complications including haemolytic anaemia, thrombocytopenia, renal failure and death. Many of these cases are treated with combinations of quinine and clindamycin or atovaquone and azithromycin, and in rare instances exchange transfusions are used to reduce parasitaemia levels.
The intracellular niche of Babesia spp. provides the parasite with an ideal mechanism for transmission by blood transfusion. During the past 10 years, there have been at least 40-50 reported cases of transfusion-transmitted B. microti, but the actual number is probably much higher. All transmission cases have occurred in the USA with the exception of one case in Japan and one in Canada. The Canadian case involved a donor who was likely infected during a US visit. Further, despite its initial discovery in 1996, there have already been two reported cases of WA-1 transmission. The relatively high number of transfusion cases is not surprising given the parasite’s ability to survive in stored blood products, its seroprevalence rates in endemic areas and transmissibility. Indeed, B. microti has been shown to survive at least 35 days in stored red cell units.”
Of course, without widespread awareness, it is doubtful that many physicians would be on the lookout for babesial infections in blood transfusion patients and therefore reported cases are probably fewer than the actual occurrence.
Babesial infections are well known to many farmers and veterinarians throughout the UK and are prevalent in many rural areas. Babesia divergens (the cause of Red Water Fever in UK cattle) has been implicated as the most common agent of human Babesiosis in Europe. Could our blood transfusion services be doing more to prevent such infections from entering national reserves?
What of other modes of transmission?
Bartonella henselae is a bacterium that is endemic to the British feline population. It is transmitted through the scratch or bite of a cat, through the bite of the cat flea and through tick bites. Often it causes little effect but combined with another infection, such as Borreliosis / Lyme disease, it can cause debilitating symptoms.
Without treatment, Borreliosis is known to be transmittable from mother to baby during pregnancy and has been implicated in some studies as the possible cause of abnormal birth defects and premature or stillborn births.
Mothers are warned to avoid cleaning cat litter trays during their pregnancy, due to the risks of their baby being affected by “toxoplosmosis” but there is little available information regarding tick-borne infection and pregnancy, even though many pregnant mothers are involved in farming and other outdoor occupations and leisure pursuits.
Much more study needs to be done into the transmission, symptoms, cures and prevention of tick-borne disease but, until it is given equal priority to many other medical conditions (even some less common than tick-borne disease), it is unlikely to happen in the near future.
The “Get Involved” section of the BADA-UK website has information on how you can raise awareness of this important issue.
I believe I was infected through being an active horsewoman many years ago. It took several years before I was correctly diagnosed, and then went on to receive IV antibiotics. I now still have, what my consultant considers, a chronic fatigue type syndrome, but what is of greatest concern to me is the fact that my husband has recently started to display similar symptoms to the ones I have suffered from. My husband has at no time been involved in equestrian activities, and the closest thing he sees to a bit of greenery is a snooker table. Your anecdotal evidence would certainly seem to be borne true from my own experience.
Comment by Appaloosa Gal — October 28, 2005 @ 11:00 pm
“Borreliosis / Lyme disease is known to be able to pass from mother to baby during pregnancy ……………….Yet how many pregnant mothers to be are informed of such warning advice.”
I have been ill for most of my life, and was tested and found positive for Borrelia about two years ago. Hearing of the possibility of mother to child transmission, my son (he’s 29 years old) was tested last year and sure enough he has it too.
I strongly believe that I was born with this condition and looking back at my family medical history I can see the various tell tale signs in close family members, past and present.
Comment by Celia — November 5, 2005 @ 11:03 am
I forgot to say that, prior to the test for Borreliosis, I had been diagnosed by the NHS as having Chronic fatigue syndrome, M.E. AND Fibromyalgia!”, and all within the last 3 years, after having been ill for most of my life and no doctor knowing what was wrong with me. I felt it was a bit like waiting for a bus. You wait and wait and wait and then suddenly three come along all at once……lol.
Comment by Celia — November 9, 2005 @ 12:36 pm
My children were born long before I was infected so I feel blessed that this was the case. My heart goes out to those who have children infected congenitally. How can mothers protect their future children if they don’t know that there is a threat? I certainly feel that there should be some literature available at surgeries.
I also think that leaflets on tick removal should be available in surgeries too. Not everyone has the internet. In my village there are many elderly people who happily walk their dogs in the countryside but don’t have access to the internet. Luckily, they know about my own experience, so are careful to check for ticks but I am sure that there are many people who haven’t a clue.
I feel certain that my husband has become infected through me. If the evidence points to sexual transmission then why are there no studies being carried out?
Comment by Appaloosa Gal — November 9, 2005 @ 1:17 pm
I couldn’t agree more. Research is URGENTLY needed on these subjects.
How can we drum up the interest in the right people to do the research, and for someone to fund it, when at the most basic level Lyme disease is not being taken seriously by most (medical professionals).
How can we get the right people to take the issue seriously? Not really a question to anyone here in particular, a general comment and frustration.
Roadrunner
Comment by Roadrunner — November 9, 2005 @ 1:47 pm
One thing that really worries me is the donation of blood. Am I right in saying that the NHS blood banks do not screen or are indeed unable to screen for Lyme disease or any of the co-infections. What happens if someone unknowingly has Lyme and gives blood? Is it likely to infect the person being given the blood transfusion?
Comment by Cadrina — November 14, 2005 @ 2:18 pm
If the NHS can’t test properly for Lyme for those of us who have it, they certainly can’t test for asymptomatic carriers. I can’t see how recipients of blood from Lyme carriers can fail to be infected.
In my opinion your worry is justified, Cadrina.
Comment by Nigel — November 14, 2005 @ 3:30 pm
QUOTE(Cadrina)
One thing that really worries me is the donation of blood. Am I right in saying that the NHS blood banks do not screen or are indeed unable to screen for Lyme disease or any of the co-infections. What happens if someone unknowingly has Lyme and gives blood? Is it likely to infect the person being given the blood transfusion?
Cadrina
I would think it’s pretty likely, but of course, it doesn’t mean the recipient will definitely get ill. Or not for some years possibly.
Comment by Roadrunner — November 14, 2005 @ 4:02 pm
Duh! That reply by me reads as if I don’t think it is a problem. What I mean is that it is a problem also because I think many are infected, not displaying symptoms (yet) and then if they donate blood, the next person may also not get sick or for quite some time - therefore any connection does not become obvious to those who are ignorant about it.
I would think it’s pretty likely, but of course, it doesn’t mean the recipient will definitely get ill. Or not for some years possibly.
Comment by Roadrunner — November 15, 2005 @ 9:21 am
Bartonella spp. found in 16.1% of 498 blood donations in Sweden
Scand J Infect Dis. 2005;37(10):723-30.
Bartonella spp. seroprevalence in healthy Swedish blood donors.
McGill S, Wesslen L, Hjelm E, Holmberg M, Auvinen MK, Berggren K,
Grandin-Jarl B, Johnson U, Wikstrom S, Friman G.
From Infectious Diseases, Uppsala University Hospital, Uppsala.
Serum samples were collected from healthy blood donors in 5 regions in
Sweden in 1999, i.e. from the local Blood Centres (collecting
facilities) in Boden, Jonkoping, Lund, Skovde, and Uppsala.
In total, 498 serum samples (63% males, 37% females) were received and tested by immunofluorescence assay for antibodies against B.elizabethae, B. grahamii, B.henselae (Houston-1), B. henselae (Marseille), B. quintana, and B. vinsonii subsp. vinsonii.
An overall Bartonella spp. seroprevalence of 16.1% was found, with a predominance of immunoreactivity to B. elizabethae, at 14.1%; B. grahamii, 2.6%; B. henselae (Houston-1), 1.2%; B. henselae (Marseille), 1.8%; B. quintana, 0.2%; and B. vinsonii subsp. vinsonii, 0.0%.
Univariate and multivariate analyses of epidemiological and demographical information revealed an increased rate of B. elizabethae seropositivity in blood donors working outdoors, being out in the wild a minimum of once a week, hunting moose, having cat contact, and travelling to Eastern Europe. Living in the southern region of Sweden (Lund area) was associated with decreased seropositivity to B. elizabethae.
PMID: 16191889 [PubMed - in process]
Comment by 1scoopor2 — November 27, 2005 @ 2:50 pm
Tick-Borne Disease Transmission by Blood Donation Prevalent in Endemic Areas
Mary Beth Nierengarten
Medscape Medical News 2005. © 2005 Medscape
Oct. 11, 2005 (San Francisco) - The need to develop strategies to prevent transmission of tick-borne disease via blood transfusion is increasing as new reports continue to surface. Although not as much in the popular press as Lyme disease, Babesia microti is creating its own quieter havoc.
In a study presented here at the Infectious Diseases Society of America 43rd annual meeting, Megan Nguyen, BS, from the American Red Cross in Rockville, Maryland, presented data from a six-year study that showed the prevalence of B microti transmission via blood transfusion in areas where the tick is commonly found.
Examination of 13,573 samples from blood donors from 1999 to 2004 in endemic regions of Connecticut showed that 175 samples (1.3%) tested positive for B microti infection based on indirect fluorescent antibody testing.
Of these 175, 129 donors consented to participate in a three-year follow-up study in which they were tested by IFA for the presence of antibodies to B microti as well as receiving nested polymerase chain reaction (PCR) testing for parasitemia on a regular basis. Overall, 27 donors (21%) were found to have parasitemia as indicated by a positive PCR test, suggesting that some patients have persistent, ongoing infection.
In addition, parasitemia rates decreased from 55% in the first two years of the follow-up study to 3% in the third and final year. Ms. Nguyen said the study did not show a clear reason for this, adding that many factors could account for it.
Ms. Nguyen emphasized that “anybody who has had B microti is permanently prohibited from donating blood” and is registered in the blood bank system of the Red Cross nationwide. However, it is important to identify those people infected with B microti prior to blood donation. According to Ms. Nguyen, most of the transfusion-related transmission occurs through people who are infected with the tick-borne disease but who are asymptomatic.
Identifying infected people before they donate blood is therefore an important goal in reducing the risk of transfusion-related B microti transmission, but the best way to do this is not yet clear, she said.
Richard Whitley, MD, a professor of pediatrics at the University of Alabama in Birmingham who moderated the session, told Medscape that prospective blood donors are not currently screened routinely for tick-borne diseases, an issue that needs to be addressed by local blood banks.
However, Ms. Nguyen told Medscape she is hopeful “that there will be screening” or a U.S. Food and Drug Administration (FDA) approval for testing before donation. Unfortunately, she added, she does not know of any test under investigation for FDA approval.
IDSA 43rd Annual Meeting: Abstract LB-3. Presented Oct. 7, 2005.
Reviewed by Gary D. Vogin, MD
http://www.medscape.com/viewarticle/514364
Comment by 1scoopor2 — February 4, 2006 @ 11:48 pm