*Added 12th Sep 2014
New tick-borne disease threatens primarily immune suppressed persons
Date:May 27, 2014
Source:University of Gothenburg
A newly discovered tick-borne bacterium known as “Candidatus Neoehrlichia mikurensis” has been implicated in six cases of disease in Sweden. A new international study has shown that this bacterium is primarily a risk for people who are already sick and who are receiving immunosuppressive drugs.
More at: http://www.sciencedaily.com/releases/2014/05/140527114503.htm
Intro to co-infections:
One tick may carry more than one disease, so sometimes people get more than one co-infection from the bite of a single tick. The symptoms of these coinfections are often nonspecific – such as fever and headache – which makes diagnosis difficult. And the treatments may be different. Doxycycline, for example, works for Lyme disease and ehrlichiosis, but is not effective for babesiosis.
Experienced doctors may be able to distinguish each of the tick-borne coinfections and order appropriate tests and treatment. Sometimes they start to suspect a coinfection when the patient doesn’t respond well to treatment and it becomes obvious that something else is causing the symptoms. Coinfection generally results in more severe illness, more symptoms, and a longer recovery.
List of co-infections:
(This site explains the types of co-infections, symptoms & treatments)
Other tick-borne diseases: http://www.lymedisease.org/lyme101/coinfections/other_tick_diseases.html
There are several labs in Germany who will test for the main co-infections as well as for Lyme disease using their LTT tests.
MELISA Diagnostics Ltd 6 Heatherdene Mansions Cambridge Road Twickenham TW1 2HR UK Phone +44 20 8133 5166 Fax +44 20 8711 5958
BCA/Infectolabs in Germany also do testing for lyme & other tick-borne infections…
B-C-A Betriebs GmbH & Co. KG Morellstraße 33 · 86159 Augsburg, Germany. Phone + 49 821 4550740 Fax + 49 821 4550741
Plus Arminlabs offer an extensive testing service
Zirbelstraße 58, 2nd floor 86154 Augsburg, Germany. Phone +49 821 218 2879 Fax +49 821 218 3081
P.S Both Arminlabs & BCA Labs can offer patients a co-infection check list for those who feel that other infections may be at play (treatment may differ depending on which infection you may have). The co-infection check list can help rank which tests to go for based on your symptoms..
Mycoplasma & Lyme
(extracts below – full text available at the following link)
In one study looking at Mycoplasma in patients with Chronic Fatigue Syndrome, Dr. Nicolson has observed some interesting patterns in his research. Generally, the majority of CFS patients have Mycoplasma infections. However, CFS patients infected with Borrelia burgdorferi, the punitive agent in Lyme disease, had an even higher overall Mycoplasma infection rate. As many as 75% of Lyme disease patients appear to have Mycoplasma infections, and yet Mycoplasma is often overlooked in the diagnosis and treatment of chronic Lyme disease, neurodegenerative diseases, and many other chronic illnesses lacking clear origins.
Even more startling was the finding that of the patients infected with Borrelia, over 50% of the patients had the M. fermentans infection. Approximately 23% carried M. pneumoniae.
Chronic Fatigue patients that did not test positive for Borrelia had much more of a mixture of various species of Mycoplasma. Only 28% of the group not co-infected with Lyme disease had the M. fermentans infection. In normal, healthy controls, only 1.7% were found to have M. fermentans and at a total Mycoplasma infection rate of 5% compared to the 75% group mentioned earlier.
Dr. Nicolson notes that these findings are consistent with the fact that it is the Mycoplasma fermentans species that is more often isolated in ticks collected from the environment. The same tick that serves as the vector for Borrelia burgdorferi often also transmits M. fermentans simultaneously. Once a patient is multiply co-infected, the duration and severity of their illness both increase.
In his experience, Dr. Nicolson has found that Mycoplasma is the number one Lyme coinfection. The rate of infection with Mycoplasma in patients with Lyme disease surpasses that of Bartonella (25-40%) slightly and that of Babesia (8-20%) significantly.
According to Dr. Nicolson, a healthy immune system can generally clear M. pneumoniae infections though will have a harder time eradicating M. fermentans on its own. Healthy people can often hold these infections in check – essentially having the infection but not expressing symptoms.
Dr. Nicolson recommends that the physician adopt an initial 6-month course of treatment with no break followed by several 6- week on, 2-week off antibiotic cycles. Candidate antibiotics include: Doxycycline, Ciprofloxacin (Cipro), Azithromycin (Zithromax), Minocycline, or Clarithromycin (Biaxin). He notes that antibiotic combinations may be required if there is a limited response to single drug, and most patients require switching antibiotics at least once during their treatment. Some patients may find the addition of Flagyl to be a benefit to treatment.
In chronic Lyme disease, it is often difficult to know which infections are actually responsible for the persistence of illness. However, in general terms, chronic intracellular infections that change the metabolism of cells and suppress mitochondrial and other functions will lead to patients remaining in a chronically ill state. Dr. Nicolson believes that these infections must be aggressively treated. “Similar to chronic Lyme disease, the current CDC or IDSA recommendations for short-term treatment of chronic infections are simply inadequate,” he says.
Babesiosis: under-reporting or case-clustering?
C. S. Clarke, E. T. Rogers, and E. L. Egan
Department of Haematology, Galway Regional Hospital, Ireland.
Describes 3 cases of Babesia among farmers in the Galway region (1989)
Disease Caused By Insect Bites Can Be Transmitted To Children At Birth, NC State Researcher Finds
A North Carolina State University researcher has discovered that bacteria transmitted by fleas–and potentially ticks–can be passed to human babies by the mother, causing chronic infections and raising the possibility of bacterially induced birth defects.
Dr. Ed Breitschwerdt, professor of internal medicine in the Department of Clinical Sciences, is among the world’s leading experts on Bartonella, a bacteria that is maintained in nature by fleas, ticks and other biting insects, but which can be transmitted by infected cats and dogs as well. The most commonly known Bartonella-related illness is cat scratch disease, caused by B. henselae, a strain of Bartonella that can be carried in a cat’s blood for months to years. Cat scratch disease was thought to be a self-limiting, or “one-time” infection; however, Breitschwerdt’ s previous work discovered cases of children and adults with chronic, blood-borne Bartonella infections–from strains of the bacteria that are most often transmitted to cats (B. henselae) and dogs (B. vinsonii subsp. berkhoffii) by fleas and other insects.
In his most recent case study, Breitschwerdt’ s research group tested blood and tissue samples taken over a period of years from a mother, father and son who had suffered chronic illnesses for over a decade. Autopsy samples from their daughter–the son’s twin who died shortly after birth–contained DNA evidence of B. henselae and B. vinsonii subsp. berkhoffi infection, which was also found in the other members of the family.
Both parents had suffered recurring neurological symptoms including headaches and memory loss, as well as shortness of breath, muscle weakness and fatigue before the children were born. In addition, their 10-year-old son was chronically ill from birth and their daughter died due to a heart defect at nine days of age.
Results of the parents’ medical histories and the microbiological tests indicated that the parents had been exposed to Bartonella prior to the birth of the twins, and finding the same bacteria in both children, one shortly after birth and the other 10 years later, indicates that they may have become infected while in utero.
Breitschwerdt’s research appears online in the April 14 Journal of Clinical Microbiology.
“This is yet more evidence that Bartonella bacteria cause chronic intravascular infections in people with otherwise normal immune systems, infections that can span a decade or more,” Breitschwerdt says. “Also this new evidence supports the potential of trans-placental infection and raises the possibility that maternal infection with these bacteria might also cause birth defects.”
The Department of Clinical Sciences is part of NC State’s College of Veterinary Medicine. Dr. Breitschwerdt is also an adjunct professor of medicine at Duke University Medical Center.
“Molecular evidence of perinatal transmission of Bartonella vinsonii subsp. berkhoffii and B.henselae to a child”
Authors: Edward B. Breitschwerdt, Ricardo G. Maggi and Patricia E. Mascarelli, NC State University; Peter Farmer, Department of Pathology, North Shore University Hospital
Published: April 14, 2010 in Journal of Clinical Microbiology
Contact: Tracey Peake, News Services, Tel: 919.515.6142
Source: North Carolina State University
New Bartonella Species Discovered
Volume 16, Number 3–March 2010
Candidatus Bartonella mayotimonensis and Endocarditis
Eleanor Y. Lin,1 Comments to Author Constantine Tsigrelis, Larry M. Baddour, Hubert Lepidi, Jean-Marc Rolain, Robin Patel, and Didier Raoult
Author affiliations: Mayo Clinic, Rochester, Minnesota, USA (E.Y. Lin, C. Tsigrelis, L.M. Baddour, R. Patel); and Université de la Méditerranée, Marseille, France (H. Lepidi, J.M. Rolain, D. Raoult)
We describe a new Bartonella species for which we propose the name Candidatus Bartonella mayotimonensis. It was isolated from native aortic valve tissue of a person with infective endocarditis. The new species was identified by using PCR amplification and sequencing of 5 genes (16S rRNA gene, ftsZ, rpoB, gltA, and internal transcribed spacer region).
We isolated a new Bartonella species and propose that it be named Candidatus Bartonella mayotimonensis to recognize the contributing institutions (Mayo Clinic and Hôpital de la Timone, Marseille, France). This is the seventh Bartonella species documented to cause infective endocarditis in humans.
The reservoir of Candidatus B. mayotimonensis has yet to be determined. Different Bartonella species have been isolated from a variety of mammals, and each species is highly adapted to its reservoir host (11,12). The domestic cat is the primary mammalian reservoir for B. henselae (13). Other Bartonella species have been found in mammalian hosts, including rats (B. elizabethae), dogs and coyotes (B. vinsonii subsp. berkhoffii), cats (B. koehlerae), humans (B. bacilliformis and B. quintana), moles (B. talpae), voles (B. vinsonii subsp. vinsonii), cows (B. bovis [weissii]), deer (B. schoenbuchensis), and rabbits (B. alsatica) (3–6,12,14,15). Our patient had direct exposure to mice on his farm and also had intermittent contact with cats while visiting his daughter. Additional investigations are needed to determine the reservoir(s) and vector(s) for this novel bacterium.
The immunofluorescent assay, the current serologic method for diagnosis of Bartonella infection, does not distinguish among Bartonella species. Only Western blot analysis and cross-adsorption enable serologic identification of species. PCR and culture are critical when a Bartonella species is identified for the first time as a human pathogen. Newly encountered Bartonella strains should be considered a new species if a 327-bp gltA fragment shares <96.0% sequence similarity with those of validated species, and if an 825-bp rpoB fragment shares <95.4% sequence similarity with those of validated species as reported in the current case (8).
This case reinforces the hypothesis that any Bartonella species can cause human infection, including culture-negative endocarditis. Candidatus B. mayotimonensis should be added to the list of human pathogens that can cause culture-negative endocarditis.
Dr Lin was an internal medicine resident at the Mayo Clinic in Rochester, Minnesota, when the patient's condition was investigated. She is currently an endocrinology fellow at Massachusetts General Hospital in Boston, Massachusetts. Her research interest is neuroendocrinology.
A symptoms list for Lyme & Co-infections by Joseph Burrascano:
The Pain of Bartonella
Scientists study bacteria known to cause trench, cat scratch fever
By Sarah Avery / McClatchy-Tribune News Service
Published: June 03. 2010 4:00AM PST
RALEIGH, N.C. — A bacterial infection typically spread by fleas, lice and biting flies could be more prevalent than many think, and may have been transmitted from a mother to her children at birth, scientists from N.C. State University say.
Dr. Edward Breitschwerdt, an infectious disease veterinarian and one of the world’s leading researchers of bacteria called Bartonella, has for the first time documented evidence that the pathogen may have been passed between family members.
Although more studies are needed to back up his findings, Breitschwerdt and colleagues describe the case of a mother and father who began battling chronic aches, fatigues and other symptoms soon after they were married. When their twins were born in 1998, the daughter died after nine days from a heart defect, and the son developed chronic health problems.
Using tissue from the daughter’s autopsy and blood from the surviving family members, Breitschwerdt’s team discovered that the entire family was infected with the same species of Bartonella bacteria, despite having no shared exposures to flea or lice infestations. Bartonella is known to causes such illnesses as trench fever and cat scratch disease, and it is increasingly suspected of triggering a variety of aches and inflammations that doctors have been unable to diagnose.
“I think we have stumbled across something that is of monumental medical importance,” said Breitschwerdt, whose findings were published recently in the Journal of Clinical Microbiology.
Proving the mother-child transmission could be difficult, however. Little funding is available for such research because the bacteria are still not considered a major source of human disease.
Dr. Michael Kosoy, who heads the Bartonella laboratory for the Centers for Disease Control and Prevention in Fort Collins, Colo., said scientists are only beginning to build evidence that Bartonella infections may be more common than previously thought.
“Bartonella are circulated around the world in many animals, but there are different Bartonella species, and the question is how can they be transmitted to humans?” Kosoy said, noting that most known cases have been transmitted from biting insects. He said the NCSU findings about the potential family transmission is compelling but inconclusive.
Dozens of strains
At least 26 strains of Bartonella have been named worldwide, and the list is growing. The most notorious Bartonella infection is cat scratch disease, a fever illness passed to humans from flea-infected cats. Fleas are the primary hosts, and they spread the bacteria in their feces.
Other Bartonella strains spread more serious diseases. Kosoy is studying how often heart inflammation is caused by a Bartonella that thrives among rat fleas in Thailand. He has already established that about 25 percent of unexplained fever illnesses among a group of patients there were caused by Bartonella.
“This is not limited to cat scratch,” Kosoy said. “That’s just the tip of the iceberg.”
Breitschwerdt said he thinks the bacteria may be the hidden cause behind a host of chronic symptoms — muscle aches, neurological problems, fatigue, arthritis — that defy diagnosis.
About two years ago, Breitschwerdt began testing blood samples from a doctor in Maryland, who was curious whether Bartonella infections might be causing problems for some of his patients.
“There are lab tests showing inflammation,” but no discernible cause, said Dr. Robert Mozayeni, a Yale-educated rheumatologist who practices in Rockville, Md.
Mozayeni contacted Breitschwerdt and his NCSU colleague, Ricardo Maggi, who together developed a more sensitive test for Bartonella. Routine blood tests fail to detect Bartonella because they search for antibodies that the body is slow to produce.
Instead, Breitschwerdt and Maggi figured out how to cultivate the bacteria in the laboratory from blood samples of infected people. They founded a company called Galaxy Diagnostics to handle the laboratory volume.
Of Mozayeni’s mystery patients tested at the lab, nearly 20 percent had Bartonella infections.
“I suspect this is going to be one of the causes of rheumatoid arthritis and a few other things, but it’s too speculative right now to say,” Mozayeni said.
More studies are needed, and Mozayeni said he has now joined Breitschwerdt and Maggi in the diagnostic company to oversee human testing.
“Certainly, the prevalence of Bartonella infection in people with chronic illness is higher than I would have ever guessed, but we still don’t know what that means,” Breitschwerdt said.
Among the biggest unknowns is how to treat people who have been infected. The effectiveness of antibiotics depends on which strain of Bartonella is at work, and with so many strains, treatments can be hit or miss.
Breitschwerdt said the family in his most recent study declined to comment about their experience. He said they were having difficulty finding a doctor to treat them.
“It is very difficult to find a physician who wants to see someone with a chronic illness that is poorly defined,” he said, adding that many such patients often think they have Lyme disease, a tick-borne bacterial infection with similar symptoms — and stigma. “With an unexplained illness, it becomes problematic.”
Lyme isn’t the only risk from ticks
Extract from article re: discussion on co-infections in the Cape Cod Area, U.S.
“We’re doing a lot more testing” for co-infections, said Dr. Alan Sugar, who is director of infectious disease at Cape Cod Hospital. He said he sees dozens of people a year with tick-borne illnesses other than Lyme, either in the hospital or when consulting with other physicians.
The illnesses often are called co-infections because they frequently are diagnosed in Lyme patients. But Sugar said that this year he is seeing dual infections consisting of babesiosis and anaplasmosis, with no Lyme involvement. Every now and then, he sees an unlucky patient who has all three tick-borne diseases, he said.
Young healthy people may not even know they have the illnesses, Sugar said. But in older people or those with compromised immune systems, the co-infections can be dangerous.
People with babesiosis can get very anemic as the microscopic parasites known as babesia gobble up red blood cells. It’s especially dangerous for people with no spleen, Sugar said, and can cause breathing problems.
People with anaplasmosis, also known as human granulocytic ehrlichiosis, may develop a low white blood cell count and experience fever, headache, malaise, chills, muscle and joint pains, nausea, vomiting and lack of appetite, according to the DPH.
Sufferers can get bad cases of hepatitis, and the illness has a mortality rate of about 5 percent, Sugar said.
The same antibiotic used to treat Lyme — Doxycycline — is used with anaplasmosis, he said. Babesiosis patients get a different combination of two antibiotics, he said.
For more go to..
Tick fever: a reality many times forgotten…
MEDITERRANEAN Spotted Fever (MSF) is a tick born rickettsial disease. Rickettsiae are strict intracellular parasites, requiring host cells in which to replicate.
Rickettsioses represent some of the oldest but most recently recognised infectious diseases. A type of rickettsia is suspected of having been responsible for the Athens plague described by Thucydides during the 5th century BC.
MSF was first described in Tunisia in 1909 and the disease is encountered all around the Mediterranean, in sub Saharan Africa, in India, around the Black Sea, and even in the eastern part of Russia close to Japan. An increase in the number of cases of MSF in France, Italy, Spain and Portugal paralleled that of the Rocky Mountain Spotted Fever (RMSF) in the United States during the 1970s. This increase in incidence was correlated in Spain with higher temperatures and lower rainfall and, in France, with a decrease in the number of days of frost during the preceding year. Sporadic cases are observed in areas without endemic infection.
MSF is endemic in Portugal, where Ricardo Jorge recognised it in 1930. The etiologic agents are two strains of Rickettsia conorii. A tick (Rhipicephalus sanguineus) is the main vector and reservoir of the disease.
For more go to: http://www.algarveresident.com/story.asp?XID=2843
NB Link now broken but kept for reference purposes…
Bartonella, Rat, Flea Connection – the New Plague?
Posted on Dr Singleton’s web page (author of Lyme Disease Solution)
There is fascinating research concerning the “brown rat” (AKA Norwegian rat) that just came out this month that you should know about. The brown rat (Rattus norvegicus) is the hardiest mammal on earth, next to the human. They live everywhere on the planet except Antarctica. Research done by Professor Chao-Chin Chang suggests that brown rats may be carrying several species of Bartonella bacteria that can cause serious illnesses in humans. More than 20 species of Bartonella bacteria have been discovered since the early 1990’s, and at least eight are known to be pathogenic to humans.
In the study, the researchers took samples from 58 rodents, including 53 brown rats, 2 mice, and 3 black rats. Results showed that 10.3% of the rodents were carrying Bartonella bacteria, and 80% of those carriers were brown rats. Most were carrying B. elizabethae, which can cause heart disease (endocarditis) in humans. The researchers also identified a species of Bartonella that had not previously been identified in rodents. Further tests showed that the species was closely related to B. rochalimae, which is known to be pathogenic to humans.
Exactly how the bacteria are being spread to humans in uncertain, however the researchers are confident that, just like the plague, infections are spread by fleas. Clinically, this might help explain why so many Bartonella/BLO patients have no clear history of tick bites, but do have history of other “insect bites” where the insect was never actually seen by the patient. And who knows what other vector(s) might be able to pass this on in addition to fleas.
In conclusion, Professor Chang states: “Several different Bartonella bacteria are surely transmitted by rodents. These results raise concerns about the existence of other reservoirs and vectors for this emerging infection. This certainly warrants further investigation.”
As many of us in Lyme medicine well know, Bartonella truly qualifies as an “emerging infection” which represents a real challenge to patients and Lyme doctors alike. Testing is not particularly good at this point in our history, making clinical recognition the most important method of diagnosis. And then there are other pathogens which can, in some cases, look somewhat similar to Bartonella including Q fever (which is carried by brown rats also, by the way), mycoplasma, toxoplasmosis, tularemia, brucellosis, and so forth, to name just a few.
It is very gratifying to see the medical research world attempting to explore and better understand the complexity of vector-borne diseases. Interestingly, the veterinary research world is well ahead of us in this arena. But, as the old saying goes: “better late than never.”
Reference: Lin JW, Chen CY, Chen WC, Chome BB, Chang CC. Isolation of Bartonella species from rodents in Taiwan including a strain closely related to ‘Bartonella rochalimae’ from Rattus norvegicus. J Med Microbiol. 2008;57:1496-150.
Dr. Ed Breitschwerdt, professor of internal medicine at North Carolina State University, discusses recent research into the Bartonella bacteria. Animals and humans can both become infected with the bacteria from insect bites. It may be possible for an infected mother to pass the bacteria to her unborn child.
The Bartonella Plague Ignored:
[For full article go to:]
A Common Reason Lyme Treatment Fails..
First, the routine testing done at routine labs and even some specialty labs misses this infection routinely. There are just so many species that some labs are giving up looking for Bartonella at the species level, and are going to try PCR at the larger genus level. It is amusing to read that 40-60% of USA cats carry this infection, when this is based on junk lab testing. The numbers are much higher in my opinion. In my first article we showed one new patent pending blood smear stain that captures many, but not all, Bartonella human cases. If the numbers are low, it can be missed. Other cases of Bartonella can be found by many other means, for example, by finding abnormally high levels of VEGF in a mold-free environment. But remember VEGF can go down in the presence of indoor mold (per US Patent 6528489 and other data) found in 30% of USA structures and this can hide Bartonella because it secretes VEGF.
Second, it is important to realize that Bartonella is not rare. It is all over the world and only those living in the polar ice caps are immune to the risk of infection. I personally believe based on newer and more aggressive testing that it is more common than Lyme disease. Many are falsely diagnosed with Babesia because they are tired and fatigued, and yet this is a highly common symptom of Bartonella reported in vast numbers of studies. It is a major contributing infection to chronic fatigue and Fibromyalgia symptom clusters.
Third, Bartonella causes about 20-30 problems with each body organ. And this is merely what we know about, at this time, before a real mastery of this organism exists. Why such damage? Perhaps because it is outside or inside Red Blood Cells, but it also enters the lining of all blood vessels in all tissues and when in this location, it can cause a wide range of destructive actions. All tissues eventually have ultra tiny blood vessels called capillaries which are so small Red Blood Cells have to sometimes squeeze through to get oxygen to the deepest cells. It also causes nodules in many types of tissues like the liver, spleen and skin.
If you read some simplistic articles on Bartonella they treat it like a cold, and falsely assume you need enlarged lymph nodes and a purple, blue or red blood vessel rash or flat rash, and a papule to have Bartonella or “Cat Scratch Fever.” Of course Bartonella is most commonly found without these things. Even the so called Bartonella rashes, caused by VEGF making and opening capillaries, are usually listed as having 3-4 forms when we have found over 30 forms, including occasionally open sores with debris. But most people who have any rashes miss them because it takes years to learn how to see them because they often mix in with other common skin vascular findings.
Fourth, you should appreciate that it is unlikely you will ever be cured of Lyme in the presence of Bartonella. Why? Bartonella is a massive immune suppressing bacteria. It can float attached to Red Blood Cells in vast numbers and not even cause a cold or fever. Just imagine, bacteria are floating in your blood and you might not have any fever at all! If you had Staph or Strep in your blood at these levels you would likely be dead in 48 hours unless you were pumped full of antibiotics in an ICU. So how is it this huge elephant floats in vast numbers and causes no severe fever and no disastrous signs of deadly sepsis — infected blood throughout the body with massive inflammation. It is because it has ways of shutting down the immune system. It violates many rules of bacteria behavior and this is one reason it has been so seriously missed until recent years.
Mycoplasma & Chronic Illnesses
A summary of 2 studies:
International Journal Medicine Biology Environment 2000; 28(1):15-23.
EXAMINATION OF MYCOPLASMAS IN BLOOD OF 565 CHRONIC ILLNESS PATIENTS BY POLYMERASE CHAIN REACTION
Marwan Y. Nasralla, Jörg Haier, Nancy L. Nicolson and
Garth L. Nicolson.* The Institute for Molecular Medicine
…Over the last years many studies have shown that microorganisms of otherwise unimpressive virulence, such as Mycoplasmas or Chlamydia, seem to be involved in slow progression of chronic diseases with a wide spectrum of clinical manifestations and disease outcomes. , Our results suggest that mycoplasmas, such as M. fermentans, appear to be related to CFS/ME and FMS. However, it remains unclear whether they are causative, cofactors or opportunistic infections in these diseases. One may speculate that the ability of M. fermentans to invade into different types of human cells and disturb immune functions is responsible for its involvement in pathogenesis of different chronic illnesses. The identification of mycoplasmal infections in blood specimens of a rather large subset of rheumatoid arthritis, GWI, CFS/ME and FMS patients suggests that mycoplasmas, and probably other chronic infections as well, may be an important source of morbidity in these patients. If such infections are important in these disorders, then appropriate treatment with antibiotics may result in improvement and even recovery. However, further investigations are necessary to establish the role of mycoplasmal infections in CFS/ME and FMS patients and their pathomechanisms.
Journal of Chronic Fatigue Syndrome 2008; 14(4): 5-17.
Chronic Fatigue Syndrome Patients Subsequently Diagnosed with Lyme Disease Borrelia burgdorferi: Evidence for Mycoplasma species Co-Infections
Garth L. Nicolson,1 PhD
Nancy L. Nicolson, 1 PhD
Joerg Haier,2 MD, PhD
1The Institute for Molecular Medicine, Huntington Beach, California, USA,
2Department of Surgery, University Hospital, Munster, Germany
Previously we reported that chronic bacterial and viral infections appear to be a rather common feature of CFS, and most CFS patients examined had multiple infections (9, 14, 24). Since CFS patients often report that their CFS signs and symptoms slowly evolved after acute infections, this result is not unexpected (9, 16, 25). Also, the severity of CFS signs and symptoms appear to be related to the number of chronic infections but not their specific type (26).
CFS patients have also been diagnosed with Lyme Disease (18), and Eskow et al. (20) have found that the attachment of ticks and subsequent appearance of musculoskeletal signs and symptoms is associated with systemic M. fermentans infections (20). Thus it was not unexpected that CFS patients with evidence of Borrelia burgdorferi infections would also show evidence of Mycoplasma species in their blood. What is interesting is that the predominant presence of M. fermentans in the Borrelia burgdorferi-positive CFS patients is consistent with the finding of this species of Mycoplasma in ticks collected from the environment (20).
Previously we studied North American and European CFS patients and found that most showed evidence of mycoplasma infections (5, 9, 14, 24-26). Like Borrelia burgdorferi, Mycoplasma spp. are slow-growing, fastidious, intracellular infections that can invade a variety of tissues but they can also present as superficial infections (27-29). Others who studied CFS patients also found evidence of widespread mycoplasma infections (6-8). When we examined the incidence of particular mycoplasma infections in North American CFS patients, we found that the most common species found was M. pneumoniae and most patients had multiple mycoplasma infections, which were for the most part combinations of M. fermentans and other mycoplasma species (9, 24, 26). However, in a study on European CFS patients a slightly different picture was found (5). The most common species found in Belgium and Dutch patients was M. hominis, and there was a lower overall rate of multiple mycoplasma co-infections in the European CFS patients (5). We also found that more than 50% of North American patients with rheumatoid arthritis had mycoplasma infections, and in the majority of these patients multiple mycoplasma co-infections were found (23, 27).
Patients with the Lyme Disease spirocyte Borrelia burgdorferi usually have multiple co-infections involving bacteria other than Mycoplasma spp., such as Ehrlichia spp. and Bartonella spp. as well as protozoan species of Babesia (30, 31). Ehrlichia species are small, gram-negative, pleomorphic, obligate intracellular infections similar to mycoplasmas in their structures, intracellular locations and resulting signs/symptoms (32). The other common bacterial co-infection is caused by Bartonella spp. (33), and this co-infection (along with Mycoplasma spp.) appears to be one of the most common tick-borne co-infections found with Borrelia burgdorferi. Bartonella spp., such as Bartonella henselae, which also causes cat-scratch disease (34), is often found in neurological cases of Lyme Disease (33, 35). A non-bacterial co-infection found with Borrelia burgdorferi is the intracellular protozoan Babesia spp. (36). There are over 100 species of the genus Babesia, but most Lyme Disease co-infections in humans in North America are caused by Babesia microti and in Europe by Babesia divergens and Babesia bovis (37, 38).
In CFS multiple infections are associated with more severe signs and symptoms (26), and similarly when multiple infections are present in Lyme Disease, the number of signs/symptoms and their severity and duration are usually greater in the early stages of disease (36). In Lyme Disease patients with multiple co-infections can present with high fever, chills, generalized weakness, gastrointestinal symptoms (anorexia, nausea, abdominal pain, vomiting, diarrhea, among others), anemia, muscle and joint pain, respiratory problems and dark urine. The combination of Borrelia, Mycoplasma and Babesia infections can be lethal in some patients (about 7% of patients can have disseminated intravascular coagulation, acute respiratory distress syndrome and heart failure), but the majority of patients with tend to have the chronic form of the disease. In Babesia infections patients can show mild to severe hemolytic anemia (probably correlating with the protozoan colonization of erythrocytes, which can be seen by experienced individuals in blood smears) and a normal to slightly depressed leukocyte count (36). However, these symptoms are usually not seen in patients who have progressed to the chronic phase of the disease, which can be similar in presentation to CFS (18).
Lyme Disease Diagnosis & Therapy Suggestions 2006 ACAM Meeting
Useful tables showing meds to use for each type of co-infection and discusses detox, herbs, nutritional support etc. etc. The hardest part is getting tested for co-infections as they don’t always show up!!
DIAGNOSIS AND THERAPY OF CHRONIC SYSTEMIC CO-INFECTIONS IN LYME DISEASE AND OTHER TICK-BORNE INFECTIOUS DISEASES
Prof. Garth L. Nicolson
The Institute for Molecular Medicine (Website http://www.immed.org)
16371 Gothard Street H, Huntington Beach, CA 92647
Transmission of Bartonella henselae by Ixodes ricinus
Violaine Cotté,* Sarah Bonnet,* Danielle Le Rhun,* Evelyne Le Naour,* Alain Chauvin,†
Henri-Jean Boulouis,‡ Benoit Lecuelle,‡ Thomas Lilin,‡ and Muriel Vayssier-Taussat*
Extract below – full report available on link above
Bartonella spp. are facultative intracellular bacteria associated with several emerging diseases in humans and animals. B. henselae causes cat-scratch disease and is increasingly associated with several other syndromes, particularly ocular infections and endocarditis. Cats are the main reservoir for B. henselae and the bacteria are transmitted to cats by cat fl eas. However, new potential vectors are suspected of transmitting B. henselae, in particular, Ixodes ricinus, the most abundant ixodid tick that bites humans in western Europe. We used a membrane feeding technique to infect I. ricinus with B. henselae and demonstrate transmission of B. henselae within I. ricinus across developmental stages, migration or multiplication of B. henselae in salivary glands after a second meal, and transmission of viable and infective B. henselae from ticks to blood. These results provide evidence that I. ricinus is a competent vector for B. henselae.
Bartonella spp. are facultative intracellular bacteria associated with several emerging diseases in humans and animals (1). Domestic animals and wildlife represent a large reservoir for Bartonella spp., and at least 10 species or subspecies have been reported to cause zoonotic infections.
B. henselae causes cat-scratch disease, possibly the most common zoonosis acquired from domestic animals in industrialized countries and is becoming increasingly associated with other syndromes, particularly ocular infections and endocarditis (2–6). Although cat fl eas are well-established vectors for B. henselae (7–10), transmission by other arthropods, in particular ticks, has been suggested (11–13). Ixodes ricinus is the most widespread and abundant ixodid tick in western Europe and is frequently associated with bites in humans. It is a vector of emerging zoonotic pathogens including Borrelia burgdorferi sensu lato (14), Anaplasma phagocytophilum (15), and Babesia spp. (16).
Direct proof of transmission of Bartonella spp. by a tick was reported by Noguchi in 1926 (17), who described experimental transmission of B. bacilliformis (cause of Oroya fever) to monkeys by Dermacentor andersoni. In this study, ticks were allowed to feed on infected monkeys for 5 days. After removal, partially engorged ticks were placed on healthy monkeys in which disease then developed.
This study showed that ticks could acquire and transmit the bacteria but did not demonstrate their vector competence or transtadial transmission throughout the tick’s life cycle. Since this early study, the role of ticks in Bartonella spp. transmission has been strongly implied but never definitively demonstrated. Bartonella spp. DNA was detected in questing and engorged nymphs and adults Ixodes spp. collected in North America, Europe, and Asia (13,18–26). If one considers that ixodid ticks feed only once per stage, Bartonella spp. DNA in questing ticks suggests transtadial transmission of these bacteria.
Other observations support Bartonella spp. Transmission by ticks. Co-occurrence of Bartonella spp. With known tick-borne pathogens such as B. burgdorferi sensu lato, A. phagocytophilum, or Babesia spp. is not a rare event in ticks and hosts (13,19,24,27). A study conducted in a veterinary hospital in the United States (California) demonstrated that all dogs with endocarditis and infected with Bartonella spp. were also seropositive for A. phagocytophilum (28). In humans, several case studies have reported patients with concurrent Bartonella seropositivity and detection of Bartonella spp. DNA in their blood, along with B. burgdorferi infection of the central nervous system after tick bites (11,29). Moreover, Bartonella spp. DNA has been detected in human blood cells after a tick bite (30), and 3 patients with B. henselae bacteremia who had no history of contact with cats but had sustained tick bites were reported in Texas (12). Finally, tick exposure was determined to be a risk factor associated with B. vinsonii seropositivity in dogs (31)
Babesia – Life cycle of ticks & transmission of Babesia (a malaria type parasite) explained:
Bartonella henselae and the Potential for Arthropod Vector-Borne Transmission
Mark E. Mosbacher, Stephen Klotz, John Klotz, Jacob L. Pinnas. Vector-Borne and Zoonotic Diseases. -Not available-, ahead of print. doi:10.1089/vbz.2010.0106.
Online Ahead of Print: October 25, 2010
Bartonella henselae, the causative agent of the illness referred to as cat scratch disease, is a common infection, particularly in children, and clinicians need to be aware of its potential transmission to humans by arthropod vectors such as fleas and ticks in addition to animal bites and scratches. The absence of a vertebrate bite or scratch does not preclude infection with B. henselae.
Babesiosis is an uncommon but worldwide vector-borne malaria-like parasitic disease caused by protozoan parasites of the genus Babesia.1 Babesiosis is an infection of rodents, cattle, wild animals and man and is spread by the bites of ixodid (hard-bodied) ticks which are also the vectors for Lyme disease (25% of babesiosis patients have both diseases).2
Babesial parasites reproduce in red blood cells, forming cross-shaped inclusions (rarely seen). There are over a hundred different Babesia species; human disease is usually caused by B. divergens in Europe and B. microti in the Northeast and Midwest United States. B. divergens infections tend to be more severe (frequently fatal) than those due to B. microti, where clinical recovery is usual. Patients who are immunosuppressed (including HIV-infected patients), splenectomised or elderly are most susceptible to babesial infection. B. microti infection can occur in non-splenectomised individuals and be transmitted by blood transfusion.
Ehrlichiosis is a tick-borne infection of mononuclear cells and granulocytes that affects various mammals, including mice, cattle, dogs, deer, horses, sheep, goats, and humans. Ehrlichia are obligate, intracytoplasmic bacteria that resemble Rickettsia and are tiny gram-negative organisms.1
* One of the most common Ehrlichia species infecting humans is Ehrlichia chaffeensis, which mainly infects human monocytes and macrophages (human monocytic ehrlichiosis – HME).
* Anaplasma phagocytophilum causes human granulocytic anaplasmosis (HGA).
* Ehrlichia species that infect granulocytes are called human granulocytic ehrlichiosis (HGE).
The clinical manifestations of HME, HGA and HGE are the same.
* Ehrlichial pathogens are distributed globally, mainly in temperate regions, and have been reported throughout Europe.2
* More common in males than females.
* Most often occurs in young adults.
* Elderly patients are more likely to develop severe infections.
Case Report: Successful non-operative management of spontaneous splenic rupture in a patient with babesiosis.
World J Emerg Surg. 2011 Jan 20;6(1):4. [Epub ahead of print]
Tobler WD, Cotton D, Lepore T, Agarwal S, Mahoney EJ.
BACKGROUND: Babesiosis is a zoonotic disease transmitted by the Ixodes tick species. Infection often results in sub-clinical manifestations; however, patients with this disease can become critically ill. Splenic rupture has been a previously reported complication of this babesiosis, but treatment has always led to splenectomy. Asplenia places a patient at greater risk for overwhelming post-splenectomy infection from encapsulated bacteria, Lyme disease, Ehrlichia as well as Babesia microti. Therefore, avoiding splenectomy in these patients must be considered by the physician; particularly, if the patient is at risk for re-infection by living in an endemic area. Case Presentation: A 54 year-old male from the northeast United States presented with left upper quadrant abdominal pain associated with fever, chills, night sweats and nausea. A full evaluation revealed active infection with Babesia microti and multiple splenic lacerations. This patient was successfully treated with appropriate pharmacological therapy and non-operative observation for the splenic injury.
CONCLUSION: Patients diagnosed with Babesia microti infection are becoming more common, especially in endemic areas. Although clinical manifestations are usually minimal, this infection can present with significant injuries leading to critical illness. We present the successful non-operative treatment of a patient with splenic rupture due to babesiosis infection.
PMID: 21251311 [PubMed – as supplied by publisher
Acute Parvovirus B19 Infection Causes Nonspecificity Frequently in Borrelia and Less Often in Salmonella and Campylobacter Serology, Posing a Problem in Diagnosis of Infectious Arthropathy
Clinical and Vaccine Immunology, January 2011, p. 167-172, Vol. 18, No. 1
Several infectious agents may cause arthritis or arthropathy. For example, infection with Borrelia burgdorferi, the etiologic agent of Lyme disease, may in the late phase manifest as arthropathy. Infections with Campylobacter, Salmonella, or Yersinia may result in a postinfectious reactive arthritis. Acute infection with parvovirus B19 (B19V) may likewise initiate transient or chronic arthropathy. All these conditions may be clinically indistinguishable from rheumatoid arthritis. Here, we present evidence that acute B19V infection may elicit IgM antibodies that are polyspecific or cross-reactive with a variety of bacterial antigens. Their presence may lead to misdiagnosis and improper clinical management, exemplified here by two case descriptions. Further, among 33 subjects with proven recent B19V infection we found IgM enzyme immunoassay (EIA) positivity for Borrelia only; for Borrelia and Salmonella; for Borrelia and Campylobacter; and for Borrelia, Campylobacter, and Salmonella in 26 (78.7%), 1 (3%), 2 (6%), and 1 (3%), respectively;
more follows at: http://cvi.asm.org/cgi/content/abstract/18/1/167
Babesia divergens, a Bovine Blood Parasite of Veterinary and Zoonotic Importance
Annetta Zintl,1 Grace Mulcahy,1 Helen E. Skerrett,1 Stuart M. Taylor,2 and Jeremy S. Gray2*
*Corresponding author. Mailing address: Department of Environmental Resource Management, University College Dublin, Belfield, Dublin 4, Ireland. Phone: 353 1 7167739. Fax: 353 1 7161102. E-mail: Jeremy.email@example.com.
The parasite was first positively identified in a splenectomized deep-sea fisherman from Northern Ireland, who probably contracted the disease during a camping holiday (54). In contrast to North America, where human babesiosis is considered an emerging zoonosis with a mortality rate of about 5% (93), babesia infections in Europe are much less common but much more severe and require immediate aggressive treatment. To date, 31 human cases of autochthonously acquired babesia infections have come to medical attention in Europe, all of which occurred in splenectomized individuals (38, 65, 130).
..Human cases of B. divergens infection have been reported in France, Britain, Ireland, Spain, Sweden, Switzerland, the former Yugoslavia, and the former USSR (38, 65). Geographically they coincide with B. divergens-infected cattle populations and I. ricinus-infested areas (106), involving inhabitants of rural areas who are exposed to ticks by virtue of their occupation or their recreational activities (176). Most cases are reported between May and September or October, during the main season of tick activity (65, 176). Thus, although the vector has never been formally identified, I. ricinus is generally regarded as the tick species responsible for the transmission of B. divergens to humans, and experimental evidence shows that human isolates can be transmitted by I. ricinus (120).
Vector transmission of Bartonella species with emphasis on the potential for tick transmission.
Med Vet Entomol. 2008 Mar;22(1):1-15.
Billeter SA, Levy MG, Chomel BB, Breitschwerdt EB.
Center for Comparative Medicine and Transitional Research, North Carolina State University College of Veterinary Medicine, Raleigh, North Carolina 27606, USA.
Bartonella species are gram-negative bacteria that infect erythrocytes, endothelial cells and macrophages, often leading to persistent blood-borne infections. Because of the ability of various Bartonella species to reside within erythrocytes of a diverse number of animal hosts, there is substantial opportunity for the potential uptake of these blood-borne bacteria by a variety of arthropod vectors that feed on animals and people. Five Bartonella species are transmitted by lice, fleas or sandflies. However, Bartonella DNA has been detected or Bartonella spp. have been cultured from numerous other arthropods. This review discusses Bartonella transmission by sandflies, lice and fleas, the potential for transmission by other vectors, and data supporting transmission by ticks. Polymerase chain reaction (PCR) or culture methods have been used to detect Bartonella in ticks, either questing or host-attached, throughout the world. Case studies and serological or molecular surveys involving humans, cats and canines provide indirect evidence supporting transmission of Bartonella species by ticks. Of potential clinical relevance, many studies have proposed co-transmission of Bartonella with other known tick-borne pathogens. Currently, critically important experimental transmission studies have not been performed for Bartonella transmission by many potential arthropod vectors, including ticks.
PMID: 18380649 [PubMed – indexed for MEDLINE]
Coinfections Acquired from Ixodes Ticks
Stephen J. Swanson,1,2 David Neitzel,2 Kurt D. Reed,3 and Edward A. Belongia3*
Clinical Microbiology Reviews, October 2006, p. 708-727, Vol. 19, No. 4
A look at tick-borne infections in Europe by Tick Talk Ireland
Is Lyme disease always poly microbial?–The jigsaw hypothesis.
Med Hypotheses. 2006;67(4):860-4. Epub 2006 Jun 30. Owen DC.
University of Wales, College of Medicine, Accident and Emergency, Heath Park, Cardiff United Kingdom, Cardiff, United Kingdom. firstname.lastname@example.org
Lyme disease is considered to be caused by Borrelia species of bacteria but slowly evidence is accumulating which suggests that Lyme disease is a far more complex condition than Borreliosis alone. This hypothesis suggests that it may be more appropriate to regard Lyme disease as a tick borne disease complex. Over recent years numerous different microbes have been found in ticks which are known to be zoonotic and can coinfect the human host. The hypothesis suggests that multiple coinfections are invariably present in the clinical syndromes associated with Lyme disease and it is suggested that these act synergistically in complex ways. It may be that patterns of coinfection and host factors are the main determinants of the variable clinical features of Lyme disease rather than Borrelia types. An analogy with a jigsaw puzzle is presented with pieces representing Borreliae, coinfections and host factors. It is suggested that many pieces of the puzzle are missing and our knowledge of how the pieces fit together is rudimentary. It is hoped that the hypothesis will help our understanding of this complex, enigmatic condition.
PMID: 16814477 [PubMed – indexed for MEDLINE]
Vet Res. 2011 Jan 18;42(1):7.
Babesias of red deer (Cervus elaphus) in Ireland.
Zintl A, Finnerty EJ, Murphy TM, de Waal T, Gray JS.
UCD School of Biology and Environmental Science, University College
The initial screen using PCR protocol I revealed that 18 deer carried Babesia spp. infections (26%), with 17 originating from Glenveagh and 1 from Killarney (Table (Table2).2). The Babesia species present in these animals were identified by sequence-analysis of fragments amplified using both PCR protocols.
Six samples from Glenveagh showed 100% similarity to B. divergens. In a further five isolates one amplicon (resulting either from PCR protocol I or II) showed 100% B. divergens similarity, although the second amplicon could only be identified to genus level. In addition, identical nested PCR products (amplified using protocol I) from three Glenveagh deer samples were 98% similar to B. odocoilei
Five products from PCR protocol II (4 from Glenveagh and 1 from Killarney) were also identical to each other but did not closely match any Babesia species in the GenBank database (96% similarity with B. divergens, B. odocoilei and EU1) (Table (Table2).2).
Figure Figure22 shows the phylogenetic positions of the amplicons arising from PCR protocol I, which proved to be more discriminating than PCR protocol II. The latter protocol generated amplicons that did not differentiate bovine-origin B. divergens from any of the B. divergens-like species, but showed that the unknown Babesia sp. is clearly separate from B. divergens, B. odocoilei and B. venatorum (Figure (Figure3).3). The remaining positive PCR amplicons could only be identified to Babesia genus level due to poor sequencing data.
From discussion..The highest proportion of babesia-infected deer occurred in the Glenveagh herd and most identifiable babesia sequences were also obtained from this herd. Although serology detected antibodies in the majority of the Killarney samples (unpublished data), no identifiable amplicons could be generated by PCR. It is not obvious why these differences occurred. The deer in all the locations were exposed to heavy tick (Ixodes ricinus) challenge judging by the numerous attached ticks observed at culling.
Analysis of the complete 18S rRNA gene would, of course, have provided a greater level of confidence in the identity of the babesias detected in this study. Unfortunately, available resources did not permit this. Nevertheless, the gene fragment analysis presented here suggests that there are at least two Babesia species, if not three, in the red deer sampled in this study. The significance of these parasites as disease agents is unknown and further studies, in addition to gene analysis, including isolation of the parasites and transmission studies in in vitro or in vivo systems are necessary to establish their identities, particularly that of the putative B. divergens.
Some other diseases transmitted by ticks, such as human erlichiosis and babesiosis, are immunosuppressive and can affect the severity of the infections and lead to treatment difficulties (EUCALB; Krause et al., 1996, 2002). Co-infection with human erlichiosis has, for example, been found in 11.4% of LB cases in a study from southern Germany (Fingerle et al., 1999).
Occurrence of Bartonella henselae and Borrelia burgdorferi sensu lato co-infections in ticks collected from humans in Germany. [Journal Article]
Mietze A, Strube C, Beyerbach M, Schnieder T, Goethe R
Clin Microbiol Infect 2011; 17: 918-920
ABSTRACT: Bartonella (B.) henselae is the zoonotic agent of cat scratch disease. B. henselae has been associated with therapy-resistant Lyme disease in humans suggesting that B. henselae and Borrelia burgdorferi sensu lato might be transmitted concurrently by ticks. In the present study we found that 16 (6.9%) of 230 Ixodes ricinus collected from humans harboured DNA of Bartonella spp. Fifteen positive ticks were infected with B. henselae and one tick with B. clarridgeiae. Twenty-five percent of the 16 Bartonella positive ticks were co-infected with Borrelia burgdorferi sensu lato. Our data show that B. henselae is present in Ixodes ricinus and that ticks may serve as source of infection for humans.