Tag Archives: tick-borne co-infections

GLA Point of View on New Tick-Borne Co-infection Diagnostic Test

by Timothy Sellati, Ph.D., Chief Scientific Officer, GLA

Lyme disease is the most commonly occurring vector-borne disease in the United States. The number of cases reported to the Centers for Disease Control and Prevention (CDC) has increased steadily over the past 25 years. The actual number of cases that occur annually is difficult to pinpoint given several shortcomings associated with the current FDA-approved two-tier serologic testing protocol. Laboratory methods for the diagnosis of Lyme disease fall into two categories: (1) direct methods to detect the Borrelia burgdorferi,bacterium, the causative agent of Lyme disease, and (2) indirect methods that detect the immune response (antibodies) against it. Shortcomings associated with the current testing protocol include low sensitivity in those newly infected, subjectivity in the interpretation of Western immunoblot results, and the inability of the test to discriminate between current active infection versus past exposure.

Despite the annual estimated number of cases being 300,000 to 329,000 nearly 3.4 million Lyme serologic tests are performed each year.  The predictive value of a test is determined by its sensitivity, specificity, and the prevalence of the disease in the population to be tested. Given the Lyme testing protocol’s shortcomings, coupled with sometimes inappropriate use of the test (prior to production of antibodies against B. burgdorferi) and the ability of the pathogen to shut down antibody production during later disease, there is an unacceptably high rate of false-negative and false-positive results.  The most effective treatment options can only be pursued when rapid and accurate diagnosis occurs. Compounding the challenge faced by physicians in choosing the correct course of treatment is the fact that the black-legged (“deer”) tick, Ixodes scapularis, also serves as a vector for Powassan virus, Borrelia miyamotoi and mayonii infections, and the causative agents of anaplasmosis, babesiosis. Lack of knowledge about the co-infection status of an individual can delay provision of appropriate treatment(s) to combat all the symptoms experienced by a patient. Recognizing that the longer a pathogen remains in the body the more likely the severity and duration of disease will be greater, there is a critical medical need for rapid, sensitive, and specific diagnosis.

It is for this latter reason that so much excitement surrounds the announcement that Global Lyme Diagnostics (GLD), which launched its ground-breaking Lyme diagnostic in 2017, and is now launching its tick-borne co-infections diagnostic test. This new co-infection panel offers physicians the ability to test patient samples for evidence of the most common tick-borne diseases (i.e., Anaplasma, Babesia microti and B. duncani, Bartonella henselae and B. quintana, and Rickettsia including the Spotted Fever Group).

According to GLD’s CEO, Mickey Ramchandani, “The new co-infection test is the most affordable on the market with the quickest turnaround time from test to results and allows physicians to custom-pick the co-infections they want to test for—not forcing them to run a battery of tests for a co-infection they have already deemed unnecessary through their own analysis.” Ramchandani also states that “Our mission at Global Lyme Diagnostics has been to reduce false negatives plaguing the Lyme testing assays with a test that is not only reliable but is also affordable to a wider population. We are now expanding our test menu to also include multiple different co-infections that result from tick bites.”

GLD licensed the technology platform and related intellectual property surrounding chimeritopes developed by Richard T. Marconi, Ph.D., a Professor in the Department of Microbiology and Immunology at Virginia Commonwealth University. Dr. Marconi also serves on the Scientific Advisory Board of Global Lyme Alliance.


timothy sellatiTimothy J. Sellati, PH.D. is Chief Scientific Officer at Global Lyme Alliance

As GLA’s Chief Scientific Officer, Dr. Sellati leads GLA’s research initiatives to accelerate the development of more effective methods of diagnosis and treatment of Lyme and other tick-borne diseases.

What is Air Hunger, Anyway?

By Jennifer Crystal

Chronic Lyme disease & its co-infections, like Babesia, can produce unique symptoms. One of them is referred to as air hunger.

When I tell people I have chronic Lyme and some of its co-infections, they often look at me quizzically and ask: “What’s a co-infection?” I explain that in addition to Lyme ticks can transmit other diseases as well. I get an understanding nod until I say the names of the diseases. Rarely have people heard of them: Babesia, Ehrlichia, and Bartonella. One of my graduate school professors got so tired of trying to say “Babesia” that he jokingly renamed it “babelicious.”

I get a similar reaction when I tell people that a chief symptom of Babesia is air hunger. Some hear the term and think of marathon runners or asthma patients. Most really have no idea what it actually means. Literally, it means to be hungry for air. But how is that related to Babesia, and what does the symptom actually entail?

Babesia is a parasite that eats the oxygen in red blood cells. This result is low blood oxygen levels in the body. When you are hungry for food, your stomach might grumble, and you might feel a gnawing or emptiness, a craving for sustenance. You might become lightheaded or even faint. The same is true when your blood is hungry for oxygen, except you feel the hunger in your cells rather than in your stomach.

You know when exercising how you can feel your blood pumping, whereupon endorphin release makes you vivacious and energized? That feeling when your muscles are a little tired from running or biking, but you’re also exhilarated, hitting that “runner’s high” when you feel like you can do a million jumping jacks?

I used to feel that, too. I used to ski for eight hours in the back bowls of the Rocky Mountains, bouncing through mogul fields with reckless abandon. And at the end of the day, my body would be loose and limber. I was tired, sure, but it was nothing that a good meal and a good night’s sleep couldn’t fix. The next morning, I’d be ready to ski again.

Then I got Lyme, Babesia, and Ehrlichia. At first, before the illnesses were properly diagnosed, I simply noticed that I couldn’t keep up with my fellow skiers as I used to. I tired more easily, needed more breaks, and often experienced blood sugar crashes and lightheadedness after a particularly intense run. Skiing at a high altitude means there’s less oxygen available, to begin with, but what I didn’t know was that a blood parasite was also compromising my oxygen levels.

As the tick-borne illnesses slowly took over my body, my post-exertional fatigue and hypoglycemia increased. Sometimes I’d experience these symptoms when I was simply walking down the street. I started to get terrible migraines, always after exercise but sometimes just after a long day of teaching, and sometimes for no apparent reason at all. What I didn’t know was that the oxygen level of my red blood cells was getting lower and lower, causing these debilitating symptoms.

One day towards the end of my second year of teaching in Colorado, I tried to go for a short hike near my apartment. I barely made it a few feet up the dirt path before I found myself gasping for air. I wanted to take a deep breath, but couldn’t get one. As I clutched my chest, another hiker asked if I was okay. “Asthma,” I wheezed, even though I’d never experienced that condition before.

A doctor did diagnose asthma but didn’t explain the sudden onset. He didn’t realize that my gasping for breath was a literal manifestation of air hunger caused by Babesia. Instead, he gave me an inhaler, which I sometimes needed to use in class; in the middle of a lecture, I would get so lightheaded and short of breath.

Later, when I was finally diagnosed with and treated for tick-borne illnesses, I experienced Herxheimer reactions so bad that skiing, hiking and even walking became activities of the past; I could barely get up a flight of stairs. Often my arms and legs would feel jumpy like I was having a panic attack. This is because they weren’t getting enough oxygen; the jumpiness was their way of “grumbling” like a stomach does when it needs food. My limbs felt, how can I put this? They felt empty, the opposite of the way they used to feel when they were pumped full of healthy oxygenated blood during exercise. I wanted to take a deep breath and send the air right to my limbs, right to my cells, to re-invigorate them, but I couldn’t.

Overeager during treatment, I started physical therapy too soon, and paid for it. A mere thirty seconds on a stationary bike left my limbs gasping for air. It seemed like a thick molasses was seeping through my whole body, weighing me down. A heavy sensation crept into my head, filling it with pressure until I was overtaken by a full-blown migraine. After, I was in bed for a week.

The good news about that experience is that it told my doctor I needed to increase my Babesia treatment. Anti-malarial medication got me back on my feet, eventually back on the stationary bike, and, finally, back on my skis. I don’t think I’ll ever be able to bounce through moguls for eight hours at a time again, but I can ski a full morning without getting air hunger. I can paddle-board or canoe for hours. Sometimes, when I push myself too hard, I feel a tightening in my chest for a day or two after exercise. And sometimes I begin to feel air hunger in my cells as I’m walking around the city, getting that jumpy feeling in my limbs when I climb a flight of stairs or get a headache shortly after exercise. This tells me that it’s time to increase the homeopathic drops I now take to keep Babesia at bay.

Now I can say to my doctor, “I’m starting to feel some air hunger,” and he knows exactly what we need to do. Hopefully, this explanation will be a revelation for those readers who, like me, were so long perplexed by this frightening undiagnosed symptom.


Opinions expressed by contributors are their own.

Jennifer Crystal is a writer and educator in Boston. Her memoir One Tick Stopped the Clock is forthcoming. Contact her at [email protected].

Podcast: Tick-Borne Co-Infections, Bartonella and Powassan Virus

Bartonella is a tick-borne co-infection. As with Lyme disease, its symptoms can be debilitating.

 

While the most common tick-borne infection is Lyme disease, infected ticks may carry more than one kind of microbe or disease producing organism that can make humans very sick. The microbes are called co-infections, the simultaneous infection of a host by multiple pathogenic or disease-producing organisms.

Dr. Mayla Hsu, GLA’s Director of Research and Science, and Dr. Harriet Kotsoris discuss Lyme and its co-infections in a recent podcast. Below is an excerpt of the podcast that focuses on Bartonella and the Powassan virus.

CLICK HERE to listen to the entire podcast.


Host: I’ve heard there’s a new tick-borne infection that’s somewhat controversial called Bartonella. Mayla would you like to tell us more about that?

Dr. Hsu: Sure. Bartonella is a bacterium that’s controversial in discussions of tick-borne illnesses because there is quite a lot of debate about whether it is actually spread by ticks and causes human disease. Now we know that it’s spread by fleas and body lice and sand flies, but ticks are a somewhat new idea that is gaining traction in some quarters. Bartonella is in domestic and wild animals and it causes various illnesses that we know about, such as cat scratch disease and trench fever, where people get bitten by fleas that are feeding on animals or by body lice. Now in recent years, Bartonella bacteria has been found in ticks in many countries around the world. The ticks do feed on host animals that carry Bartonella so it’s not surprising to find the bacterium in the ticks.

Humans with tick exposure, like hunters, have been found to have antibodies against Bartonella so that indicates they’ve been exposed, but whether Bartonella actually causes illness in healthy people is under debate. There’s no question that Bartonella is a big problem for people who are immuno-compromised and they can get sick, but even there we don’t know how much of it is acquired from tick bites versus flea bites. Now, if people do get Bartonella it’s diagnosed by looking for the DNA of the bacteria or by growing or culturing the bacteria, and then it is treated with antibiotics. Often the first symptom is striations or lines that look like stretch marks on the skin and it can progress into fever and lead to very serious illnesses including things like heart inflammation or endocarditis.

Host: A new class of microbe that is very different from the bacteria and parasites we’ve been hearing about are the viruses spread by ticks. Since they can’t be treated with antibiotics, should we be worried about them?

Dr. Hsu: The virus that is spoken about as transmitted by Ixodes or black-legged ticks, is the Powassan virus, which is also sometimes called deer tick virus. Powassan virus or deer tick virus are actually two different genetic lineages of very similar virus so let’s just call it Powassan virus. It was first described in the 1950s. Powassan virus can be very serious because in half of cases, 50% of cases, people have continued long-term neurological consequences and disability due to encephalitis, or inflammation of the central nervous system. The virus actually infects the brain. The fatality rate can be 10 to 20%, especially in the elderly, the immunocompromised or people with other health conditions.

The symptoms for Powassan virus are fever, vomiting, weakness, memory loss, and seizures. The diagnosis is made by doing a blood test or a spinal tap looking for antibodies against the virus. The treatment for Powassan virus is, as you said, it can’t be treated with antibiotics. They don’t work against the virus, so the treatment is mostly supportive. That is providing respiratory support, fluids, drugs to reduce brain swelling. Now, luckily Powassan virus is rare. There were 13 cases that were reported in 2013 to the CDC, so it’s actually not a really prevalent disease. It is found in actually a very low percentage of ticks, maybe three to 5% of ticks are co-infected with Lyme disease and Powassan virus, so it is there. It is present so we have to be concerned about it. Now overseas there are many more cases of a brain infection caused by ticks, there is tick-borne encephalitis, and that is also caused by a virus, a tick-borne encephalitis virus, that has been recorded and associated with serious illness.

Host: Obviously a lot of people haven’t heard of these co-infections spread by ticks, can you tell us about some of the major problems and how we cope with tick-borne diseases?

Dr. Hsu: One of the biggest issues is probably awareness. There are medical professionals who have heard of Lyme disease but may not have heard of these others.

Dr. Kotsoris:  Health authorities may not test for some of these if they’re unaware of them and then ordering the right diagnostic tests has to be done. The Lyme disease diagnostic by itself is highly inaccurate and so even getting that diagnosis is problematic. Without reliable molecular diagnostic techniques some tests are only available experimentally or at limited federal or state levels. Initial diagnosis is very difficult and you can’t sit around and wait for an antibody response, so physicians have to be better diagnosticians. They can not, as I said before, they can not sit around and wait for convalescent titers, antibody titers to indicate that the patient has had the infection. That’s four to six weeks after the initial infection. Until the FDA approves some of these experimentally available techniques, makes them more widely available to the frontline physician, we have to rely on clinical diagnosis.

Host: What about the treatment of tick-borne illnesses?

Dr. Kotsoris: It’s important to note the treatment for Lyme disease doesn’t cure the others necessarily, so proper diagnosis is critical to getting proper treatment that is specific for the co-infecting microbe. Also having two infections might make the symptoms tougher to treat. There are some research studies that indicate that co-infections actually make the illnesses more powerful individually. For example co-infections of Babesia and Lyme disease may make it harder to treat the patient than if he or she had only one of those.

Host: Are there other issues we should be thinking about with regard to tick-borne co-infections?

Dr. Hsu: I think there’s a lot we simply don’t know about the biology of co-infecting pathogens. For instance, we don’t understand a lot about how they grow in their host animals, more than one microbe. We don’t really understand how they get into a tick and how they survive in the tick, and very basic questions like infection of humans, from ticks to humans.

Host: Given all the lack of awareness, what kind of studies are needed to better understand and treat tick-borne diseases?

Dr. Hsu: There are some emerging illnesses now that are suspected of being caused by ticks but we don’t know for sure. We need more research. For instance, there’s a new illness that’s emerging called stari, S-T-A-R-I, and what that stands for is Southern Tick-Associated Rash Illness. We know that this is caused by a tick bite but we still don’t know what the pathogen or the microbe is that is responsible for the illness. Diagnosis, which we talked about is sometimes complicated. Some of the technology to diagnose some of these co-infections, like really sensitive molecular biology, looking for the DNA of the organism, is not readily available in some parts of the world.

Dr. Kotsoris: Travelers to other parts of the world may come home to the United States where the best of medical care is apparently available and doctors here may not know about those tick-borne illnesses, so education has to be a big part of it.

Host: Tick-borne diseases are a very big problem. Let’s hope that public health officials and the funding organizations take them seriously, especially since climate change is going to mean more sick people, more school and work absences, less productivity, and have a huge economic impact. Thank you for all the discussion today and thank you to all of you listeners.

CLICK HERE to listen to the entire podcast.