While most of us are concerned about Lyme disease, a tickborne illness circulating during the spring and summertime in the Northeastern U.S, there is another, potentially more serious infection to be aware of as well.

The causative organism behind Lyme disease, the spirochete Borriela burgdorferi, is not alone.

An emerging tickborne infection in the Northeastern U.S. leading to more pronounced symptoms and severity of illness may be more common than previously thought, according to a recent case series published online today in the Annals of Internal Medicine.

Borrelia miyamotoi disease (BMD) was first reported in the Northeastern US in 2013. It has been seen in high numbers among deer ticks, and because of this, it is clear that human exposure has been occurring. But the symptoms associated with BMD are nonspecific, making it difficult to distinguish it from other tick-borne diseases such as Lyme disease, Anaplasmosis, and Babesiosis.

The case series being published in Annals of Internal Medicine by Dr. Phillip Molloy and his colleagues from Imugen Inc, describes the clinical presentation of 51 patients out of 97 identified has having active BMD infection. Researchers utilized a polymerase chain reaction (PCR) for evaluating DNA of blood specimens. In 51 patients analyzed, fever, headache, muscle and joint pains were the most prominent symptoms, usually without any rash. A quarter of these patients required hospitalization for severe illness.

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With BMD, the illness can have a variable course, but in general there was an increased severity of sickness observed among the patients studied. Most patients had a severe headache, along with high relapsing fever, chills, muscle aches, along with abnormal white blood cell and platelet counts.

The authors note that many cases appeared during July and August, suggesting transmission by larval ticks, which have their peak activity during these months. They conclude that infection with BMD should be considered in areas where infections transmitted by deer ticks are endemic.

BMD is so important, according to Molloy, “that in late 2013, the state of Massachusetts became the first state to mandate Borriela miyamotoi being a mandatory reportable infectious disease.”

Sunil K. Sood, MD, Chairman of Pediatrics, North Shore-LIJ’s Southside Hospital, Bayshore, NY, Attending physician, infectious diseases, Cohen Children’s Medical Center, New Hyde Park, New York, believes that BMD is an important emerging disease to consider among those persons who develop fever after possible tick exposures in the Northeastern US.

Sood explains that it has been known for a long time “that spirochetes (spiral shaped bacteria) of the Borrelia genus can cause relapsing fever, but these were transmitted to humans by “soft-bodied ticks” and only in the western U.S.”

But we now know, Sood says, that people can get sick from Borrelia miyamotoi, “a newly discovered Borrelia in the U.S., from the bite of the hard-bodied, black legged deer tick.”

This is the same tick that transmits the Borrelia spirochete that causes Lyme disease. This means that cases of Borrelia miyamotoi disease could be diagnosed in areas of the country where Lyme disease is common — the northeastern, north-central, and far western United States.

“This study makes it important for physicians to keep Borrelia miyamotoi in mind when they see patients with fever during the spring through fall season,” urged Sood. “Fortunately, the infection responds well to common antibiotics used to treat other tick-borne infections.”

Another expert concurred and offered his insight into this disease.

“The take away is that we have on our hands, another tick borne infection, that could potentially cause trouble. We don’t really know the full health burden of this disease yet, but this article adds to our current knowledge about this disease,” said Peter Krause, M.D, Senior Research Scientist in Epidemiology, Infectious Diseases and Pediatrics from the Yale School of Public Health.

The first important finding of Molloy’s study, according to Krause, is that “the frequency of BMD is probably similar to Babesiosis and Anaplamosis.” And after examining seroprevalence rates in studies from Krause’s previous work, and comparing them with data from the current study being evaluated, Krause believes it reasonable to say that “this disease [BMD] is less frequent than Lyme, but in the ballpark frequency of Babeiosis and Anaplasmosis.”

The fact that 25% persons were hospitalized in Molloy’s study is concerning, and is “an illness people need to know about,” based on the 51 patients analyzed, according to Krause. “We don’t know about their immune status, but presumably many of them were not immunocompromised,” added Krause.

The methodology of the current study would tend to favor those that are hospitalized, according to Krause, implying that more in-depth testing for tick borne illness might occur among these hospitalized sicker patients, thereby introducing selection bias. That said, Krause still believes this is an impressive number [24%] in light of any perceived or potential bias.

Krause explains that BMD also occurs a month later than Lyme disease–primarily July and August–because the infected larvae emerge later in the season, the clear product of an infection in the mother tick.

The medical approach to treatment management of BMD does not represent a dramatic shift, according to Krause, but he also urges medical providers to have a higher index of suspicion, and consider BMD in patients with relapsing fevers during the summer months.

Knowing what we know about relapsing fevers during the summertime, Krause also emphasizes that if a pregnant woman develops high fever and any clinical signs to suggest meningitis, BMD should be in the differential, and appropriate testing pursued. While not clinically identified and reported with BMD, tick borne fevers–especially Borriela species–according to Krause, can lead to miscarriages and fetal demise in pregnant women.

While most standard hospital laboratories do not currently offer testing for BMD, Krause believes that by next summer testing will become more widespread–beyond academic centers and the CDC who have the capability for analysis.

Krause emphasizes that an important test for physicians to consider in the setting of BMD is a peripheral blood smear. BMD, unlike Borriela burgdorferi–the causative agent in Lyme disease–lives entirely in blood and you are much more likely to capture it in a peripheral smear.

Finally, Molloy believes that in endemic areas, tick panels (Lyme, Babesiosis, Anaplasmosis, Borriela miyamotoi) are quite useful for evaluating patients presenting to emergency departments in the summer months with undifferentiated fever and viral symptoms–especially in the absence of a rash–essentially because of the issue and presence of co-infections.

 

Source: Forbes

 

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Reference source per PharmaLive editors:

National Alliance of Safe Pest Control at http://www.pests.org