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Tick Borne Diseases 4/20/2018 Tick-Borne Diseases Awareness, understanding and compassion Dr. Onnie Thatcher 1 AGENDA • Tick-Borne Disease Epidemic • Lyme Disease & Co-Infections • Diagnosis & Testing • Acute Treatment • Chronic Disease Treatment & Support • 3 Tests for Tick-Borne (hands-on) 2 1 4/20/2018 AN EPIDEMIC • Tick-borne disease is the most common vector- borne infectious disease in the U.S. • We need to educate our family, friends & patients • We will discuss & demo chiropractic tools you can use to help your patients 3 4 2 4/20/2018 5 6 Source: https://www.cdc.gov/lyme/stats/index.html 3 4/20/2018 Source: Wisconsin Division of Public Health 7 8 4 4/20/2018 9 U.S. MAPS 10 5 4/20/2018 U.S. MAPS 11 TickNET A Collaborative Public Health Approach to Tick-Borne Disease Surveillance & Research Figure 2. US cases of Lyme disease, ehrlichiosis, anaplasmosis, babesiosis, and spotted-fever group rickettsioses reported to the Centers for Disease Control and Prevention, 2001–2013. Counts include confirmed and probable cases, according to the case definition in effect in each year. Anaplasmosis cases were reported as human granulocytic ehrlichiosis before 2008. Ehrlichiosis refers to infections caused by Ehrlichia chaffeensis, E. ewingii, and undetermined species. *Babesiosis was first designated a nationally notifiable condition during 2011. Source: www.cdc.gov 12 6 4/20/2018 https://wwwnc.cdc.gov/eid/article/21/9/15-0301_article 13 TICK-BORNE DISEASES OF THE U.S. • Anaplasmosis • Rickettsia parkeri • Babesiosis rickettsiosis • Borrelia mayonii • Rocky Mountain Spotted • Borrelia miyamotoi Fever (RMSF) • • STARI (Southern Tick- Bourbon virus Associated Rash Illness) • Colorado tick fever • Tickborne relapsing fever • Ehrlichiosis (TBRF) • Heartland virus • Tularemia • Lyme disease • 364D Rickettsiosis • Powassan disease Source: https://www.cdc.gov/ticks/diseases/index.html 14 7 4/20/2018 WHY IS IT GETTING WORSE? • Climate • Encroachment • Wildlife management • Toxic environment 15 TICK ID 16 8 4/20/2018 TICK ID 17 18 9 4/20/2018 DEER TICK • Ixodes scapularis • Can carry co-infections and triple infections • Nymphs have had one blood meal, usually from rodents and small animals • Adults have had two blood meals, the second can be larger animals or humans and can carry more infections • Can transmit: Lyme, babesiosis, anaplasmosis, tick paralysis, Powassan encephalitis, tularemia, Rocky Mtn. Spotted Fever, and bartonella 19 20 10 4/20/2018 TICKS SPREAD DISEASE VIA FEEDING Prepares to feed (10 mins to 2 hours) Drops off, Grasps skin, prepares for cuts into next life surface stage Ingests host pathogens or transmits Sucks blood Inserts previously for several barbed acquired days feeding tube pathogens to host Secretes “cement” & Cement-like substance to stay anesthetic attached; saliva with anesthetic properties so host can’t feel it 21 NYMPH CAN YOU SEE IT? 22 11 4/20/2018 TICK SPECK 23 ADULT DOG/WOOD TICK 24 12 4/20/2018 ENGORGED TICKS Nymph Adult 25 TICK ATTACHMENT • Chemoreceptors in legs & arms – Sense body heat, vibrations such as voices and barking, CO2 (exhalation) & movement • Can release from high areas, jump from grasses, twigs, leaves • Also blow thru wind CT Dept. of Health: “Ticks are found in grassy and overgrown areas where they wait to grasp onto warm bodies that pass by; they do not jump, fly or drop out of trees.” 26 13 4/20/2018 TICK ON SCREEN 27 TICKS ON OUR PETS 28 14 4/20/2018 TICKS ON BILL (CASE STUDY) • Tick magnet • MDs thought heart trouble • Tested for Lyme, Babesia, Bartonella • After treatment, no longer a tick magnet • Years later he said, “I’m a tick magnet again” – Re-tested, & positive for ticks 29 REMOVING TICKS 1. Use fine tip tweezers 2. Grab close to skin 3. Pull straight up • Don’t twist or jerk • Mouthparts may break off & remain in skin* *Remove the mouth-parts with clean tweezers If unable to remove the mouth easily, leave it alone and let the skin heal 30 15 4/20/2018 AVOID FOLKLORE • Goal = remove tick as quickly as possible – Don’t wait for it to detach 31 THOROUGHLY CLEAN BITE & HANDS Iodine scrub 32 16 4/20/2018 PREVENTION • Avoid tall grass & over-grown areas • When hiking, stay in middle of trails • Tuck pant legs into socks • Wear long-sleeved shirts, closed shoes • Wear light-colored clothing – Easier to see ticks for removal • Talk to your veterinarian – Protect pets from tick bites 33 CONSIDER TICK REPELLENT 34 17 4/20/2018 PERMETHRIN • Synthetic chemical that acts like natural extracts from chrysanthemum flower • Affects nervous system of insects that eat or touch it – Insects can’t break it down as quickly as people & dogs • Broken down by soil microorganisms • Does not mix well with water (doesn’t break down) – Do NOT use near lakes or rivers – Tiny amount can wipe out fish 35 RETURNING HOME • Remove clothing outside • Shower using a washcloth or puff to remove unattached ticks • Put clothes in dryer – Heat kills ticks hiding in clothing 36 18 4/20/2018 AGENDA • Tick-Borne Disease Epidemic • Lyme Disease & Co-Infections • Diagnosis & Testing • Acute Treatment • Chronic Disease Treatment & Support • 3 Tests for Tick-Borne (hands-on) 37 HISTORY OF LYME IN U.S. • Lyme Disease on Plum Island – Fringe conspiracy theory or government cover-up? 38 19 4/20/2018 39 40 20 4/20/2018 LYME DISEASE • 5 subspecies of Borrelia burgdorferi – Over 100 strains in the US – 300 strains worldwide • This diversity is thought to contribute to the antigenic variability of the spirochete and its ability to evade the immune system and antibiotic therapy, leading to chronic infection (From ILADS) 41 SPIROCHETES • Worm-like, coiled bacteria (around for billions of years) • Eight different genera • Over 200 species & counting – Numerous subspecies (they change their genetic structure) – Difficult to find & research – All need a host to survive • Borrelia burgdorferi (Bb) causes Lyme disease – Discovered by researcher Willy Burgdorfer in 1982 – Lyme arthritis discovered in 1975 (Lyme, CT) • B. afzelii & B. garinii are primary causes of Lyme in Europe & Asia 42 21 4/20/2018 43 Production of filamentous B. burgdorferi by ATc-mediated induction of asftsZ RNA. (A) B. burgdorferi 297/tetR cultured for 24 h in the presence of 1.5 μg of ATc/ml (acridine orange staining; magnification, 1,250). Lydia Dubytska et al. J. Bacteriol. 2006;188:1969-1978 44 22 4/20/2018 PLEOMORPHIC FORMS OF BORRELIA • “…Taken together, the results indicated that B. burgdorferi can change morphology very quickly, adapt and survive in adverse environments, and have pleomorphic forms consisting of DNA as well as antigenic relevant proteins that are freely recognized by the immune system. In addition, B. burgdorferi and its pleomorphic forms have atypical cell wall characteristics and that these sleath round bodies have the ability to become viable spirochetes.” 26 April 2014, ILADS European Conference, Augsburg, Germany Written text by Leena Meriläinen, and Leona Gilbert from Department of Biological and Environmental Sciences and NanoScience 45 Center, University of Jyväskylä, Jyväskylä, Finland 46 23 4/20/2018 TRANSMISSION • Ticks • Fleas • Other biting insects? • Blood transfusion • Crosses through placenta • Possibility in breast milk • Intercourse 47 SHOULD WE LIVE IN A BUBBLE? 48 24 4/20/2018 ILADS LYME PREVENTION TIPS 49 Source: http://www.ilads.org/lyme/lyme-tips.php LYME SIGNS & SYMPTOMS “THE GREAT IMITATOR” • Fatigue, chills, fever, headache, muscle & joint aches, swollen lymph nodes, migrating pain • EM rash • Brain fog • Insomnia • Facial or Bell's palsy • Severe headaches and neck stiffness due to meningitis • Joint swelling • Shooting pains that may interfere with sleep • Heart palpitations & dizziness due to changes in heartbeat • Shortness of breath 50 25 4/20/2018 COMMON LYME CO-INFECTIONS 1. Bartonella 2. Babesia 3. Anaplasmosis 4. Ehrlichiosis 51 1. BARTONELLA • Gram-negative pleomorphic rods • Slow-growing, but fastidious • Cellular targets: erythrocytes & endothelial cells • Hide in RBC’s • Transmitted via fleas, ticks & many think any biting insect • Cause inflammation, fibrin deposits & biofilms in blood vessels 52 26 4/20/2018 BARTONELLAE COMMON INFECTION STRATEGY Alexander Harms, and Christoph Dehio Clin. Microbiol. Rev. 2012;25:42-78 53 FLAGELLATION OF BARTONELLA Alexander Harms, and Christoph Dehio Clin. Microbiol. Rev. 2012;25:42-78 54 27 4/20/2018 BARTONELLA RASH 55 BARTONELLA EFFECTS • Damage collagen fibers, causes skin problems such as striae (longitudinal lines) • Damage spongy bone (creating deep bone pain) • Cause vascular neuropathy (from destroying small blood vessels) • Many neurological & psychological symptoms (especially in adolescent boys) • Reaction time decreases, executive function decreases, OCD, slow response 56 28 4/20/2018 2. BABESIOSIS (BABESIA) Description Signs & Symptoms • Protozoa parasite • High fever transmitted by deer ticks • Muscle aches • Invade RBC’s • Chills • Treatment includes anti- • Fatigue microbial agents: • Headache – Atovaquone, AZT, or clyndamycin are typical • Cough • Herbal remedies (anti- • Athralgia parasitical) • Loss of appetite • Anemia 57 MICROSCOPIC VIEW OF BABESIA LENGAU SP. NOV. Anna-Mari Bosman et al. J. Clin. Microbiol. 2010;48:2703- 2708 58 29 4/20/2018 BABESIA RASH 59 3. ANAPLASMOSIS Description Symptoms • Discovered in mid 1990s • Typically no rash • Transmitted by deer ticks • Fever • 6 states account for 90% of all • Malaise reported cases (CDC) • Headache – New York, Connecticut, New • Chills Jersey, Rhode Island, Minnesota & Wisconsin • Muscle pain • Needs immediate treatment; • Nausea Doxycycline is recommended • Brain fog antibiotic • Most acute infections feel like – Interestingly, no age limit, as “worst illness they’ve had” with treating Lyme 60 30 4/20/2018 ANAPLASMOSIS Number of annual anaplasmosis cases 1994-2010: The graph displays the number of human cases of anaplasmosis cases reported to CDC annually from 1994 through 2010. Cases of anaplasmosis have generally increased from 350 cases in 2000, when the disease became nationally notifiable, to 1163 cases in 2009. The number of reported cases increased 52% between 2009 and 2010.
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