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burgdorferi, and Western Blotting consequently demonstrated false positivity of testing for
Borrleia burgdorferi (4)
In Britain, we know that at least 13 million birds, carrying over 1 million ticks, arrive in
Britain from Africa every Spring (5). Africa has the highest prevalence of relapsing fever
borrelia strains, and of human illnesses and deaths due to the infection. It is reasonable to
conjecture that relapsing fever strains of borrelia have been introduced into the British Isles
by bird ticks, and consequently into the ecosystem.
It has recently been shown by Public Health England that B. miyamotoi is present in Britain
in Ixodes ticks. B. miyamotoi is genetically related to tick-borne relapsing fever (TBRF)
strains. However, in clinical presentation, it can appear more like Lyme borreliosis.
In North America, researchers have shown that, in 182 cases of febrile illness from ticks,
presenting as very similar to Lyme disease, most patients who were eventually found to
have antibodies to B. hermsii were serologically positive for B. burgdorferi, and it was only
the second tier testing (Western blot) that demonstrated false positivity of testing for B.
burgdorferi. "This study demonstrates that TBRF is underrecognized and underreported
and may be falsely identified as Lyme disease" (4).
Similarly, Scoles et al in 2001 found that yet another TBRF strain in the US was
transmitted by Ixodes ticks (6)
Of greatest relevance to Britain, European scientists Richter et al have found a third strain
of the relapsing fever borrelia in Europe and state "We now know that a third member of
this group infects I. ricinus ticks in central Europe. We conclude that each of the various
kinds of ticks that serve as vectors for Lyme disease spirochetes, I. ricinus, I. persulcatus,
I. scapularis [= dammini], may be infected by relapsing fever–like spirochetes" and they
state "Exposure risk for relapsing fever–like spirochetes is similar to that of certain Lyme
disease genospecies." (7)
Many patients report to us that they have had positive results on the initial ELISA tests for
Lyme disease, but that subsequent Western blot tests have proved negative. It seems
possible that they might have been in fact infected with a TBRF strain, even one that is as
yet unrecognised, which would have produced such test results.
Thus it is necessary to include the TBRF illnesses into the scope of this committee, as they
may be indistinguishable from Lyme disease.
References1) Co-infection of Ticks: The Rule Rather Than the Exception Sara Moutailler, Claire Valiente Moro, Elise Vaumourin,Lorraine Michelet, Florence Hélène Tran, Elodie Devillers, Jean-François Cosson,, PatrickGasqui, Van Tran Van, Patrick Mavingui, Gwenaël Vourc'h, Muriel Vayssier-Taussat. PLOS Neglected Tropical Diseases | DOI:10.1371/journal.pntd.0004539 March 17, 20162) [Brazilian lyme-like disease or Baggio-Yoshinari syndrome: exotic and emerging Brazilian tick-borne zoonosis].Yoshinari NH1, Mantovani E, Bonoldi VL, Marangoni RG, Gauditano G. Rev Assoc Med Bras. 2010 May-Jun;56(3):363-9. http://www.ncbi.nlm.nih.gov/pubmed/206765483) http://www.columbia-lyme.org/patients/tbd_stari.html4) Tick-Borne Relapsing Fever in the Northwestern United States and Southwestern
Canada Dworkin, M. Anderson S.D.E,Jr, Schwan,T.G., Shoemaker, P.C., Banerjee, S.N.,
Kassen, B.O., and Burgdorfer, W.
Clinical Infectious Diseases 1998;26:122–31Tick-Borne Relapsing Fever in the
Northwestern United States and Southwestern Canada T
http://cid.oxfordjournals.org/content/26/1/122.full.pdf
5) Population estimates of birds in Britain and in the United Kingdom.
Br. Birds. (Stone et al., 1997)
https://www.britishbirds.co.uk/wp-conte…/…/2010/12/APEP3.pdf
6) A Relapsing Fever Group Spirochete Transmitted by Ixodes scapularis Ticks. Scoles, G
A; Papero, M; Beati, L and Fish, D. Vector Borne and Zoonotic Disease Vol.1 Number 1,
2001.
7) Relapsing Fever–Like Spirochetes Infecting European Vector Tick of Lyme Disease
Agent. Dania Richter, Daniela B. Schlee,and Franz-Rainer Matuschka. Emerging
Infectious Diseases • Vol. 9, No. 6, June 2003
Co infections must be considered in tick-bite patients.
The Anaplasmataceae are already being diagnosed as tick-bite infections, and co-
infections, by PHE microbiologists: it is hoped that infectious disease consultants in
England and Wales are aware of the possibility.
However, it is patient experience that testing for the infection is not routine, despite
patients presenting with signs and symptoms of a febrile illness - even in those with a
known tick bite.
This must change, especially because climate warming means that all vector-borne
diseases will increase in incidence in the next decade.
It has been well known for 40 years at least, that ticks carry and may transmit to humans, a
wide variety of pathogens, including nematodes, trypanosomes, and Rickettsiae, as well as
a number of viruses(1).
A recent review of the relevance to public health by Professor Christian Peronne deserves
careful perusal (2).
Bartonellosis is one of the most frequently diagnosed infections found as a co-infection in
UK Lyme disease patients. Yet we know that diagnosis, especially after the acute phase,
can be a difficult task. It is our experience that chronically infected patients are not offered
tests. Even when tested, most are negative by UK methods, yet they have been found to
be positive for Bartonella species by non-UK laboratories.
Ticks play a role in the natural cycles of some of the bartonellae including those
pathogenic for humans. Consequently, bartonelloses should be included in the differential
diagnosis for patients exposed to tick bites(3). Health authorities must take into account
the possibility of bartonellosis in persons exposed to tick bites, and the Bartonella species
recognised as tick-borne pathogens (4).
Bartonella infection causes symptoms which are similar to LB, in many ways including
neurological signs, but the therapeutic treatment is different from that used for
borreliosis(5, 6). Thus an accurate diagnosis is crucial for successful treatment, and patient
survival and quality of life.
Babesiosis
German scientists A. Hildebrandt, J. S. Gray and K.-P. Hunfeld, in their report "Human
Babesiosis in Europe: what clinicians need to know" (7) state: " Although best known as an
animal disease, human babesiosis is attracting increasing attention as a worldwide
emerging zoonosis. Humans are commonly infected by the bite of ixodid ticks. Rare ways
of transmission are transplacental, perinatal and transfusion-associated. Infection of the
human host can cause a very severe host-mediated pathology including fever, and
hemolysis leading to anemia, hyperbilirubinuria, hemoglobinuria and possible organ failure.
In recent years, apparently owing to increased medical awareness and better diagnostic
methods, the number of reported cases in humans is rising steadily worldwide. Hitherto
unknown zoonotic Babesia spp. are now being reported from geographic areas where
babesiosis was not previously known to occur, and the growing numbers of travelers and
immunocompromised individuals suggest that the frequency of cases in Europe will also
continue to rise."
Babesia, though relatively rarely diagnosed in the UK other than in cattle, has caused
canine deaths in Leeds and Nottingham this year (2016) and there are many cases of
debilitating human illness. A one-hour discussion on the UK's largest Lyme forum revealed
5 fully-diagnosed patients responding, within that short time on Wednesday 16th March, 9
am - 10 am, to state that they had acquired Babesiosis in the UK. No one knows how
many human deaths may have been attributable to Babesiosis, because there has been
no surveillance in potential clinical cases which could have been due to the infection. For
example, stroke patients are not screened for this piroplasm, yet blood dyscrasias from the
infection are bound to have effects on blood clotting etc.
Within the last three decades a dramatic rise in numbers of reported transfusion-
associated cases in the US has been documented, with at least 12 fatalities and 160 cases
[8, 9]. Outside America only two other cases of transfusion-transmitted babesiosis had
been reported by 2013, one from Japan that involved a B. microti-like parasite [10] and
one from Germany caused by B. microti (11).
VIRAS urges the NICE guideline committee, and all health protection agencies, to include
Babesia from tick bites into the scope of the Lyme guidelines. It is a a clear threat to the
health and safety of British citizens, not just through transmission through tick bites, but as
a potential blood supply contaminant.
REFERENCES
1/ Aspects nouveaux du rôle de vecteur joué par Ixodes ricinus L. en Suisse Note
préliminaire. Aeschlimann A, Burgdorfer W, Matile H, Peter O, Wyler R. Acta Tropica 36
181-191 (1979)
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