New course on healthy cat ownership

Invisible’s new continuing medical education course, “Zoonotic diseases and pet cats,” describes common diseases that can spread from cats to humans, along with some simple prevention tips. It’s taught by Erin Lashnits, MS, DVM, PhD, DACVIM, a clinical assistant professor in small animal internal medicine at University of Wisconsin’s School of Veterinary Medicine. Her pedigree as a veterinarian and a cat lover includes an MS degree in biology from Stanford University, a DVM from Cornell University, and a PhD in comparative biomedical sciences from North Carolina State University.

There are about 370M domestic cats and 600M unowned cats around the world, and they all come with a certain amount of disease risk. In this course, Dr. Lashnits provides an overview of these risks, as well as preventative measures to take when introducing a new cat into a home.

In Dr. Lashnits’ experience, she sees cat bites as a concerning risk. There are an estimated 400,000 cat bites a year, and a high percentage of these may lead to deep infections.

“Cat bites are much more likely to get infected than dog bites,” said Dr. Lashnits. “So taking care to play safely with cats and kittens is super important – use toys, not fingers.”

Fleas are also a major concern, since they can transmit, bartonelloses, plague, and rickettsial diseases. Toxoplasmosis and various types of worms can also be transmitted from cat feces. To avoid these diseases and others she recommends daily cleaning of litter boxes and year-round flea, tick, and heartworm medicine.

It’s also important to note that humans can transmit COVID to their cats, and this risk goes up if cats share a bed with humans.

Dr. Lashnits also provides a checklist for new cat owners:

  • Make sure your new cat is vaccinated, dewormed, and treated for fleas and ticks before taking it home.
  • Keep your cat quarantined for at least a week before giving it the run of the house, to minimize stress and look for signs of disease.
  • Discourage children from letting kittens bite their hands during play.
  • Avoid feeding your cat raw food to prevent food-borne diseases.
  • Take your cat for routine veterinarian checkups.
  • Provide your cat with year-round flea, tick, and heartworm protection.
  • Get into a routine of cleaning litter boxes daily.

The Invisible Education Initiative, funded by the Montecalvo Foundation, provides free, accredited Continuing Medical Education (CME) courses that focus on vector-borne and environmental illness within a One Health framework. These courses are available to clinicians and the public. To donate to this initiative and to learn about Invisible International, please go here http://invisible.international/give.

Watch here: https://learn.invisible.international/courses/zoonotic-disease-and-pet-cats/

Neuropsychiatric Lyme symptoms: A new masterclass

Invisible International has just released an important medical education course on neuropsychiatric symptoms associated with Lyme disease, with treatment recommendations for specific manifestations. The course is taught by Shannon Delaney, MD, MA, an assistant professor in the Department of Psychiatry and neuropsychiatrist at Columbia University Irving Medical Center.

A key section of the course reviews the latest evidence on Lyme disease persistence after standard treatments, useful in overturning the long-held belief that Lyme disease is always easy to treat and cure.

“It’s staggering,” said Dr. Delaney. “Months to years after the initial infection of Borrelia burgdorferi, patients with Lyme disease may have chronic encephalopathy, polyneuropathy, or less commonly, leukoencephalitis,” she said.

Other topics covered in this masterclass include:

  • The definition of Post-Treatment Lyme Disease Syndrome (PTLDS), as defined by the medical community.
  • Case studies that illustrate the unreliability of testing for neurological Lyme disease.
  • Immune system biomarkers associated with neurological Lyme disease.
  • A description of how the Lyme bacteria creates disease in humans.

Dr. Delaney also reviews a cohort study that analyzed the clinical data of 12,616 Lyme disease patients over 22 years. The study, a collaboration of Columbia University and the Copenhagen Research Centre for Mental Health, is believed to be the first large, population-based study examining the relationship between Lyme disease and psychiatric outcomes. The results are a wakeup call for those who think of Lyme as a disease of mainly rashes and swollen joints; the study found that patients who received a hospital diagnosis of Lyme disease—inpatient, outpatient, or at the ER—had a 28 percent higher rate of mental disorders and were twice as likely to have attempted suicide post-infection, compared to individuals without the diagnosis.

This course reinforces the need for physicians to consider mental health symptoms when developing treatment plans for tick-borne disease patients.

The Invisible Education Initiative, funded by the Montecalvo Foundation, provides free, accredited Continuing Medical Education (CME) courses that focus on vector-borne and environmental illness within a One Health framework. These courses are available to clinicians and the public. To donate to this initiative and to learn about Invisible International, please go here http://invisible.international/give.

Watch here: https://learn.invisible.international/courses/neuropsychiatric-symptoms-with-lyme-disease-tick-borne-illness/

Why is it so hard to find a Lyme doctor? Here are some reasons.

In the first study of its kind, two Lyme disease experts gathered data on a question frequently asked by tick-borne disease patients: Why is it so hard to find a Lyme-treating physician? And how could there be such a doctor shortage, when there are 476,000 new annual Lyme cases per year reported from all 50 states?

Invisible’s new short course answers this question based on data from a survey-study of 155 clinicians from 30 states who treat Lyme patients. The study’s goal was to identify the problems that clinicians face when treating these patients, a first step to overcoming these obstacles. The study’s authors are Elizabeth L. Maloney, MD, a Minnesota family physician and Invisible’s education co-director; and Lorraine Johnson, JD, MBA, the Chief Executive Officer of LymeDisease.org and the principal investigator of its patient registry and research platform, MyLymeData.

The first point that the study authors make is that these patients aren’t easy. Seventy-nine percent of survey respondents said that their biggest challenge was the complexity of care required for tick-borne disease patients. Because Lyme and co-infection testing is unreliable or nonexistent, clinical exams typically take longer than is reimbursed by medical insurance. This means that clinicians lose money on these patients because the economic reimbursement model in the U.S. doesn’t work for complex and/or chronic conditions.

In many cases, Lyme patients have cognitive impairments caused by brain inflammation, making it hard for patients to communicate accurate medical histories and follow treatment protocols. About half of the providers said that their Lyme patients require more handholding and calls between regular appointments than with other diseases.

One of the most surprising findings was the stigma-burden faced by Lyme-treating physicians. Three-quarters said that they had suffered from professional stigma, including:

  • 61% experienced a lack of collegial support
  • 59% faced opposition from physician organizations
  • 19% had been subject to medical board inquiries
  • 11% had been excluded from insurance networks

“We can think of professional stigma, regulatory investigations, and failed economic models as forming a wall that not only separates patients from clinicians but produces significant disincentives for clinicians to provide care,” said Dr. Maloney. “This leads to a significant supply-and-demand mismatch, which is why patients have trouble finding a treating clinician.”

The Invisible Education Initiative, funded by the Montecalvo Foundation, is working to educate more health-care providers on the best protocols for getting Lyme patients better  faster. We do this by providing free, accredited Continuing Medical Education (CME) courses that focus on vector-borne and environmental illness within a One Health framework. These courses are available to clinicians and the public. To donate to this initiative and to learn about Invisible International, please go here http://invisible.international/give.

Watch here: https://learn.invisible.international/courses/barriers-to-lyme-disease-treatment-what-the-data-is-showing/

New course on healthy dog ownership

Invisible’s new continuing medical education course, “Zoonotic diseases and pet dogs,” discusses common diseases that can spread from dogs to humans, along with some simple prevention tips. It’s taught by Erin Lashnits, MS, DVM, PhD, DACVIM, a clinical assistant professor in small animal internal medicine at University of Wisconsin’s School of Veterinary Medicine. Her pedigree as a veterinarian and a dog lover includes an MS degree in biology from Stanford University, a DVM from Cornell University, and a PhD in comparative biomedical sciences from North Carolina State University.

It’s estimated nearly half of all U.S. households own one or more dogs (80 to 90 million total), and along with cohabitation comes additional disease risks. In this course, Dr. Lashnits covers diseases that can be transmitted from dogs, advice on how to safely import dogs from abroad, and preventative measures when introducing a new dog into a home.

Dr. Lashnits’ new dog checklist:

  • Make sure your dog is vaccinated, dewormed, and treated for fleas and ticks before taking it home.
  • Before letting a new dog roam free with other dogs, keep it separated for about a week, observing for any signs of disease.
  • Avoid feeding your dog raw food to prevent food-borne diseases.
  • Take your dog for routine veterinarian checkups.
  • Provide your dog with year-round flea, tick, and heartworm.
  • Review the CDC guidelines on importing dogs from abroad.

In Dr. Lashnits’ practice, she sees dog bites and flea- and tick-borne diseases as major disease risks. Fleas can carry Bartonella, plague, and rickettsia species. Ticks can transmit Lyme disease, Rocky Mountain spotted fever, several deadly viruses, and a host of other pathogens.

She also offers a warning about dog kisses: “Try to train your dog not to lick you on the mouth, and if it does, wash your hands and face,” said Dr. Lashnits.

Dr. Lashnits goes on to explain how dogs can serve as sentinels for human disease, citing the use of dogs for tracking the alarming spread of invasive Asian longhorned ticks across the middle Atlantic states.

The Invisible Education Initiative, funded by the Montecalvo Foundation, provides free, accredited Continuing Medical Education (CME) courses that focus on vector-borne and environmental illness within a One Health framework. These courses are available to clinicians and the public. To donate to this initiative and to learn about Invisible International, please go here http://invisible.international/give.

Watch here: https://learn.invisible.international/courses/zoonotic-disease-and-pet-dogs/

New CME course on “Diagnostic Challenges in Lyme disease”

In Invisible’s latest medical education course, Monica Embers, PhD, associate professor of microbiology and immunology at the Tulane National Primate Research Center and a leading expert in Borrelia burgdorferi (Lyme) infections in non-human primates, discusses problems with the current two-tiered Lyme testing protocol and describes a promising new diagnostic approach that her lab is working on.

Most Lyme experts agree that the 30-year-old antibody testing approach that we use needs a serious overhaul. The tests don’t work well in the first few weeks after a tick bite because the immune system hasn’t yet produced measurable antibodies. And people who have the worst infections or compromised immune systems may have antibody levels too low to measure. These “false negatives” can lead to truly sick people being denied treatment and going on to become chronically ill.

After a brief overview on the clinical stages of Lyme disease and the two-tiered testing protocol, Dr. Embers goes deep on how immune system responses change during an infection and after treatment. Her strong recommendation: Start over with Lyme testing criteria using next-generation molecular detection equipment to define antibody profiles for all stages of Lyme disease, guided by a more statistically valid study design—because every positive Lyme case missed could result in a life lost to chronic disease.

Another must-see course from Dr. Embers is “Antibiotic efficacy for treatment of Lyme disease,” which presents emerging evidence from animal studies suggesting that the Lyme disease bacterium, Borrelia burgdorferi, is a clever trickster that uses multiple strategies to evade the immune system and survive long after an onslaught of the recommended course of antibiotics. And in her third course, “Chronic Infection and the Etiology of Dementia,” she lays out the evidence that the Lyme bacteria could be one possible cause of dementia.

The Invisible Education Initiative, funded by the Montecalvo Foundation, provides free, accredited Continuing Medical Education (CME) courses that focus on vector-borne and environmental illness within a One Health framework. These courses are available to clinicians and the public. To donate to this initiative and to learn about Invisible International, please go here http://invisible.international/give.

Watch here: https://learn.invisible.international/courses/diagnostic-challenges-in-lyme-disease/

The tick-borne disease epidemic in Ireland: A call for more research

In our newly released medical education course, a Dublin-based infectious disease physician-researcher raises the alarm about the undercounting and under-treatment of tick-borne diseases in Ireland, as well as the risk that this poses to the country’s blood supply.

This course, “Call for international collaboration and data sharing from the clinical trenches,” is taught by Jack Lambert, MD, PhD, a Professor of Medicine and Infectious Diseases at Mater and Rotunda hospitals, and University College of Dublin School of Medicine in Dublin, Ireland. He is also the founder of the Lyme Resource Centre in Scotland and a member of Invisible’s Scientific Advisory Board.

In the course, Dr. Lambert cites studies that have found that:

  • The standard two-tiered antibody tests miss more than 50% of verifiable Lyme patients.
  • One-in-five serum samples from the Irish blood bank showed the presence of antibodies to the Lyme disease bacterium, Borrelia burgdorferi. [Source: Irish Surveillance Center data from high prevalence areas]
  • The overall rate of borrelial infection in ticks collected at six sites in Ireland was 5%, with a range from 2% to 12%, depending on the locations of tick collection. The most prevalent species detected were garinii (70%) followed by B. valaisiana (20%) and B. miyamotoi (10%). All of these Borrelia species cause human disease, and this is the first time that Bmiyamotoihas been detected in Ireland.

“Most people don’t remember a tick, many don’t get the bullseye rash, and many are not offered a Lyme test. For those truly infected, the Lyme antibody test is insensitive. Until we have enhanced surveillance of clinical cases and improved sensitivity of the diagnostic testing, numbers of cases of Lyme disease and coinfections will be underreported,” said Dr. Lambert.

Dr. Lambert also highlights a major flaw in the Lyme disease tracking in Ireland: Reporting is only required for the most serious neurological manifestations of the disease, i.e., patients who have been admitted to a hospital and have had a lumbar puncture that shows specific abnormalities in the cerebral spinal fluid.

Other topics covered include the undercounting of Lyme cases in Canada and the United Kingdom, the geographic spread of Lyme in Europe, and the need to treat patients according to symptoms, not one-size-fits-all guidelines. He goes on to cite evidence that treating with longer courses of combinations of antibiotic yields better patient results.

This free, accredited Continuing Medical Education (CME) is brought to you by the Invisible Education Initiative, funded by the Montecalvo Foundation.

Watch here: https://learn.invisible.international/courses/call-for-international-data-sharing-from-the-clinical-trenches-in-ireland/

Invisible’s Big Wins of 2022

As 2022 comes to an end, the team at Invisible International is taking a moment to reflect on and celebrate our top five achievements of the last year. Invisible was founded only three years ago by a team of passionate and experienced physicians and scientists who recognized the need for a unique approach to solving the challenges of tick-borne illness. This dynamic team remains united around a common mission: To solve the persistent problem of vector- and tick-borne diseases with collaborative, creative educational approaches. In 2022, Invisible officially adopted the One Health framework, which positions its mission within the nexus of climate, human, and animal health. With this change, Invisible has many more collaborators and tools to engage new partners on the challenges of tick-borne disease. Invisible has a lot more in store for 2023, but let’s take a moment to celebrate the wins of 2022!

Our 30+ medical education courses had 7,000 views and received industry accreditation

The Invisible Education Initiative, funded by the Montecalvo Foundation, received accreditation from the prestigious Accreditation Council for Continuing Medical Education (ACCME) for its library of 30-plus continuing medical education courses. (Individual courses are accredited by the American Academy of Family Physicians.) These free courses serve up the latest in research and clinical advice on vector-borne illness, delivered by some of the most knowledgeable experts in their respective fields.

Why it matters: There’s a shortage of experienced tick-borne disease clinicians, with many patients having to wait months and travel long distances for appointments. Our free, on-demand courses—which have been viewed by 7,000+ health-care providers, medical schools, and patients—will increase the number of informed health-care providers. The education platform’s ACCME validation will encourage more physicians to take these courses for credit and will make it easier to integrate these courses into medical school curriculums. These courses will save lives.

Our storytelling team launched a Bartonella education campaign that reached millions

Swamp Boy” — an article, video, and TikTok — tells the dramatic tale of a 14-year-old boy who suddenly experiences sudden-onset psychosis. The story follows his parent’s hellish journey into the medical system as they struggle to save their oldest son from permanent residency in a psychiatric ward. At the root of the teen’s medical problems was Bartonella henselae, a poorly understood stealth bacterium that causes cat scratch disease and disseminated Bartonellosis. This story was published through NowThis, which reaches 115+ million people and 60% of millennials (18-34) each month in the U.S. It was their #2 most read story in 2022 and was lauded by New York Times columnist Ross Douthat. The online story is backed up by a peer-reviewed case study and seven new medical education courses on Bartonellosis developed by members of our “Storytelling for Change” team.

Why it matters: This story is educating the public on common symptoms, testing strategies, and effective treatments for this misunderstood pathogen. It will help many sufferers shed the stigma associated with the mental health symptoms associated with these infections to seek treatment from Bartonella-aware physicians.

Our first “One Health” course is now featured on a CDC training website

Invisible is using the One Health problem-solving framework to reduce the impact of tick- and vector-borne diseases, which have worsened with climate change, ecosystem imbalances, and funding inequities. This year we released a new course taught by Cheryl Stroud, DVM, PhD, “One Health for Human Health Clinicians,” which helps clinicians view their most difficult patient diagnostic challenges through the eyes of a veterinarian and an academic researcher focused on environmental toxins. This course is featured on the CDC’s “Southeastern Center of Excellence in Vector Borne Diseases” training website.

Why it matters: The rise in vector-borne diseases is harming both humans and animals, yet veterinarians and physicians rarely share clinical wisdom on these common foes. Human clinicians can learn a lot from veterinarians on disease pattern recognition, diagnostic strategies, and prevention, and we’re trying to facilitate this transfer of knowledge through our courses.

Our online Hackathon brought global innovators together to propose solutions for connecting animal and human health experts

This year our Innovation Hackathon, funded by the Lovell Family Foundation, focused on enhancing communication between animal and human clinicians. During this One Health Day event, four winning teams received funding for proposals to develop 1) A social network for animal and human health professionals; 2) A comprehensive national review of childhood tick prevention education; 3) An AI-powered surveillance system for vector-borne diseases; 4) A novel tick-borne illness detection device

Why it matters: There are no easy ways for veterinarians, physicians, and public health officials from different countries to share emerging disease data and best practices. Yet diseases and epidemics don’t respect borders. We use our annual hackathons to encourage multidisciplinary teams from around the world to solve our toughest challenges in inventive, technology-driven ways.

We expanded our educational partnerships to Europe and are sharing content with other Lyme nonprofits and wellness websites

This year our curriculum team added our first international CME instructor, Jack Lambert, MD, PhD, a Professor of Medicine and Infectious Diseases at Mater and Rotunda hospitals, a University College of Dublin School of Medicine in Dublin, Ireland, and the founder of the Lyme Resource Centre in Scotland. As we release new courses, our storytelling team works to maximize visibility through content-sharing with the Lyme community and popular wellness websites. For example, this year, MindBodyGreen and LymeDisease.org co-published two important articles on diagnosing tick-borne diseases in adults and young children, reaching millions.

Why this matters: The rise of tick-borne diseases is an international problem that is getting worse with climate change and global travel. After we invest in the development of evidence-based courses, we strive to share this information as widely as possible through strategic partnerships. We will continue to grow our international outreach in the coming year.

If you’d like to see more of these types of projects, please consider making a donation, no matter the size, to Invisible International. With your donation we will be able to continue to pursue medical education, research, and community empowerment programs, all with the mission of alleviating the suffering caused by invisible illnesses.

Wishing you all a healthy holiday and a prosperous new year. We know that our success wouldn’t be possible without your support, and we look forward to improving the health of all in the coming year.

When a loved one dies of Lyme: Donating to BAL’s Research Biorepository

Donating the tissues of a loved one who dies of Lyme disease is one of the best ways to accelerate research into better diagnostics and treatments for tick-borne diseases, because sample acquisition is often the most expensive and time-consuming part of a research study. There are very few sources of prescreened human tissue available to researchers.

The Lyme Disease Biobank (LDB), run by Bay Area Lyme Foundation (BAL), offers the best program for facilitating tissue donations and for delivering these samples to qualified researchers. LDB works in partnership with two non-profits, the National Disease Research Interchange (NDRI) and MyLymeData.

The process goes like this: NDRI works with families on the completion of authorization/consent forms and medical histories, then manages the tissue collection. LDB funds the collection and sample storage, and qualifies researchers to receive samples. Families can also link donations to the deceased’s MyLymeData profile, providing researchers with valuable information on a person’s medical history and Lyme or tick-borne disease diagnoses and treatments.

Since the tissue bank was launched in 2018, more than 10 families have donated tissue from deceased loved ones, and over 1,100 blood and urine samples have been collected. Thus far, more than 70 projects have been approved to receive samples. These tissues are being sent to researchers to study infection and inflammation processes and markers, which will provide insights for improving future diagnostics and treatments.

To make this process less stressful on families, NDRI can work with families to create a donation plan. LDB recommends that the NDRI forms be completed as soon as possible in advance of an expected death by requesting them through NDRI’s website at https://ndriresource.org/lyme-disease.

There is someone at NDRI available 24/7/365 to answer questions and assist with shorter timelines. NDRI will determine if a collection site is nearby or will help families locate a pathologist through a mortuary or a nearby medical institution. You can donate from anywhere in the continental U.S.

For more information about tissue or organ donation, visit NDRI’s Lyme registration page, or call 800-222-NDRI (6374), option 5. If the donation is imminent, or if you need immediate assistance, please call the number above.

For general questions that are not time-dependent for collection, please email Liz Horn, PhD, MBI, Principal Investigator, Lyme Disease Biobank at info@lymebiobank.org.

For more information:

Lyme Disease Biobank

Diagnosing young children with Lyme disease, advice from a pediatrician

Lyme disease affects children more than any other age group, but the young ones are often difficult to diagnose, especially before they’ve developed the vocabulary to describe how they’re feeling. To help parents recognize symptoms and prevent serious illness, I chatted with Charlotte Mao, MD, a pediatric infectious disease physician who trained at Harvard Medical School and Boston Children’s Hospital, and practiced at The Dean Center for Tickborne Illness, Spaulding Hospital, where she treated children with complex Lyme disease. She currently serves as the Curriculum Director for Invisible International’s Medical Education Initiative. Here are some frequently asked questions that she encounters in her practice.

Q: What do I do if I find a tick on my child?

If you see a tick embedded in your child, position a fine-tipped tweezer where the tick’s head meets the skin, then swiftly pull it straight out. Do not grasp, squeeze, or twist the tick’s body. Then place it in a plastic baggie with a small piece of damp paper towel. Wash the extraction area and your hands thoroughly with soap and water.

Consider sending the the tick to a testing lab, to identify the species and what microbes are inside of it. Because the current Lyme disease screening tests are unreliable in the first few weeks after a bite (it takes this long for humans to develop antibodies that can be measured), the results might provide your physician with useful information, especially if your child later comes down with symptoms. You can also go online to identify which tick species transmit various disease agents. Lyme disease is carried by blacklegged ticks, Ixodes scapularis in the Eastern United States and Ixodes pacificus in the West.

Some experts say that it takes at least 36 hours for an attached tick to transmit Lyme bacteria to a host, because this is the minimum time it takes for these bacteria to travel from a tick’s midgut to its saliva glands. However, transmission can happen in some cases with a shorter duration of attachment, specifically when bitten by a partially fed tick that already has Lyme bacteria in its saliva from a previous attachment. This occurs in about 5 to 10 percent of infected ticks, according to the Lyme bacteria discoverer, Willy Burgdorfer. Other tick-borne microbes, such as the potentially deadly Powassan virus, can be transmitted in as little as 15 minutes after tick attachment.

Time is of the essence in preventing serious tick-borne disease. So, in Lyme endemic areas, I personally advise parents to begin preventative antibiotic treatment before tick testing results come back, within 48 to 72 hours of attachment. Over the following month, closely observe a child for symptoms, such as an expanding skin lesion at the bite site, fever, malaise, headache, mild neck stiffness, aches/pains in muscles, or joints aches. If these develop, visit your pediatrician.

Q: How can I tell if my child has Lyme disease?

Early signs of Lyme disease include flu-like symptoms, such as fever (often mild), chills, head and neck pain, body aches (muscle and joint), malaise, and fatigue. (Unfortunately, these symptoms can be mistaken for irritability or viral infections, such as the flu or COVID. Check your child for a Lyme disease rash and don’t forget to check the scalp and skin-fold areas (groin, armpits, behind the knees, and ears). Not everyone gets the classic “bulls-eye” rash; an expanding rash without central clearing is more common. You can find some sample rash images on the Internet.

Other classic Lyme manifestations that can develop include a weakness or paralysis of facial muscles (Bell’s palsy); intense headaches, numbness, tingling, or weakness in extremities (neuropathy); eye and heart issues (especially cardiac rhythm abnormalities); and joint swelling or pain. Gastrointestinal symptoms, generally underappreciated as potential Lyme manifestations, may include nausea, abdominal pain, vomiting, loss of appetite, gastroparesis (stomach paralysis), and/or constipation.

Q: What are some of the late-stage Lyme symptoms?

Physical complications can involve the joints, nervous system, and eyes. Lyme arthritis most commonly involves  one or a few large joints, especially the knee, but can also affect the jaw (temporomandibular joint or TMJ), and, occasionally, small joints of the fingers and toes. Fatigue and aches/pains are common in late and early disease. Lyme disease can also cause behavioral or mood changes in children. Some children develop neuropsychiatric manifestations such as anxiety, depression, panic attacks, or obsessive-compulsive disorders. All these symptoms can come and go, and this can be confusing to a patient, their family, and teachers. But trust that you know your child best, and if you suspect Lyme, visit your pediatrician.

Q: What are the best Lyme disease tests?

A Lyme disease diagnosis ultimately needs to be made based on a multifaceted clinical evaluation with lab work viewed as supportive (or not), but not definitive. My diagnosis is based on a comprehensive medical history, a physical exam, and diagnostic testing for other potential explanations besides Lyme disease.

In testing, I prefer to use Lyme specialty labs that provide more diagnostic information than standard commercial labs. I particularly like Medical Diagnostics Laboratory (MDLab.com) for Lyme immunoblot testing. Immunoblots detect the presence of antibodies to specific proteins of a microorganism that develop  after a person has been exposed to a target infectious organism. Once detected, these antibodies  can be seen as dark bands on a blotting membrane or an imaging system. MDLab’s immunoblot reports include detection results for more than the 10 CDC-specified Lyme bands, and a photo of the patient’s actual blot with an objective optical density score grading the intensity of each detected band.  In some cases, fainter bands that do not meet the lab’s positivity threshold still might provide useful clinical information, increasing the suspicion of a past or present Lyme infection.

Q: What’s your treatment approach for young children?

As an infectious disease specialist, I typically see children who’ve already been treated by their pediatrician but have continuing symptoms after standard treatment courses. These more complex cases often require individualized management approaches.

If a child has not yet received an initial antibiotic course for Lyme disease, I start with recommended oral antibiotics—doxycycline, amoxicillin, or cefuroxime. (While doxycycline has traditionally not been prescribed for children under 8 years of age due to concerns of dental staining, studies have shown the risk of dental staining is much less with doxycycline than older tetracyclines. The American Academy of Pediatrics now says doxycycline can safely be used in children under 8 years for short durations, up to 21 days. Notably, doxycycline has long been the treatment of choice, regardless of age, for tick-borne rickettsial diseases such as Anaplasma, Ehrlichia, and Rocky Mountain Spotted Fever.

For acute central nervous system issues such as Lyme meningitis, I prescribe recommended intravenous antibiotics (typically ceftriaxone), which more effectively reaches therapeutic drug levels in the brain and central nervous system. I also use intravenous ceftriaxone for Lyme arthritis when symptoms haven’t resolved after two courses of oral antibiotics.

To avoid gut issues, I prescribe probiotics and monitor for adverse effects such as diarrhea.

Q: What if symptoms continue after treatment?

In the U.S., ticks are known to carry 18 or more disease-causing microbes, and sometimes concurrent infections can cause lingering symptoms, even after recommended Lyme disease treatment. A considerable degree of overlap exists among the nonspecific manifestations of Lyme disease and other tick-borne infections, but there are certain symptoms that are more prevalent for specific co-infections. I routinely test for Bartonella, Babesia, Anaplasma/Ehrlichia, and Borrelia miyamotoi if the child has not already had this testing done.

Bartonellosis, an under-recognized bacterial infection that can be transmitted by fleas, lice, or cat scratches/bites, can cause a multitude of symptoms, some of them overlapping with those of Lyme disease. These might include fever; swollen lymph nodes; an enlarged liver or spleen; skin “tracks” that may resemble striae or stretch marks; “evanescent” rashes that come and go; and neuropsychiatric symptoms, especially anxiety, panic attacks, anger/aggression/rage episodes, and obsessive-compulsive disorders. Other potential symptoms include tremors; jerky movements; sudden muscle weakness (e.g., “legs giving way”); a sensation of internal vibration; seizures; musculoskeletal pain, including in soles of the feet or shins (the latter is a reported feature of trench fever, caused by Bartonella quintana); abdominal pain; and eye issues (including uveitis and retinitis, both also seen with Lyme). Lab findings occasionally seen with Bartonella, all typically mild, include decreases in white blood cell count; increased eosinophils or monocytes; hemolytic anemia (rarely); increased C-reactive protein levels; and liver enzyme elevations.

Common babesiosis symptoms, caused by a parasite that infects red blood cells, include night or day sweats, fevers (can be high), chills, fatigue, malaise, hemolytic anemia and low platelets. Less common symptoms include headache, dry cough, shortness of breath (sometimes described as “air hunger”), nausea, abdominal pain, vomiting, and diarrhea.

The combination of low white blood cell and platelet counts make me suspect Anaplasma or Ehrlichia.

I always ask about factors that increase risk for repeat exposure/infection, such as outdoor hobbies (hiking, camping, gardening) and exposures to animals and blood-sucking bugs such as ticks, fleas, and lice. For the child with persistent symptoms after recommended treatment regimen(s), I also explore the possibility of nutritional/vitamin deficiencies or environmental toxic exposures, such as water-damaged buildings with mold contamination. Mold toxins or mycotoxins, produced by certain mold species, can complicate Lyme disease or co-infections by causing overlapping symptoms or negatively impacting treatment response.

The decision to administer additional antimicrobial therapy in patients with persistent or recurrent symptoms following standard treatment for Lyme disease is a controversial issue. According to treatment guidelines of most major medical societies, there is no good evidence that these persistent “post-treatment” symptoms are driven by an active infection that might benefit from additional antimicrobial therapy. The topic is too complex to cover here, but I’ll say simply that I do not agree with this blanket statement. The question of how best to treat this subgroup of patients is an area that requires more research and funding.

Q: I’m pregnant. Can I pass Lyme disease to my unborn child?

Borrelia infections can be transmitted from a pregnant mother to her infant. How frequently this occurs and the range of potential health risks for the infant/child have not been well-established. Studies to-date indicate significantly fewer adverse outcomes in treated compared to untreated pregnant women. This is another area that has been under-studied and requires more research attention and funding.

Q: I’m sending my kids to summer camp. Any advice on keeping them safe?

 I recommend pre-spraying clothing with permethrin to keep ticks away. This typically remains effective for six to eight washings. Have them pack insect repellents and don’t forget to teach them how to do tick checks.

Q: What resource can I give my child’s pediatrician to learn more about tick-borne illness?

Invisible International has created the first-ever continuing medical education platform that focuses on tick-borne illness. It is accredited by the American Academy of Family Physicians. Courses on this platform are available at no cost to physicians and other providers. Learn more and share this with your child’s pediatrician. Invisible’s Medical Education Initiative is supported by the Montecalvo Foundation.

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New CME: A roadmap for treating neuro-Lyme patients

Dr. Nevena Zubcevik, co-founder of “The Dean Center for Tick Borne Illness” at Spaulding Rehabilitation Hospital/Harvard Medical School and Invisible International’s Chief Medical Officer, has spent a decade successfully treating patients with Central Nervous System (CNS) Lyme disease, aka “neuro-Lyme.” This week she shares her best clinical advice in the first of three medical education courses covering neuro-Lyme symptoms, diagnosis, and treatment strategies.

Unfortunately, the population of chronic neuro-Lyme patients has grown steadily over the last few decades, primarily because of systemic delays in early diagnosis and inefficacy of treatments. It’s sobering to realize that the standard screening test misses up to 89% of early infections (Steere et al, 2008). And after treatment, many patients reported new-onset patient-reported symptoms that increased or plateaued over time. At 6 months, 36% of these patients reported new-onset fatigue, 20% widespread pain, and 45% neurocognitive difficulties. (Aucott, 2013)

Dr. Zubcevik’s first course describes typical neuro-Lyme clinical presentations and discusses the mechanisms of nerve injury that are caused by Lyme disease bacteria. She emphasizes that these injuries are complex but treatable.

Based on her experience as a Harvard-trained, board-certified physical medicine and rehabilitation physician, Dr. Zubcevik stresses the importance of a multidisciplinary “all hands on deck” approach for these patients, many of whom have serious deficits in memory and brain functioning. She recommends that coordination of care —appointment management, home support, physician referrals, and insurance coverage—be an integral part of any treatment plan. She says that mental health support and an anti-inflammatory diet are also key to a patient’s recovery.

The next two courses will dive deeper into how the Lyme bacteria damages the neurological system and dysregulates the immune system. It then lays out detailed diagnosis and treatment strategies for physicians.

This free, accredited Continuing Medical Education (CME) is brought to you by the Invisible Education Initiative, funded by the Montecalvo Foundation.

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