scholarly journals Powassan Virus Encephalitis Following Brief Attachment of Connecticut Deer Ticks

2020 ◽  
Author(s):  
Henry M Feder ◽  
Sam Telford ◽  
Heidi K Goethert ◽  
Gary P Wormser
Keyword(s):  
United States ◽  
Lyme Disease ◽  
The United States ◽  
Tick Bite ◽  
Molecular Testing ◽  
Tick Bites ◽  
Epidemiologic Evidence ◽  
Powassan Virus ◽  
Tick Attachment ◽  
Virus Subtype

Abstract Background Powassan virus (POWV) is a tick-transmitted pathogen that may cause severe encephalitis; experimentally, it can be transmitted within just 15 minutes following a tick bite. The deer tick virus subtype of POWV (DTV) is transmitted by the deer tick and is the likely cause of the increase in the number of POWV cases reported in the United States. However, DTV has only been definitively documented in 6 patients by molecular analysis of the virus. Methods Two patients from Connecticut with encephalitis, who had a recent deer tick bite, were evaluated by the relevant serologic tests to determine if they had been infected with POWV. Evaluation also included molecular testing of an adult deer tick that had been removed from one of the patients. Results We documented neuroinvasive POWV infection in 2 children from Connecticut. Based on the results of testing the tick removed from case 2, this patient was infected by DTV, representing the 7th reported case and the first documented case of DTV infection in a child. Of note, the duration of the tick bites in both cases was very short. Conclusions We provide the first clinical and epidemiologic evidence that POWV/DTV can be rapidly transmitted to a human host, that is, within hours of tick attachment, which is distinctive when compared to other deer tick-transmitted infections such as Lyme disease.

Complement Split Products C3a and C4a Are Early Markers of Acute Lyme Disease in Tick Bite Patients in the United States

2008 ◽  
Vol 146 (3) ◽  
pp. 255-261 ◽  
Author(s):  
Ritchie C. Shoemaker ◽  
Patricia C. Giclas ◽  
Chris Crowder ◽  
Dennis House ◽  
M. Michael Glovsky
Keyword(s):  
United States ◽  
Lyme Disease ◽  
The United States ◽  
Tick Bite ◽  
Early Markers

Diagnosis, Treatment, and Prevention Practices for Lyme Disease by Clinicians, United States, 2013-2015

2021 ◽  
pp. 003335492097323
Author(s):  
Alyssa R. Beck ◽  
Grace E. Marx ◽  
Alison F. Hinckley
Keyword(s):  
United States ◽  
Health Care ◽  
Lyme Disease ◽  
Disease Diagnosis ◽  
Tick Bite ◽  
Clinical Practices ◽  
Tick Bites ◽  
Treatment And Prevention ◽  
High Incidence ◽  
Disease Testing

Objectives Although tick-borne diseases account for a large number of health care visits in the United States, clinical practices for tick bite and Lyme disease treatment and prevention are not well understood. The objective of this study was to better understand factors associated with clinical practices related to tick bites and Lyme disease. Methods In 2013-2015, questions about tick-bite evaluation, Lyme disease diagnosis and treatment, appropriate use of Lyme disease testing, and tick-bite prevention were included in Porter Novelli’s DocStyles survey, a nationally representative annual web-based survey of health care providers. We performed analyses of responses by provider license type and state-level incidence (high or low) of Lyme disease in 2019. Results A total of 4517 providers were surveyed across the 3 study years. Overall, 80.9% of providers reported that they had evaluated at least 1 patient for a tick bite, 47.6% had diagnosed at least 1 patient with Lyme disease, and 61.9% had treated at least 1 patient for Lyme disease in the previous year. Providers from states with a high incidence of Lyme disease saw more patients for tick bites and Lyme disease than providers from states with a low incidence of Lyme disease. Few providers correctly chose Lyme disease testing as clinically useful in the hypothetical case of a patient from a state with a high incidence of Lyme disease with an arthritic knee (36.0%) or with new-onset atrioventricular block (39.5%), and respondents across all provider types incorrectly chose testing when not clinically indicated. Most providers (69.7%) reported routinely recommending tick-bite prevention methods to patients. Conclusions Many providers evaluate patients for tick bites and treat patients for Lyme disease, but knowledge about appropriate testing is low. Providers may benefit from tailored education about appropriate Lyme disease diagnosis, testing, and effective tick-bite prevention.

scholarly journals 153. Utilization of Post-Exposure Prophylaxis to Prevent Lyme Disease in a Large US Healthcare Database

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S188-S188
Author(s):  
Grace E Marx ◽  
Candace C Fuller ◽  
Nicole Haug ◽  
Dave Martin ◽  
Catherine Corey ◽  
...  
Keyword(s):  
Single Dose ◽  
Lyme Disease ◽  
Disease Incidence ◽  
The United States ◽  
Emergency Department Visits ◽  
Tick Bite ◽  
Post Exposure Prophylaxis ◽  
Tick Bites ◽  
Post Exposure ◽  
Exposure Prophylaxis

Abstract Background In the United States, at least 50,000 emergency department visits for tick bite and an estimated 476,000 Lyme disease diagnoses occur annually, with incidence of both high among children. The majority of these healthcare visits occur in the northeastern and midwestern states having high Lyme disease incidence and during the summer and fall months, corresponding to peak opportunities for exposure to blacklegged ticks. Post-exposure prophylaxis (PEP) with a single dose of doxycycline can effectively prevent Lyme disease after a tick bite that is high risk for transmission of Lyme disease. We describe characteristics of patients with dispensings of single-dose doxycycline in a large US-based system that includes patients enrolled in private and public health insurance plans. Methods Single-dose doxycycline (≤200 mg) dispensings during January 2009 – February 2020 were identified for patients enrolled in seven Data Partners that contributed electronic healthcare data to the Food and Drug Administration Sentinel Distributed Database, including large national insurers, an integrated delivery care network, a state Medicaid, and the 100% Medicare fee-for-service plan. We examined patient and PEP dispensing characteristics by patient age, state of residence, and month of dispensing. Results We identified 408,897 patients with PEP (n=474,414 total dispensings) with a mean age of 60 years at first dispensing. Overall, there were 21 patients per 10,000 eligible members with PEP dispensings. Dispensings were less common in children (< 1 and 4 patients per 10,000 eligible members aged < 8 and 8-18 years, respectively). Most dispensings (72%) occurred in states with high incidence of Lyme disease. Seasonality of dispensings was bimodal, with most occurring during April – July and October – November (71 – 83%, by year). Conclusion Lyme disease PEP was relatively common and mirrored geographic and seasonal trends observed for ED visits for tick bites and Lyme disease diagnoses. However, we observed more PEP among older adults, and few dispensings among children. Despite healthcare visits for tick bites and Lyme disease occurring disproportionately among pediatric age groups, PEP appears to be underutilized in children. Disclosures All Authors: No reported disclosures

Mosquito and Tick-borne Illnesses in the United States. Guidelines for the Recognition and Empiric Treatment of Zoonotic Diseases in the Wilderness.

2019 ◽  
Vol 19 (3) ◽  
pp. 238-257
Author(s):  
Suresh Antony
Keyword(s):  
United States ◽  
Lyme Disease ◽  
Spotted Fever ◽  
Disease Process ◽  
Rocky Mountain ◽  
The United States ◽  
Health Care Facilities ◽  
Diagnostic Tools ◽  
Rocky Mountain Spotted Fever ◽  
Number Of Patients

Background:In the United States, tick-borne illnesses account for a significant number of patients that have been seen and treated by health care facilities. This in turn, has resulted in a significant morbidity and mortality and economic costs to the country.Methods:The distribution of these illnesses is geographically variable and is related to the climate as well. Many of these illnesses can be diagnosed and treated successfully, if recognized and started on appropriate antimicrobial therapy early in the disease process. Patient with illnesses such as Lyme disease, Wet Nile illness can result in chronic debilitating diseases if not recognized early and treated.Conclusion:This paper covers illnesses such as Lyme disease, West Nile illness, Rocky Mountain Spotted fever, Ehrlichia, Tularemia, typhus, mosquito borne illnesses such as enteroviruses, arboviruses as well as arthropod and rodent borne virus infections as well. It covers the epidemiology, clinical features and diagnostic tools needed to make the diagnosis and treat these patients as well.

scholarly journals Protective Effectiveness of Long-Lasting Permethrin Impregnated Clothing Against Tick Bites in an Endemic Lyme Disease Setting: A Randomized Control Trial Among Outdoor Workers

2020 ◽  
Vol 57 (5) ◽  
pp. 1532-1538
Author(s):  
Cedar Mitchell ◽  
Megan Dyer ◽  
Feng-Chang Lin ◽  
Natalie Bowman ◽  
Thomas Mather ◽  
...  
Keyword(s):  
United States ◽  
Rhode Island ◽  
The United States ◽  
Amblyomma Americanum ◽  
Adverse Outcomes ◽  
Control Group ◽  
Tick Bites ◽  
Outdoor Workers ◽  
Significant Difference ◽  
Protective Effectiveness

Abstract Tick-borne diseases are a growing threat to public health in the United States, especially among outdoor workers who experience high occupational exposure to ticks. Long-lasting permethrin-impregnated clothing has demonstrated high initial protection against bites from blacklegged ticks, Ixodes scapularis Say (Acari: Ixodidae), in laboratory settings, and sustained protection against bites from the lone star tick, Amblyomma americanum (L.) (Acari: Ixodidae), in field tests. However, long-lasting permethrin impregnation of clothing has not been field tested among outdoor workers who are frequently exposed to blacklegged ticks. We conducted a 2-yr randomized, placebo-controlled, double-blinded trial among 82 outdoor workers in Rhode Island and southern Massachusetts. Participants in the treatment arm wore factory-impregnated permethrin clothing, and the control group wore sham-treated clothing. Outdoor working hours, tick encounters, and bites were recorded weekly to assess protective effectiveness of long-lasting permethrin-impregnated garments. Factory-impregnated clothing significantly reduced tick bites by 65% in the first study year and by 50% in the second year for a 2-yr protective effect of 58%. No significant difference in other tick bite prevention method utilization occurred between treatment and control groups, and no treatment-related adverse outcomes were reported. Factory permethrin impregnation of clothing is safe and effective for the prevention of tick bites among outdoor workers whose primary exposure is to blacklegged ticks in the northeastern United States.

Surveillance of Lyme Disease in the United States, 1982

1985 ◽  
Vol 151 (6) ◽  
pp. 1144-1149 ◽  
Author(s):  
G. P. Schmid ◽  
R. Horsley ◽  
A. C. Steere ◽  
J. P. Hanrahan ◽  
J. P. Davis ◽  
...  
Keyword(s):  
United States ◽  
Lyme Disease ◽  
The United States

scholarly journals 1428. Lyme Disease Treatment in the United States: Prescribing Patterns from a Nationwide Commercial Insurance Database, 2016-2018

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S720-S720
Author(s):  
Amy M Beeson ◽  
Grace E Marx ◽  
Amy M Schwartz ◽  
Alison F Hinckley
Keyword(s):  
United States ◽  
Lyme Disease ◽  
Standard Treatment ◽  
Age Distribution ◽  
Public Health Problem ◽  
The United States ◽  
Adverse Outcomes ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Low Incidence

Abstract Background Lyme disease (LD) is the most common vector-borne disease in the United States and is a significant public health problem. The use of non-standard antibiotic treatment regimens for LD has been associated with adverse effects; however, the overall landscape of treatment has not been described previously. We aimed to describe real-world antibiotic prescribing patterns for LD. Methods We performed a retrospective analysis of the MarketScan commercial claims database of outpatient encounters from 2016-2018 in the United States. We identified all individuals with a visit that included an LD diagnosis code and a prescription within 30 days of the visit for one or more of 12 antibiotics that may be prescribed for LD. We then categorized each individual as having received either standard or non-standard treatment during the two-year period. Standard treatment was defined as treatment with a first, second or third-line antibiotic for LD, for no longer than 30 days, and for no more than two episodes during the study period. Descriptive and multivariable analyses were performed to compare characteristics of people who received standard vs non-standard treatment for LD. Results A total of 84,769 prescriptions met criteria for inclusion, written for 45,926 unique patients. The mean duration of prescriptions was 21.4 days (SD 10.8). Most individuals (84.5%) treated for LD received standard treatment during the study period. Female gender (OR 1.5, p< 0.0001) and age 19-45 (p=0.0003) were significantly associated with being prescribed non-standard LD treatment. Treatment in low-incidence states (OR 2.2 compared to high-incidence states, p< 0.0001) and during non-summer months (OR 2.2, p< 0.0001) was more likely to be non-standard. Age distribution of patients receiving treatment for Lyme disease, by gender and age at first prescription Seasonality of standard versus non-standard treatment of Lyme disease Conclusion In this population of employed, young, and insured patients, young and middle-aged women were at the highest risk of receiving non-standard LD treatment. Treatments prescribed in states with low incidence of LD or during non-summer months were also more likely to be non-standard, a trend which likely reflects misdiagnosis or overtreatment of LD. Future studies are needed to further define prescriber and patient factors associated with non-standard LD treatment and related adverse outcomes. Disclosures All Authors: No reported disclosures

scholarly journals Human Coinfection withBorrelia burgdorferiandBabesia microtiin the United States

2015 ◽  
Vol 2015 ◽  
pp. 1-11 ◽  
Author(s):  
Kristen L. Knapp ◽  
Nancy A. Rice
Keyword(s):  
United States ◽  
Lyme Disease ◽  
Causative Agent ◽  
Ixodes Scapularis ◽  
Immunological Response ◽  
The United States ◽  
Babesia Microti ◽  
Current State ◽  
Tick Borne Disease ◽  
Multiple Pathogens

Borrelia burgdorferi, the causative agent of Lyme disease, andBabesia microti, a causative agent of babesiosis, are increasingly implicated in the growing tick-borne disease burden in the northeastern United States. These pathogens are transmitted via the bite of an infected tick vector,Ixodes scapularis, which is capable of harboring and inoculating a host with multiple pathogens simultaneously. Clinical presentation of the diseases is heterogeneous and ranges from mild flu-like symptoms to near-fatal cardiac arrhythmias. While the reason for the variability is not known, the possibility exists that concomitant infection with bothB. burgdorferiandB. microtimay synergistically increase disease severity. In an effort to clarify the current state of understanding regarding coinfection withB. burgdorferiandB. microti, in this review, we discuss the geographical distribution and pathogenesis of Lyme disease and babesiosis in the United States, the immunological response of humans toB. burgdorferiorB. microtiinfection, the existing knowledge regarding coinfection disease pathology, and critical factors that have led to ambiguity in the literature regarding coinfection, in order to eliminate confusion in future experimental design and investigation.

The Epidemiology of Lyme Disease in the United States 1987-1988

1990 ◽  
Vol 21 (5) ◽  
pp. 285-289 ◽  
Author(s):  
Gayle L. Miller ◽  
Robert B. Craven ◽  
Ray E. Bailey ◽  
Theodore F. Tsai
Keyword(s):  
United States ◽  
Lyme Disease ◽  
The United States
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