Diagnosing Tick-Borne Disease?
There are over 20 tick-borne diseases currently known to occur throughout the US and many of these diseases have impacted Colorado residents and/or their pets. Seven diseases are currently required physician/laboratory reportable diseases in Colorado.
As a rule, the sooner a tick-borne disease is properly diagnosed and treated, the better!
Though not all infections manifest into serious disease. Lack of timely, accurate, diagnosis and treatment can result in adverse outcomes for patients including extended treatment, hospitalization, disability or death.
ID Doctors at Walter Reed Medical Center in Bethesda, MD state in this new study… “The availability of laboratory testing for tick-borne diseases is limited, especially in the acute setting. Therefore, if a tick-borne disease is suspected, empiric therapy should often be initiated before laboratory confirmation of the disease is available.”
Tick-borne illnesses may manifest in vague, classic or dramatic and unusual presentations. Many of the tick-borne infections can initially present as a flu-like syndrome that are often misdiagnosed as viral other illnesses.
Initial symptoms common to many tick-borne diseases are often flu-like and may include:
- Fever (may be high and/or relapsing in nature)
- Rashes (multiple presentations)
- Stiff neck
Individuals and their pets returning to Colorado from travel out of state or country may not be aware of their tick exposure or risk of diseases in other regions of the US or World. Colorado medical care providers are faced with diagnosing diseases they may not have any previous experience with. It is important to notify a physician if you become ill after an exposure to ticks or their habitat. For instance, a flu-like illness following a camping trip even if you did not notice a tick-bite!
Children and Tick-borne Disease
Children are at risk of tick exposures both within Colorado and when traveling out of state. Our children can be exposed through play, sports, camps, school field trips, contact with pets and family activities, running through grass and rolling on the ground. Doing what kids do!
There are currently 20 known tick-borne diseases in the United States and 7 of those diseases are reportable in the State of Colorado.
According to the CDC, the highest infection rates of Lyme disease occur in children, ages 5 to 9. Of the over 300,000 people infected in the U.S. each year, one in four is a child.
Keep in mind that children exposed to Lyme disease may present with unique symptoms. Sometimes neurological/cognitive symptoms are the only symptoms that present in a child with a Lyme infection. The tick that transmits Lyme and sometimes multiple co-infections is as tiny as a poppy seed and may be easily missed.
Per the CDC, diagnosis of Lyme and many other tick-borne diseases must be made clinically. Testing for tick-borne diseases is variable in both availability and reliability depending on the infection. Often patients may require treatment before laboratory tests can return a confirmation of disease. For some diseases, commercial tests are not yet available or diagnosis may depend on the experience of the pathologist reviewing a blood slide or tissue sample under a microscope. For others, antibodies may never develop to levels able to be detected by current testing methods. In some cases you may want to have the tick tested.
Though tick testing is also not 100% reliable and can not confirm if the tick has or has not transmitted a disease, information regarding tick species and the pathogens they may be carrying can aid in potential treatment decisions.
There are many laboratories specialized in testing of tick-borne diseases may be more sensitive in detecting the presence of pathogens than standard laboratories.
For many tick-borne diseases a negative test does not mean no infection. Therefore, recognition of many diseases through clinical diagnosis is critical in the process of administering timely, effective and sometimes life-saving treatment to patients.
Dr. Daniel Cameron, lead author for the 2014 ILADS peer reviewed guidelines (the only guidelines currently published by the National Guidelines Clearinghouse in the treatment of Lyme disease), also provides guidance in test choice in regard to Lyme disease.
The CDC provides the Tick-borne Diseases of the United States: A Reference Manual for Health Care Providers to aid in diagnosis, testing and treatment of tick-borne diseases.
Is it Lyme Disease?
The rate of infections with Borrelia sp. that cause Lyme disease, as well as other tick-borne pathogens are increasing nationwide and worldwide, Researchers are discovering new, previously unknown species that cause Lyme disease as well as other new pathogens that are causing additional diseases. Lyme is the most prevalent vector-borne disease in the US and ranks 5th of all reported infectious diseases in the US behind, Chlamydia, Gonorrhea, Salmonella, and HIV/Aids (new cases). The CDC estimates that Lyme is under reported by 10 times. Case numbers have increased to nearly 400,000 in 2015. Lyme and many other TBD’s are most often a clinical diagnosis due to the lack of reliable laboratory testing.
The controversy and confusion about Lyme diagnosis and treatment leaves many Coloradans undiagnosed, undertreated, and vulnerable to long-term, preventable, health problems from Lyme and tick-borne infections. Currently, many Coloradans already sick from neurological or untreated infections must drive hours or even travel out of state to receive access to evaluation, diagnosis and adequate treatment. Colorado needs more physicians trained in the diagnosis and treatment of Lyme and other tick-borne diseases.
As previous research has demonstrated, self-reported symptoms can be reliable predictors of health outcomes. Three studies evaluated The Horowitz Multiple Systemic Infectious Disease Syndrome (MSIDS) Questionnaire, a screening questionnaire that is both useful for providers and patients in diagnosing Lyme disease.
The National Guidelines Clearinghouse removed the IDSA Lyme Treatment Guidelines (in February, 2016) because the guidelines were out of date. Their official statement:
“It was removed from the NGC database because the guideline no longer met the NGC Inclusion Criteria pertaining to date. More specifically, the NGC inclusion criteria require that all guidelines represented in the NGC database have been developed, reviewed or revised within the last five years. All guidelines that no longer meet these criteria are removed from the NGC site on an annual basis.”
Currently, the only NGC endorsed treatment guidelines specific to Lyme disease in the U.S. are the peer reviewed Evidence Assessments and Guideline Recommendations created in 2014 by ILADS.
ILADS offers an annotated appendix with comparisons of the IDSA and ILADS guidelines.
Lyme disease may not have a traditional presentation. In December 2013 the CDC published a report on three sudden deaths caused by Lyme Carditis. Patient 3 “complained of episodic shortness of breath and anxiety during the 7–10 days before death. No rash, arthralgia, or neurologic symptoms were noted. A physician consulted 1 day before death prescribed clonazepam for anxiety.” Patient 1 “described a nonspecific illness with malaise and muscle and joint pain during the 2 weeks before death.”
Lyme disease remains a clinical diagnosis as per the CDC. Lyme disease is spreading worldwide, with multiple Borrelia species causing a broad range of clinical symptoms that mimic other illnesses. Lyme disease in its early stage can often be effectively treated, but persistent infection, complex pathology affecting multiple body systems and organs, biofilm and cyst formation, and associated tick-borne co-infections make Chronic Lyme/Post Treatment Lyme Disease Syndrome (PTLDS) difficult to diagnose and complex to treat.
A variety of CME opportunities are available for Physicians and other medical care providers to gain experience and training in the diagnosis and treatment of Lyme and other tick-Borne Disease. Visit the Physician Training.