Wednesday, January 21, 2015

Anaplasmosis in Maine

“Then you have to start thinking about different possibilities, such as viral or tick-borne diseases,” Borelli said. “It was in a summer month. Tick-borne diseases are always things we need to consider. And we learned she had had some tick exposure.”
Some of the blood work showed that the woman’s blood didn’t have enough white blood cells in it. Tests also revealed a high level of liver enzymes in the blood, most commonly seen when the liver is damaged or inflamed.
Taken together, the two things pointed to anaplasmosis.
A tick bite usually spurs thoughts of Lyme disease, but a recent rise in anaplasmosis has caught the attention of epidemiologists in the state."



There are two kinds of ehrlichiosis, both of which are caused by tick-borne rickettsial parasites called Ehrlichia that infect different kinds of white blood cells. In HME (human monocytic ehrlichiosis), they infect monocytes. In HGE (human granulocytic ehrlichiosis), they infect granulocytes. HGE was renamed anaplasmosis in 2003. Ticks carry many Ehrlichia-like parasites that have not been identified yet. It is likely that the lone star tick transmits HME and that the deer tick transmits HGE.
Ehrlichiosis (HME) was originally thought to be only an animal disease. It was described in humans in 1987 and is now found in 30 states, predominately in the southeast, south-central, and mid-Atlantic states, Europe and Africa. Anaplasmosis (HGE)in humans was first identified in 1990 in a Wisconsin man. Before that it was known to infect horses, sheep, cattle, dogs and cats. It occurs in the upper midwest, northeast, the mid-Atlantic states, northern California, and many parts of Europe. Studies suggest that in endemic areas as much as 15% to 36% of the population has been infected, though often it is not recognized.


The clinical manifestations of ehrlichiosis and anaplasmosis are the same. Each is often characterized by sudden high fever, fatigue, muscle aches, headache. The disease can be mild or life-threatening. Severely ill patients can have low white blood cell count, low platelet count, anemia, elevated liver enzymes, kidney failure and respiratory insufficiency. Older people or people with immune suppression are more likely to require hospitalization. Deaths have occurred.


Diagnosis is limited by our current ability to test for only two species. Ehrlichia parasites multiply inside host cells, forming large mulberry-shaped clusters called morulae which doctors can sometimes see on blood smears. The infection still can easily be missed. The doctor may suspect ehrlichiosis/anaplasmosis in a patient who does not respond well to treatment for Lyme disease.


The treatment of choice for ehrlichiosis/anaplasmosis is doxycycline, with rifampin recommended in case of treatment failure.

This site has additional details and information on Ehrlichiosis too.

The first case of human anaplasmosis was described in 1990, when a Wisconsin patient developed a severe febrile illness following a tick bite and died two weeks later. Blood smears revealed clusters of bacteria within the patient’s neutrophils, similar to the morulae seen in monocytes with E. chaffeensis infection. However, cultures and serologic tests for E. chaffeensis were negative. Nevertheless, the patient’s clinical course suggested ehrlichiosis of some kind, and when several additional cases of the disease were reported in the northern Midwest in ensuing years, it was posited that a new species of Ehrlichia might be emerging. The new disease was tentatively given the name “human granulocytic ehrlichiosis,” or HGE.
Ultrastructure of A.phagocytophilum by transmission
electron microscopy. Photo by V.Popov, reprinted
from Dumler JS et al. Human granulocytic
anaplasmosis and Anaplasma phagocytophilum.
Emerg Infect Dis;11:1828-34.
In 1994, DNA sequencing studies revealed that the HGE agent was clearly distinct from E. chaffeensis but essentially identical to two previously known ehrlichial veterinary pathogens, E. equi and E. (Cytoecetes) phagocytophila. Under a new taxonomic scheme since implemented (see Introduction), these three organisms have been united as a single species within a new genus, Anaplasma. The new species is referred to as Anaplasma phagocytophilum, and the disease it causes is now known as human granulocytic anaplasmosis, or HGA.
Like Ehrlichia species, Anaplasma organisms are small, gram-negative and intracellular. A. phagocytophilum targets neutrophils, alters their function in the host, and forms morulae within vacuoles. Most of the damage it causes appears to be related to host inflammatory processes, as there is little evidence of a correlation between the number of organisms and host disease severity.
Anaplasmosis is a global infection, occurring in North America, most of Europe and eastern Asia. Ticks from the Ixodes persulcatus-complex are the vectors: I. scapularis in the northeastern and upper Midwestern regions of the United States; I. pacificus in the Pacific Northwest; I. ricinus in Europe and I. persulcatus in Asia. A. phagocytophilum is maintained in nature by cycling between these ticks and various small mammals, primarily mice and other small rodents. Because Ixodes ticks are also the vectors for Lyme disease, babesiosis and tick-borne encephalitis, Anaplasma coinfection with these other diseases can and does occur in humans.
In the last decade, cases of HGA have outnumbered those of HME in the United States. Similar to HME and human ewingii ehrlichiosis, the median age of patients with HGA is around 50 years old. Over 4000 total cases have been reported in the CDC’s Morbidity and Mortality Weekly since the disease became nationally reportable; as with most tick-borne diseases, the true incidence is suspected to be considerably higher.
Signs and Symptoms
The clinical course of HGA is very wide, ranging from asymptomatic infection to fatal disease. When initial symptoms appear, usually 5-10 days after tick bite, they are largely non-specific and similar to those of HME: fever, chills, severe headache and myalgias. Nausea, cough and arthralgias also occur. Rash is uncommon but has been reported.
Compared with HME, HGA appears less likely to involve the central nervous system, but peripheral neuropathies are more common and can last weeks to months. Among the neurologic findings reported in the medical literature are facial palsy, demyelinating polyneuropathy and brachial plexopathy. Respiratory distress syndrome and a septic or toxic shock-like syndrome have been reported, but appear to be less common than in HME. The overall fatality rate from HGA also seems to be slightly lower than that of HME, with most of the deaths resulting from opportunistic infections (for example, herpes simplex esophagitis, Candida pneumonitis, and pulmonary aspergillosis) in immunocompromised patients.
Standard blood tests in HGA usually reveal findings similar to those seen in HME: leukopenia, thrombocytopenia and liver function abnormalities (elevated transaminases). However, the hematological abnormalities frequently resolve by the second week of symptoms, so their absence should be interpreted in that context if patients are presenting later in the course of their illness. In general, empiric antibiotic treatment should be considered for patients in endemic areas who present with an acute febrile illness suggestive of HGA.
For specific diagnosis, Wright or Giemsa-stained blood smears have a slightly higher yield than with HME, but are still not optimal for general clinical utility, given that there appears to be a wide variation (25-75%) in the sensitivity of these tests in visualizing morulae in host neutrophils. More helpful, but not always available, are polymerase chain reaction (PCR) tests, which are estimated to have a sensitivity of 67-90%. Prior antibiotic therapy dramatically reduces the sensitivity of both  of these diagnostic methods.
Serologic testing is useful to confirm the diagnosis of anaplasmosis. The most commonly used method is indirect immunofluorescence (IFA) of IgM and IgG anti-A. phagocytophilum antibodies. Seroconversion is perhaps the most sensitive laboratory evidence of A. phagocytophilum infection, but is not always obtained in a timely enough manner to provide useful input on clinical (i.e., treatment) decisions.
The optimal dose and duration of antibiotic treatment for anaplasmosis has not been definitively established, but it is clear that A. phagocytophilum is highly sensitive to tetracyclines. Thus, oral doxycycline is the recommended treatment, at the same dose used for Ehrlichia infections: 200 mg/day in two divided doses. The usual treatment duration is 5-10 days, which is extended if there is suspected coinfection with B. burgdorferi, the agent of Lyme disease. In any case, treatment should continue for at least three days after the patient’s fever resolves. Response to treatment is usually rapid; if the patient remains febrile more than two or three days after initiation of doxycycline therapy, the diagnosis should be revisited.
As with Ehrlichia infections, rifampin is used in cases where doxycycline is contraindicated, such as pregnancy or allergy. Rifampin has also been used successfully in pediatric cases, and thus is sometimes employed in mild cases of pediatric A. phagocytophilum infection. If coinfection with B. burgdorferi is suspected in a pediatric case, doxycycline is sometimes used as an initial treatment for 3-5 days, with another antibiotic employed thereafter to complete the somewhat longer recommended treatment period for early Lyme disease.

Tuesday, January 20, 2015

From Chronic Illness to Radiant Health and Wellness

On Tuesday, February 24th,   Julie Meyer, LAc, will be speaking at the Midcoast Lyme Disease Support & Education group at the Wicasset Community Center from 6-8pm. She will be sharing her firsthand knowledge and specialized healing technique as it applies to those with chronic illness.

Her career in the 80s and early 90s was advocacy. She was a legal advocate for low income clients who had been denied Social Security Disability benefits. They were all experiencing a combination of chronic problems, and none of them were being healed by the long list of pharmaceuticals that each one had been prescribed. She loved working with people to understand their conditions so that she could advocate for them before Administrative Law Judges. But then it occurred to her, wouldn't it be great if people actually got better? Julie went on to study traditional Chinese Medicine and traditional Japenese meridian-style treatment at the New England School of Acupunture. Early in her career, she worked in a hospital-based clinic and was the 1998 Tsay Fellowship for post-graduate research. She is board certified by the NCCAOM and by the State of Maine. She has been in private practice since 1998.

Julie is part of a collective group of individual practitioners who have formed the Heart of Bath Heath Center in Bath, Maine, each bringing their unique sense of healing beliefs and practices together for the betterment of the Midcoast community.

The Midcoast Lyme Disease Support & Education group was created and exists to raise awareness, foster education, advocate for change and provide support for those affected by Lyme Disease and other tick-borne associated diseases. We foster EDUCATION by continually networking with Lyme Literate providers and staying on the cutting edge of available resources and sharing what we learn with the wellness and medical providers and the local community at-large.

Please join us for this free event. This is a support group setting and childcare is not provided so we ask that you please plan accordingly. For more information, please contact Paula Jackson Jones (207) 446-6447 or Angele Rice(207) 841-8757 or email us at

Saturday, January 3, 2015

Yes You Have Found Your Tribe

  I hear this question so many times from new patients diagnosed with Lyme Disease.  I finally got a diagnosis now what?  It can seem like a daunting task and very overwhelming.  I know I remember the week my blood results came back from Quest Labs and my Naturopathic Doctor looked at me and said "you tested positive for Lyme Disease".  My jaw dropped to the floor.  I was hoping for something other than that, something easy.  I didn't think there was a cure for Lyme Disease which is what scared me the most.  I went into a depression for a couple of weeks because I was rocked out of my denial.  And no that doesn't make sense, I felt horrible.  I had nightmares, restless leg syndrome, brain fog, migraines, mood swings, depression, anxiety, bruised easily, I forgot stuff easily, I was angry, upset and I felt all alone.  So you think I would of been so happy to be diagnosed.  Instead I felt more afraid of what was yet to come.  I felt no one could prepare me for the journey ahead.  No one could tell me I would be better sooner than later.  
As I look back at that moment I realize now all the things I could of done differently.  I think the biggest one was being real with myself.  I was miserable and I felt like I was dying from the inside out.  I could face facts and move forward or stay stuck.  I wish I could of given myself more time to grieve the loss of health, loss of myself, loss of the ability to just feel like a normal human.  I wish I had gotten counseling and support sooner.  I didn't have a lot of self love to begin with.  I never really took good care of myself.  I took care of my husband and son and when that was done I had nothing left.  If I had only realized that they would be okay with out me a bit while I took care of myself and healed up.  I didn't need to wear a super woman cape.  Being Lyme Disease was heroic enough.  I have to admit its has been a hard battle but I have made strides and improvements.  Now sick or well or in between I am myself as best I can be.  The dishes and laundry might pile up while my son and I rest and watch a movie.  But I've learned to let things go.  I've learned to be my own best advocate.  And I've seen how all this experience has helped me to reach out to another hand and say "yes you have found your tribe."  
 I have also cabinet's full of help and I try to keep my favorite things around to soothe me when I feel my worst.  My husband, son, and two cats help ground me.  They remind me joining the living is worth it.  When I'm having a flare I feel like I'm from another planet.  Always loosing stuff.  Forgetting stuff.  And sleeping.  Lots of sleeping.  I am lucky enough to have neighbors, friends and family who understand.  So don't give up on them.  They may take time to understand what you are going through but some may get there sooner than you think.  They may even surprise you and offer you help.  Whatever you do, don't stop doing the things you love.  Photography and making cards have gotten me through some tough days and weeks.  You may discover some hobbies you can do while lying down in bed.  Anything is possible.  Please keep your imagination, creativity, hope, and humor.  You will be surprised how much you will need them.  And Yes you too in time will be the hand that reaches out to someone new and says "yes you have found your tribe".  

Rockport Lyme Disease Support Meeting

The Midcoast Lyme Disease Support & Education group was created and exists to raise awareness, foster education, advocate for change and provide support for those affected by Lyme Disease.

If you have or have had Lyme Disease and continue to suffer from its affects, if you are a caretaker or know someone who suffers from Lyme Disease or you think they may have Lyme Disease, if you want to know more about Lyme Disease, prevention and treatment ~ then this group is for you.

We are a support group setting and do not have childcare so we ask that you please plan accordingly.

We look forward to seeing you and encourage you to contact us if you have any questions. We are always available to listen and provide support anyway we can ~

~ Paula & Angele ~