Southern Tick-Associated Rash Illness (STARI) in the North: STARI following a tick bite in Long Island, New York

The most common clinical manifestation of Lyme disease is the characteristic rash, erythema migrans (EM). In the 1980s EM-like eruptions were reported in Missouri and other southeastern states. The EM-like eruptions, which were of unknown etiology, often followed the bite of the Lone Star tick (Amblyomma americanum) and the rash is called STARI (southern tick-associated rash illness). Although the Lone Star tick is found in the Lyme disease-endemic areas of New England and Mid-Atlantic regions of the United States, STARI has been reported only once from the Northeast and Mid-Atlantic regions. We report a child from Connecticut who visited Long Island, New York, and developed a rash that was thought to be EM. Because the patient failed to respond to antibiotics used to treat Lyme disease, an investigation ensued, and the diagnosis of STARI was established.     

Laboratory Biosafety: Sentinel surveillance of Lyme disease risk in Canada, 2019: Results from the first year of the Canadian Lyme Sentinel Network (CaLSeN)

BackgroundLyme disease is an emerging vector-borne zoonotic disease of increasing public health importance in Canada. As part of its mandate, the Canadian Lyme Disease Research Network (CLyDRN) launched a pan-Canadian sentinel surveillance initiative, the Canadian Lyme Sentinel Network (CaLSeN), in 2019.ObjectivesTo create a standardized, national sentinel surveillance network providing a real-time portrait of the evolving environmental risk of Lyme disease in each province.MethodsA multicriteria decision analysis (MCDA) approach was used in the selection of sentinel regions. Within each sentinel region, a systematic drag sampling protocol was performed in selected sampling sites. Ticks collected during these active surveillance visits were identified to species, and Ixodes spp. ticks were tested for infection with Borrelia burgdorferi, Borrelia miyamotoi, Anaplasma phagocytophilum, Babesia microti and Powassan virus.ResultsIn 2019, a total of 567 Ixodes spp. ticks (I. scapularis [n=550]; I. pacificus [n=10]; and I. angustus [n=7]) were collected in seven provinces: British Columbia, Manitoba, Ontario, Québec, New Brunswick, Nova Scotia and Prince Edward Island. The highest mean tick densities (nymphs/100 m²) were found in sentinel regions of Lunenburg (0.45), Montréal (0.43) and Granby (0.38). Overall, the Borrelia burgdorferi prevalence in ticks was 25.2% (0%–45.0%). One I. angustus nymph from British Columbia was positive for Babesia microti, a first for the province. The deer tick lineage of Powassan virus was detected in one adult I. scapularis in Nova Scotia.ConclusionCaLSeN provides the first coordinated national active surveillance initiative for tick-borne disease in Canada. Through multidisciplinary collaborations between experts in each province, the pilot year was successful in establishing a baseline for Lyme disease risk across the country, allowing future trends to be detected and studied.     

Lyme disease: why the controversy?

Some Australians have become convinced of the existence of locally acquired Lyme disease (LD). The history of LD, since its recognition in the early 1970s, is reviewed as a model for investigative approaches to unknown syndromes. Australian Management Guidelines for LD include the requirement for diagnostic testing by National Association of Testing Authorities‐accredited laboratories using Therapeutic Goods Administration‐licensed tests, which result in the efficient diagnosis of LD in overseas travellers. Despite this, patients who have not left Australia pay many thousands of dollars for non‐specialist consultations and testing at overseas laboratories. Unproven long‐term therapy with multiple antibiotics has resulted in serious complications, including allergies, line sepsis, pancreatitis and pseudomembranous colitis. Studies have shown that LD vectors are not found in Australia, and Lyme Borrelia has not been found in Australian vectors, animals or patients with autochthonous illnesses. I propose that (i) A non‐controversial name for the chronic syndrome should be adopted, ‘Australian Multisystem Disorder’. (ii) Research funding should enable the development of a consensus case definition and studies of the epidemiology of this syndrome with laboratory investigations to identify an aetiology and surrogate markers of disease. Prospective, randomised treatment studies could then be undertaken using ethical protocols.     

Diagnosis not to be missed: Lyme carditis,rare but reversible cause of complete atrioventricular block

Lyme carditis is a known cause of atrioventricular block and in most cases, atrioventricular block is reversible with appropriate antibiotic treatment. The diagnosis can be challenging if the disease is either not suspected, or if the initial cutaneous manifestation of erythema migrans is missed. It is important to diagnose Lyme carditis as the cause of complete heart block if unnecessary pacemaker implantation is to be avoided. We present a 43-year-old male who presented with complete heart block and also illsustained ventricular tachycardia due to Lyme carditis that reversed completely with antibiotic therapy.     

从全沟硬蜱分离的伯氏疏螺旋体的实验研究

本文报道了从全沟硬蜱分离的一株伯氏疏螺旋体(VL株)实验研究的结果。该株螺旋体同莱姆病螺旋体标准株在超微结构上相近,可以和高稀释度的抗伯氏疏螺旋体抗体发生间接免疫荧光反应。SDS-PAGE电泳结果显示其蛋白组成和标准株的蛋白图谱相同。热变性温度法测定其DNA的G+Cmol％含量为28.1％,和标准株的含量无明显区别,试验结果证实此株螺旋体属伯氏疏螺旋体。     

Validation of the Cumulative Illness Rating Scale (CIRS) in hospitalized nonagenarians

This is a retrospective analysis of patients aged 90-99 years, admitted over a 6-month period to a district hospital. One hundred three patients were included in the study with an average age of 92 years and a male to female ratio of 1:3. Fifty-five percent of the patients hospitalized came from nursing care facilities. Comparisons were made of patient characteristics from nursing homes and the community. The physical burden of illness was measured by the CIRS, Illness Severity Index (SI), and Co-morbidity Index (CI). The average length of stay was 6.3 days for those from nursing care facilities and 10.2 days from the community as compared with 3.3 days for total hospital in-patients. Excluding deceased patients there was a significant (p < 0.05) correlation between patient's CIRS to length of stay in hospital but was equivocal for SI and CI. There were no association between patient's CIRS, SI, and CI to mode of referral and residence. The mortality rate for this group was 13% as compared with the hospital rate of 10.2%. CIRS, SI, and CI were useful in distinguishing the mortally ill from the morbidly ill; otherwise there were no differences, between patients who hail from nursing care facilities or from the community and whether they were referred by carers, nursing staff, medical practitioners/specialists or themselves. There were significant differences in the CIRS scores between deceased and survivors indicating CIRS is potentially useful tool in predicting outcome. The SI and CI composites performed equally well in predicting outcome.