2 Video: Jorge Benach On Tickborne Disease At Stony Brook

I came across this video on Youtube which I haven't seen mentioned elsewhere. It is a presentation by Dr. Jorge Benach on tickborne diseases, mostly focused on cases in New York State and much of it on Lyme disease - but there is also discussion on tickborne diseases in a more general sense as well.

I watched the video and made a note on topics of discussion during various points of time during the presentation which may be of interest to others.

Note that it is a little over an hour long, but you can skip the first three minutes as they are only an introduction. The last fifteen minutes are dedicated to a question and answer session with the audience - including one person who walked out because she was not satisfied with Dr. Benach's response.

[Time: 1:06:41]




11:39 Benach discusses Lone Star tick as primary tick on Long Island and that the number of cases of Lyme disease are going down in Eastern Long Island - possibly due to this tick's expansion.

16:33 Lifestyle of Ixodes tick described.

23:17 Early Babesia microti case on Long Island identified in 1970's - opens discussion on Babesiosis. Risk categories: over 50, elderly, asplenic, immunosuppressed, and/or alcoholism history.

29:00 Beginning of Lyme disease discussion... history of discovery, use of dark field microscopy for detection; electromicroscopy.

36:12 60% of patients have EM rash that is noticed. 40% do not.

37:00 Disseminated Lyme - Neuroborreliosis -20%, Cardiac disease- 5-10%, Arthritis - 60%

37:20 Secondary Disseminated symptoms - refractory to treatment - Benach does not understand what happens with chronic Lyme disease patients. Audience member brings up infection-related damage, Benach agrees with him that this is a problem - then goes back to discussing acute Lyme disease.

39:40 A rash that enlargens is clearly an EM rash. This is key to early diagnosis with a rash.

40:20 Multiple EM rash is sign of disseminated Lyme disease and requires IV or parenteral antibiotics.

40:57 Discusses spirochetes affecting the CNS and how it is similar to syphilis, and that a dementia-like form of Lyme disease is controversial. Audience member mentions person who was completely messed up by neurological Lyme disease; had CSF that was positive for Lyme disease and improved with IV treatment.

43:00 Benach thinks neurologic involvement in Lyme disease is underreported.

43:10 Explanation of Bells palsy in a child, says it is very common but not malignant.

43:57 Mentions Lyme arthritis in the classic sense. Discusses symptoms as relapsing and remitting.

44:38 Benach is under impression that most people's cases of Lyme disease are caught early and treated early due to presence of EM rash.

44:50 Epidemiology of Lyme disease in New York State and counties in NY. Benach thinks doctors in some counties are treating Lyme disease and are not reporting their cases to the state any more - they are "Lyme tired". For other counties, there is active surveillance, and the numbers are going up as more cases are new to their area.

47:00 Quip that LD now threatens politicians in Albany.

47:48 Is Lonestar tick driving other ticks away? Maybe… someone needs to study it.

48:13 Audience member asks about birds. Catbirds and robins have ticks, but don't carry a lot because they like the rims near eyes (bare skin). Birds are dead ends for the spirochetes because of their high temperature, according to Benach…

49:30 Start of Q & A session

51:38 Do people have natural immunity to Lyme disease? Benach does not think so - there is universal susceptibility to LD.

53:00 Jury still out on whether or not people have genetic susceptibility to Lyme disease. Hard to know if you are bitten multiple times if you have new instance of disease or preexisting disease because Lyme disease can last for 30 (possibly more) years in the human body.

54:40 No known existence of antibiotic resistant Lyme disease. Does he rule it out completely? No. But he states Borrelia are genetically challenged and have so few genes they need them to do housekeeping; they have a very small genome. He says there is no presence of those genes and he is 90% sure there is no antibiotic resistance.

57:09 Vaccine discussion - brief.

58:00 Pesticide soaked cotton balls used to fight ticks locally. (Damminix)

1:00 Opinion on prolonged chronic Lyme IV treatment: If  my child or I myself had a very strong titer for Lyme disease, I would use antibiotics for as long as it did good. If I did not have a very strong titer, then I would be reluctant to use antibiotics due to side effects.

Recurring arthritis and neurological manifestations come with strong serology according to Benach.

Benach leaves the audience with a confusing opinion: On one hand, he states he would not take antibiotics long term. On the other, he states that if he continued to be sick in the presence of strong serology then he would take antibiotics.

1:05 IgM doesn't drop over time in Lyme disease. We cannot culture Lyme disease easily, doesn't grow well in vitro - it is very slow growing. Only mycobacteria divides more slowly. You need 5 weeks to culture Borrelia. Benach's implication is no one would wait for those results - test is too difficult; takes too long.

More info. on Dr. Benach's research:
http://www.mgm.stonybrook.edu/benach/index.shtml


Comments:

One of my main comments for now (I may add more later) is that I think Dr. Benach is wrong about the birds.

I found this article: http://news.discovery.com/animals/migrating-birds-lower-body-temperature.html

Migrating birds can easily carry Borrelia spirochetes because their average daytime temperature is around 42.5C and goes down to 33C at night - the birds temporarily have hypothermia. They do this to save energy during long trips.

While some strains of Borrelia are sensitive to the birds' higher temperature range, some birds are actually conducive of supporting Borrelia spirochetal infections. Catharus fuscescens is one example.

See: http://jmm.sgmjournals.org/content/47/10/929.full.pdf

B. garinii, at 41C has the highest growth temperature on record. However, just because Borrelia stop growing doesn't indicate it is not present. Under varying temperature conditions, some Borrelia may be able to survive.

Another comment is that Dr. Benach mentions that Borrelia burgdorferi does not show signs of antibiotic resistance or genes for antibiotic resistance mechanism.

However, there are some spirochetes which have been resistant to erythromycin, and there is now some evidence of an antibiotic resistance mechanism in Bb: http://www.plospathogens.org/article/info%3Adoi%2F10.1371%2Fjournal.ppat.1000009

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2 Lyme Disease In Australia On Today Tomorrow Show

Last night the Australian television news show, Today Tonight, aired a segment on Lyme disease in Australia. While the dramatic reporting in this segment is not to my taste, I took special note of the research starting at roughly the 6:28 mark [11 minute video below may not work on all mobile devices]:

Excerpt from the transcript:

Inside a laboratory at Newcastle University a dedicated team, including Professor Tim Roberts, is toiling away on a fresh independent study - a collaboration with Sydney University - to determine whether Lyme disease is carried by Australian ticks. 

Professor Roberts thinks that Lyme Disease is in Australia. Thousands of ticks are being collected, and already he disputes long held theories that Australian sufferers only contract the disease after visiting Europe or America. 

“What we say and conclude is there is an organism here which is very similar to those two infected organisms, the one in Europe and the one in America,” he said. 

Some believe it got to Australia from migratory birds that fly all the way from Siberia and nest on our beaches. Then there's another school of thought that it's actually an indigenous strain, and it's always been in our country.

Professor Roberts believes that many people carry Lyme disease and don't even know. “A whole lot of people could, certainly absolutely, in the group with chronic fatigue syndrome,” he said.

It should be noted, however, that not everyone agrees with Professor Roberts - here is one person who disagrees:

“The opinion is that there is no good evidence that Lyme disease is acquired in Australia at the moment,” Dr Jeremy McAnulty from New South Wales Health and Protection said. 

“The other important information is that ticks that carry Lyme disease overseas aren't present in Australia, so we don't seem to have the right ticks for Lyme disease in Australia,” he added.

So no matter where one is in the world, Lyme disease generates controversy.

I want to know more about what Professor Roberts has found regarding finding an organism similar to the Borrelia that is in the US and Europe. This video is short on details in this regard.

I've found some mention of previous attempts to find the causative agent of this Borreliosis-like illlness from research done over 15 years ago - but nothing definitive.

What was said back then could well apply today:

Dr Bernie Hudson, a microbiologist who runs a clinic for Lyme disease sufferers at Royal North Shore Hospital, said it was better to treat those with symptoms of the disease as if they had it, rather than waiting years to have its existence in Australia accepted by other scientists, he said. 

Westmead entomologist Dr Richard Russell said his group had been "painted as baddies" but he would like to see the Newcastle team "get some money to do a definitive study and find out if it does exist".

Over fifteen years ago... is this Newcastle team which is doing research now related to those who had done the research in the past?

In the meantime, I hope those patients who were interviewed get the help they need and get better.

The transcript for the above video can be found here: http://au.news.yahoo.com/today-tonight/health/article/-/12892469/mystery-disease-cover-up

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2 More Thoughts On Birds, Cool Shirts, And My Evil Twin?

More On Ticks And The Atlantic Flyway:

I continue to think about the role of birds carrying ticks to different regions and how Lyme disease (and other tickborne infections) could be spread that way. But much as I found the overlay map I posted earlier this week to be intriguing, I don't think that tracking infected ticks on birds is as simple as following major and principal flyways - even though that could be a reasonable point to start an investigation.

Yale has already done some work in this area, and I have no idea whether or not they've factored the results of this publication, "Do birds affect Lyme disease risk? Range expansion of the vector-borne pathogen Borrelia burgdorferi", into their recently published Lyme disease risk map.

It's important not to discount the role of birds here:

"Although the role of birds in B burgdorferi transmission dynamics is often discounted, data compiled from published studies indicate that the majority (58.6%) of bird species that have been evaluated are capable of infecting larval I scapularis with B burgdorferi. We estimated – for two bird species – that the number of individual birds required to produce one infected I scapularis larva is as low as three, and we conclude that bird-mediated tick movement is an important factor in the range expansion of both I scapularis and B burgdorferi."

Read More: http://www.esajournals.org/doi/abs/10.1890/090062

There are certain behaviors birds engage in and seasonal activities which would lead to a higher likelihood of birds contributing to the spread of Lyme disease on the ground. Specific kinds of birds would be more likely to contribute to infection spread than others - for example, I suspect birds which build their nests on the ground and are ground-based hunters are more likely to contribute to infected tick populations than birds which build their nests in trees. Also, some birds feast on ticks (such as guinea fowl) and they will lower local tick populations.

These are just a few examples - there are many more. I imagine there is no simple algorithm for determining the role for birds in spreading infection. I don't know what all the factors are which would contribute to the spread of Lyme disease via birds, and it's something I continue to look into because it does play an important role in surveillance and determining how infection could spread through different vectors.

Photo credit: Andreas Trepte, www.photo-natur.de

Cool Lyme Disease T-shirts:

While doing a general search for Lyme disease related news the other day, I came across these shirts on Cafe Press:

I think they must have had me in mind as a target demographic, because it's the first Lyme disease related t-shirt that  I've seen which appealed to my appreciation of the TV show, "The Big Bang Theory", and also appealed to my appreciation on word play while mentioning Lyme disease research. It says "More nervous tics than a Lyme disease research facility"- playing on the word "tics" or "ticks".

There are a number of products for sale with this slogan on it (not just t-shirts) at Cafe Press  -  I don't know who is selling them and if they're another Lyme disease patient or not - the product page did not display this information. Check it out if you think it's something you'd like, too.

My Evil Twin?

It's been pointed out to me that I have a doppelganger online named Tom Carolan. He has Lyme disease blog, Tick Borne Diseases Radio, with entries in it which upon reading looked strikingly similar to my own blog at first glance. However, after more examination,  it's clear Tom's blog contains different content and his own unique commentary on the same topics which have grabbed my attention.

(Just so everyone knows, I have no problem with anyone passing on the content I write here as long as you give this blog credit and link to it. That's why I have a Creative Commons license posted at the bottom of each entry - so you know I support a more open source approach to copyright.)

Tom also has a podcast on iTunes on Tick Borne Diseases:
http://itunes.apple.com/us/podcast/tick-borne-disease-radio/id306917344

How about going over there to Tom's site and giving it a good read, and encouraging him to continue to post more podcasts and blog entries? It looks like he has a good thing going on and more content like his would be welcome - particularly more podcasts.

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