Update: June 2016 - Tickborne Diseases of United States

Tickborne Diseases of United States

http://www.cdc.gov/ticks/diseases/index.html 

In United States, some ticks carry pathogens that can cause human disease, including:

• Anaplasmosis is transmitted to humans by tick bites primarily from blacklegged tick (Ixodes scapularis) in northeastern & upper midwestern U.S. & western blacklegged tick (Ixodes pacificus) along Pacific coast. 
• 
  http://www.cdc.gov/anaplasmosis
• Anaplasmosis is a tickborne disease caused by bacterium Anaplasma phagocytophilum. It was previously known as human granulocytic ehrlichiosis (HGE) & has more recently been called human granulocytic anaplasmosis (HGA). Anaplasmosis is transmitted to humans by tick bites primarily from black-legged tick (Ixodes scapularis) & western black-legged tick (Ixodes pacificus). Of 4 distinct phases in tick life-cycle (egg, larvae, nymph, adult), nymphal & adult ticks are most frequently associated with transmission of anaplasmosis to humans. Typical symptoms include: fever, headache, chills, & muscle aches. Usually, these symptoms occur within 1-2 weeks of a tick bite. Anaplasmosis is initially diagnosed based on symptoms & clinical presentation, & later confirmed by use of specialized lab tests. The first line treatment for adults & children of all ages is doxycycline. Anaplasmosis & other tickborne diseases can be prevented.
•  
• Babesiosis is caused by microscopic parasites that infect red blood cells. Most human cases of babesiosis in U.S. are caused by Babesia microti. Babesia microti is transmitted by blacklegged tick (Ixodes scapularis) & is found primarily in northeast & upper midwest.
• http://www.cdc.gov/parasites/babesiosisBabesiosis is caused by microscopic parasites that infect red blood cells & are spread by certain ticks. In United States, tickborne transmission is most common in particular regions & seasons: it mainly occurs in parts of Northeast & upper Midwest & usually peaks during warm months.
  Although many people who are infected with Babesia don't have symptoms, for those who do effective treatment is available. Babesiosis is preventable, if simple steps are taken to reduce exposure to ticks.
  Babesia microti is transmitted by bite of infected Ixodes scapularis ticks—typically, by nymph stage of tick, which is about size of a poppy seed.
• Borrelia mayonii infection has recently been described as a cause of illness in upper midwestern United States. It has been found in blacklegged ticks (Ixodes scapularis) in Minnesota & Wisconsin. Borrelia mayonii is a new species & is only species besides B. burgdorferi known to cause Lyme disease in North America.

• http://www.cdc.gov/ticks/mayonii.html 

  What you need to know about Borrelia mayonii

  In 2013, scientists at Mayo Clinic noticed an unusual result while testing blood from patients suspected of having Lyme disease. Cooperation between Mayo Clinic, state public health agencies, & CDC confirmed discovery as a new bacterial species, also found in blacklegged ticks. Joint efforts between these groups are currently underway to find more patients infected with this bacteria, to look for additional areas where infected ticks live, & to identify other bacteria that cause tickborne disease.
  

  What is Borrelia mayonii?

  Borrelia mayonii is proposed name for a new bacteria species recently found to cause Lyme disease in 6 people who live in upper Midwestern United States. Worldwide, Lyme disease is caused by 3 main species of bacteria: Borrelia burgdorferi, B. afzelii, and B. garinii. Borrelia burgdorferi causes Lyme disease in United States, while other 2 species are leading causes of Lyme disease in Europe & Asia. Borrelia mayonii is a new species that is genetically distinct from these 3 species & is only species besides B. burgdorferi shown to cause Lyme disease in North America. Regardless of bacteria’s species, illness is still called Lyme disease or Lyme borreliosis.
  

  How was it discovered?

  The new bacteria species was first identified at Mayo Clinic in Rochester, Minnesota, where diagnostic samples from patients were tested for evidence of Lyme disease using a well-described polymerase chain reaction (PCR) assay.  From 2012 through 2014, six of approximately 9,000 diagnostic samples from residents of Minnesota, Wisconsin, & North Dakota revealed  presence of a genetically distinct bacteria.  Scientists analyzed DNA sequences of these bacteria & found that they belonged to a new species of Borrelia. Blood from 2 of patients was also tested by culture at CDC, & organism was successfully grown in lab.
  

  Where does B. mayonii occur?

  Current evidence suggests that B. mayonii is only found in upper Midwestern United States. The new species wasn't identified in any of approximately 25,000 samples submitted from patients living in 43 other states, including states in Northeast & Mid-Atlantic region where Lyme disease is common.
  

  Has B. mayonii been found in ticks?

  Yes. B. mayonii has been identified in blacklegged (or “deer”) ticks collected in several counties in northwestern Wisconsin & Minnesota. It is highly likely, however, that infected ticks occur in other areas of both states. The black-legged tick (Ixodes scapularis) also transmits B. burgdorferi, agents that cause anaplasmosis & babesiosis, & Powassan virus.
  

  What type of illness does B. mayonii cause?

  Limited information from first 6 patients suggests that illness caused by B. mayonii is similar to that caused by B. burgdorferi, but with a few possible differences. Like B. burgdorferi, B. mayonii causes fever, headache, rash, & neck pain in early stages of infection (days after exposure) & arthritis in later stages of infection (weeks after exposure). Unlike B. burgdorferi however, B. mayonii appears to be associated with nausea & vomiting, diffuse rashes, & a higher concentration of bacteria in  blood.
  

  What tests are used to diagnose B. mayonii?

  Lyme disease, including infection with B. mayonii, can be treated based on signs & symptoms & a history of possible exposure to ticks. Currently available information suggests that patients with B. mayonii infection develop a serologic response similar to that of patients infected with B. burgdorferi. Therefore, Lyme disease two-tier testing can be helpful for detecting infection with B. mayonii if used correctly & performed with FDA cleared tests. In some instances, B. mayonii spirochetes may also be seen on a blood smear. At this time, infection with B. mayonii can be specifically identified by Lyme disease PCR tests at Mayo Clinic.
  

  How is B. mayonii treated?

  Physicians have successfully treated patients infected with B. mayonii with a 2-4 week course of doxycycline. Amoxicillin, ceftriaxone, & cefuroxime have also been used.
  

  Why are we just discovering this now?

  Good question! The diagnostic lab at Mayo Clinic has tested approximately 100,000 patient samples in same way for over a decade but only recently detected evidence of B. mayonii. It is possible that bacteria recently emerged or that bacteria has been present in area for a long time but at levels so low it escaped detection.
  

  I live in northeastern United States where Lyme disease is common. Should I be worried about B. mayonii?

  At this time there is no evidence that B. mayonii is present outside of Upper Midwest. However, you should continue to take precautions against tick bites as Lyme disease, anaplasmosis, & babesiosis are well established in much of Northeast.
  

  What more do researchers need to know?

  CDC has initiated a project to detect & characterize species of bacteria in specimens from patients suspected of tickborne illness like Lyme disease. Over next several years, scientists aim to test 30,000 patient samples to gain more information about extent & clinical course of this illness.
  In addition, entomologists will continue to sample ticks in Upper Midwest to determine geographic extent of ticks that are infected with this bacteria. CDC & state of Minnesota recently completed a field collection of ticks from 80 sites throughout Minnesota. Ticks will be screened for B. mayonii to determine how geographically widespread & how prevalent pathogen is in that state. Researchers also plan to test for B. mayonii in ticks that have been collected from other parts of country.
  

  How can I avoid this disease?

  People living in areas where blacklegged ticks are common should continue to take precautions against tick bites & see their physician if they experience fever, rash, or malaise after a tick bite or after spending time in tick habitat. Click here for more information.
  
   
• Borrelia miyamotoi infection has recently been described as a cause of illness in  U.S. It is transmitted by blacklegged tick (Ixodes scapularis) & has a range similar to that of Lyme disease.

• http://www.cdc.gov/ticks/miyamotoi.html 

  What you need to know about Borrelia miyamotoi

  What is Borrelia miyamotoi?

  Borrelia miyamotoi is a species of spiral-shaped bacteria that is closely related to bacteria that cause tick-borne relapsing fever (TBRF). It is more distantly related to bacteria that cause Lyme disease. First identified in 1995 in ticks from Japan, B. miyamotoi has since been detected in 2 species of North American ticks,  black-legged or “deer” tick (Ixodes scapularis) & western black-legged tick (Ixodes pacificus). These ticks are already known to transmit several diseases, including Lyme disease, anaplasmosis, & babesiosis.
  

  What type of illness does B. miyamotoi cause?

  In recently published research, patients with this infection were most likely to have fever, chills, & headache. Other common symptoms included body & joint pain & fatigue. Unlike Lyme disease, rash was uncommon, presenting in only 4 out of 51 patients.
  

  What type of testing is available for patients who might be infected?

  Blood tests for Lyme disease aren't helpful in diagnosis of B. miyamotoi infections. Currently, confirmation of a diagnosis relies on 1) use of polymerase chain reaction (PCR) tests that detect DNA from organism or 2) antibody-based tests. Both types of tests are under development & not widely commercially available but can be ordered from a limited number of CLIA-approved labs.
  

  How is B. miyamotoi treated?

  Physicians have successfully treated patients infected with B. miyamotoi with a 2-4 week course of doxycycline. Amoxicillin & ceftriaxone have also been used.
  

  What more do researchers need to know?

  Researchers & health care providers need more information about signs & symptoms of this infection. Fewer than 60 well-documented cases of human infection have been reported in  United States to date.
  It is also unclear how common this infection is in United States. Improved means of diagnosing B. miyamotoi disease will help researchers learn how many people are affected by it.
  

  What is CDC doing?

  CDC is working to better define public health importance of this infection & is reviewing options for tracking disease with our partners in state & local health departments. CDC is also developing & evaluating lab diagnostic tests to detect presence of B. miyamotoi in infected individuals & measure their specific immune responses.
  

  How can I avoid this disease?

  The route of transmission of B. miyamotoi to humans hasn't been firmly established, but likely involves bite of infected black-legged ticks. People living in areas where blacklegged ticks are common should continue to take precautions against tick bites & see their physician if they experience fever, rash, or malaise after a tick bite or after spending time in tick habitat. For more information, visit CDC’s Ticks site.
  
  Colorado tick fever is caused by a virus transmitted by Rocky Mountain wood tick (Dermacentor andersoni). It occurs in Rocky Mountain states at elevations of 4,000 to 10,500 feet.
• http://www.cdc.gov/coloradotickfever 
• Colorado tick fever (CTF) virus is spread to people through bites of infected ticks. People who live in or visit areas in western United States or western Canada that are 4,000‒10,000 feet above sea level may be at risk of becoming infected. Most cases of CTF occur during spring & summer months when ticks are most active. The most common symptoms of CTF are fever, chills, headache, body aches, & feeling tired. There are no medications to treat or vaccines to prevent CTF.
  The best way to prevent CTF is to reduce your risk of tick bites.
  

  • Use insect repellent
  • Wear long sleeves & pants
  • Avoid wooded & bushy areas with high grass
  • Perform thorough tick checks after spending time outdoors

  Talk to your health-care provider if you think you or a family member may have CTF.
  
  Ehrlichiosis is transmitted to humans by lone star tick (Ambylomma americanum), found primarily in southcentral & eastern U.S.
• http://www.cdc.gov/ehrlichiosis 
• Ehrlichiosis is general name used to describe several bacterial diseases that affect animals & humans. Human ehrlichiosisis a disease caused by at least 3 different ehrlichial species in United States: Ehrlichia chaffeensis, Ehrlichia ewingii, & a third Ehrlichia species provisionally called Ehrlichia muris-like (EML). Ehrlichiae are transmitted to humans by bite of an infected tick. The lone star tick (Amblyomma americanum) is primary vector of both Ehrlichia chaffeensis & Ehrlichia ewingii in United States. Typical symptoms include: fever, headache, fatigue, & muscle aches. Usually, these symptoms occur within 1-2 weeks following a tick bite. Ehrlichios is diagnosed based on symptoms, clinical presentation, & later confirmed with specialized lab tests. The first line treatment for adults & children of all ages is doxycycline.  Ehrlichiosis & other tickborne diseases can be prevented.
• Heartland virus infection has been identified in 8 patients in Missouri & Tennessee as of March 2014. Studies suggest that Lone Star ticks may transmit virus. It is unknown if virus may be found in other areas of U.S.
• http://www.cdc.gov/ncezid/dvbd/heartland/index.html 

• What is Heartland virus?

  Heartland virus belongs to a family of viruses called Phleboviruses. Viruses in this family are found all over world. Some of these viruses can cause people to get sick. Most of  phleboviruses that cause people to become ill are passed through bite of a mosquito, tick, or sandfly.
  

  How do people get infected with Heartland virus?

  It isn't yet fully known how people become infected with Heartland virus. However, recent studies suggest that ticks, namely Lone Star ticks, may transmit virus.
  

  Where have cases of Heartland virus disease occurred?

  As of March 2014, eight cases of Heartland virus disease have been identified among residents of Missouri & Tennessee. It is unknown at this time if virus may be found in other areas of United States.
  

  What are symptoms caused by Heartland virus?

  Since Heartland virus disease was first described in 2012 & there have only been a few cases, scientists are still learning about it. So far, all patients diagnosed with Heartland virus disease became sick during May-September. They all had a fever & felt very tired. Some also complained of headaches, muscle aches, diarrhea, losing their appetite, or feeling sick to their stomach. They all had low numbers of cells that fight infection & that help blood clot. Most patients required hospitalization for their illness. Most patients fully recovered, but one patient died.
  

  Who is at risk for infection with Heartland virus?

  People likely become infected with Heartland virus through a bite of a tick or other insect. Therefore, people who work or do activities outside, where they're exposed to ticks or insects, may be more likely to be infected.
  

  How can people reduce chance of getting infected with Heartland virus?

  There is no vaccine or drug to prevent or treat disease. Preventing bites from ticks & mosquitoes may prevent this & other infections. 
• Use insect repellents
• Wear long sleeves & pants
• Avoid bushy & wooded areas
• Perform thorough tick checks after spending time outdoors

Additional information on reducing exposure to ticks is available on CDC Ticks website

• Lyme disease is transmitted by blacklegged tick (Ixodes scapularis) in northeastern U.S. & upper midwestern U.S. &  western blacklegged tick (Ixodes pacificus) along Pacific coast.
• http://www.cdc.gov/lyme 
• Lyme disease is caused by bacterium Borrelia burgdorferi & is transmitted to humans through bite of infected blacklegged ticks. Typical symptoms include fever, headache, fatigue, & a characteristic skin rash called erythema migrans. If left untreated, infection can spread to joints, heart, & nervous system. Lyme disease is diagnosed based on symptoms, physical findings (e.g., rash), & possibility of exposure to infected ticks. Lab testing is helpful if used correctly & performed with validated methods. Most cases of Lyme disease can be treated successfully with a few weeks of antibiotics. Steps to prevent Lyme disease include using insect repellent, removing ticks promptly, applying pesticides, & reducing tick habitat. The ticks that transmit Lyme disease can occasionally transmit other tickborne diseases as well.
• Powassan disease is transmitted by blacklegged tick (Ixodes scapularis) & groundhog tick (Ixodes cookei). Cases have been reported primarily from northeastern states & Great Lakes region.
• http://www.cdc.gov/powassan
• Powassan (POW) virus is transmitted to humans by infected ticks. Approximately 60 cases of POW virus disease were reported in United States over past 10 years. Most cases have occurred in Northeast & Great Lakes region. Signs & symptoms of infection can include fever, headache, vomiting, weakness, confusion, seizures, & memory loss. Long-term neurologic problems may occur. There is no specific treatment, but people with severe POW virus illnesses often need to be hospitalized to receive respiratory support, intravenous fluids, or medications to reduce swelling in brain.You can reduce your risk of being infected with POW virus by using tick repellents, wearing long sleeves & pants, avoiding bushy & wooded areas, & doing thorough tick checks after spending time outdoors. If you think you or a family member may have POW virus disease, it is important to consult your healthcare provider.
  Rickettsia parkeri rickettsiosis is transmitted to humans by Gulf Coast tick (Amblyomma maculatum).
• http://www.cdc.gov/otherspottedfever 
• In addition to Rickettsia rickettsii, agent of Rocky Mountain spotted fever (RMSF), several other tick-borne species of Rickettsia, broadly grouped under heading "Spotted Fever group Rickettsia (SFGR)" have been shown to cause human infections. Tick-borne SFGR are transmitted to humans by bite of an infected tick, & may cause similar signs & symptoms to those observed for RMSF. These pathogens include several species of Rickettsia found in United States, including R. parkeri & Rickettsia species 364D (Table1). In addition, numerous tick-borne SFGR pathogenic to humans have been described internationally, including but not limited to R. conorii & R. africae (Table 2). Travelers may be at risk for exposure to these pathogens when engaging in behaviors that place them at risk for tick exposure, & physicians should maintain awareness of these diseases when a patient presents with a febrile illness within 2 weeks of returning home. Rickettsial infections with R. africae have been reported as a common cause of fever in travelers returning from South Africa.
• Rocky Mountain spotted fever (RMSF) is transmitted by American dog tick (Dermacentor variabilis), Rocky Mountain wood tick (Dermacentor andersoni), & brown dog tick (Rhipicephalus sangunineus) in U.S. The brown dog tick & other tick species are associated with RMSF in Central & South America.
• http://www.cdc.gov/rmsf 
• Rocky Mountain spotted fever (RMSF) is a tickborne disease caused by bacterium Rickettsia rickettsii. This organism is a cause of potentially fatal human illness in North & South America, & is transmitted to humans by bite of infected tick species. In United States, these include American dog tick (Dermacentor variabilis), Rocky Mountain wood tick (Dermacentor andersoni), & brown dog tick (Rhipicephalus sanguineus).  Typical symptoms include: fever, headache, abdominal pain, vomiting, & muscle pain. A rash may also develop, but is often absent in first few days, & in some patients, never develops. Rocky Mountain spotted fever can be a severe or even fatal illness if not treated in first few days of symptoms. Doxycycline is first line treatment for adults & children of all ages, & is most effective if started before 5th day of symptoms. The initial diagnosis is made based on clinical signs & symptoms, & medical history, & can later be confirmed by using specialized lab tests.  RMSF & other tickborne diseases can be prevented.
• STARI (Southern tick-associated rash illness) is transmitted via bites from lone star tick (Ambylomma americanum), found in  southeastern & eastern U.S.
• http://www.cdc.gov/stari 
• A rash similar to rash of Lyme disease has been described in humans following bites of lone star tick, Amblyomma americanum. The rash may be accompanied by fatigue, fever, headache, muscle & joint pains. This condition has been named southern tick-associated rash illness (STARI). The cause of STARI isn't known.
• Tickborne relapsing fever (TBRF) is transmitted to humans through bite of infected soft ticks. TBRF has been reported in 15 states: Arizona, California, Colorado, Idaho, Kansas, Montana, Nevada, New Mexico, Ohio, Oklahoma, Oregon, Texas, Utah, Washington, & Wyoming & is associated with sleeping in rustic cabins & vacation homes.
• http://www.cdc.gov/relapsing-fever 
• Relapsing fever is bacterial infection characterized by recurring episodes of fever, headache, muscle & joint aches, & nausea. It is caused by certain species of Borrelia spirochetes. There are 2 types of relapsing fever:
  
  
• Tick-borne relapsing fever (TBRF)
• Louse-borne relapsing fever (LBRF)

Tick-borne relapsing fever occurs in western United States & is usually linked to sleeping in rustic, rodent-infested cabins in mountainous areas. Louse-borne relapsing fever is transmitted by  human body louse & is generally restricted to refugee settings in developing regions of world.

• Tularemia is transmitted to humans by dog tick (Dermacentor variabilis), wood tick (Dermacentor andersoni), & lone star tick (Amblyomma americanum). Tularemia occurs throughout U.S. 
• http://www.cdc.gov/tularemia
• Tularemia is a disease of animals & humans caused by bacterium Francisella tularensis. Rabbits, hares, & rodents are especially susceptible & often die in large numbers during outbreaks. Humans can become infected through several routes, including:
  

  • Tick & deer fly bites
  • Skin contact with infected animals
  • Ingestion of contaminated water
  • Inhalation of contaminated aerosols or agricultural dusts
  • Lab exposure

  In addition, humans could be exposed as a result of bioterrorism.
  Symptoms vary depending on route of infection. Although tularemia can be life-threatening, most infections can be treated successfully with antibiotics.
  Steps to prevent tularemia include:
  

  • Use of insect repellent
  • Wearing gloves when handling sick or dead animals
  • Avoiding mowing over dead animals

  In United States, naturally occurring infections have been reported from all states except Hawaii.
  
• 364D rickettsiosis (Rickettsia phillipi, proposed) is transmitted to humans by Pacific Coast tick (Dermacentor occidentalis ticks). This is a new disease that has been found in California.
• http://www.cdc.gov/otherspottedfever 
• In addition to Rickettsia rickettsii, agent of Rocky Mountain spotted fever (RMSF), several other tick-borne species of Rickettsia, broadly grouped under heading "Spotted Fever group Rickettsia (SFGR)" have been shown to cause human infections. Tick-borne SFGR are transmitted to humans by bite of an infected tick, & may cause similar signs & symptoms to those observed for RMSF. These pathogens include several species of Rickettsia found in United States, including R. parkeri & Rickettsia species 364D (Table1). In addition, numerous tick-borne SFGR pathogenic to humans have been described internationally, including but not limited to R. conorii & R. africae (Table 2). Travelers may be at risk for exposure to these pathogens when engaging in behaviors that place them at risk for tick exposure, & physicians should maintain awareness of these diseases when a patient presents with a febrile illness within 2 weeks of returning home. Rickettsial infections with R. africae have been reported as a common cause of fever in travelers returning from South Africa.
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• 2016 HHS joint webinar: Trends in Tickborne Diseases - Video

  by the Centers for Disease Control & Prevention (CDC)

  Published on Aug 16, 2016
  HHS Working Group on Lyme & Other Tickborne Diseases webinar: Trends in Tickborne Diseases in United States Experts in field of tickborne diseases
• 
  
• https://youtu.be/p6ZlEcaJDrw
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•  2013 HHS joint webinar on Novel & Emerging Tickborne Diseases: Agents, Clinical Features, & Surveillance - Video

  by the Centers for Disease Control & Prevention (CDC)

  Published on Jul 11, 2014
  This webinar features: Dr. Aaron DeVries from  Minnesota Department of Health speaking about Powassan virus disease; Dr. Roger Nasci of CDC speaking about heartland virus; Dr. Peter Krause from  Yale School of Medicine describing Borrelia miyamotoi, Dr. Jennifer McQuiston of CDC discussing  Ehrlichia muris-like organism; Dr. Barbara Herwaldt of CDC providing an update on Babesia microti, & Anna Perea of CDC describing CDC's tickborne disease prevention resources.

  https://youtu.be/-pWpKdl-tsA