On 2017 Aug 20, Daniel Weiss commented:

This review of Tickborne diseases other than Lyme by Drs. Eickhoff and Blaylock paints a frightening picture of diverse illnesses increasing in prevalence in the United States.

A recent survey found over 20% of U.S residents reporting a tick attached to themselves or a family member within the previous year(1). Yet, as Eickhoff and Blaylock point out, the absence of a known tick bite “never precludes the diagnosis of a tick-borne infection” and “co-infections with multiple pathogens may occur”. Throughout their review, the authors emphasize that insensitive laboratory testing methods increase the complexity of diagnosis, and result in an unknown risk to the blood supply. All health care practitioners require a high index of suspicion and sound clinical judgment to identify individual tick-borne infections. Simultaneous co-infections increase the diagnostic and therapeutic challenge.

As examples of the challenges faced, Borrelia miyamoti infection may not demonstrate the erythema migrans rash occurring with B. burgdorferi—the agent of Lyme disease. But up to 70% of patients with Lyme disease have no history of this rash(2). Similarly, there is no proven clinical difference between the rash seen with B. lonestari and B. burgdorferi. Lonestar ticks can transmit both spirochetes(3).

Because no gold standard exists to prove the absence of any of these infections, practitioners must avoid declaring with certitude that no infection is present—especially if an acute infection has gone untreated or undertreated. In his accompanying editorial, Dr. Mandell reiterated the difficulty of identifying acute tick-borne infection. Therefore, we were confused by his concluding paragraph. Given the diagnostic uncertainties, one must not dismiss dogmatically the possibility of an infection, either acute or chronic. A call for improved diagnostics and more effective therapeutics is the more logical response to the issues raised by this important review.

1. Hook SA, Nelson CA, Mead PS. U.S. public's experience with ticks and tick-borne diseases: Results from national HealthStyles surveys. Ticks Tick Borne Dis. 2015;6(4):483-8. doi: 10.1016/j.ttbdis.2015.03.017. PubMed PMID: 25887156.
2. Aucott JN, Seifter A, Rebman AW. Probable late lyme disease: a variant manifestation of untreated Borrelia burgdorferi infection. BMC Infect Dis. 2012;12:173. Epub 2012/08/03. doi: 10.1186/1471-2334-12-173. PubMed PMID: 22853630; PMCID: PMC3449205.
3. Clark KL, Leydet B, Hartman S. Lyme borreliosis in human patients in Florida and Georgia, USA. Int J Med Sci. 2013;10(7):915-31. doi: 10.7150/ijms.6273. PubMed PMID: 23781138; PMCID: PMC3675506.

On 2017 Aug 20, Daniel Weiss commented:

This review of Tickborne diseases other than Lyme by Drs. Eickhoff and Blaylock paints a frightening picture of diverse illnesses increasing in prevalence in the United States.

A recent survey found over 20% of U.S residents reporting a tick attached to themselves or a family member within the previous year(1). Yet, as Eickhoff and Blaylock point out, the absence of a known tick bite “never precludes the diagnosis of a tick-borne infection” and “co-infections with multiple pathogens may occur”. Throughout their review, the authors emphasize that insensitive laboratory testing methods increase the complexity of diagnosis, and result in an unknown risk to the blood supply. All health care practitioners require a high index of suspicion and sound clinical judgment to identify individual tick-borne infections. Simultaneous co-infections increase the diagnostic and therapeutic challenge.

As examples of the challenges faced, Borrelia miyamoti infection may not demonstrate the erythema migrans rash occurring with B. burgdorferi—the agent of Lyme disease. But up to 70% of patients with Lyme disease have no history of this rash(2). Similarly, there is no proven clinical difference between the rash seen with B. lonestari and B. burgdorferi. Lonestar ticks can transmit both spirochetes(3).

Because no gold standard exists to prove the absence of any of these infections, practitioners must avoid declaring with certitude that no infection is present—especially if an acute infection has gone untreated or undertreated. In his accompanying editorial, Dr. Mandell reiterated the difficulty of identifying acute tick-borne infection. Therefore, we were confused by his concluding paragraph. Given the diagnostic uncertainties, one must not dismiss dogmatically the possibility of an infection, either acute or chronic. A call for improved diagnostics and more effective therapeutics is the more logical response to the issues raised by this important review.

1. Hook SA, Nelson CA, Mead PS. U.S. public's experience with ticks and tick-borne diseases: Results from national HealthStyles surveys. Ticks Tick Borne Dis. 2015;6(4):483-8. doi: 10.1016/j.ttbdis.2015.03.017. PubMed PMID: 25887156.
2. Aucott JN, Seifter A, Rebman AW. Probable late lyme disease: a variant manifestation of untreated Borrelia burgdorferi infection. BMC Infect Dis. 2012;12:173. Epub 2012/08/03. doi: 10.1186/1471-2334-12-173. PubMed PMID: 22853630; PMCID: PMC3449205.
3. Clark KL, Leydet B, Hartman S. Lyme borreliosis in human patients in Florida and Georgia, USA. Int J Med Sci. 2013;10(7):915-31. doi: 10.7150/ijms.6273. PubMed PMID: 23781138; PMCID: PMC3675506.