I recently attended lectures given by
Ed Breitschwerdt, DVM, Dipl. ACVIM from North Carolina
State College of Veterinary Medicine that I found
stimulating and interesting. The Vector Borne Diseases
Diagnostic Laboratory at NCSU offers the most
comprehensive veterinary panel for vector (tick and
other insect) borne diseases. At some point I would love
to go into a great deal more detail on his seminars, but
for now I will restrict myself to a few important points
he raised, as well as some others I gleaned from a
lecture on the Epidemiology of Tick Borne Disease East
of the Rockies by Michael Dryden, DVM, MS, PhD. I had to
miss the companion lecture on TBD West of the Rockies.
Lyme and many other vector borne
diseases (Anaplasma, Babesia, Bartonella, Ehrlichia
and Leishmania spp.) as well as other
microorganisms (Chlamydi, Mycoplasma spp. and
retroviruses) can set up long-term or even permanent
house-keeping in the body, and while treatment may
control symptoms they will not eradicate the disease.
Transmission of more than one disease by a single vector
is not uncommon. These diseases can result in chronic,
insidious disease – glomerulonephritis (glomerular
kidney disease), polyarthritis) or acute decompensation
– immune-mediated hemolytic anemia (AIHA),
immune-mediated thrombocytopenia (IMTP). While these can
occur in dogs of any age, breed or sex, infection in
older animals will likely be more severe and atypical of
expectations for a particular disease. The interactions
between the various organisms in a multiple disease
infection can also contribute to the range of symptoms.
A word about AIHA and IMTP would be
appropriate as they are of particular interest to
Beardie owners. While we have been led to believe that
these diseases are always genetic in origin, this is not
necessarily the case when they are induced by vector
borne diseases. There is some evidence that some dogs
may be more susceptible to developing these
manifestations of the diseases, and genetics can play a
role, but other factors are involved. Dr. Breitschwerdt
pointed out that the presence of AIHA, IMTP and
glomerulonephritis may obscure diagnosis of the
underlying vector borne disease. Once immunosuppressive
treatment has been begun for suspected AIHA, ITP or SLE
(systemic lupus erythematosus – which can manifest as
glomerulonephritis and polyarthritis) low or
non-existent titers for tick borne disease may sky
rocket. It is always advisable to retest for tick borne
diseases after starting treatment, lest the underlying
cause be missed.
The reason these diseases make us and
our dogs sick is that we are non-reservoir hosts.
Parasitic diseases will not survive if they kill their
host species, and so have evolved in conjunction with
reservoir hosts – insects, mammals etc – in which they
do not cause disease. Only when they end up in the wrong
place is disease created. It has recently been shown
that Ehrlichia and Anaplasma species
can inhibit white cell apoptosis (natural cell death)
and so prolong the life span of the cells they inhabit.
Chronic infection can not only complicate diagnosis of
these illnesses, it can also influence and complicate
other illnesses that a patient experiences over time –
whether they are degenerative, immune-mediated, allergic
or neoplastic. As the incidence of these illnesses
increases with age, so will the severity of bizarre
presentations from vector borne and other persistent
infections. These organisms could also influence the
body’s response to normal bacteria that colonize the
skin, gastrointestinal system or urinary tract.
It has been demonstrated that many
animals are co-infected with Lyme disease and
Anaplasma phagocytophilum. Dogs with both organisms
are far more likely to become severely ill than those
infected with only one of the two. The same is true of
other co-infections. Toxicity, nutrition and genetics as
well as the burden of multi-organism infection are all
factors in determining whether or not a dog will develop
immunity to the disease organisms or become sick.
Antibody titers cannot determine whether a dog becomes
sick or not, they only tell us that the dog has been
exposed to the disease.
Many people believe that ticks jump
onto passing dogs from trees and tall bushes, but most
ticks are found on plants under 18” in height. There
they wait upside down for a carbon dioxide secreting
organism to pass and drop off onto it. Most ticks will
therefore be found on the front end of the dog, which is
the part they are most likely to encounter. People have
reported ticks persisting well into the winter this
year, and they can be expected to be active if there is
no snow cover whenever temperatures rise over 35 oF.
Further disturbing news is that the Lone Star Tick,
which as its name implies used to be primarily resident
in Texas is now found in virtually all states east of
Texas up to and throughout New England. The distribution
of other tick species is also expanding. Different ticks
serve as hosts for different diseases, and we need to
improve our ability to identify the different tick
species in our area. We also need to expand our testing
for tick borne diseases to include diseases which in the
past were ignored.
Lyme disease goes hand in hand with
the deer population. When settlers pretty much
eradicated the white tailed deer, they also saw
virtually no ticks. The white tailed deer population is
soaring so is that of the tick. Other factors are at
play though. Ticks acquire the spirochetes of Lyme
disease from blood meals taken as larvae and nymphs from
small mammals, most often the white footed mouse. In
Florida, instead of mice most larvae and nymphs get that
blood meal from lizards that do not host the
spirochetes. So despite the burgeoning populations of
deer and ticks in Florida the incidence of Lyme is only
about 20% of that in states with similar deer densities
where mice are the preferred snack. Another interesting
fact is that humans are primarily infected by ticks in
the nymphal stage, much smaller than the adult, which is
also pretty small, and explaining why so few people know
they were bitten by the tick. Dogs, OTOH, are almost
always infected by the adult tick. How long it takes for
the tick to infect the dog is unclear, but it is
probably less than 40 hours, much faster than we used to
believe.
Dr. Breitschwerdt likes to quote
Voltaire: “Doctors put drugs of which they know little,
into our bodies of which they know less, to treat
disease of which they know nothing at all.” We have made
a little progress since the 18 th century, but we still
have a long way to go.
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PON Digest would like to extend a
grateful thank you to Dr. Aronson for allowing the use
of her articles. |