THINGS TO KNOW ABOUT TICKS

CONVERSATION WITH DR. WOJCIECH OZIMEK

Doctor Woijciech Ozimek has been running a private medical practice for over 20 years, giving advice in the field of pediatrics as well as tick-borne and parasitic diseases. He is an author of the best-seller  „I WILL NOT GIVE IN TO PARASITES. How to regain health.”

He is a member of the American Society of Parasitologists, the Scandinavian Baltic Society for Parasitology, the British Society for Parasitology, the Physicians Committee for Responsible Medicine, the Association for Comprehensive NeuroTherapy and the Mitochondrial Medicine Society.

Mama Mia: What do you think about the public knowledge about tick-borne diseases? 

Dr. Woiciech Ozimek: It’s getting better. More and more is said in the media about ticks and diseases transmitted by them, which results in greater social awareness.

MM: Families with children want to spend time in the meadows and forests. What should they do to feel safe? 

WO: The basis is to minimize the risk of contact with ticks. This can be achieved by caution, repellents – substances that repel ticks, appropriate clothing, e.g. socks, hats, and anti-tick leggings impregnated with Sanitized AM 23-24. Cautious people can also think about electronic devices that emit ultrasounds making people „invisible” for ticks. Amateurs of picnics in the bosom of nature should consider buying an anti-tick picnic blanket soaked with the above substance. It protects not only against ticks. Flies do not sit down, ants do not get to food, and fleas and lice are deterred. However, I must emphasize the fact that no method alone or even all together give a 100% guarantee that the tick will not bite us. Therefore, after a walk in the forest, park or meadow, it is worth checking the whole body for the presence of ticks, and the clothing should be washed as soon as possible at the highest possible temperature.

MM: Are there any special periods of the year when we are most exposed to bites? 

WO: Unfortunately, the whole Poland is currently an endemic area for Lyme disease and other tick-borne diseases, and at the current temperatures we are exposed to tick bites all year round. However, the most cases of Lyme disease in Poland are usually reported from April to the end of July. It is worth remembering that not only adult ticks attack us, but also very small nymphs and even smaller larvae. They are also dangerous, and they are the size of a poppy seed. In addition, the larvae are practically transparent.

MM: What to do when we find a tick on the body? 

WO: It should be removed quickly and efficiently so as not to make the tick vomit and not increase the risk of infection. After removing the tick the wound should be disinfected. It is not enough to remove the tick, for example, with a tick twister. In order to reduce the risk of tick-borne diseases it is good to suck the wound after removing the tick with the help of a pump aspirator and to disinfect the wound with chemical and physical methods.

MM: What are the symptoms of an infection with  a tick-borne disease?

WO: It depends on which one. Symptoms vary in Lyme disease, bartonellosis, tick-borne encephalitis, and when the tick infects us with various diseases. The early symptoms of Lyme disease may be similar to the symptoms of influenza, and later joint-muscular pain usually occurs.

MM: What diseases can be transmitted by ticks? 

WO: I have already mentioned Lyme disease, bartonellosis and tick-borne encephalitis, but ticks can infect us with many other diseases. The most important are: anaplasmosis, babesiosis, brucellosis, Q fever and tularemia.

MM: Do only ticks carry Lyme disease?

WO: It is widely believed to be true, although more and more scientific papers emphasize the possibility of sexually transmitted infections, fetal infections by pregnant mothers and contagion of recipients through blood and organ transplants from sick donors. Borrelia spirochetes have been found in many insects and arachnids, which feed on blood, including mosquitoes, warble flies and horseflies – also called clegs. However, contrary to popular opinion, human infections have not been confirmed for these species. This can be explained by the fact that these insects and arachnids do not have proteins that promote infection, i.e. TROSPA and Salp 15. Ticks have such proteins, while other insects and arachnids do not.

MM: Is there always an erythema after a bite? 

WO: Definitely not. There are differences in expert opinions, but the majority of experts believe that erythema occurs in up to 50%  of people with Lyme disease. In children it is even less frequent.

MM: There are many tests, but which ones are the most reliable?

WO: The commonly binding two-stage diagnostics of Lyme disease is based on serological tests including the detection of IgM and IgG antibodies produced by the patient and directed against spirochetes. In the first stage, a serological screening test – ELISA (enzyme-linked immunosorbent assay – immunoenzymatic method) is performed as standard. The results of the ELISA test are commonly questioned. Nevertheless, this method still functions as a screening test for Lyme disease due to the speed of analysis, low cost and probably lack of knowledge about its low usefulness.

The Western Blot confirmation test is used to eliminate false positive tests as well as tests with limit values. Difficulties in the interpretation of serological tests result from delayed appearance of antibodies after infection (4-6 weeks), biological features of Borrelia spirochetes (antigenic variability, intracellular presence of bacteria, hiding the pathogen in the so-called immunologically privileged areas), binding antibodies in immune complexes, previous use of antibiotic therapy, impaired immunity, and finally, the imperfection of  diagnostic methods as such. It is worth noting that the percentage of infected people who do not produce antibodies, i.e. permanently seronegative patients, is estimated at 7-15%. In addition, neither the ELISA test nor the Western Blotting can assess the effectiveness of Lyme disease treatment. Therefore, although cyclic repeating of tests (both ELISA and Western Blot) after the end of therapy to assess the effectiveness of treatment has no scientific justification, it is quite often practiced. It is true that the presence and concentration of antibodies and the analysis of the intensity of  so-called ‚bands’ help determine the approximate duration of Lyme disease, but antibodies can be present in human serum for many years, even for the rest of patient’s life, so their persistence or slight increase does not indicate the failure of treatment.

Summing up, the current standard diagnostic approach in Lyme disease primarily includes the detection of anti-spirochete antibodies using ELISA and Western/Immuno-blot.

Currently, we are working on improving and authenticating many new tests with scientific research, including those based on blastic lymphocyte transformation (LTT), disruption of circulating immune complexes, and the exploitation of metabolomics. I am afraid, however, that these tests will not be used for a long time as part of standard diagnostics.

MM: What is it best place to do such tests?

WO: Centres with good standardized tests, modern equipment and/or experienced staff.

MM: Is it a good idea to examine a tick found on the body?

WO: Opinions differ. In my opinion – yes, but the tick should be examined as soon as possible so that we can also examine the patient’s blood. The maximum time to test the blood of the „victim of a tick” is 48-72 hours. Later, this examination makes less sense because the bacteria disappear from the blood. Both in the tick and possibly in the patient’s blood we search directly for bacterial DNA – in this case,

DNA of bacteria causing Lyme disease and co-infections, or other diseases transmitted by ticks. The mentioned PCR test is a kind of genetic testing.

It is worth noting that not every tick is infected, and even if it is, it does not always infect us. The risk of infection increases proportionally to the time that elapsed from the tick bite. The longer the tick is stuck in the skin, the greater the risk of infection is. If we do not perform the PCR test, then we can passively wait for possible erythema appearance or have serological tests, i.e. standard ELISA test and confirming Western blotting for Lyme disease, which are performed not earlier than 4 weeks after the tick bite. Of course, if erythema appears, we do not perform the examinations but immediately implement the treatment.

MM: Can the disease reappear after many years?

WO: Yes, it can reappear in the form of Lyme disease or its distant complications, which until recently were not associated with Lyme disease. We currently know that in some cases of multiple sclerosis, Hashimoto’s disease, Alzheimer’s disease and several other conditions, mainly autoimmune diseases, the development of the disease results from a long-term „fooling” of our immune system by the spirochete, which finally turns against us. This phenomenon is called autoaggression.

MM: Can tick-borne diseases be cured and how long does the treatment last?

WO: If the diagnosis is made quickly and the treatment is carried out correctly, a full recovery is possible even after 20-30 days of treatment. If Lyme disease is diagnosed late and treated incorrectly, recovery can be problematic. Experts do not agree on the existence of a chronic form of Lyme disease. Some of them call symptoms that persist despite using the correct standard treatment, a ‚post-Lyme disease syndrome’ or non-chronic Lyme disease.

MM: Does having pets at home increase the risk of bites and how to protect animals and the home to avoid unpleasant surprises?

WO: The role of animals is often demonized, but it is true that if not treated with the right substances, they can bring ticks home and thus increase the risk of our contact with ticks. By taking care of animals and using anti-tick prophylaxis, we take care of ourselves. It is also worth spraying the garden with appropriate substances. By removing ticks from the garden, we reduce the risk of tick attack. As I mentioned before, after walking, running, having a picnic, mushroom picking, hunting or just being in tick-infested areas, we should check our bodies and clothes as soon as possible for the presence of ticks both before entering the car and after returning home. The same applies to animals we take with us. We should wash and dry clothes as soon as possible, at the highest possible temperature.

MM: Is there a Lyme disease vaccine? 

WO: No, there isn’t. We had such a vaccine (Lymerix), but it gave  a lot complications and was withdrawn from use in a scandal. A new vaccine  (working name – VLA15) is being developed, but given its composition, I’m afraid that it can share the predecessor’s fate.

MM: What kind of treatment works best? Are only antibiotics able to overcome the disease or are there alternative treatment options?

WO: Every patient is unique so treatment should be personalized. I am a supporter of combining antibiotics, herbs and apitherapy, i.e. using bee preparations. I know that there are alternative methods of treatment, but their effectiveness has not been confirmed by scientific methods.

MM: How many victims of abnormal treatment of tick-borne diseases do you encounter every day? Why are these people bombarded with drugs for thousands of different ailments, and the probability of infection with tick-borne diseases is ignored?

WO: The answer to this question is not simple. First of all, we need to define a ‚victim’ of incorrect treatment of tick-borne diseases. Do we only refer to people who have not been diagnosed with tick-borne diseases and are treated for other diseases or just receive symptomatic treatment? Or do we also mean people who have been misdiagnosed with a tick-borne disease and are treated for  a disease that they do not suffer from? I understand that the question concerns the first group. It is true that Lyme disease and other tick-borne diseases are recognized as rare and many patients walk for months and years from one specialist to another, receiving another drug combination….. I cannot answer why the probability of tick-borne diseases is ignored, especially considering the growing population of ticks, the prolongation of their feeding period and the number of officially reported cases growing year by year. In 2016, there were 21,200 cases reported. In Germany, about 80,000 cases are reported every year, and in the US it is 300,000 a year.

MM: People with tick-borne diseases in Poland, who suffer from thousands of ailments, discuss them online on various forums and join support groups. We hear and read about fatal cases so how is it possible that doctors ignore the problem?

WO: Doctors do not ignore the problem intentionally. They are simply not aware of this problem. Sometimes doctors also lack knowledge or reliable diagnostic tests. The sensitivity and specificity of commonly performed serological tests are limited.         The reasons for false positive results may include infections caused by other spirochetes, infections caused by herpes virus, HIV-1 or cytomegalovirus and hypergammaglobulinemia in the course of autoimmune diseases. On the other hand, too early tests,  antibodies bound in immune complexes or antibiotic therapy may give false negative results.

MM: Is the p41 band in the Western Blot test typical Lyme disease or is it also indicative of other diseases?

WO: The band 41 corresponds to a protein called flagellin. It is flagellum-related protein occurring in all spirochetes, also non-pathogenic, and in other bacteria, e.g. Helicobacter pylori.

Therefore, cross-reactivity and nonspecific reactions may occur.

MM: What illnesses can Lyme disease imitate and what diseases should be excluded?

WO: There are many such diseases. It is widely believed that differential diagnosis of Lyme disease should first of all involve other infectious diseases – such as infectious mononucleosis, cytomegaly, tuberculosis, HIV infection as well as neoplastic processes, multiple sclerosis and sarcoidosis.

MM: What do you think about the ILADS treatment guidelines? Isn’t it harmful to take a combination                            of antibiotics for 2 years?

WO: As everyone knows, there are official guidelines for the treatment of Lyme disease, but the choice of treatment is made jointly by the doctor and patient. I do not conceal that I belonged  to ILADS for a few years, but this does not mean that I agree with all the treatment methods proposed by this organization. For example, I have never used antibiotic therapy for many months according to ILADS standards, due to the risk of complications. ILADS was an educational platform for me, where I learned about the comprehensive approach to treatment, not only Lyme disease and co-infections, but also the complications of these diseases, which is rarely mentioned outside of ILADS.

MM: Why do infectious diseases specialists affiliated with IDSA not recognize co-infections in Lyme disease? For example, they think that babesiosis does not occur in humans, but you can find publications about documented human cases.

WO: I do not know why it is like that. I do not understand their position. Ticks carry many pathogens, not only Borrelia sp. spirochetes. In addition, numerous scientific studies have conclusively demonstrated that many cases of Lyme disease are accompanied by other infections called co-infections, the treatment of which is as important as the treatment of Lyme disease.

MM: What alternative methods are considered effective in the treatment of Lyme disease, in addition to antibiotics? 

WO: I will speak only about the methods that from my and my friends’ (doctors from the USA and in Germany with whom I cooperate) point of view are helpful. These are mainly bee products, herbs and supplements to compensate for any vitamin and microelement deficiencies. They support antibiotic therapy, compensate for possible deficiencies, and have immunomodulatory and anti-inflammatory effects.

MM: Do you agree that Lyme disease opens the gate to other bacteria and parasites?

WO: I do not conceal that wording ‚open the gate’ is a typical ‚altmed’ phrase, but I do not intend to discuss on it. Both tick saliva and Lyme disease (and possible co-infections) impair our immune system by weakening and confusing it. This obviously may promote potential infections and the development of autoimmune diseases.

MM: Why are some IgM antibodies still found in the Western Blot test in some patients with Lyme disease lasting for several years, despite the lack of new bites, while IgG antibodies  are negative?

WO: Both IgM and IgG antibodies can be present in the serum for many years even despite the elimination of Borrelia burgdorferi infection (spontaneously or as a result of treatment). Therefore, the control of the presence of specific antibodies cannot be used to assess the effectiveness of Lyme disease treatment. On the basis of serological tests, it is also impossible to determine the duration of infection.

MM: Do you think that MS is a consequence of untreated Lyme disease? Can we have both diseases at the same time?

WO: One of my masters and teachers Dr. Alan MacDonald and his student Dr. Eva Sapi have long suggested a relationship between Lyme disease and neurodegenerative diseases such as multiple sclerosis. They published several papers on this topic in highly respected scientific journals. I would also like to emphasize that last year Dr. MacDonald was ‚recalled from his well-deserved retirement’ to head an institution that would further explore these relationships, created at … Harvard. We do not know, however, whether Lyme disease is the cause or the so-called ‚trigger’, a stimulus that triggers MS in predisposed patients. There are also scientific reports, for the time being mainly hypotheses, linking Borrelia sp. infection with Hashimoto’s disease, fibromyalgia, amyotrophic lateral sclerosis, Parkinson’s disease, Alzheimer’s disease or congenital neuroborreliosis, the presentation of which is similar to autism and very often confused with it. In the case of Hashimoto’s disease, there are also associations with other chronic infections such as Epstein-Barr virus (EBV), Helicobacter pylori and yersiniosis.

MM: What diet do you recommend to patients during Lyme disease treatment?

WO: Each patient has a modified diet depending on individual needs, possible deficiencies confirmed by the results of laboratory tests, and other coexisting diseases. This diet is supposed to prevent mycosis, eliminate inflammation, strengthen immunity, but also suppress possible auto-aggression. In summary, the diet should provide the patients with everything they need at a given stage of treatment. 

Thank you very much for the interview. Information that our readers have obtained from you can help many people.

 

Translated by The Palms

www.thepalms.edu.pl