My plans to keep the blog updated daily has already fallen by the wayside!
The week started with a vector lab team meeting, the lab are involved in tick and mosquito studies. The lab is developing an insectary to raise mosquitos and look at factors that sustain or inhibit their development as well as looking at insecticide resistance. The growing worldwide concerns around mosquito borne disease such as Zika virus has led to an increase in areas of study.Discussion took place around the other studies ongoing at the moment, ticks are collected from a range of sites and habitats, identifying tick abundance and their preferred sites and how they can cope and adapt to different environments. The lab covers a very large area and extensive travel is required to allow for sampling at a range of sites.
Over many years the lab has collected ticks and have previously identified the range of ticks that are found in Maine:
Ixodes scapularis (deer tick) is the most commonly associated with transmission of lyme disease to humans (Ixodes Ricinus in Europe). The studies undertaken across the USA over the years have been able to map the movement of ticks along the country and identify any new species and strains of disease associated with the ticks.
Ticks are tested in the lab for Borrelia, more recently it has become routine to test for Anaplasma and Babesiosis. Current Studies studies are looking at co-infections which is significant when considering treatment options and the symptoms humans present with.
The Maine Medical Research facility lab is unique in that it is very connected to the hospital and has been part of the hospital research structure from the beginning this is essential when looking at human disease, infectious diseases are a significant threat to human health and are emerging at an alarming rate. Successful medical research is a complex process requiring the close collaboration of scientists, physicians, epidemiologists and data analysts. Being able to offer patients the best available evidence based medicine requires physicians to adopt a rigorous, scientific approach and look critically at all the efforts to understand transmission, diagnose and treat Lyme disease. This collaboration is achieved within Maine and is advancing the available knowledge.
At the end of the Lab meeting I gave a presentation to those present on the situation in the Outer Hebrides with regard to Lyme disease.
This led to some interesting questions and also gave Chuck and Dr Smith some ideas about other people I should make contact with.
I was privileged to be able to attend an Infectious disease clinic where patients with Lyme disease had been referred. This gave me an idea of the care people receive and their treatment options and expectations. The clinic I attended was at an InterMed facility https://www.intermed.com/about/about-intermed/. There is no other Infectious disease clinic facility in Portland so all patient requiring specialist input are referred here.
It was apparent that primary care physicians are very informed on Lyme disease with regard to recognising and treating patients, patients have had preliminary tests which include blood panels for Borrelia, Babesiosis and Anaplasma and the patients have been prescribed the recommended 2-3 weeks course of antibiotics. Those with persisting symptoms which the primary care physician has investigated and found no cause are referred for specialist input.
There is a two tier level of testing, these tests are most reliable a few weeks after an infection episode and after your body has had time to develop antibodies. The test used to detect Lyme disease, the enzyme linked immunosorbent assay test looks for antibodies to Borrelia. If antibodies are detected a further blot test is completed, the blot test is used to look at outer surface protein antibodies, some of these proteins will be present due to other conditions. Skilled physicians will interpretate the antibody/blot results and give consideration to the history of tick bite, patients health and symptoms and the evident patterns with the patients illness, prior to making any treatment recommendations.
Without doubt many patients fear that they have a chronic debilitating illness and are concerned that they are not being treated appropriately, for these patients it is important to use the best evidence based information to give the most appropriate treatment.
When seeing patients it is important to educate patients about reducing the risks of further bites and giving guidance on tick removal etc, the facility had some really nice resources
I really liked the bookmarks. We may be able to make our own NHS Western Isles version.
Susan Elias has worked in the Vector Lab for over 18 years and he is currently in the final stages of her PhD. As part of her studies she commissioned an artist to produce a drawing depicting Lyme disease.
Ecology of Lyme (c) Olaf Hayek, 2017
Hajek’s colorful painting titled “Ecology of Lyme” includes multiple interconnected factors associated with the infectious disease — Earth being altered by a changing climate, a deer, a mouse, invasive Japanese barberry, and three stages of deer ticks. The painting also includes a person infected with Lyme bacteria.
Susan affirms that our health is dependent on the health of the landscape and human, animal and ecological health are inextricably linked and need to be studied and managed holistically.
I was able to attend the annual open house event at Maine Medical Research Centre. The event is open to the general public and schools and universities are invited to bring students along. The aim of the event is to inform people on the scope of research being undertaken and give the opportunity to speak to the departments to find out about their projects. The Lyme and Vector Lab had a stall at the event.
Dr Rob Smith and Susan Elias at the stall
Dr Smith and I
Students that were interested in pursuing a career in science and research asked some questions.There was a microscope and many test tubes full of ticks for people to look at. Some tick removers were available for people to take, the Centre for Disease Control (CDC) provides tick removers to services and I have included a picture of the two types of tools.
The tweezers are very fine tipped and the spoons appear to be very similar to the tick cards people have in Scotland. I have asked why they didn’t advocate the twisting tool but the consensus was that the fine tipped tweezers were the tool of choice here.
In case you think its all work, work , work! It is October and the USA really do Halloween so here are a couple of the pictures I have taken