Symptoms Of Lyme Disease Research Articles

Analysis of Lyme infections among children hospitalised in the Provincial Specialist Children’s Hospital in Olsztyn in 2013–2018

Introduction and objective: Lyme disease is the most common chronic, infectious, multisystem, multiform disease. The region of Warmia and Mazury, as well as Podlasie, and the region of Lower Silesia are endemic areas for Lyme disease in our country. The aim of the study was to analyse the prevalence of Lyme disease among children from the Warmian-Masurian Voivodeship hospitalised in the Provincial Specialist Children’s Hospital in Olsztyn. Materials and methods: The study group consisted of 109 patients admitted to a hospital with Lyme disease diagnosis. The study used a retrospective method based on the analysis of the medical history of patients admitted to the hospital in the period from January 2013 to December 2018. Results: More than half of the cases (56.88%) were elective hospital admissions, while 43.12% were emergency admissions. The largest number of patients complained of headaches (68.81%). In about half of the patients (54.13%), the first symptoms of the disease appeared in less than 3 months. Conclusions: Among hospitalised patients diagnosed with Lyme disease, urban school age girls were significantly more likely to be affected. Most patients hospitalised due to Lyme disease denied a tick bite. The majority of patients hospitalised during the study period presented with non-specific symptoms of Lyme disease. The time between symptom onset and the diagnosis of Lyme disease was significantly shorter in children under 7 years of age. The time of hospitalisation of children under the age of 7 years was significantly shorter than in other age groups.

Plantago major and Plantago lanceolata Exhibit Antioxidant and Borrelia burgdorferi Inhibiting Activities.

Lyme disease, caused by Borrelia burgdorferi sensu lato infection, is the most widespread vector-borne illness in the Northern Hemisphere. Unfortunately, using targeted antibiotic therapy is often an ineffective cure. The antibiotic resistance and recurring symptoms of Lyme disease are associated with the formation of biofilm-like aggregates of B. burgdorferi. Plant extracts could provide an effective alternative solution as many of them exhibit antibacterial or biofilm inhibiting activities. This study demonstrates the therapeutic potential of Plantago major and Plantago lanceolata as B. burgdorferi inhibitors. Hydroalcoholic extracts from three different samples of each plant were first characterised based on their total concentrations of polyphenolics, flavonoids, iridoids, and antioxidant capacity. Both plants contained substantial amounts of named phytochemicals and showed considerable antioxidant properties. The major non-volatile constituents were then quantified using HPLC-DAD-MS analyses, and volatile constituents were quantified using HS-SPME-GC-MS. The most prevalent non-volatiles were found to be plantamajoside and acteoside, and the most prevalent volatiles were β-caryophyllene, D-limonene, and α-caryophyllene. The B. burgdorferi inhibiting activity of the extracts was tested on stationary-phase B. burgdorferi culture and its biofilm fraction. All extracts showed antibacterial activity, with the most effective lowering the residual bacterial viability down to 15%. Moreover, the extracts prepared from the leaves of each plant additionally demonstrated biofilm inhibiting properties, reducing its formation by 30%.

Neuropsychiatric Manifestations and Cognitive Decline in Patients With Long-Standing Lyme Disease: A Scoping Review.

Lyme disease (LD), or Lyme borreliosis, is a vector-borne disease that is caused by the transmission of the bacterium Borrelia burgdorferi through a tick bite. The symptoms of LD can persist in individuals chronically, even after the treatment and resolution of the initial infection. These symptoms include various neuropsychiatric manifestations and cognitive decline. The purpose of this review was to report the neuropsychiatric manifestations, cognitive decline, and effects of a delayed diagnosis on symptom severity in patients with long-standing LD (LSLD). A scoping review was conducted utilizing the electronic databases Embase, Ovid Medical Literature Analysis and Retrieval System Online (MEDLINE), and Web of Science. A total of 744 articles were retrieved and considered for inclusion. After a rigorous screening process, 10 articles that met the inclusion criteria for this review were included (i.e., reported neuropsychiatric manifestations and cognitive decline in patients with LSLD and the effects of a delayed diagnosis). Neuropsychiatric manifestations in the patients consisted of suicidal ideation, homicidal tendencies, extreme anger, depressive symptoms, aggression, and anxiety. Cognitive symptoms included dysfunctions in working memory, verbal learning/memory, non-verbal learning/memory, alertness, visuoconstructive, and frontal executive functioning. A delayed LD diagnosis increased symptom severity in most patients. The findings of this review indicate that neuropsychiatric and cognitive symptoms tend to present for a chronic period, even after disease recovery. Although researchers have established a link between a delayed LD diagnosis and increased symptom severity, LSLD is often an overlooked diagnosis in patients with neuropsychiatric symptoms and cognitive decline. More research is needed to compare the time to diagnosis and symptom severity in patients with LSLD.

Qualitative Description of the Exertional Symptoms of Participants with Persistent Symptoms of Lyme Disease during a Low Intensity Resistance Training Intervention

Introduction: Greater emphasis needs to be placed on approaches to improve the health-related quality of life of patients with persistent symptoms of Lyme disease (PSLD), but little information exists to inform an exercise professional’s expectations of their supervision of resistance training (RT) programs with PSLD patients. In order to build this knowledge base, a secondary qualitative analysis was performed to explore the RT exertional symptoms of PSLD patients that participated in a 4-week study investigating the feasibility of an RT intervention. Methods: Comments regarding exertional symptoms that were recorded in a daily exercise log were the main source of data for this secondary analysis. A manifest content analysis was performed in order to identify recurrent themes of exertional symptoms experienced by this sample of PSLD patients during RT. Results: The reported findings revealed that strain, discomfort, crepitus, tightness, shaking, and control loss were the major themes of exertional symptoms recorded during the RT intervention. Conclusions: These results provide insights intended to inform the expectations of supervisors of exercise (personal trainers, physical therapists, exercise researchers, etc.) when directing RT programming with patients with PSLD.

Successful diagnosis and treatment of Borrelia miyamotoi in a patient with joint and muscle pains, ME/CFS and cognitive dysfunction following tick bites: a case report

Abstract Introduction Diagnosing Borrelia miyamotoi disease (BMD) presents challenges due to its overlap with Lyme disease (LD) symptoms and the lack of reliable laboratory diagnostics. This case study demonstrates the successful use of phage-based PCR (phb-PCR) in identifying B. miyamotoi in a patient with multiple tick bites. A 46-year-old female presented with joint and muscle pain, chronic fatigue, and cognitive impairment after being bitten by ticks in Europe. Standard diagnostic tests, including Enzyme-linked immunosorbent assay (ELISA), immunoblot for LD, and antibody tests for Bartonella, Anaplasma, and autoimmune conditions, all returned negative results. However, phb-PCR identified the presence of B. miyamotoi. The patient was treated with intravenous ceftriaxone, oral azithromycin, and intravenous vitamin and mineral therapy, resulting in significant improvement in symptoms, including reduced pain, improved cognitive function, and decreased fatigue. This case emphasises the importance of direct diagnostic methods like phb-PCR for accurately identifying BMD, especially when conventional serological tests fail. Clinicians should consider testing for B. miyamotoi in cases of complex tick-borne diseases for timely and effective management.

What patients tell us: Assessing feedback and perspectives of patients with post-treatment Lyme disease symptoms.

While most patients with Lyme disease fully recover within 6 months, a minority of patients develop significant and persistent symptoms after appropriate antibiotic treatment. With no clear pathophysiology or treatment, post-treatment Lyme disease (PTLDS) (also sometimes referred to as chronic Lyme) is a highly contested condition within the medical community. After conducting a phone survey of 25 patients who had visited an outpatient, academic center for Lyme and other tick-borne diseases, we collected and summarized patients’ perspectives and feedback of the care they received for ongoing Lyme-related symptoms. Findings from this phone survey demonstrated an extremely varied history with regards to experiences with diagnosis, treatment, and management of long-term symptoms. Key themes include a wide-ranging but life-altering self-reported symptomatology, pervasive doubts/frustrations in the medical system regarding treatment of PTLDS symptoms, and how often patients tried unconventional and nontraditional treatment methods. Importantly, patients were unified in their appreciation for an approachable and validating healthcare team even if they did not find complete resolution in their symptoms.

Current and emerging approaches for eliminating Borrelia burgdorferi and alleviating persistent Lyme disease symptoms.

Lyme disease is the most prevalent tick-borne infection caused by Borrelia burgdorferi bacteria in North America. Other Borrelia species are predominately the cause of this disease in Eurasia with some distinct and various overlapping manifestations. Consequently, caution must be exercised when comparing the disease and its manifestations and treatment regimens in North America and Europe. Diagnosis of the early Lyme disease remains difficult using the currently FDA approved serological tests in the absence of a reported tick bite or of erythema migrans in many individuals, non-specific initial symptoms, and the absence of detectable anti-Borrelia antibodies in the prepatent period of infection. Furthermore, it is difficult to distinguish persistence of infection and disease versus reinfection in the endemic regions of Lyme disease by serological assays. If early infection remains untreated, spirochetes can disseminate and could affect various organs in the body with a variety of disease manifestations including arthralgias and musculoskeletal pain, neurologic symptoms and anomalies, and acrodermatitis chronicum atrophicans (ACA) in Europe. Although most patients recover after antibiotic treatment, an estimated ∼10-20% patients in the United States show persistence of symptoms known as post-treatment Lyme disease syndrome (PTLDS). The causes and biomarkers of PTLDS are not well-defined; however, several contributing factors with inconsistent degree of supporting evidence have been suggested. These include antigenic debris, dysregulation of immunological response, bacterial persisters, or combination of these features. This review highlights currently employed treatment approaches describing different antimicrobials used, and vaccine candidates tried to prevent B. burgdorferi infection.

Detection of IgG antibodies against Borrelia burgdorferi in adults


 
 
 The aim of this study was to determine the prevalence of IgG antibodies against Borrelia burgdorferi in adults who were bitten by a tick at least once and did not have classical signs and symptoms of Lyme disease. A total of 88 people from different cities in Lithuania were tested for the presence of Lyme disease IgG. The results showed that the prevalence of infection among participants was 11.4%. Unit values ranged from 12.26 U to 44.78 U. A higher number of Lyme disease cases was observed in older people and those who actively spend their time outdoors. This study shows the importance of the use of serological tests in the diagnosis of Lyme disease for patients with non-specific symptoms.
 
 

Challenges and Opportunities in One Health: Google Trends Search Data.

Google Trends data can be informative for zoonotic disease incidences, including Lyme disease. However, the use of Google Trends for predictive purposes is underutilized. In this study, we demonstrate the potential to use Google Trends for zoonotic disease prediction by predicting monthly state-level Lyme disease case counts in the United States. We requested Lyme disease data for the years 2010-2021. We downloaded Google Trends search data on terms for Lyme disease, symptoms of Lyme disease, and diseases with similar symptoms to Lyme disease. For each search term, we built an expanding window negative binomial model that adjusted for seasonal differences using a lag term. Performance was measured by Root Mean Squared Errors (RMSEs) and the visual associations between observed and predicted case counts. The highest performing model had excellent predictive ability in some states, but performance varied across states. The highest performing models were for Lyme disease search terms, which indicates the high specificity of search terms. We outline challenges of using Google Trends data, including data availability and a mismatch between geographic units. We discuss opportunities for Google Trends data for One Health research, including prediction of additional zoonotic diseases and incorporating environmental and companion animal data. Lastly, we recommend that Google Trends be explored as an option for predicting other zoonotic diseases and incorporate other data streams that may improve predictive performance.

Features of the immune response in early period of ixodid tick-borne borreliosis

Lyme borreliosis is a group of transmissible infectious diseases that are similar in etiology, but diverse in clinical manifestations. The development of Lyme disease symptoms is due not only to the activity of the pathogen itself, but also to the result of its interaction with immune system of macroorganism. The first line of defense, represented by a variety of cellular and humoral components of innate immunity, is most rapidly involved in immune response, and it is it that seeks to limit dissemination of the causative agent from the initial site of infection. However, a wide range of protective surface proteins of Borrelia and a number of other structures aimed at avoiding immune mechanisms prevent the destruction of the pathogen. Not the last place in this dynamic process is occupied by ixodid ticks themselves, since the secret of their salivary glands has an inhibitory effect on a number of cells and complement system. In parallel with innate immunity, adaptive immune response factors are activated, serving as a second line of defense. The synthesis of specific antibodies in the early period of Lyme disease has its own ambiguous features, but this does not exclude their importance in fight against borreliosis infection. To date, the issues of interaction with dendritic cells and cytotoxic T-lymphocytes remain less studied. Research of all aspects, including little-studied ones, is extremely important for both practical healthcare and fundamental medicine.

Identifying Potential Lyme Disease Cases Using Self-Reported Worldwide Tweets: Deep Learning Modeling Approach Enhanced With Sentimental Words Through Emojis.

Lyme disease is among the most reported tick-borne diseases worldwide, making it a major ongoing public health concern. An effective Lyme disease case reporting system depends on timely diagnosis and reporting by health care professionals, and accurate laboratory testing and interpretation for clinical diagnosis validation. A lack of these can lead to delayed diagnosis and treatment, which can exacerbate the severity of Lyme disease symptoms. Therefore, there is a need to improve the monitoring of Lyme disease by using other data sources, such as web-based data. We analyzed global Twitter data to understand its potential and limitations as a tool for Lyme disease surveillance. We propose a transformer-based classification system to identify potential Lyme disease cases using self-reported tweets. Our initial sample included 20,000 tweets collected worldwide from a database of over 1.3 million Lyme disease tweets. After preprocessing and geolocating tweets, tweets in a subset of the initial sample were manually labeled as potential Lyme disease cases or non-Lyme disease cases using carefully selected keywords. Emojis were converted to sentiment words, which were then replaced in the tweets. This labeled tweet set was used for the training, validation, and performance testing of DistilBERT (distilled version of BERT [Bidirectional Encoder Representations from Transformers]), ALBERT (A Lite BERT), and BERTweet (BERT for English Tweets) classifiers. The empirical results showed that BERTweet was the best classifier among all evaluated models (average F1-score of 89.3%, classification accuracy of 90.0%, and precision of 97.1%). However, for recall, term frequency-inverse document frequency and k-nearest neighbors performed better (93.2% and 82.6%, respectively). On using emojis to enrich the tweet embeddings, BERTweet had an increased recall (8% increase), DistilBERT had an increased F1-score of 93.8% (4% increase) and classification accuracy of 94.1% (4% increase), and ALBERT had an increased F1-score of 93.1% (5% increase) and classification accuracy of 93.9% (5% increase). The general awareness of Lyme disease was high in the United States, the United Kingdom, Australia, and Canada, with self-reported potential cases of Lyme disease from these countries accounting for around 50% (9939/20,000) of the collected English-language tweets, whereas Lyme disease-related tweets were rare in countries from Africa and Asia. The most reported Lyme disease-related symptoms in the data were rash, fatigue, fever, and arthritis, while symptoms, such as lymphadenopathy, palpitations, swollen lymph nodes, neck stiffness, and arrythmia, were uncommon, in accordance with Lyme disease symptom frequency. The study highlights the robustness of BERTweet and DistilBERT as classifiers for potential cases of Lyme disease from self-reported data. The results demonstrated that emojis are effective for enrichment, thereby improving the accuracy of tweet embeddings and the performance of classifiers. Specifically, emojis reflecting sadness, empathy, and encouragement can reduce false negatives.

“I Can Do Anything if I’ve Overcome That”: A Collaborative Case Study of an Adolescent with Symptoms of Lyme Disease in Canada

This qualitative case study explored the experiences of one Canadian adolescent with symptom-persistent Lyme disease. Lyme disease is the most prevalent vector-borne illness in North America, and infection rates are rising across Canada. Peak incidence occurs in children aged 5–9 years, making it a significant childhood infectious disease. This involves collaboration with an adolescent with symptom-persistent Lyme disease in Canada to address a gap in the literature. This empirical research was guided by the central research question: “What is the experience of an adolescent with symptom-persistent Lyme disease in Canada?” The purpose of this study was to understand the unique experiences of symptom-persistent Lyme disease in Canada by emphasizing one adolescent’s unique voice. The findings of this case study demonstrate the challenges this adolescent faced in receiving appropriate diagnosis and treatment for Lyme disease, pointing to a need for increased awareness among health professionals regarding the impact and prevalence of tick-borne illnesses for young people, their caregivers, and their healthcare providers. Additional findings suggest that collaborative healthcare may be beneficial for patients with symptom-persistent Lyme disease, and health researchers should continue to engage young people to ensure accurate representation of their experiences.

Autoantibodies in post-treatment Lyme disease and association with clinical symptoms.

Autoantibodies have been described in the post-infectious state, specifically after Lyme disease and COVID-19. We aimed to describe the prevalence and potential clinical utility of several commercially available autoantibodies after these infections. Euroimmun panels (myositis, scleroderma and ANA5) were assayed using sera from patients with Lyme disease with return to health (RTH) (n=70), post-treatment Lyme disease (n=58), COVID-19 RTH (n=47) and post-acute symptoms of COVID-19 (n=22). The post-Lyme questionnaire of symptoms (PLQS) was used to determine symptom burden after Lyme disease. There was no statistically significant difference in autoantibody prevalence across the four groups (p=0.746). A total of 21 different antibodies were found in the Lyme cohorts and 8 different antibodies in the COVID-19 cohorts. The prevalence of scleroderma-associated antibodies was higher after Lyme disease than COVID-19 (12.5% vs. 2.9%, p=0.026). There was no statistically significant difference in symptom burden based on antibody status. Several autoantibodies were found after Borrelia burgdorferi and SARS-CoV2 infection, although the prevalence was similar in those with persistent symptoms and those who returned to health. While our data show no difference in autoantibody prevalence across the four post-infectious states, we do not imply that autoantibodies are irrelevant in this setting. Rather, this study highlights the need for novel antibody discovery in larger cohorts of well-defined patient populations.

Borrelia Burgdorferi Sensu Lato Infection-induced Autoimmunity – A Decennary Literature Review

Abstract Borrelia burgdorferi sensu lato is a Gram-negative spirochete that causes Lyme disease (Lyme borreliosis). The signs and symptoms of Lyme disease are a consequence of the immune response to spirochete in soft tissues, and it is debated if said immune response can become an autoimmune disease of the body over time due to bacterial and HLA/MHC molecular mimicry. Continual Lyme Disease (CDL) also known as Post-Treatment Lyme Disease Syndrome (PTLDS) is a broad group of rapidly appearing flu-rash symptoms and cognitive difficulties combined with chronic fatigue that is observed after at least six months after completing treatment. This review contains scientific collections throughout the last 10 years of studies related to alleged post-infection auto-immunogenicity.

Prevalence of Lyme Carditis in Patients with Atrioventricular Blocks.

Infections with Borrelia may cause cardiac conduction system abnormalities, including atrioventricular blocks (AVBs). Therefore, we aimed to identify patients in whom Lyme carditis (LC) could be considered as the initial diagnosis among consecutive subjects who were referred for implantation of a permanent pacemaker due to symptomatic AVBs. To date, such a systematic evaluation has not been reported yet. Validation of the Suspicious Index for Lyme Carditis (SILC) in our study population was considered as an additional goal. We investigated consecutive patients with AVB admitted to our department for a pacemaker implantation. Serological diagnostic tests against Borrelia burgdorferi sensu lato (Bbsl) were performed in those with no obvious cardiac causes of AVB. The final study population consisted of 130 patients (80 M, mean age 67.4 ± 17.6). Lyme carditis was assumed as the initial diagnosis in 16 patients (12%) based on ABV and IgM Bbsl seropositivity. The patients with LC were younger and more frequently manifested constitutional symptoms of infection and fluctuating AVB. The highest prognostic value for identification of LC patients was obtained for the modified SILC, which included the following parameters: (1) age lower than 75 years; (2) risky outdoor activity and living in the countryside; (3) tick bite; (4) constitutional symptoms of Lyme disease; (5) erythema migrans; (6) male sex and (7) fluctuating atrioventricular block. We concluded that diagnostics for LC should be routinely considered in patients with advanced AVB. Modified SILC may identify the patients at risk of LC.

Gene set predictor for post-treatment Lyme disease

Lyme disease (LD) is tick-borne disease whose post-treatment sequelae are not well understood. For this study, we enrolled 152 individuals with symptoms of post-treatment LD (PTLD) to profile their peripheral blood mononuclear cells (PBMCs) with RNA sequencing (RNA-seq). Combined with RNA-seq data from 72 individuals with acute LD and 44 uninfected controls, we investigated differences in differential gene expression. We observe that most individuals with PTLD have an inflammatory signature that is distinguished from the acute LD group. By distilling gene sets from this study with gene sets from other sources, we identify a subset of genes that are highly expressed in the cohorts but are not already established as biomarkers for inflammatory response or other viral or bacterial infections. We further reduce this gene set by feature importance to establish an mRNA biomarker set capable of distinguishing healthy individuals from those with acute LD or PTLD as a candidate for translation into an LD diagnostic.

Opinion among veterinarians on equine Lyme disease - results of a questionnaire study

Recording equine veterinarians opinion on equine Lyme disease. A survey was conducted to get a general impression of the opinion of German equine vets on the topic of equine Lyme Borreliosis. The main focus of this questionnaire study was set on the diagnostic and therapeutic approach of the horse vets. Overall almost half of the veterinarians (48 %) detected only rarely or never serological antibodies against Bb , 47 %found occasionally and 5 % frequently Borrelia antibodies within their clientel.Concerning the existence of clinical LB in horses, 51 % of the veterinarians reported clinical cases, 43 % thought it might be possible but have not seen cases themselves and 6 % categorically ruled out the existence.On average, further diagnostic measures for LB diseases were initiated 15 ± 9 times per year and 1.4 ± 1.0 cases of equine LB diseases were diagnosed per year. In the majority of 68 % of the cases, the veterinarians chose serological tests as diagnostic measures, followed by a combination of serological tests and Antigen detection tests (27 %) and only 5 % of the veterinarians were using Antigen detection tests exclusively. Blood and skin biopsies were submitted most frequently for direct Antigendetection. The treatment of horses with positive laboratory results indicating Lyme disease and clinical symptoms assessed as suitable was carried out by 93 % of the veterinarians with antibiotics and 7% with homeopathy. Doxycycline (68 %) was used most frequently. The antibiotic treatment was applied over a period of 3 (31 %) to 4 (63 %) weeks.Regarding the question of a possible vaccination, 39 % of veterinarians do not offer vaccination against Lyme borreliosis, 20 % have not yet used it, but do not categorically reject it, and 41 % regularly carry out vaccinations against Lyme borreliosis. The opinion on the clinical relevance of Equine Lyme Borreliosis among german equine veterinarians vary considerably. Uniform diagnostic guidelines and, possibly, recommendations for therapy would serve to counteract the existing uncertainty concerning this disease within the equine veterinary community.

Triangulating the New Frontier of Health Geo-Data: Assessing Tick-Borne Disease Risk as an Occupational Hazard among Vulnerable Populations.

Determining interventions to combat disease often requires complex analyses of spatial-temporal data to improve health outcomes. For some vulnerable populations, obtaining sufficient data for related analyses is especially difficult, thus exacerbating related healthcare, research, and public health efforts. In the United States (U.S.), migrant and seasonal workers are especially affected in this regard, with data on health interventions and outcomes largely absent from official sources. In response, this study offers a multi-modal approach that involves triangulating geographically specified health data that incorporate reports on canine tick species, Lyme disease (LD) incidence, and patient symptom severity indicating potential subsequent disease burden. Spatial alignment of data at the U.S. county level was used to reveal and better understand tick-borne disease (TBD) incidence and risk among the identified populations. Survey data from migrant and seasonal workers in Texas were employed to determine TBD risk based on symptoms, occupations, and locations. Respondents who were found to have a higher likelihood of a TBD were also considerably more likely to report the most common symptoms of LD and other TBDs on the Horowitz Multiple Systemic Infectious Disease Syndrome Questionnaire. Those in the highly likely scoring group also reported more poor health and mental health days. Overall, a notable number of respondents (22%) were likely or highly likely to have a TBD, with particular relevance attributed to county of residence and living conditions. Also of note, almost a third of those reporting severe symptoms had received a previous Lyme disease diagnosis. These findings underscore the need for further surveillance among vulnerable populations at risk for TBDs.

Neurological Pain, Psychological Symptoms, and Diagnostic Struggles among Patients with Tick-Borne Diseases.

Public health reports contain limited information regarding the psychological and neurological symptoms of tick-borne diseases (TBDs). Employing a mixed-method approach, this analysis triangulates three sources of symptomology and provides a comparison of official public health information, case reports, medical literature, and the self-reported symptoms of patients with Lyme disease and other TBDs. Out of the fifteen neuropsychiatric symptoms reported in the medical literature for common TBDs, headaches and fatigue and/or malaise are the only two symptoms fully recognized by public health officials. Of TBDs, Lyme disease is the least recognized by public health officials for presenting with neuropsychiatric symptoms; only headaches and fatigue are recognized as overlapping symptoms of Lyme disease. Comparisons from a patient symptoms survey indicate that self-reports of TBDs and the associated symptoms align with medical and case reports. Anxiety, depression, panic attacks, hallucinations, delusions, and pain—ranging from headaches to neck stiffness and arthritis—are common among patients who report a TBD diagnosis. Given the multitude of non-specific patient symptoms, and the number and range of neuropsychiatric presentations that do not align with public health guidance, this study indicates the need for a revised approach to TBD diagnosis and for improved communication from official public health sources regarding the wide range of associated symptoms.

Assessment of Knowledge, Attitudes, and Practices Toward Ticks and Tickborne Disease among Healthcare Professionals Working in Schools in New York and Maryland.

Healthcare Professionals Working in Schools (HPWS) are responsible for providing health services to students and play a role in providing education to prevent illnesses, including tickborne diseases (TBD). Providing TBD education to children has been shown to increase prevention behaviors and knowledge of TBD symptoms, but little is known regarding the current state of TBD awareness among HPWS. In spring 2019 we conducted a cross-sectional knowledge, attitudes, and practices (KAP) survey of HPWS in two states with a high incidence of Lyme disease (LD) to inform design of TBD prevention programs. The survey queried general knowledge of TBDs, school practices regarding TBDs, and availability of TBD resources. Overall, higher confidence, experience, risk perception, prior training on TBD, and more years employed as a HPWS were independently associated with knowledge of LD transmission, symptoms, and correct tick removal practices. State and local health departments should consider prioritizing engagement with HPWS to provide educational opportunities about tickborne diseases.