Dr. Nevena Zubcevik, co-founder of “The Dean Center for Tick Borne Illness” at Spaulding Rehabilitation Hospital and Invisible International’s Chief Medical Officer, has recently developed a three-module medical education course series to help physicians with the challenges of diagnosing and treating patients with Central Nervous System (CNS) Lyme disease, aka “neuro-Lyme.”

Her first course describes typical neuro-Lyme clinical presentations and an overview of the treatment strategies that she uses to get patients back to living normal lives. Her second course, released this week, takes a deeper dive into the clinical presentations of neuro-Lyme and tools for making an evidence-based diagnosis. The course also discusses peer-reviewed studies that show that the recommended treatment of 21 days of doxycycline is often insufficient to clear the Lyme bacteria.

The third module, soon to be released, offers clinical advice on managing the rehabilitation of patients suffering from serious neurological Lyme disease.

The Invisible Education Initiative, funded by the Montecalvo Foundation, has received accreditation from the Accreditation Council for Continuing Medical Education (ACCME) for its library of 28-plus continuing medical education courses. These free courses serve up the latest in research and clinical advice on vector-borne and environmental illness, delivered by some of the most knowledgeable experts in their respective fields. This CME library is the first to offer in-depth course series on topics such as persistent Lyme disease, Bartonellosis, antibiotics for Lyme disease, and congenital transmission of tick-borne diseases.

Invisible’s Physician Kit is designed to enhance clinical practice with evidence-based tools that help medical teams collect validated, patient-centric clinical information.

The first tool in the kit is the “General Symptom Questionnaire-30 (GSQ-30): A Brief Measure of Multi-System Symptom Burden in Lyme Disease.” This scientifically validated questionnaire helps physicians assess symptom burden among patients with acute Lyme and post-treatment Lyme disease syndrome. It is useful in both clinical and research settings, for assessing the symptom burden affecting patients, monitoring the progression of symptoms over time, and providing a precision-medicine metric for conducting disease research.

The questionnaire was jointly developed by three academic medical centers and used in two peer-reviewed studies. The first was a “big data” study on the categorization of Post Treatment Lyme Disease (PTLD) symptom clusters, and the second was a study identifying small fiber neuropathy as an injury biomarker of PTLD. Dr. Nevena Zubcevik, Invisible’s Chief Medical Officer, and Dr. Charlotte Mao, our Curriculum Director, are authors on both of these studies.

The Asian longhorned tick (Haemaphysalis longicornis) was first discovered in the United States in 2017 on a farm in New Jersey, but archived ticks have been identified in West Virginia as early as 2010. This species is a “serious pest of livestock in the Australasian and Western Pacific Regions where it [naturally] occurs. It is an aggressive biter and frequently builds intense infestations on domestic hosts causing great stress, reduced growth and production, and severe blood loss,” according to the United States Department of Agriculture (USDA).

The most worrisome characteristic of this tick species is that a female can reproduce parthenogenetically, without mating with a male. Given that a single female can lay between 2,000 to 4,000 eggs, this means that these ticks can spread much faster than native species. Indeed, as of September 27, 2021, longhorned ticks had been found in Arkansas, Connecticut, Delaware, Georgia, Kentucky, Maryland, Missouri, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Virginia, and West Virginia. (Source: CDC)

Although the risk of disease for humans is lower due to the longhorned ticks' preference for livestock (as seen in this Cornell video), the impact to animal suffering and the food supply are significant. And there are still serious implications to human health, since this species can feed on the same animal with other species and share disease-causing microbes. Outside of the US, these ticks have been shown to carry the causative agents for anaplasmosis, babesiosis, ehrlichiosis, theileriosis, and rickettsiosis, as well as several viruses. However, thus far, no infectious agents have been identified in the Asian longhorned ticks found in the US. (Source: University of Tennessee Beef & Forage Center)

To help track the spread of this invasive species, the CDC recommends that residents who find longhorned ticks send them into their local health departments.

This week Psychiatry Today published an article by psychiatrist Susan Trachman, MD, on the symptom overlaps between neurological Lyme disease and mental illness. Citing author Amy Tan’s experience with chronic Lyme in the PBS documentary, “Amy Tan: Unintended Memoir,” she reminds us that Lyme disease, like syphilis, can imitate many other diseases.

“Many psychiatrists see patients with documented or suspected Lyme disease because of the significant overlap in symptoms between Lyme disease and common psychiatric disorders such as anxiety and depression,” she said.

Yet, we do fault the article for not mentioning that the two-tiered Lyme screening test is not accurate during the first three weeks of infection, and that it’s no better than coin flip in the later stages of the disease. A Lyme disease diagnosis needs to be made based on a multifaceted clinical evaluation with lab work viewed as supportive (or not), but not definitive. But Dr. Trachman’s main message is important: Time is of the essence in diagnosing and treating Lyme disease.

A Columbia-led study advises physicians and patients to be aware of psychiatric symptoms, particularly the first year after diagnosis

In a new study, U.S. and Danish researchers report that patients who received a hospital diagnosis of Lyme disease—inpatient, outpatient, or at the ER—had a 28 percent higher rate of mental disorders and were twice as likely to have attempted suicide post-infection, compared to individuals without the diagnosis.

The study, a collaboration of Columbia University and the Copenhagen Research Centre for Mental Health, is believed to be the first large, population-based study examining the relationship between Lyme disease and psychiatric outcomes.