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The Dose Transcript for June 20, 2024

Host: Brian Goldman

BRIAN GOLDMAN: Hi, I'm Dr. Brian Goldman. Welcome to The Dose. It's almost the official start of summer, which means more time outdoors and more exposure to ticks. You probably know they spread Lyme disease, but a lesser-known tick-borne illness is on the rise. It's called anaplasmosis. So this week we're asking, what do I need to know about anaplasmosis? Hi, Heather, welcome to The Dose.

HEATHER COATSWORTH: Hi, Brian. How are you?

BRIAN GOLDMAN: I am just fine. I have not been hanging out in wooded areas lately. As part of your job, do you hang out in wooded areas?

HEATHER COATSWORTH: Sometimes, yes. Purposely trying to go and collect those ticks.

BRIAN GOLDMAN: To find out whether they're infected or not?

HEATHER COATSWORTH: Yes, exactly.

BRIAN GOLDMAN: Then you are obviously the right person to ask about this important subject. But before we begin, can you give us a hi, my name is? Tell us what you do and where you do it. Just ad lib.

HEATHER COATSWORTH: Yeah. Hi, my name is Dr. Heather Coatsworth. I'm a research scientist at the National Microbiology Lab within the Public Health Agency of Canada, and I'm based out of Winnipeg, Manitoba. And in our lab we do human diagnostics for anaplasmosis, as well as tick surveillance for the pathogen as well.

BRIAN GOLDMAN: Okay, can't wait to dig into this. Let's start with the most basic question. What is anaplasmosis?

HEATHER COATSWORTH: Yeah. So, anaplasmosis is caused by infection with the bacterium Anaplasma phagocytophilum in humans, and other species will cause similar disease in livestock. It's a bacterium that unusually infects white blood cells or neutrophils, unlike other pathogens that can infect red blood cells. And you're going to get typical symptomology of your malaise -- so, fever; headache. And then left untreated or long-term symptomology is going to be things like respiratory failure, anemia, and on the rare occasion, death.

BRIAN GOLDMAN: So, how is anaplasmosis spread?

HEATHER COATSWORTH: Primarily spread by the bite of an infected tick. As long as that tick has, generally speaking, been on you for over 18 hours/been feeding for over 18 hours. Since it is a blood-borne disease, it can also be transmitted by blood transfusion. Solid organ donation is also possible. And there is the hypothesis that it can be transmitted from mother to baby as well.

BRIAN GOLDMAN: Roughly speaking, compared to Lyme disease, how common is anaplasmosis at this point?

HEATHER COATSWORTH: So, much less common than Lyme in Canada. But it is kind of the new kid on the block, especially in areas that have high Lyme incidence. So, primarily in Nova Scotia, in Quebec, as well as Ontario. So looking at just some numbers, it's not nationally notifiable. Well, it was, as of this year, nationally notifiable. So we don't have great case count information. But we're looking at kind of a handful of cases in early 2000. So, 2005-2006 to now, probably over hundreds to up to maybe 500 cases per province per year.

BRIAN GOLDMAN: And comparing that to Lyme, Lyme would be much higher at this point.

HEATHER COATSWORTH: Yes. So Lyme, we're looking at thousands upon thousands of cases in those high-incidence provinces.

BRIAN GOLDMAN: Remind us about the ticks that spread anaplasmosis. What are they called? What do they look like?

HEATHER COATSWORTH: So these will all be primarily blacklegged ticks. So, they have characteristic black legs. And then the adult stage of the ticks will have that black scutum or shield on the back, and then kind of a reddish-brownish colour on the rest of their body. And those are going to be Ixodes ticks. So they're Ixodes scapularis. Or if you live in western provinces, primarily in B.C., that's Ixodes pacificus. The same ticks that are going to transmit the Anaplasma bacterium are also the same ticks that can cause Lyme, as well as other tick-borne diseases such as Powassan and Babesiosis.

BRIAN GOLDMAN: Can ticks be infected with both germs so that you could potentially be infected with both -- with Lyme and anaplasmosis -- at the same time?

HEATHER COATSWORTH: Yes. We're seeing that more commonly since a lot of these ticks are being infected kind of in the same focal areas within those high-incidence provinces. So, we do see co-infections being a lot more prevalent now than they were previously.

BRIAN GOLDMAN: You started to mention the symptoms, but I want to kind of ask that as a separate question. What are the most common symptoms of anaplasmosis?

HEATHER COATSWORTH: So, common symptoms are going to be your general malaise or flu-like symptoms. So, headache, fever. General tiredness. Those are kind of your general symptomology within 1 to 2 weeks of onset. And then longer term if left untreated or if you're an immunocompromised individual, you get kind of long-term effects such as respiratory failure, sometimes liver disease. And then, on the rare occasion, is death.

BRIAN GOLDMAN: Who is most likely to get the most severe form of anaplasmosis?

HEATHER COATSWORTH: So that primarily would be immunocompromised people, as well as children and elderly.

BRIAN GOLDMAN: And what about failing to recognize anaplasmosis promptly? Is that a factor in the development of more serious disease?

HEATHER COATSWORTH: It can be, yes. Usually it's quite treatable when antibiotics are given. So, primarily front-line doxycycline -- which is the same treatment as you would give for Lyme -- is going to resolve symptoms quite quickly. We don't see those kind of post-treatment symptoms that we do with Lyme. So with Lyme, we kind of have that post-treatment Lyme disease syndrome, where you can get kind of these more long-term symptomology, like arthritis-like symptoms. We don't see that occur as often or at all with Anaplasma, so we don't kind of have the long-term effect.

BRIAN GOLDMAN: And is doxycycline -- I know that's the main antibiotic that's [HEATHER: Yeah.] used. Is it the only one?

HEATHER COATSWORTH: Primarily. There will be other antibiotics given on different occasions -- especially during pregnancy, for example. But primarily it's front-line doxycycline, yeah.

BRIAN GOLDMAN: Once you receive antibiotics and you've recovered, can you get reinfected?

HEATHER COATSWORTH: Not commonly. So, unlike Lyme, Anaplasma has a very low rate of reinfection. The literature does have a few cases where reinfection happened in immunocompromised individuals who probably didn't have a great immune response during the first round of infection. But generally speaking, you are protected for life once you've been infected once.

BRIAN GOLDMAN: And you mentioned that there are several provinces where cases are popping up. So, there's Nova Scotia -- like Atlantic Canada. [HEATHER: Yeah.] Quebec. Ontario.

HEATHER COATSWORTH: Yes.

BRIAN GOLDMAN: Are there any other provinces that are also showing up with cases?

HEATHER COATSWORTH: Yes. So, we have seen cases across all provinces in Canada. No territories yet. But Anaplasma is present across all of Canada. It's just kind of those higher areas that we're seeing a real increase in case counts.

BRIAN GOLDMAN: So anaplasmosis became a nationally recognized disease in April. What's the significance of that?

HEATHER COATSWORTH: So it's really letting us, on a federal level, actually case-count and track these cases. Some provinces have been great and kind of ahead of the game in making it provincially notifiable within their province. But actually having all of the statistics federally, together together, allows us to have a better picture of disease tracking across the country.

BRIAN GOLDMAN: You know, this is maybe a bit of an inside baseball question. If Lyme disease and anaplasmosis are treated with the same antibiotic, why does it matter to know whether you've got one and not the other?

HEATHER COATSWORTH: I think... I mean, the symptomology is quite different. It's kind of important for a tracking statistic to let us know what pathogen is where so health professionals can be educated properly; so you can take proper procedures, and getting the right diagnostic test for actually counting accurate case counts. I think the idea of co-infection is well known in a tick setting, and it's not well known in the human setting. So, what happens if a human is infected with both these pathogens? So, it is important for us to track that information, so if there is a difference in treatment, for example, or how symptoms progressed, or how the pathogen deals with being with another pathogen in the human body, I think that's a really important piece to getting that specific pathogen information.

BRIAN GOLDMAN: Is anaplasmosis spreading differently in Canada compared to Lyme disease? Is it just behind the curve compared to the proliferation of infections and cases of Lyme in Canada?

HEATHER COATSWORTH: A bit different spread. So, it'll be in the same areas that you have those blacklegged or western blacklegged ticks. The main difference with Anaplasma is right now we're seeing much more of a focal spread. Whereas with Lyme, we kind of saw Lyme really spreading alongside, directly, the movement of the ticks. The biggest difference is going to be the ecological niche for anaplasmosis is quite different than Lyme. So, with Lyme we're looking at primarily deer mice. Whereas in Anaplasma, preliminary research suggests that chipmunks are actually the primary reservoir.

BRIAN GOLDMAN: Any idea why that is?

HEATHER COATSWORTH: No clue. You would have to ask the individuals doing that research who are much, much better zoned in to chipmunk ecology than I.

BRIAN GOLDMAN: Well, that would make two of us. [Heather laughs] Can we say then that research on the proliferation of anaplasmosis is not anywhere near what we know about Lyme disease right now?

HEATHER COATSWORTH: I would say so, yes. I think we just haven't had the long-term data set that we have with Lyme. It's kind of popped up quite quickly. Besides the kind of outbreak that happened in the Estrie region in Quebec a few years ago with anaplasmosis, we haven't seen kind of those hard-hitting numbers that we did with Lyme early on. And I think the focal spread has kind of limited, generally speaking, the widespread infection potential for Anaplasma historically.

BRIAN GOLDMAN: You know, when we talk about Lyme disease, we talk about the impact of climate change. [HEATHER: Yeah.] And it's a point that I don't think we should ignore. What effect, if any, is climate change having on the geography of ticks spreading anaplasmosis?

HEATHER COATSWORTH: So I mean, it's the same thing you hear time and time again with ticks in Canada. I mean, with these Ixodes species ticks, we really only started noting them. A lot of people didn't grow up with these ticks. They were first noted in Canada in the late '80s/early '90s, and now we're looking at the distribution of the tick continuing to move at a pace of about 45km a year. So that range expansion continues to be ongoing, especially as the climate becomes warmer and more humid.

BRIAN GOLDMAN: What role do household pets play in potentially spreading anaplasmosis?

HEATHER COATSWORTH: Probably about the same role as most tick-borne diseases. So, any time that you're going to get ticks on your animals, if they're bringing them into the house and they're not loving being attached to your dog or your cat or any other pet that you may have -- a bird, perchance -- those are going to be now in your household and you can pick them up from within your house. I would say you're much more likely to pick them up while walking outside in wooded areas or tall grassy areas than you would be to pick them up from a pet.

BRIAN GOLDMAN: And why does the tick have to remain on your skin for, like, 18 hours for you to have the potential to get infected?

HEATHER COATSWORTH: It just seems, from the literature, that is the amount of time that ticks need for feeding that bacterial transmission tends to be possible for these cases. It's not sure, the scientific community, why this longer transmission time is needed. There are other organisms -- such as the transmission of Powassan virus -- that can be transmitted in attachment times as quick as 15 minutes. So, we know that other pathogens can be transmitted much quicker to a human host. But if there's that kind of length of time, that can be quite helpful for us to kind of complete those tick checks and remove the ticks safely before transmission has occurred.

BRIAN GOLDMAN: So, perfect. I think we need to talk about prevention. What are the options for, first of all, for avoiding a tick bite entirely?

HEATHER COATSWORTH: So I mean, that's obviously the best prevention. We don't have a vaccine as of current. So, I mean, the easiest thing is going to be pre-treating your clothes or buying some of those now permethrin-embedded clothes that you can find -- that are Health Canada approved -- throughout a variety of different stores in Canada. And you can make those yourself by just spraying your clothes the night before you go out. Obviously, spraying kind of topical agents like DEET or icaridin before you go on any kind of walk is helpful; wearing long clothing; tucking your socks over your pants; making sure you're wearing long sleeves; and then making sure you're staying on trails that are well-groomed and doing tick checks before, during, and after your walks. If you do find a tick on you, I would highly suggest kind of a free public service tool like eTick where you can upload a picture of that tick online. Even if you don't find it embedded on you and it's just crawling on your clothing, you can get an accurate-- scientist IDs that tick for you. And you'll get local health messaging that will tell you about the risk that particular tick may pose. It may not be a blacklegged tick. You may not be in a high endemic area for Lyme. So it's a great tool to kind of give you a quick picture of what the risk that you may have in that particular case is.

BRIAN GOLDMAN: And if you do get bitten by a tick, is there a right way and a wrong way to remove it?

HEATHER COATSWORTH: Yes. Generally speaking, taking some kind of item that you can help remove the ticks. So, either if you have one of those tick tweezer tools or even just household tweezers, grabbing as close as you can to the attachment side of the skin and pulling slowly and directly out so you get all of those embedded tick mouthparts, and then washing that area thoroughly with soapy water is going to be the best way to get rid of that tick. We don't suggest burning the tick or burning at the site of the tick. Obviously, that could cause burning. But that's the best way to remove a tick.

BRIAN GOLDMAN: From what you said, it's probably worthwhile to try to keep ticks off of pets. How do we do that?

HEATHER COATSWORTH: Yep. So, pet prevention is a bit easier than human prevention. There are some great oral and topical tools you can get for your pets that will either kind of act as a deterrent for ticks if you're using something topical, or if you're giving an oral medication if ticks attach onto your pets and start feeding, they will die due to the kind of circulating antibiotics that are in your pet's bloodstream. You can also get-- there are Lyme vaccines for pets available on the market, so that's always a great option for pets. Not for anaplasmosis, but for Lyme.

BRIAN GOLDMAN: And for those of us who are looking for more natural, less chemical pesticides, are there any more naturally occurring substances that we can use that might help keep the ticks off of us?

HEATHER COATSWORTH: So there's a few, great kind of up-and-coming research items that suggest things like ant pheromones are great deterrents for ticks. I'm looking forward to seeing where that product goes. There's some preliminary research that shows lime is a great prevention for Lyme. So, like, the lime dust from rocks is a good prevention tool, kind of around your property. And then kind of your similar things that you would be using -- any kind of natural product like citronella. Those things can be helpful on a local front. But really, for ticks in particular, you're going to be looking at kind of those harder-hitting chemicals and then just making sure you're checking yourself.

BRIAN GOLDMAN: Well, Heather Coatsworth, you have considerable expertise on anaplasmosis, and I want to thank you for sharing it with us on The Dose.

HEATHER COATSWORTH: Of course, yeah. Thanks for having me.

BRIAN GOLDMAN: Heather Coatsworth is the chief research scientist in the National Microbiology Laboratory's Field Studies section. Here's your dose of smart advice. Anaplasmosis is a disease caused by infection with the bacteria Anaplasma phagocytophilum. The infection is mainly spread to people by the bite of an infected blacklegged tick or the western blacklegged tick. It can also be a blood-borne infection. Ticks carrying and Anaplasma bacteria tend to reside in wooded areas where Lyme is well-established, including parts of Ontario, Quebec, and Nova Scotia, as well as clusters in Manitoba and Alberta. Though there have been cases across Canada. The majority of reported cases have occurred from June through August. Signs and symptoms of anaplasmosis typically begin within 1 to 2 weeks after the bite of an infected tick. Symptoms include: fever, chills, severe headache, muscle aches, abdominal pain, nausea, vomiting, diarrhea, and loss of appetite. The diagnosis can be confirmed through blood testing. Anaplasmosis is treated with antibiotics. Doxycycline is the drug of choice for adults and children of all ages with anaplasmosis. Pregnant women should take the antibiotic rifampin instead of doxycycline. In people who are otherwise healthy, prompt antibiotic treatment means fast recovery. Seniors and those with compromised immune systems can get serious complications such as respiratory failure, bleeding problems, organ failure, and death. There is no vaccine yet to prevent anaplasmosis. The best advice is to avoid tick bites by using insect repellent, wearing proper clothing, removing ticks as soon as possible after bites, and cutting shrubs and tall grass around the home where ticks live. You can also reduce the risk by preventing ticks from getting onto your pets. If you have topics you'd like discussed or questions answered, our email address is thedose@cbc.ca. If you liked this episode, please give us a rating and review wherever you listen. This edition of The Dose was produced by Sameer Chhabra and Isabelle Gallant. Our senior producer is Colleen Ross. The Dose wants you to be better informed about your health. If you're looking for medical advice, see your health care provider. I'm Dr. Brian Goldman. Until your next dose.

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What do I need to know about anaplasmosis? - Transcript

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