Expect Rickettsial Infections in North America Now
Blood Work May Only Reveal Elevated Hepatic Transaminase Levels
Credit: By NIAID_Flickr (Coxiella burnetii, the Bacteria That Cause Q Fever) [CC BY 2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons
No, Fatal Strep A is Not Common
R/O Wolbachia: A Cancer-Causing Bacteria & Reproductive Parasite
After reading about a healthy 24-year-old who died after being diagnosed with a hospital-acquired aggressive group A streptococcus (GAS) bacterial infection and later reading about three other cases, I became even more convinced that the Wolbachia-infected Aedes releases (just south of the Canadian border) have something to do with it.
Wolbachia is an α-proteobacteria of the order Rickettsiales: Rickettsiaceae.
The typical symptoms of rickettsial infections may include: fever, headache, muscle aches, swollen lymph glands, cough, rash, confusion, and breathing difficulties.
Severely ill people suffering from a rickettsial infection (of the typhus or spotted fever group) may have ecchymotic skin necrosis, edema (due to increased vascular permeability), digital gangrene, circulatory collapse, shock, oliguria, anuria, azotemia, anemia, hyponatremia, hypochloremia, delirium, and coma.
Rickettsial infections cause similar clinical illness, with varying presence of fever, rash, headache, myalgia, altered liver tests, and thrombocytopenia. The severity may vary from a mild febrile illness, to a more severe illness with multi-organ involvement.
Credit: Rose Webster (aka RoseWrites) Ask me about resuse.
Notably, these women complained of high fever, abdominal or one-side of body pain, shakiness (indicating neurological involvement), and to quote the Global News post:
"I was a bit delirious," Tina Hamilton told Global News. "After a while, my fever got really high and I had severe pain on the right side of my body. My husband convinced me to go back to the hospital." [Our liver, the largest internal organ of the body, is located in the right upper quadrant of the abdomen].
Sadly, the woman who died, I am told, visited New York last year.
And it struck me that no one complained of a rash until I discovered the 2011 paper titled Fatal Brazilian spotless fever caused by Rickettsia rickettsii in a dark-skinned patient by Favacho, Alexsandra Rodrigues de Mendonça, Rozental, Tatiana, Calic, Simone Berger, Scofield, Maria Aparecida Mota, and Lemos, Elba Regina Sampaio de.
Key Points From This 2011 Report
A 32-year-old, previously healthy black man, sought medical attention by a primary care physician with complaints of high fever, headache, nausea, myalgia, and asthenia [abnormal weakness]. He was treated with oral amoxicillin, but his symptoms persisted.
Examination showed fever to 38.8ºC, mild dehydration, and hypotension. The laboratory findings showed a hematocrit of 47%, white blood cell count of 4,700/mm3, neutrophils 50%, a platelet count of 60,000/mm3, creatinine of 4.2mg/dl, ureia of 139mg/dl, and total bilirubin level of 6.2mg/dl.
After symptomatic treatment, the patient developed neurological manifestations, lethargy, mental confusion, agitation, and a generalized seizure. Empiric treatment with chloramphenicol was initiated, but the patient's condition worsened and he died from multiple organ failure 24 hours after admission.
Notably, there was no history of tick bites or exposure to tick-infested habitats, the patient lived in a rural area where two other cases of unexplained deaths in young adults had been notified within the preceding months.
OmpA sequences by PCR amplification detected in tissue fragments of his liver, heart, and lung were sequenced and R. rickettsii was identified as the etiologic agent.
This report illustrates the difficulty of detecting a rash on dark-skinned individuals or perhaps a rash is no longer part of the diagnosis since Wolbachia has been put into a mosquito
(and not a tick).
Could Wolbachia pipientis — morphologically similar to Coxiella burnetii, the cause of Q fever — infect humans via inhalation too?
C. burnetii bacteria are found in the birth products (i.e. placenta, amniotic fluid), urine, feces, and milk of infected animals. People can get infected by breathing in dust that has been contaminated by infected animal feces, urine, milk, and birth products.
A couple of the women who were deemed to have strep A infections (in Canada) have darker skin than caucasians, but I suspect that the rash may not be necessary to make the diagnosis.
2011: No Sign of Group A Strep Antibiotic Resistance
Other factors must cause the re-emergence of GAS postpartum infections
A 2011 paper Postpartum Group A Streptococcus Sepsis and Maternal Immunology by Katie L. Mason and David M. Aronoff emphasized:
"Notably, there does not appear to be an increase in GAS [Group A Strep] antibiotic resistance, so other factors must underlie the re-emergence of GAS postpartum infections."
And an ignored 2014 paper, An Unclassified Microorganism: Novel Pathogen Candidate Lurking in Human Airways, by Kazumasa Fukuda, Kazuhiro Yatera, Midori Ogawa, Toshinori Kawanami, Kei Yamasaki, Shingo Noguchi, Robert S. Murphy, Hiroshi Mukae, and Hatsumi Taniguchi confirmed my worst fear:
"To dig deeper, we attempted a phylogenetic analysis with ARB-software and the SSU Ref NR 111 dataset. The result showed that the IOLA (Infectious Organism Lurking in Airways) genes were located in the “mitochondria” cluster composed of mitochondrial 16S rRNA genes from Eukaryota, and was classified in Rickettsiales (order) of Alphaproteobacteria (class) on the phylogenetic tree."
In 2015, Chen, Dong, et al. reported:
"Wolbachia 16S rRNA and fbpA genes were twice detected over 5 days in the blood of a patient with high fever ... Horizontal transmission in insects and among helminths occurs via cell–cell invasion, predation and cannibalism, among other possibilities, establishing the potential for horizontal transfer to animals and humans as well. Hence, Wolbachia spp. should be further evaluated as causes of human infection, especially as Wolbachia infection of mosquitoes is increasingly considered to be a tool for interfering with mosquito-borne transmission of human pathogens."
The NIH even "awarded MosquitoMate Inc., a $1.3 Million grant to develop the Wolbachia biopesticide method against invasive Tiger mosquitoes (Aedes albopictus)". Stephen Dobson posted this news June 22nd, 2015 — over six months after Chen, Dong, et al. reported their findings.
Wolbachia Pipientis Belongs to Supergroups A and B
Filariodea coxI gene was not amplified from the blood = No nematode
Credit: Fair Use Portion of Detection of Wolbachia genes in a patient with non-Hodgkin's lymphoma by Chen, Dong, et al. 2015
MosquitoMate is Seeking Nationwide Release
New York and Kentucky were also approved in 2016:
Credit: Fair Use Portion of Post: EPA Approved Wolbachia-Infected Aedes and MosquitoMate is Applying For Nationwide Release
Allison McGeer has ties to both the NIH and the WHO
She feels Group A strep is what caused a healthy 24-year-old to die
Dr. McGeer told CBC news:
"And, you know, these serious Group A strep infections after delivery are a common and really tragic problem. But they're most frequently not infections that can be prevented."
I don't think there is one healthcare professional out there (and I've worked in four Ontario hospitals) that would agree Group A strep infections are common.
Credit: Mark Twain Quote [Fair Use]
Zika Could Be the Phage Which Modifies Wolbachia
"Wolbachia could invade from a very low prevalence" (Dean JL, Dobson SL (2004); Plichart C, Legrand AM (2005).
"One phage could potentially be used to modify a broad range of Wolbachia stains (Tanaka et al., 2009; Kent and Bordenstein, 2010; Wang et al., 2013)."
A 20-fold increase in Guillain–Barré Syndrome (GBS) was noted — attributed to Zika — in French Polynesia, the site of the first known Wolbachia-infected Aedes releases.
And I couldn't help but think a healthy 24-year-old is unlikely to experience heart failure within such a short time frame from Group A strep.
According to the Mayo Clinic:
"The exact cause of Guillain-Barre syndrome isn't known." [Or is it?]
"The disorder usually appears days or weeks after a respiratory or digestive tract infection. Rarely, recent surgery or immunization can trigger Guillain-Barre syndrome. Recently, there have been a few [many?] cases reported following infection with the Zika virus."
"Guillain-Barre syndrome affects your nerves. Because nerves control your movements and body functions, people with Guillain-Barre may experience: breathing difficulties. The weakness or paralysis can spread to the muscles that control your breathing, a potentially fatal complication."
"Up to 30 percent of people with Guillain-Barre syndrome need temporary help from a machine to breathe when they're hospitalized for treatment."
Since This Strep A Case Reminded Me More of GBS
I decided to look into any correlation with Wolbachia and I was gobsmacked
The 2014 paper, Zika virus infection complicated by Guillain-Barré syndrome – case report, French Polynesia (December 2013), by Oehler E, Watrin L, Larre P, Leparc-Goffart I, Lastère S, Valour F, Baudouin L, Mallet HP, Musso D, and Ghawche F. stated:
"Retrospectively, anamnestic data revealed that she had suffered from an influenza-like syndrome at Day 7, with myalgia, febricula, cutaneous rash, and conjunctivitis. Because an epidemic of Zika fever, which is still ongoing, had begun a few weeks prior to the patient presenting this syndrome, Zika fever was suspected."
"Laboratory findings showed no inflammatory syndrome and the blood count was normal."
"A twofold increase in transaminase level was observed." All other pathogens were ruled out.
Even the usual aetiologies of GBS were eliminated: serological tests for human immunodeficiency virus (HIV), hepatitis B and C, Campylobacter jejuni, and Leptospira were negative. [See the study for more details].
Elevated liver enzymes may be discovered during routine blood testing. In most cases, liver enzyme levels are only mildly and temporarily elevated. Elevated liver enzymes tests indicative of transaminase levels include:
- Alanine transaminase (ALT)
- Aspartate transaminase (AST)
This immediately reminded me of the uveal melanoma cases (in young adults) which I feel Wolbachia is also implicated. Metastases are most frequently localized to the liver and up to 50 percent of patients develop metastatic disease.
Twofold Increase in Transaminase Level Reminded Me of
The 2016 report Diagnosis and Management of Tickborne Rickettsial Diseases
The 2016 report Diagnosis and Management of Tickborne Rickettsial Diseases: Rocky Mountain Spotted Fever and Other Spotted Fever Group Rickettsioses, Ehrlichioses, and Anaplasmosis — United States: A Practical Guide for Health Care and Public Health Professionals mentions:
"Mild thrombocytopenia has been observed in 40%, mild leukopenia in 50%, and modest elevation of hepatic transaminase levels in 78% of cases."
And I found other posts that confirmed the same, here are just a few:
Credit: Fair Use Portions of Google Search
After reading many rickettsial-related posts, the mindset appears to be that it is still rare in North America and that it is only caused by ticks (usually beginning in the spring).
I was also disheartened by Medscape's Rickettsial Infection Workup which seemed to "go against" what I knew about Wolbachia (rickettsia) bacterial counts in mammals.
The book Immunology, Inflammation and Diseases of the Eye by E. Pearlman and K. Gentil (on page 91) states:
Wolbachia "is most numerous in the mammalian host compared with the insect stage ... Elevated Wolbachia DNA and even intact Wolbachia are detected in the blood."
Further along, it states "within 7 days in the mammalian host, bacteria numbers increased 600-fold."
Medscape Revised Their Rickettsial Infection Workup Page
Apparently, no lab tests are available to diagnose Wolbachia early on and the causative agent (at the species level) cannot be identified:
Credit: Fair Use Portion of Medscape's Rickettsial Infection Workup Page
Wolbachia is Extremely Powerful: Can Insert Its Own DNA
And, Dmp53 Binds Specifically to Human p53 (aka Tumor Gene)
Credit: Public Domain | Text and Modifications by Rose Webster (aka RoseWrites on InfoBarrel) Ask me about reuse.
Oxitec Complained About Wolbachia Pipientis ZAP Strain
It Was No Exaggeration That Over 1000 New Genes Would Be Introduced
Credit: Fair Use Portion of Oxitec Ltd. Valid Concerns About Wolbachia Pipientis in Aedes
I am certain that ruling out the most damaging pathogen is difficult because there is much to consider in the extracellular matrix, within host cells, and surface proteins that interact with each other. We all harbor strep A in and on our body.
Think of it as a dysfunctional family: when a virus (like Zika) interacts with Wolbachia's surface proteins and then is introduced to our normal flora (which includes strep A). It's like bringing a bar-brawling drunk to a family reunion.
It changes how pathogens and normal bacteria behave.
Credit: Alex Indigo on flickr (CC-by-2.0)
Pillow Fight in Toronto, Ontario (May 31, 2008) Credit: Alex Indigo on flickr (CC-by-2.0)
The microbial pan-genome, a brilliant 2005 paper by DuccioMedini, ClaudioDonati, HervéTettelin, VegaMasignani, and RinoRappuoli states:
"The surprising conclusion from the study is that, in theory, the bacterial species will never be fully described, because new genes will be added to the genome of the species with each new genomic sequence."
"Although new genes can originate through duplication of existing sequences, followed by diversification, the most common way to acquire new functions is by the transfer of genetic material from unrelated organisms."
My thoughts: UNRELATED organisms could mean Wolbachia (Rickettsia) and Zika or strep A or other pathogenic organisms or simply the normal bacteria that we all carry.
And the authors concluded:
"The importance of the mechanisms of lateral gene transfer in evolutionary processes has been hotly debated in recent years, but it is now generally accepted that it represents an evolutionary ‘fast route’, which enables an organism to quickly adapt to a changing environment."
Most Important: Species With Open Pan-Genomes
"Species with open pan-genomes include Streptococcus agalactiae, Streptococcus pneumoniae, Escherichia coli, Bacillus cereus and Prochlorococcus marinus (Tettelin et al., 2008). Those with closed pan-genomes include Staphylococcus aureus, Streptococcus pyogenes, Ureaplasma urealyticum and Bacillus anthracis (Tettelin et al., 2008)."
What stood out like a sore thumb to me was the fact that Streptococcus agalactiae is actually group B strep (GBS). This organism colonizes the vagina, GI tract, and the upper respiratory tract of healthy humans.
Since this type of strep normally colonizes the vagina, and it has an open pan-genome, I would imagine that "the transfer of genetic material from unrelated organisms" (such as Wolbachia +/- ZIKV) could be what is causing the severe infections postpartum (and not group A strep bacterium found in the nose, throat, and on the skin).
Credit: By Blueiridium (Own work) [CC0], via Wikimedia Commons
An example of a positive cAMP test proving that group B Streptococcus species (Streptococcus agalactiae) is present. The arrowhead formation on the Blood agarose gel, BAP (5% sheep blood) indicates that this bacteria is Streptococcus agalactiae (group B Strep), also abbreviated as GBS. Credit: Blueiridium (Own work) [CC0], via Wikimedia Commons
Sepsis: Not Caused by Gram-Positive Strep A Alone
Both gram-negative and gram-positive bacteria play a major role
The 2014 paper, Gram-positive and gram-negative bacterial toxins in sepsis, by Girish Ramachandran clearly states:
"Bacterial sepsis is a major cause of fatality worldwide. Sepsis is a multi-step process that involves an uncontrolled inflammatory response by the host cells that may result in multi organ failure and death. Both gram-negative and gram-positive bacteria play a major role in causing sepsis."
This is key because Wolbachia pipientis are gram-negative bacteria and Streptococcus agalactiae are a gram-positive coccus (round bacterium) with a tendency to form chains (as reflected by the genus name Streptococcus).
So while we are only hearing in the media (and from those with ties to the WHO
and NIH) that invasive Group A strep are causing these severe infections, I highly doubt that one pathogen is the sole cause.
Remember my analogy: the dysfunctional family. Once you introduce Wolbachia into the mix, you have bacteria that are capable (via open pan-genomes) of working in tandem to overwhelm a healthy person's balance of normal flora. And it is likely that both gram-positive and gram-negative bacteria are causing sepsis.
In fact, "Endotoxins are the glycolipid, LPS macromolecules that make up about 75% of the outer membrane of gram-negative bacteria that are capable of causing lethal shock."
So while no one could say group A strep does not play some part, Wolbachia pipientis could be the gram-negative bacteria that is more responsible for the lethal shock working alongside gram-positive Streptococcus agalactiae.
Bottom Line: It is important to have a high index of suspicion for rickettsial infection in North America because Wolbachia-infected Aedes releases have been carried out despite the valid concerns of scientists and those with backgrounds in healthcare (like me).
Credit: Fair Use Portion of Paper by Girish Ramachandran
No Surprise (to me) is Wikipedia's Septic Shock Page
Wikipedia has skewed the study literature (once again):
Credit: Fair Use Portion of Wikipedia's Septic Shock Page
On May 22nd, 2017, I Tried to Add Crucial Studies But
Wikipedia Editor Jytdog Removed All My Edits and It Will Cost Lives
Wolbachia-Infected Aedes Have Been in Development
For Over 30 Years. But Many Sources Now Claim Only About a Decade:
Credit: Fair Use Portion of Time and The Atlantic Posts About Wolbachia-Infected Aedes
Over 6 Years Later, 90 Percent of Mosquitoes Still Infected
Ergo, it will take decades to restore the ecological balance in some regions.
Credit: Fair Use Portions of MosquitoMate's FAQ and 90 Percent Still Infected Over 6 Years Later
Since 2003, Wolbachia Pipientis Could Grow at 37 C
The Medical and Scientific Community Should Have Stopped It
Credit: Rose Webster (aka RoseWrites on InfoBarrel) Ask me about reuse.
I Don't Feel Physicians Are Entirely to Blame, Though
They are being pushed hard to NOT prescribe antibiotics now:
Credit: Fair Use Portion of Dr. Goldman's Blog and My Comment
The Public and Physicians Are Told Conflicting Advice
Group A Strep Is a "Mystery"; Digital Rectal Exams Are Not Needed (Zika+/- Wolbachia Infections Cause Prostatitis); and Pink Eye Needs 'to Run Its Course' (Zika +/- Wolbachia Infections Can Cause Pink Eye):
Credit: Fair Use Portions of CBC Headlines and Posts and My Comment
Many Studies Are Warning Us About Rickettsia
But scientists are ignored by the media and studies are under paywalls
Credit: Fair Use Portion of Genotyping, evolution and epidemiological findings of Rickettsia species by Vicky Merhej, Emmanouil Angelakis, Cristina Socolovschi, and Didier Raoult
My Most Comprehensive Video To Date Shows You
Why Wolbachia-Infected Aedes Releases Are Just a Money Grab
Recommended Articles and Other Ways to Help
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Petition to help humans: Acute Inflammatory Response, Uveal Melanoma, or Lymphoma? R/O Rickettsiales (Wolbachia).
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