In this episode, Drs. Blair Bigham and Mojola Omole speak with two leading experts: Dr. Samira Jeimy, an allergist, and Dr. Isaac Bogoch, a specialist in infectious diseases, about the increasing prevalence of allergies and infections in Canada attributed to insects.
Dr. Jeimy authored the article in the CMAJ titled “Five things to know about… tick-borne red meat allergy (α-gal syndrome)”. Dr. Jeimy describes how tick bites introduce a carbohydrate, alpha-gal, leading the human body to manifest allergic reactions to red meat. She underscores the diagnostic challenges associated with this allergy due to its delayed reactions and the spectrum of symptoms, which can range from mild to critical.
Dr. Bogoch shifts the focus to the expanding footprint of tick and other insect-borne diseases in Canada, such as Lyme disease, anaplasmosis, and babesiosis. He attributes this surge to the climatic shift towards warmer temperatures and abbreviated winters. He emphasizes the indispensability of preventive measures, including vigilant tick checks, use of repellents, and donning protective clothing.
Both experts stress the urgency of heightened education, rigorous surveillance, and enhanced testing methodologies. As ticks and insects advance further north, physicians need to be alert to this emerging health challenge.
Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.
You can find Blair and Mojola on X @BlairBigham and @Drmojolaomole
X (in English): @CMAJ
X (en français): @JAMC
Facebook
Instagram: @CMAJ.ca
The CMAJ Podcast is produced by PodCraft Productions
In this episode, Drs. Blair Bigham and Mojola Omole speak with two leading experts: Dr. Samira Jeimy, an allergist, and Dr. Isaac Bogoch, a specialist in infectious diseases, about the increasing prevalence of allergies and infections in Canada attributed to insects.
Dr. Jeimy authored the article in the CMAJ titled “Five things to know about… tick-borne red meat allergy (α-gal syndrome)”. Dr. Jeimy describes how tick bites introduce a carbohydrate, alpha-gal, leading the human body to manifest allergic reactions to red meat. She underscores the diagnostic challenges associated with this allergy due to its delayed reactions and the spectrum of symptoms, which can range from mild to critical.
Dr. Bogoch shifts the focus to the expanding footprint of tick and other insect-borne diseases in Canada, such as Lyme disease, anaplasmosis, and babesiosis. He attributes this surge to the climatic shift towards warmer temperatures and abbreviated winters. He emphasizes the indispensability of preventive measures, including vigilant tick checks, use of repellents, and donning protective clothing.
Both experts stress the urgency of heightened education, rigorous surveillance, and enhanced testing methodologies. As ticks and insects advance further north, physicians need to be alert to this emerging health challenge.
Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.
You can find Blair and Mojola on X @BlairBigham and @Drmojolaomole
X (in English): @CMAJ
X (en français): @JAMC
Facebook
Instagram: @CMAJ.ca
The CMAJ Podcast is produced by PodCraft Productions
Dr. Blair Bigham:
I'm Blair Bigham.
Dr. Mojola Omole:
And I'm Mojola Omole. This is the CMAJ podcast.
So today, Blair, we are talking about a paper in the journal named, “Tickborne Red Meat Allergy, the alpha-gal syndrome”.
Dr. Blair Bigham:
This is a very weird syndrome indeed, and I have so many questions for the people we're going to talk to, but basically this “Five Things You Need to Know” article walks us through this really weird reaction where you get bit by a tick, not the Lyme tick, not one of the deer ticks, but just this other tick that usually lives in the States. But I guess with climate change, it's marching its way up here.
And it bites you. You might not even know it, but it basically causes your body to suddenly become allergic to things like red meat. And so then a couple of weeks later, I guess you just have this anaphylactic reaction and end up in the emergency room.
Dr. Mojola Omole:
Or milder reactions.
Dr. Blair Bigham:
Or a milder reaction. Yeah.
But it sort of is very odd because as an emergency doctor, I'm always looking for, okay, what caused your allergy? What caused your anaphylaxis? And when we can't find a cause... I mean sometimes it's super obvious, but sometimes we're kind of like, well, is it anaphylaxis? Maybe it's something else. And then we go down all these crazy diagnostic pathways. And some people can have these recurrent episodes that kind of just go on undiagnosed. And now maybe this is one of those explanations for an otherwise idiopathic reaction.
Dr. Mojola Omole:
And I think maybe one part that makes it a bit more of a serious consideration, because some people could argue that the less consumption of red meat in society is good for society. But I do think a major part of it is the fact that we have bovine and porcine products for medicine, whether it's in heart valve replacements, medications that's used for colon cancer... So it actually can have some serious medical sequelae aside from the anaphylaxis or gastrointestinal disturbances.
Dr. Blair Bigham:
So we're going to talk to an allergist and immunologist, and then we're going to broaden this out, not just for this odd tick bite red meat allergy reaction, but we're going to talk about tick bites in general and get an update from an infectious disease doctor on things like West Nile and Lyme and all sorts of other tickborne problems. So let's jump into it.
Dr. Mojola Omole:
Dr. Samira Jeimy is an allergist and clinical immunologist at London Health Sciences Centre. She's also the program director of the Clinical Immunology and Allergy at Western University. She's the co-author of the paper “Five Things to Know About Tick-Borne Red Meat Allergy”. Samira, thank you so much for being with us today.
Dr. Samira Jeimy:
Thank you very much for having me.
Dr. Mojola Omole:
So what were you seeing in your practice that made you want to write this paper?
Dr. Samira Jeimy:
So not just my practice, but since about the mid-2000s, there's been odd reactions that don't quite fit the natural history and presentation of food allergy. So these reactions happen in adults who suddenly develop either this phenomenon that we call idiopathic anaphylaxis, which literally means we don't know the cause for why they're having repeated bouts of serious life-threatening reactions, allergic reactions. Or they, at a later stage in life, after having no allergies or after having very distinct allergies that present in childhood as usual, suddenly are not able to eat meat, red meat in particular, because they have a spectrum of reactions ranging from either gastrointestinal symptoms like nausea, vomiting, or diarrhea, or actual anaphylaxis.
The difficult part of the reaction is that the reactions happen delayed, unlike other food allergy reactions. So six to eight hours after eating that red meat, which is difficult to pick up. So that phenomenon was picked up in the mid-2000s, but we didn't have an explanation for why it was happening.
Then, around the same time, people were having unusual reactions to a chemotherapy agent, specifically a monoclonal antibody called cetuximab, which is used for colon cancer fairly frequently. Very unusual reactions that in the later part of the 2000s ended up being due to the same thing. And that's due to a carbohydrate allergy. That carbohydrate, called alpha-gal, is in non-mammalian organisms. So mammals, typically if we see alpha-gal on anything, we tend to create an allergic response to it and tick bites is how we develop the allergy.
Dr. Mojola Omole:
So just for me as a non allergist and just non-medicine person, how common is it?
Dr. Blair Bigham:
Oh, come on.
Dr. Mojola Omole:
I'm a surgeon.
How common is it even to develop allergies later on in life?
Dr. Samira Jeimy:
It's not very common. It's actually exceedingly uncommon. And there are specific foods to which adults develop reactions to, and typically it's shellfish. So shellfish allergies can come about later on in life, and there's a very distinct mechanism for that. The reason that happens is because most of us have heard of dust mite allergy. Dust mites actually contain a shared protein with shellfish, particularly crustacean shellfish.
So someone earlier on in life will have a dust mite allergy that can actually evolve into a shellfish allergy. So when I counsel patients on this, I say, "Oh, it's because shellfish are the dust mite of this ocean, sea. I don't know. Wherever shrimp and crab live.
Dr. Mojola Omole:
Water.
Dr. Samira Jeimy:
Water. Or dust mites are the shrimp of the air. Right? So that we expect. Red meat allergy is very unexpected. Red meat, as many people know, is not on the list of an allergenic food. So when people started developing reactions to red meat, that was a bit of a red flag, no pun intended.
Dr. Mojola Omole:
So how common are you seeing this increase in red meat allergy?
Dr. Samira Jeimy:
Yeah. So we, unfortunately in Canada, haven't kept track. The Center for Disease Control, CDC, actually published a report recently that showed over 100,000 reports in the last decade. And we think that this is an underestimation because this is not a reportable phenomenon. This is not like an illness that we report to our local health units.
Dr. Mojola Omole:
I guess the question still is, but why would you think the tick is the cause of the red meat allergy?
Dr. Samira Jeimy:
That's a really great question. And there are, I think, some more astute clinicians that were noticing a geographical trend in areas where the lone star tick is I guess the culprit for carrying this antigen and instances of red meat allergy.
So then there are actually specific methods where we can through, something called western blotting, isolate what the allergy antibody that is created, we can isolate what that protein is, and we can have a suspect. And then we look for how a person would be exposed to that suspect. So then we know from previously that one of the many things that ticks do when they bite you is they can transfer this antigen to humans through their bite, this antigen called galactose-alpha-1,3-galactose is the full name of the antigen. And that antigen is not, as I said, is not found in mammals, so when a mammalian immune system sees it, it develops an allergic response to it.
Dr. Blair Bigham:
Okay.
Dr. Mojola Omole:
So how do they present with this?
Dr. Samira Jeimy:
Very challenging to diagnose, again, because a patient might not pick up on the fact that their unusual reactions or allergic reactions are due to the meat, because it's two to six hours later. But it's a spectrum. So some people have only nausea, vomiting, diarrhea that they can't explain. Other people have full-blown anaphylaxis, and it can be serious and life-threatening.
And just to sort of give a refresher, anaphylaxis can be anything from generalized hives, swelling, plus another organ system involvement like feeling dizzy, having difficulty breathing, or having nausea, vomiting, diarrhea, or simply being exposed to your allergen and feeling dizzy or passing out. So pretty broad spectrum of presentations.
Dr. Mojola Omole:
And when I think of Lyme disease previously, it tended to be in people who were in the outdoors. I'm an indoor person. I don't like the great outdoors. Could I get this?
Dr. Samira Jeimy:
Yeah. So the reason that I brought this up with CMAJ was because there has been an ever-increasing habitat for the lone star tick. And in fact in other countries... So Sweden and Australia are two I can think of. Other ticks have been implicated in carrying this allergy. So with the ever-spreading habitat of ticks and the fact that tick bites can sometimes go unnoticed. Right? Because if I don't know how much you know about the life cycle of ticks, so just go back a little bit, you can get a tick bite from even a little tiny nymph or something visible. So you may not always get a reaction and you may not see the organism. And most of the cases I've seen, the patient did not know that they were ever bitten by a tick.
Dr. Blair Bigham:
So how do you diagnose it? Do you do serologies for the tick or...
Dr. Samira Jeimy:
That's right. So serology, as in drawing blood, and then looking for serum specific IgE versus this carbohydrate called alpha-gal. We can do skin testing with the red meats that have caused the reactions. The skin testing is not perfect in that it's not entirely sensitive. Even the blood test is not as sensitive as we would like. So the way that we make the diagnosis is really... It's a global picture of the clinical history, the combination of tests, and then we can do something called a graded oral food challenge where we actually expose the patient to the food. Now as I said, the diagnosis can be challenging compared to a regular food allergy because the reaction can be delayed.
Dr. Blair Bigham:
Other than red meat, what else can trigger these idiopathic or seemingly idiopathic reactions?
Dr. Samira Jeimy:
It's a work in progress identifying all of the medical products that contain bovine and porcine ingredients. But as we are finding out, it's a lot.
So if there's a patient who's having issues with their bovine or porcine cardiac valves, or if there's a patient who suddenly starts having issues with their chemotherapy like cetuximab, or if there are cases of anaphylaxis in the operating room, this is now an emerging area that we have to look at because in the operating room they may be exposed to things like heparin or other blood products that contain bovine ingredients or porcine ingredients.
And then the other important thing are vaccine reactions. So some vaccines like the measles-mumps-rubella vaccine and the Zostavax vaccine both contain gelatin. Now, very low amounts, so I wouldn't expect it to be a problem, but allergy tends to be on a spectrum, so people have different thresholds at which they have reactions to their allergen.
Dr. Mojola Omole:
And for the most important question, can we still eat gummy bears if you have a red meat allergy?
Dr. Samira Jeimy:
If you eat gummy bears that contain gelatin and it suddenly poses a problem, then think of this as a potential reason.
Dr. Blair Bigham:
If I ever get an allergy to gummy bears, I think I'm going to cry for the rest of my life.
Dr. Mojola Omole:
So what is the treatment for this?
Dr. Samira Jeimy:
The treatment unsatisfyingly is avoidance, carrying an EpiPen and treating a reaction as soon as it happens, and recognition and education around what products might cause reaction.
Dr. Blair Bigham:
But once you have it, you have it for life?
Dr. Samira Jeimy:
You don't have it for life actually.
Dr. Blair Bigham:
Okay.
Dr. Samira Jeimy:
So one of the positive prognostic factors of this particular entity is that the serology, the serum IgE values actually decrease over time, although the rate of decrease is very variable between people. So we have to just follow their serology over time, and if it decreases to a level that we think is low risk for the patient to have exposure to that food, then we expose them to the food.
Dr. Mojola Omole:
So what in terms of for primary care practitioners, how should they consider this in their differential?
Dr. Samira Jeimy:
I love that question. So if you see a patient who starts having odd reactions, so the patient who is coming to you with nausea, vomiting, diarrhea and you can't find a cause, or if they're coming in with that idiopathic anaphylaxis phenomenon where they just cannot understand why they're having bouts of anaphylaxis, the serum specific IgE for alpha-gal and a total IgE level should be sent as part of the initial workup and then send them to your local allergist.
Dr. Blair Bigham:
This is so cool.
Dr. Mojola Omole:
Funny enough is I literally, in the last two months, cannot tolerate red meat. And I was like... It's not anaphylaxis. I'm just having stomach cramps. And I'm like, I'm just going to stop eating it.
Dr. Samira Jeimy:
Yeah, so it might be worthwhile to see us. It might be.
Dr. Mojola Omole:
I'll call my friend, she's an allergist, so I'll see if she'll see me. This has been a great conversation. Thank you very much for joining us today.
Dr. Blair Bigham:
Yeah, thank you.
Dr. Samira Jeimy:
Thank you again for having me.
Dr. Mojola Omole:
Thank you again,Dr. Samira Jeimy, for joining us today. She's an allergist and clinical immunologist at London Health Sciences. She's the co-author of the paper “Five Things to Know About Tickborne Red Meat Allergies”.
(silence)
Dr. Blair Bigham:
We're going to continue talking about ticks. Isaac Bogoch is an infectious disease specialist in Toronto and an associate professor at the University of Toronto in the Department of Medicine And Division of Infectious Diseases.
Isaac, thank you so much for joining us today.
Dr. Isaac Bogoch:
Oh, thanks for having me on.
Dr. Blair Bigham:
So I find ticks fascinating. I think Jola is sort of on the... Mojola is shaking her head.
Dr. Mojola Omole:
They're not fascinating.
Dr. Blair Bigham:
Oh, come on. They're so cool. And they're like this unique type of bug. We just heard about how they can cause this meat allergy, which is crazy. Tell me a little bit more about other things that we're worried about when it comes to ticks transmitting infections and other problems to people here in Canada.
Dr. Isaac Bogoch:
Sure. So for starters, there's ticks all over the world. There's lots of different types of ticks. Forget infections for a second. It's just the concept of having an insect burrow its head under your skin and suck your blood is disgusting. And then of course we add in the infection component too, which makes it worse and adds insult to injury.
But yeah, in Canada obviously, we certainly are seeing the emergence and maybe reemergence of some tick-transmitted infections. And then we also have other insect-transmitted infections that are not tick-related as well. And these are things we've got to keep an eye on because we're seeing more and more of them.
I think the obvious most common tick-transmitted illness we're seeing in Canada is Lyme. And if you look at the published data year after year, we're seeing a trend towards more and more cases of Lyme in Canada. Obviously the 2023 data isn't available yet, but we know it's going to be high. And unfortunately those numbers are still a gross underestimate. We're probably missing a lot of cases of Lyme.
But there's other tick-transmitted illnesses that are much more rare in Canada, but they certainly are here and we're probably going to see more of them as we see ticks spread throughout parts of the country or survive the winters in areas where they weren't normally surviving.
Dr. Blair Bigham:
What diseases would those be?
Dr. Isaac Bogoch:
Yeah, there's a couple. The two big ones that are on some of our radars are... One's called anaplasmosis and the other one is called babesiosis. They've been diagnosed in Canada. They're certainly here. They're still probably fairly rare, but it's probably a reasonable suggestion that we actually don't know how much of these infections are around and we're probably missing diagnoses as well, so we should be doing a better job at picking them up.
Dr. Blair Bigham:
When it comes to those two, what should people be looking for? How are they different from Lyme or are they syndromically similar?
Dr. Isaac Bogoch:
Sometimes it's pretty hard to clinically distinguish between these infections because the syndrome will overlap. With Lyme, sometimes, in fact, a lot of the time there's this classic target lesion, but it doesn't happen in everybody.
But with these other infections, there's a lot of syndrome overlap: fever, muscle aches and pains, fatigue. And you don't really have a home run diagnosis just based on signs or symptoms. There's some subtle clues. For example, this one infection anaplasmosis. Oftentimes you see what we call leukopenia or a lower white blood cell count with that infection. But a lot of things can give you leukopenia. The key thing here is I think it's important to acknowledge that these infections are here, that they're not necessarily easy to distinguish just on clinical evaluation and history and physical alone, and we should be doing more testing for these infections moving forward.
Dr. Blair Bigham:
So talk to me about what we all need to be on the lookout for to pull the trigger to order testing. And if I'm doing testing for one, should I be doing testing for more than just Lyme disease? Or what's your recommendation for the people out in the field seeing these in family clinics or emergency departments?
Dr. Isaac Bogoch:
Yeah. I think the first obvious step is avoid getting bitten by ticks. Right? Prevention is obviously number one, and I think we can do a lot better.
Dr. Blair Bigham:
And how do you do that?
Dr. Isaac Bogoch:
Yeah.
Dr. Mojola Omole:
That's what I care the most about.
Dr. Blair Bigham:
Never go outside, Jola.
Dr. Isaac Bogoch:
No. So that's the other thing too.
Dr. Mojola Omole:
I'm an indoor cat. That's okay.
Dr. Blair Bigham:
That's what she wants you to say, Isaac. Just tell her she can never go outside.
Dr. Isaac Bogoch:
I honestly think we are so lucky to live in the most beautiful country on the planet. And spring and summer and fall, even winter are absolutely gorgeous. But we should be outside as much as possible. But just some simple tricks to prevent tick bites.
Number one, you can wear long pants and long sleeve shirts. That'll help. But of course if it's the middle of summer and it's 35 degrees Celsius, that's completely impractical. You can put on insect repellent. DEET or picaridin products are pretty helpful in preventing bites from insects. That'll go a long way. And the other key thing is doing tick checks when you come back in. These are insects that live in usually wooded areas or tall grass. And just do a tick check before you go back in.
Sometimes it can be pretty small and it's pretty helpful to have another person look at some of the hard to see places like the back of the legs. So it's also helpful to have a family member or friend have a peek at some of the hard to look places, and you can remove them right away if you find one. That's the most important thing is prevention, and not being scared to go outside. We should really be going out as much as possible.
Dr. Blair Bigham:
And then what about the actual testing itself? What guidance is there for family docs and emerg docs to pull the trigger? Because I seem to remember in the back of my brain from residency that some of the serologies can give you a false positive, or at least some of the testing for Lyme can give you a false positive.
Dr. Isaac Bogoch:
Right. So I think there's a couple of points here. Let's look at our friends and neighbors to the south. And in areas like New England, which of course border Canada, these ticks don't respect political boundaries. We know that in many of these areas there is a significant degree of co-infection.
So if someone has Lyme there's, depending on where you are, up to a 10 or even a 15% chance that they're going to have another one of these infections like Babesia or anaplasmosis. It's ingrained into a lot of the protocols in some parts of the United States, if you're testing for one, you're actually testing for all three. We haven't really started that in Canada yet. We really haven't seen that, but there's at least chatter about if you're ordering a Lyme test to also order a Babesia test and an Anaplasma test.
And people might scoff at that, because we've only had a very small handful of those infections detected in Canada. But the other part is we're not actually looking for them, so we don't really know how much are here. And if you look at some of the other data where public health units have done analysis on ticks, not on people, but environmental analysis and swept areas for ticks and evaluated ticks, yeah, these infections are showing up in ticks, so they're also probably showing up in people, and they're just not going diagnosed.
So I've ingrained this into my practice, and we certainly see a bunch of Lyme in southern Ontario, and I've started ordering more Anaplasma and Babesia tests. And there's different ways you can do it.
I think the key thing is, across the country, you just look at your provincial public health website and see what tests to order. But generally there's serology tests, there's PCR tests, and even for Babesia you can do a blood film similar to what we do for malaria. And there's some very classic signs of Babesia on a blood film as well. You just have to call the lab and let them know what you're looking for and they'll do it.
Dr. Mojola Omole:
So we focused on ticks for a little bit, but are there other non-tickborne infections that we should also be concerned about or be looking out for?
Dr. Isaac Bogoch:
Yeah, absolutely. I think the big obvious one is mosquitoes and West Nile. And a lot of it depends on the year, but some years we have more West Nile and other years we have less West Nile. And it seems to be pretty sporadic year after year to see what is the burden. Usually we start to see West Nile in the mid to late summer and into the fall.
And again, the vast majority of cases of West Nile are either asymptomatic or mildly symptomatic. People might have fever, malaise, muscle aches and pains, but I think it's also important to recognize that there can be rare, severe, but also rare manifestations of the virus, typically neurologic manifestations of the virus resulting in paralysis, so it can be very severe and very nasty.
Luckily it's a rare manifestation, but the same rules apply. Go outside, have a great time, but you can use bug spray and insect repellent to prevent transmission of this infection.
There's pretty good surveillance for this. I mean, you'll hear public health units discuss how many mosquito areas they've detected West Nile, and they're pretty keen to report it so people can take appropriate precautions to prevent mosquito bites when we're starting to see West Nile circulate.
Dr. Blair Bigham:
Isaac, why are we seeing a rise in some of these diseases now?
Dr. Isaac Bogoch:
Yeah. I mean it's important to recognize in many settings that climate change is really having an impact. And from a Canadian perspective, winters may not be as long, winters may not be as cold, so tick populations can survive in areas where they weren't normally surviving. And ticks can flourish and transmit infections for a longer time of the year than they did before, which you can't really draw a static map in Canada say, this is where Lyme is and this is where it isn't. This is a dynamic map and it's changing and it appears to be changing unfortunately quickly.
If you asked people 10, 15 years ago, "Where's Lyme in Canada?" They'd say, "Oh, it's probably in spots of Nova Scotia in Port Pelee in the most southern part of Ontario. But now there's lots of hot spots far north of those areas and over a much larger geographic area.
Dr. Blair Bigham:
What are the stakes here? How big of a public health problem is this right now?
Dr. Isaac Bogoch:
I think it's important. I certainly think it's important. We know what Lyme can do. Luckily, it's not hard to diagnose. Luckily, it's not hard to treat. Luckily, the vast majority of people who get treated for Lyme or for other tick transmitted illnesses will make a full recovery.
Yes, of course there's risk factors for severe disease and we have to be mindful of that, but I think the key here is number one, public education. People need to know that ticks are around. Ticks can transmit illnesses, and that's here in Canada, and here's how you can protect yourself.
I think number two, we also need to do a better job in informing clinicians on what the tick-transmitted illnesses and insect-transmitted illnesses are in Canada and informing them on how to screen for them, when to think about this, how to cancel counsel patients, how to diagnose and treat them.
And then the third thing, from a public health standpoint, is really upping our game on surveillance and really having a better understanding of what infections are circulating in Canada, how their boundaries are changing, and using that data to really drive a sound public health and clinical response.
Dr. Blair Bigham:
If there were one or two things that you wanted the public to hear and family doctors and emergency doctors to hear about insect diseases, what would that be?
Dr. Mojola Omole:
Not surgeons?
Dr. Blair Bigham:
And surgeons, yes. Surgeons too.
Dr. Isaac Bogoch:
So number one would be enjoy nature and get outside as much as possible. And I can't stress this enough. This should not be a reason for people to stay inside. Number two would be what we chatted about earlier in terms of prevention. And then number three is those little tips and tricks for diagnosing and managing cases. And we don't have to go down that rabbit hole of how to manage Babesia or how to manage Anaplasma, but I think we're going to start to see more and more public education on this.
I live and work in Ontario, and as of this year, Babesia and Anaplasma are now reportable infections in Ontario. That's good. We now will have a much better understanding of what the burden is in the province. And I think with that, we'll see more and more public education geared towards the general public and towards clinicians on diagnosis and management. So I think that's a key point as well.
Dr. Blair Bigham:
Is co-treatment easy? Is it just doxycycline, or is it a little more complicated?
Dr. Isaac Bogoch:
You certainly can use that for anaplasmosis, but Babesia is treated with different medications. It's interesting. Babesia is like the malaria of North America. It's a protozoa. Sometimes it's intracellular, sometimes it's extracellular. But you do the very similar tests like the blood thick and thin smear, you can detect it on just like with malaria. You use medications like atovaquone and azithromycin, which will treat malaria and also Babesia. It's pretty fascinating infection.
The other thing is the risk factors for severity are pretty similar with Babesia and malaria. It's a very similar parasite in many ways. So asplenia for example, is a risk factor for severe babesiosis as well.
So I did some of my training in New England and we saw a lot of it in the summers. It was pretty interesting to see, but I'm looking for it in Canada. I know there's been reported cases. I personally haven't seen a case in Canada, but it certainly has been reported and I think we should be screening patients for it more because we're going to find it more.
Dr. Blair Bigham:
Very cool. Isaac, thank you so much for joining us today.
Dr. Mojola Omole:
Thank you. This has been fascinating.
Dr. Isaac Bogoch:
No problem guys. Nice to chat.
Dr. Blair Bigham:
Isaac Bogoch is an infectious disease specialist in Toronto and an associate professor at the University of Toronto in the Department of Medicine.
Dr. Mojola Omole:
So Blair, you were very excited about this episode because you love ticks. What are your thoughts as we're wrapping up from our interviews?
Dr. Blair Bigham:
I'm kind of excited. Maybe I can diagnose these diseases that I can't even pronounce. I don't know. I just think that ticks are super... I don't know. I don't like other bugs. I don't like mosquitoes. They're terrible. I don't like anything that's big enough to make a sound when you step on it. But I don't know. I think ticks are cool and now we've got these cool new diseases that we can be on the lookout for.
Babesiosis, I don't think I've heard of that one since medical school. All I remember is that it's like malaria, but I don't know. Now it's not carried by a mosquito. It's carried by a tick. It just seems... I don't know. I'm always interested by new stuff, and this just seems like new stuff that we need to keep our eyes out for. And it's worth, I think, highlighting in an episode like this where, hey, it's not all Lyme disease when someone says they've been bit by a tick.
Dr. Mojola Omole:
For me, what stood out was that the effect of climate change and how it's changing our world, and there's an increase in these diseases and that there's long-term sequelae.
I know that people in PETA would be excited that there's a red meat allergy, but for some people, the devastating part is not like you can't eat a steak. It's that when it comes to certain medications that contain red meat particles or when it comes to having a transplant, in terms of heart, that that could actually be a big concern.
So for me, what really stuck out is the climate change and how that it is intertwined with healthcare and that we do have to start addressing this from a medical perspective so we can prevent more diseases or it's going to be the last of us. No clue. I never watched “The Last of Us”. I'm assuming it's about some bug that destroy people.
Dr. Blair Bigham:
Well, it is an emergency. If we're going to be seeing more and more diseases that previously got wiped out every winter, or if we have bugs marching their way north as the temperature warms, this may very... I don't know. Is this going to end up in your operating room? Maybe there'll be asymptomatic cases. Maybe you'll see these in clinic. Maybe they'll mimic things.
With this weird red meat tick thing, people probably got misdiagnosed with all sorts of things. Maybe you scoped a couple of them for their weird gastrointestinal symptoms that are actually tick-related.
As these little creepy crawlies start marching north as their climate expands, who knows what will end up in a surgeon's clinic, in an emergency department, in a family office? This is going to potentially affect doctors far beyond those who sort of do primary care.
Dr. Mojola Omole:
For sure.
Dr. Blair Bigham:
That's it for this episode of the CMAJ Podcast. If you like what you heard, please give us a five star rating wherever it is you download your audio. And please remember to share us with your networks. Leave a comment and help us get the word out. The CMAJ Podcast is produced for CMAJ by PodCraft Productions. Thanks so much for listening. I'm Blair Bigham.
Dr. Mojola Omole:
I'm Mojola Omole. Until next time, be well and stay away from wooded areas.