Association of Presenting Symptoms With Abnormal Laboratory Values for Vector-Borne Illness — Experience in an Urban Gastroenterology Practice
Background: In the clinical setting, it is not common practice to consider a vector bite, such as from a tick or flea, to be a contributing factor to chronic digestive symptoms. This article investigates associations we have observed among symptomatic patients and positive blood tests for vector-bor...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Advocate Aurora Health
2021-01-01
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| Series: | Journal of Patient-Centered Research and Reviews |
| Subjects: | |
| Online Access: | https://institutionalrepository.aah.org/cgi/viewcontent.cgi?article=1729&context=jpcrr |
| _version_ | 1797723521203306496 |
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| author | Michael D. Erdman Niloofar Kossari Jessica Ye Kristen H. Reynolds Emily Blodget B. Robert Mozayeni Farshid Sam Rahbar |
| author_facet | Michael D. Erdman Niloofar Kossari Jessica Ye Kristen H. Reynolds Emily Blodget B. Robert Mozayeni Farshid Sam Rahbar |
| author_sort | Michael D. Erdman |
| collection | DOAJ |
| description | Background: In the clinical setting, it is not common practice to consider a vector bite, such as from a tick or flea, to be a contributing factor to chronic digestive symptoms. This article investigates associations we have observed among symptomatic patients and positive blood tests for vector-borne illness (VBI).
Methods: Patients who visited an urban gastroenterology clinic over a 3-year period were retrospectively reviewed. A total of 270 patients presenting with a constellation of digestive symptoms — and who had no apparent digestive pathology and reported no prior diagnosis or treatments for VBI — were analyzed. Before the initial visit, all patients completed a review of systems medical history form, which comprised 19 gastrointestinal (GI) symptoms and 73 non-GI-related symptoms and conditions. Patients were tested for small intestinal bacterial overgrowth (SIBO) by lactulose breath test. VBI (babesiosis, ehrlichiosis, anaplasmosis, bartonellosis, borreliosis) was established using 1 or more of several blood tests. Odds ratio (OR) analysis determined associations between exposure to VBI, SIBO, and presenting symptoms/conditions. Two age groups (≤ 35 years and ≥ 36 years) were studied using Cochran-Mantel-Haenszel stratum-based test.
Results: A higher OR (2.03, 95% CI: 1.5–3.6) was found between patients with ≥ 3 digestive symptoms and positive blood tests for ≥ 1 VBI. Five of the 19 GI symptoms were independently associated with VBI-positive samples: food intolerance, indigestion, nausea/vomiting, constipation, and heartburn. A similar association in patients with ≥ 3 non-GI symptoms (OR: 2.83, 95% CI: 1.3–6.4) was observed. Five of the 73 non-GI symptoms/conditions were independently associated with VBI-positive samples: chest pain, shortness of breath, extremity or joint pain, anxiety, and night sweats. Having ≥3 of any digestive or nondigestive symptoms generated significant relative risk of being VBI-positive. Presence of SIBO alone did not identify significant relative risk for a VBI, and age was not a confounder.
Conclusions: Findings revealed an association between positive blood tests for vector-borne illness and chronically symptomatic patients regardless of whether symptoms were digestive or nondigestive. The manifestation of 3 or more gastrointestinal and/or extraintestinal symptoms should raise suspicion for a VBI. |
| first_indexed | 2024-03-12T10:04:00Z |
| format | Article |
| id | doaj.art-fbb171cd2c874a3699f0ade92e7841cc |
| institution | Directory Open Access Journal |
| issn | 2330-0698 |
| language | English |
| last_indexed | 2024-03-12T10:04:00Z |
| publishDate | 2021-01-01 |
| publisher | Advocate Aurora Health |
| record_format | Article |
| series | Journal of Patient-Centered Research and Reviews |
| spelling | doaj.art-fbb171cd2c874a3699f0ade92e7841cc2023-09-02T11:28:58ZengAdvocate Aurora HealthJournal of Patient-Centered Research and Reviews2330-06982021-01-0181394710.17294/2330-0698.1729Association of Presenting Symptoms With Abnormal Laboratory Values for Vector-Borne Illness — Experience in an Urban Gastroenterology PracticeMichael D. Erdman0Niloofar Kossari1Jessica Ye2Kristen H. Reynolds3Emily Blodget4B. Robert Mozayeni5Farshid Sam Rahbar6Los Angeles Integrative Gastroenterology & Nutrition, Los Angeles, CALos Angeles Integrative Gastroenterology & Nutrition, Los Angeles, CALos Angeles Integrative Gastroenterology & Nutrition, Los Angeles, CAAurora Wiselives Center, Advocate Aurora Health, Wauwatosa, WIKeck School of Medicine of USC, Los Angeles, CATranslational Medicine Group, North Bethesda, MDLos Angeles Integrative Gastroenterology & Nutrition, Los Angeles, CABackground: In the clinical setting, it is not common practice to consider a vector bite, such as from a tick or flea, to be a contributing factor to chronic digestive symptoms. This article investigates associations we have observed among symptomatic patients and positive blood tests for vector-borne illness (VBI). Methods: Patients who visited an urban gastroenterology clinic over a 3-year period were retrospectively reviewed. A total of 270 patients presenting with a constellation of digestive symptoms — and who had no apparent digestive pathology and reported no prior diagnosis or treatments for VBI — were analyzed. Before the initial visit, all patients completed a review of systems medical history form, which comprised 19 gastrointestinal (GI) symptoms and 73 non-GI-related symptoms and conditions. Patients were tested for small intestinal bacterial overgrowth (SIBO) by lactulose breath test. VBI (babesiosis, ehrlichiosis, anaplasmosis, bartonellosis, borreliosis) was established using 1 or more of several blood tests. Odds ratio (OR) analysis determined associations between exposure to VBI, SIBO, and presenting symptoms/conditions. Two age groups (≤ 35 years and ≥ 36 years) were studied using Cochran-Mantel-Haenszel stratum-based test. Results: A higher OR (2.03, 95% CI: 1.5–3.6) was found between patients with ≥ 3 digestive symptoms and positive blood tests for ≥ 1 VBI. Five of the 19 GI symptoms were independently associated with VBI-positive samples: food intolerance, indigestion, nausea/vomiting, constipation, and heartburn. A similar association in patients with ≥ 3 non-GI symptoms (OR: 2.83, 95% CI: 1.3–6.4) was observed. Five of the 73 non-GI symptoms/conditions were independently associated with VBI-positive samples: chest pain, shortness of breath, extremity or joint pain, anxiety, and night sweats. Having ≥3 of any digestive or nondigestive symptoms generated significant relative risk of being VBI-positive. Presence of SIBO alone did not identify significant relative risk for a VBI, and age was not a confounder. Conclusions: Findings revealed an association between positive blood tests for vector-borne illness and chronically symptomatic patients regardless of whether symptoms were digestive or nondigestive. The manifestation of 3 or more gastrointestinal and/or extraintestinal symptoms should raise suspicion for a VBI.https://institutionalrepository.aah.org/cgi/viewcontent.cgi?article=1729&context=jpcrrbloatingfunctional bowel disordersmalabsorptionsmall intestinal bacterial overgrowthsibogastrointestinal symptomsdigestive symptomsvector-borne illnesstick-bornelyme disease |
| spellingShingle | Michael D. Erdman Niloofar Kossari Jessica Ye Kristen H. Reynolds Emily Blodget B. Robert Mozayeni Farshid Sam Rahbar Association of Presenting Symptoms With Abnormal Laboratory Values for Vector-Borne Illness — Experience in an Urban Gastroenterology Practice Journal of Patient-Centered Research and Reviews bloating functional bowel disorders malabsorption small intestinal bacterial overgrowth sibo gastrointestinal symptoms digestive symptoms vector-borne illness tick-borne lyme disease |
| title | Association of Presenting Symptoms With Abnormal Laboratory Values for Vector-Borne Illness — Experience in an Urban Gastroenterology Practice |
| title_full | Association of Presenting Symptoms With Abnormal Laboratory Values for Vector-Borne Illness — Experience in an Urban Gastroenterology Practice |
| title_fullStr | Association of Presenting Symptoms With Abnormal Laboratory Values for Vector-Borne Illness — Experience in an Urban Gastroenterology Practice |
| title_full_unstemmed | Association of Presenting Symptoms With Abnormal Laboratory Values for Vector-Borne Illness — Experience in an Urban Gastroenterology Practice |
| title_short | Association of Presenting Symptoms With Abnormal Laboratory Values for Vector-Borne Illness — Experience in an Urban Gastroenterology Practice |
| title_sort | association of presenting symptoms with abnormal laboratory values for vector borne illness experience in an urban gastroenterology practice |
| topic | bloating functional bowel disorders malabsorption small intestinal bacterial overgrowth sibo gastrointestinal symptoms digestive symptoms vector-borne illness tick-borne lyme disease |
| url | https://institutionalrepository.aah.org/cgi/viewcontent.cgi?article=1729&context=jpcrr |
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