Association of Presenting Symptoms With Abnormal Laboratory Values for Vector-Borne Illness — Experience in an Urban Gastroenterology Practice

Authors

Michael D. Erdman, Los Angeles Integrative Gastroenterology & NutritionFollow
Niloofar Kossari, Los Angeles Integrative Gastroenterology & NutritionFollow
Jessica Ye, Los Angeles Integrative Gastroenterology & NutritionFollow
Kristen H. Reynolds, Aurora Wiselives Center, Advocate Aurora HealthFollow
Emily Blodget, Keck School of Medicine of USCFollow
B. Robert Mozayeni, Translational Medicine GroupFollow
Farshid Sam Rahbar, Los Angeles Integrative Gastroenterology & NutritionFollow

Publication Date

1-19-2021

Keywords

bloating, functional bowel disorders, malabsorption, small intestinal bacterial overgrowth, SIBO, gastrointestinal symptoms, digestive symptoms, vector-borne illness, tick-borne, Lyme disease

Abstract

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.

Recommended Citation

Erdman MD, Kossari N, Ye J, Reynolds KH, Blodget E, Mozayeni BR, Rahbar FS. Association of presenting symptoms with abnormal laboratory values for vector-borne illness — experience in an urban gastroenterology practice. J Patient Cent Res Rev. 2021;8:39-47. doi: 10.17294/2330-0698.1729