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PURPOSE: 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.
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OBJECTIVE: This paper will explore ultimate frisbee injuries. METHOD: This study uses an anonymous, retrospective, self-reported survey of 135 adult athletes at a Midwestern ultimate frisbee tournament. Subjects were queried regarding injuries to specific body parts, those causing missed activity, recurring injuries, medical care sought, basic demographic data, duration of participation, handedness, and eye color. Categorical data were analyzed by chi-square tests. Qualitative responses were categorized by themes. RESULTS: Respondents had a mean age of 28 years and 59% were male. Mean playing time was 8.2 hours per week and 7.5 total years. Ultimate frisbee injuries included muscle strains (76% of subjects), ankle (65%), knee (53%), shoulder (37%), head (30%), and rib (21%) injuries. Blisters/calluses and black toenails were frequently mentioned. Recurrent injuries were reported in 49%. Shoulder injuries were more common in men than women (47% versus 24%, P<0.02). Of respondents, 88% have missed ultimate frisbee activity due to injury, and 71% have sought medical care for ultimate frisbee injuries. CONCLUSIONS: The majority of surveyed ultimate frisbee players experience injuries and seek medical care. Health care professionals should be aware of the injuries associated with ultimate frisbee and further studies should focus on prevention and education strategies.