Sunday, November 2, 2008

Activation of Lyme (and tick borne disease)

A large percent of Lyme and tick borne infected persons are asymptomatic. What percent? That's the 64 thousand dollar question. No one knows. I have seen many patients whose underlying Lyme disease has been suddenly activated; it has frequently been associated with an unrelated infectious disease. I would like to briefly discus three such cases.

An otherwise well woman is given Cipro for a urinary tract infection. Her right knee "blows up" (becomes very swollen with effusion) and becomes very painful. It turns out that the acute arthritis of her knee is due to Lyme disease. Here is my theory: Cipro and related drugs are associated with joint and tendon injury. Perhaps this occurs in patients with underlying, asymptomatic Lyme infection. the person may have Borellia, Lyme bacteria, colonizing the lining of the joint or the tendon sheath involved. The rapid killing of the organisms causes a marked inflammatory response. On could view this as a localized Herxheimer reaction. In this case Lyme arthritis developed only after Cipro was given for an unrelated urinary tract infection.

A teenage girl is diagnosed with acute mono(mononucleosis). She has a fever, sore throat, swollen glands and fatigue. Her exam shows a red throat with exudate(white coating of tonsils) and swollen glands in a typical mono pattern. Her laboratory tests showed a positive mono spot test and atypical lymphocytes on the CBC. The diagnosis of mono was very straightforward. This young woman who had enjoyed good health did not improve in the expected time frame. She developed persistent fatigue, progressive joint and muscle pain, numbness and tingling and brain fog. Further lab testing showed that she had chronic Lyme infection. The patient improved when Lyme disease was treated. Comment: the opposite situation is frequently seen. Patients with Lyme are observed to have high antibody titers of EBV and CMV, viruses associated with mono. Perhaps Lyme related immune suppression allows these chronic viruses to activate and contribute to the overall syndrome.

The last case involves a patient I saw last week. This is the most intriguing case. A 47 year old man is in good health. He has an elevated PSA (prostate specific antibody) test found during a routine physical. A urologist performs a biopsy. After this the patient develops an acute febrile illness. He is admitted to the local hospital for sepsis (blood infection) with E. coli, a colon germ associated with urinary tract infections. By chance, he is treated with IV Rocephin. Instead of improving he gets worse. He develops persistent relapsing fevers, headaches, joint pains, muscle pains, neck pain, brain fog and episodes of confusion. He is referred to me because of the unexplained headaches. His blood smear shows numerous spirochetes in the blood stream. His PCR tests are positive for both Lyme and Babesia. In this case, pre-existent, asymptomatic tick borne disease, is activated and becomes both acute and severe in the presence of Rocephin prescribed for an unrelated E.coli infection. Perhaps the old proverb "let sleeping dogs lie" is relevant here. This patient was unaware of tick borne illness and then became very symptomatic when a roaring Herx was unleashed by antibiotics given for an unrelated infection. This is a current, active case.

15 comments:

Frances said...

I rather think I have seen all these types of things happen to people I know here in the UK. Doctors here are not very Lyme literate and will usually not think of testing a person for Lyme, still less will they think of making a clinical diagnosis, or even a provisional clinical diagnosis. This type of thing is liable to be diagnosed as 'antibiotic allergy' 'arthritis' and 'pyrexia of unknown origin' and little of real relevance will be done to help the patient. The patient will have to sink or swim without appropriate help. It is my impression that fairly often, if the antibiotics are stopped, the patient may well return to their previous state of having the latent illness, not being quite well, but preferring to carry on like that than take antibiotics again. (Well, why would they without the slightest bit of medical help). It is my impression that I have even seen this occur when people like this are precipitated by antibiotic treatment into a fulminant manifestation of mental symptoms, acute confusion, acute and sudden depression/anxiety etc. and yet, if they stop the antibiotics, they return to a reasonably normal mental state. (I'm not saying that they always return to their previous functioning). How many people have this latent level of Lyme. Just the guess of a fellow (recovered) patient - in my humble opinion there are legions of people like this. Its a dilemma whether to try and tell them or not. Frances in the UK.

Frances said...

I rather think I know people who have had similar events in their medical history. Here, in the UK, Lyme is rarely tested for on a routine basis. Anyone to whom this kind of thing happens would usually have to specifically ask to be tested for Lyme. Sadly, folk know little of Lyme and just accept it when the doctor diagnoses 'antibiotic allergy' 'arthritis' 'pyrexia of unknown origin' and the patient has to sink or swim without appropriate help. My impression is that steroids are quite often given. Another thing that can happen is that the patient stops antibiotics and the symptoms subside, eventually they (fairly often) return to their previous state of health in which underlying Lyme lies low again. I do believe I've even seen this happen when the person has been precipitated into a fulminant manifestation of mental confusion and sudden severe depression or anxiety. Stop the antibiotic and they lose these mental symptoms. These are the observations of a mere patient in the UK. How many have latent Lyme or Lyme-like spirochaetosis? My guess is legions... SW, UK patient.

dogdoc said...

We see this phenomenon in dogs- large % of seropositive assymptomatic patients. Will present acutely years later.
Are we seeing Lyme as a disease usually handled by the immune system and kept at bay but not completely cleared? Many viral, bacterial, protozoal infections are this way. If fact, many of them have been associated with Lyme and CFS patients. Perhaps we have an underlying trigger to clinical disease we do not recognize in some- ie the virus that upsets the immune apple cart and all of a sudden we see reactivation of all sorts of organisms usually kept in check- Lyme, babesia, mycoplasma, chlamydia, HHV-6, CMV,ect. In some, we recognize and know the trigger like the mono case. In some we don't ?

Leslie said...
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Leslie said...
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Lyme report: Montgomery County, MD said...

I cannot diagnose this way, but Lyme is a likely explanation.

Many people start with shoulder impingement syndromes.

I not a big fan of Cat's Claw, but lots of folks claim to Herx with it.

You need 1) A Western Blot at IgeneX or Clonagen 2) Screening for co-infections 3) a LLMD.

Lyme report: Montgomery County, MD said...

Unfortunately Lyme has jumped the pond and spread throughout much of Europe, including the UK.

The strains of Borrelia are slightly different as are the vectors. You need to work with world class molecular biology labs like Clongen who can modify testing based on the strains in your locale.

Good luck

Leslie said...

Thank you for feedback, doc. I'm sorry to have made you feel put on the spot. Right now my life is pretty consumed with taking care of my cub, but when I eventually address my own symptoms, I'll report back.
Thanks, again!

karindelin said...

Interesting site, http://info.lymebook.com/matthewgoss.html, Excerpt: "So how do you know if you have Lyme Disease? Or Babesia? Or Bartonella? Or Ehrlichia?

"Those questions aren't as easy to answer as you might think. The tests for these diseases are not very accurate, so even a negative test does not rule out the possibility that you have them. For instance, there are at least 12 strains of Babesia, and tests are only available for two of them, so a negative test for Babesia really means nothing....."

Shawn said...

This is something I have been thinking about recently. The stories of those on antibiotics for a year or more and the awful herx's they go through. From my experience and of others there is usually a trigger whether it's psychological stress or physical illness or both.

It patients could be brought back to their asymptomatic state and knew how to maintain that that could preceed antibiotic treatment and perhaps give the patients immune system a chance to recharge. It would definitely allow a psychological recharge that could be very health promoting in itself.

I am in year 5 of my 2nd experience with CFS which I believe has been Lyme. I've had two tick bites when I was a child and 4.5 years ago.

My first experince with CFS I was very healthy and worked out with weights regularly. I kept this up at a pretty advance pace, took Bupropion and some supplements and Protein Powder (Soy and Milk/Egg) and Melatonin. I do remember testing with some Astragalus back then. After a little more than a year I had no symptoms.

I wish I had taken better notes. I suspect the protein may have helped maintain glutathione levels which eventually won out.

Currently I have tried over 100 supplements and am having some positive results with regular Cat's Claw. My morning temperature sensitivity has been aleviated. My general symptom level is down and I'm sleeping better and my head is much more clear. I am using charcoal and apple pectin to deal with the toxic load that circulates in the bile.

During herx if you can time the charcoal with a fatty snack it will catch the toxic bile and remove it. It has done wonders. I've found the charcoal can remove B3 and perhaps B2 and read studies that it removes T4 thyroid.

Supplementing with N-A-Tyrosine, Niacinimide and Riboflavin helped me a lot when I first started charcoal and was very sensitive to this.

If anyone knows of an LLMD near Birmingham, AL please respond. There is a clinic in Atlanta but there has got to be an LLMD here somewhere in this city.

atomicdoc said...

The last case is particuallry interesting. It would be very very useful to figure out what quiesent infection he had. What ever it was it was seems to be able to suppress the tick born diseases.

Did the biopsy come back with anything? If not, I wonder if it was a prostate centric infection?

It is also interesting to determine if the lyme activation most often occurs after treatment for the unrelated condition or after the unrelated disease cleared its self.


I have some comments on the first case but don't have time to comment on this right now. A couple of initial comments for thought though.

Its interesting - the effect that you have seen is a PERFECT description of reiter's syndrome. I will bet that no one else ever checks for lyme titers when reiter`s appears... On the activation, the cipro may have upset the balance that existed in a film colony in the joint, allowing bb to proliferate on its own...

Lyme report: Montgomery County, MD said...

Biopsy negatitve except inflammation. No bacteriologic studies done.

An Educated Patient said...

hi doctor
i am very intrigued by your comment of people often start with a shoulder impingement syndrome.
would that be supraspinatus or thoracic-scapular?

that is what happened to me once i had the bite to rash to meningitis symptoms...was told i didn't have lyme (my fault for listening to the doctor). a month later, i had a tweak in supraspinatus tendon, quick to impinge, then it worked its way around to the scapula. i am in pt for it now with a very good pt that focuses on the neurology of the rotator cuff and shoulder girdle as opposed to strengthening with therabands (a turnstyle operation's approach to pt).
anyhow, i am baffled by your observation because i have always had strong shoulders until the lyme.

on a side note- relating to your other posts on the emergence of the infection...i have a story that is regarding lyme coming out with other things happening, such as abx for something unrelated, physical injury, cortisone shots, surgery, etc...
i have a blog but never really kept up with it due to lack of comments. maybe i will get back to it!

thanks for the great blog. if only all llmd's would do this!

Endemic said...

I believe my lyme reactivated after a bout of mono 2 years ago. I'm 38. I can't seem to get well again though. I may have babesia as well. Is 2 months of malarone 1 pill per day sufficient to exorcise babesia?

bpeck said...

I had late stage untreated lyme for about 25 years before it was found and treated by my Opthalmologist. Most of my symptoms were neurological and I tested positive for Lyme by MDL labs in NJ by PCR. I had a terrible time with oral 300mg/day Doxy as my initial antibiotic. After an initial herx fromm the first dose - I had every side effect Doxy had to offer, progressing from vivid dreams, to night terrors to hallucinations, photophobia, and numerous flash back Lyme symptoms. Lucky for me, at the end of therapy, I was an excellent reponder to abx and Lyme was sent into remission for almost 6 years.. at present I have had a Lyme relapse (symptoms returning, including a popliteal cyst - classic Lyme knee - of 6 months duration). I haven't been Lyme tested again, but a regular CBC was flagged for 10% atypical Lymphocytes (liver panel OK)and together with neuro symptoms returning my Doc. put me on DOxy again.
Interestingly, I am handling the Doxy alot better this time than in 2002. Almost no side effects (a little nausea). Although early on I had a dream/hallucination - but it was fleeting.
So- my observation is that it is VERY possible that some abx side effects in Lyme patients is due to the the drug killing the bacteria in localized areas. And It's always smart (in my opinion) to withhold the drug for a few days if that occurs so the body can remove the toxins.
I think it's related to the bacterial load.
The smaller the population, the less the side effects.
bpeck