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.