Tuesday, January 13, 2009

Night sweats: Not always Babesia (or Bartonella)

A 22 year old woman likes to camp in the wooded mountains of Pennsylvania and New York. She has had numerous tick bites. Several months ago she consulted with her primary care physician when she complained of fevers, headaches, chills, sweats and strange electrical sensations in her legs. She was diagnosed with a virus- no treatment. Some months later she was treated for a sinus infection with Augmentin. She noted that fatigue improved for a few days. Looking back, perhaps she had not been 100% well for several for a few years. She had experienced migratory joint pains, headache, stiff neck, cycles of chills and sweats, speech problems- speaking gibberish at times, palpitations, mood swings and a plethora of other cognitive problems.

A SPECT scan was normal. Labcorp: Lyme WB IgG 41 band- Ehrlichia chaffeensis IgG 1:512 (normal less than 1:64)- folic acid 11- vitamin D 29/55- reversed ratio.

Clongen: Lyme WB- IgG positive- 60,41 and 23; IgM positive 39

Fairfax Medical Laboratory: Lyme ELISA index 0.86- equivocal range. No WB was performed.

Treatment: Amoxil for 3 weeks, awaiting lab results. No significant change. Doxycyline 400mg per day started- Herx. At 6 weeks she was mostly better. Night sweats were gone. Tindamax was added. At 10 weeks- today, she is 80% better. Fatigue, sweats, joint pains, multiple cognitive and speech problems, palpitations and neck pain are all gone. The only remaining symptom- strange intermittent electrical shocks to the upper extremities- some subtle cognitive issues do persist after careful questioning.

What caused the night sweats and why are they better? Take your pick: Lyme, Babesia or Ehrlychia? I would bet on Ehrlichia. Bacteria which reside in white blood cells are difficult to eradicate. Ehrlichia has been described as a mild Rocky Mountain Spotted fever like disease.

Doxycycline is the best drug. If needed, Rifampin, the second tier drug can be added.
There are no clear(credible) guidelines on how long to treat this infection. I have seen it persist for many months. Eight weeks is not adequate for many patients. Her dramatic response is gratifying. I think it is important not to drop the ball and to continue Doxycyline for several months- it works on Lyme too.

8 comments:

bitten said...

This is the first time I have heard Augmentin mentioned. I know she was being treated for a sinus infection but do you find this drug to be used in Lyme/co-infection treatment successfully and last, how good are the tests for Ehrlichia? I know she is a grateful lady.

Hoosiers51 said...

Isn't Doxycycline used prophylactically against malaria? So couldn't Doxycycline theoretically have some sort of action against babesia?

We just don't know, right?

I agree that night sweats might not always be babesia.....could be something not related directly to an infectious disease, even in those with lyme and co's.

Or, maybe the babesia just sort of went into remission spontaneously due to treating Lyme; who knows.

PatJ. said...

QUESTION:
I have read it on your posts but cannot find it, which is your "preferred" treatment for palpitations, -or chest pain - when they are associated with Lyme symptoms? Gentamicin?

Thanks, God bless!

filmfanatic said...

Dr - This could also be Mycoplasma Pneumoniae which as you know is a common co-infection.

I had night sweats in the beginning of my illness and they went away with 24 months of Doxy/Mino and pulsed low dose Zithromax. I fact I was housebound and am now in the gym 5 days a week!

Love your blog and think it is very helpful to others.

Brooke said...

I was bitten by a tick a 3 months ago, had strange symptoms, took a 3 week course of Doxy, have now been off the Doxy for a week and have small red dots re-occuring. The thing that caught my attention in this post is the electrical firing. I had one night of intense muscle twitches before I took the Doxy, and since then have had low-level muscle twitches/electrical firing in my legs. I live in New Zealand, and it is unlikely that the specialist that I saw here will prescribe any more antibiotics, as all the blood tests came back negative. I am trying to move back to Texas as soon as possible to see a doctor that understands Lyme. I am worried that other, more serious symptoms will appear without the correct treatment.

Momcat1011 said...

I developed small red dots and also twitching after a tick bite-- I had a positive WB 5 months after the bite. I would seek additional care.

Prana said...

I've read it written that a telltale sign of a Babesia flare is a red colored face. This is exactly what happens to me and I was shocked/relieved when someone explained it. I can't remember the reasons why it causes a red face but would imagine something to do with RBCs. Anyone know?

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