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.