A 30 year old female was first seen about 15 months ago. She believed she had been exposed to Lyme disease on a Maryland farm. She had a year of progressive symptoms before our first visit. She developed: joint pain, muscle pain, memory loss, numbness and tingling and sweats. She had been a patient at Kaiser and had previously tested negative for Lyme twice. Labcorp found 41 bands in the IgM and IgG positions. She was treated with: Amoxicillin, Biaxin and Plaquenil. After three months low dose Flagyl was added. An IgeneX test showed the dramatic IgM response with 11/14 bands positive after three months of treatment. Over time, her antibiotics were modified. Amoxicillin and Biaxin were changed to Ceftin and Doxycyline. She had a quick positive response to treatment, but her symptoms waxed an waned over a period of months despite continuous antibiotic therapy. After one year she reported about a 70% overall improvement. At that point Zithromax and Rifampin were used in place of the Doxyclyine. The Ceftin was continued. She showed some incremental improvement. About three months ago it was decided to target the Babesia syndrome. She was placed on Malarone and a low dose of Clindamycin.
Things quickly turned around. At our last visit, one week ago she was almost 100% improved. This is a very grateful patient who feel she might have become disabled without the help I provided for her.
Points: I think the Rifampin was of some help. I don't know why. The current model would suggest it was more active against a Bartonella organism. I would not make this claim.
The Malarone and Clindamyin was effective. The current model would suggest this treatment was active against a persistent form of Babesia. This is theory. There is no laboratory evidence to confirm this. It has been pointed out that Malaron and Mepron may also have activity against cystic forms of Lyme. There are other potential explanations for the efficacy of this therapy. Of course, she may indeed have had chronic Babesiosis. I have found, in my practice, that Malarone works just as well as Mepron. It is more palatable and much more cost effective. I do not push the dose beyond two tablets per day. I have found that the timing of its application is the critical factor. It is more effective after a prolonged course of more typical Lyme therapy. The addition of Artemesin may have some additional benefits, but I not yet convinced of this.
I believe the presence of a WB 31 band is good evidence that the disease was longstanding. It does not matter if it presents as an IgM or IgG band.