Monday, October 5, 2009

Case of Lyme pneumonitis with suspected resistant strain

See recent post about Lyme resistance to antibiotics.

This case is now much more interesting.

This is the patient as you may recall had neuroborrelios which improved when the patient was given Zosyn for pneumonial

The patient received only a short course of Zosyn in the hospital. She was discharged with oral Levaquin. She went on to develop shortness off breath. Follow up radiographic studies showed a pattern of lung nodules and diffuse interstitial disease. Various diagnoses were entertained, including: sarcoidosis, lung cancer and other better known opportunistic infection.

A brochoscopy was performed to obtain a tissue specimen. The biopsy was negative for the usual suspects with non-specific findings. Slides from the specimen were sent to Clongen Labs. A highly sensitive real time PCR test was positive for Borrelia burdorferi--the agent that causes Lyme disease.

I spoke with the pulmonologist today. He is not familiar with any medical literature supporting cases of disseminated Lyme disease in lung tissue. Lyme may have been a factor in her original pneumonia, but this is not my current hypothesis. Her initial pneumonia was due to aspiration. Perhaps the inflamed/damaged post-pneumonia lung tissue created an environment for the dissemination of Lyme bacteria into the lungs.

I offer the hypothesis that this patient has a resistant form of Lyme. This is why courses of Rocephin and Zithromax have failed. I have restarted Zosyn since it is the drug which has proved effective in the past.

There exists some research data which supports the notion that Lyme can become resistant to antibiotics. One would certainly expect this. Bb has an incredibly complex genomic structure.
It has more plasmids than any other know bacteria. Extra-nuclear DNA in plasmids can recombine with native DNA to create resistant strains of bacteria.

This is an exciting case; I hope to keep you posted.

5 comments:

filmfanatic said...

Very interesting. I look forward to reading more about her case. I am curious if she may have some resistant form of Mycoplasma which would produce the lung symptoms you describe.

Perhaps what Clongen is seeing is also a new pathogenic form of Mycoplasma (BLO)?

glytzhkof said...

Thanks for sharing this information with the blogosphere. It sounds like you are onto a pivotal case - fingers crossed for you and the patient.

dogdoc said...

Something in this polymicrobial mess seems to be multi-drug resistant. Certainly the beta-lactam sensitive organism seems to display this pattern, which would make sense to be the borrelia component.

A breakdown of a specific type of cellular immunity induced by primary infection and allowing the reactivation/ persistance of secondary infections sure would make sense based on what we are seeing persist and be resistant to therapy (ie rickettsial like bacteria, small toxo like protozoa, borrelias, bartonellas, babesias). Perhaps some of the "drug" resistance is based on the fact we have no immune clean-up for things we have no cidal drugs for.

On the bacteria in the WBC's- which type of WBC's do they seem to have a preference for? How about titers for Coxiella burnetti- that's a good common organism to potentially reactivate.

Max said...

BB ABX resistance is a dreary prospect since it requires long term treatment with combo abx and is persistent. What if you have strain which build up resistance to every abx group? Resistant TB is a menace which no one has solution for.

This is very sad news for patients with chronic BB

LL said...

Should Lyme patients receive the H1N1 vaccine?