Thursday, December 1, 2011

Chasing the sweats

Let me clarify this confusing post: It is based on a true clinical scenario. I was drawn into a hole chasing Babesia; the symptoms were classic, especially the profound night sweats. The "Babesia" stubbornly wouldn't go away, with everything thrown its way: Mepron, malarone, Artemesia, Coartem and Larium.

I was willing to treat Babesia as a clinical diagnosis with aggressive, long term therapy; positive lab confirmation is rare. I convinced myself that resolution was just around the corner.

I was reluctant to treat Lyme with intravenous therapy(I had been treating Lyme with oral antibiotics) If the clinical picture had been more "Lyme flavored," I may have pulled the trigger for IV therapy more quickly.

The patient had clear symptoms of neuroborreliosis including hallucinations at one point. Still, the clinician could rationalize the marked neuropsychiatric manifestations were the product of cerebral babesiosis.

Over a period of several months the patient requested (stridently) that she needed a PICC and IV therapy.

The diagnosis of tick borne disease is still made clinically. Still, in borderline situations the clinician sometimes turns to laboratory results, as I did here, to help justify the more dangerous step up in therapy.

The patient's mantra for some time was: I need a PICC.

I acquiesced after 9 months of oral therapies.

Incredible improvements with resoltion of both cognitive and physical symptoms were seen within the first month. The so-called classic Babesia symptoms also melted away.

This raises many interesting clinical questions.

I am not offering any clinical advise here. Please do not misinterpret. Every case is different.

In this case, the patient had insights about her care which turned out to be true.

10 comments:

Britt said...

Hi. I live in Loudoun County, Virginia and was diagnosed with lyme a few months ago after being misdiagnosed for about a year. I am seeing an infectious disease dr. now and have started my 3rd month of oral antibiotics. I am still struggling with a lot of lingering symptoms even though I have seen improvement and have developed some new symptoms as well with the treatment. Are you currently accepting new patients? brittheilman@gmail.com

I'm thankful I stumbled across your blog and I appreciate you sharing your knowledge. It's nice to hear things explained in some detail :)

glytzhkof said...

Very strange post to read - it sort of doesn't make any sense at all. Very important point you make though that sometimes patients are wrong - listen anyway. Spoken like a true doctor and not an insurance bureaucrat.

Jessica said...

I'm reading this post and really not sure whether I should be going on IV antibiotics. I'm on oral right now. I'm in my first month. I felt amazing for a week, and thought I was clear of this but this week its back. Sigh...how long do you generally go with the orals until you switch to the IV treatment? My doctors suspect co-infection with Bartonella. This might be a while....any advice?

peterpiper said...

Hi Doc,
When you say you finally "acquiesced" to the IV therapy, and then,"Incredible improvements with resoltion of both cognitive and physical symptoms were seen within the first month".

I agree with your whole point about testing, but can anyone be confident at all with "improvements with resolution".

Based on my own experience, as a patient with most all the symptoms of Lyme and Babesia for over 20 years. I have found nearly all symptoms as Relapsing / Relenting. With some relapsing relenting events occurring over days, and at times over years. No matter the amount of time the relenting period, most all have ended up with relapse. I have been on all the med. protocols up to and including IV therapy.

Would you kindly tell me your experiences with people experiencing permanent resolution. And what your guess is of % of people that actually resolve versus that % of patients that never resolve over the long term.

Thank You for the insights you share.

Lyme report: Montgomery County, MD said...

People can and do get better. Unfortunately there are a lot of questions and few answers.

Britt said...

Jessica,

I am not sure what kind of doctor you are seeing, but I know that many insurance companies prefer for doctors to try oral antibiotics before beginning IV therapy. I am on my third month of oral antibiotics. I had some improvement for the first two months with some flare-ups that I believe were Herx reactions. Now, I am experiencing a recurrence of a lot of symptoms that had subsided. I am waiting to go back in to see my infectious disease doctor to see if he thinks IV would be more appropriate at this point. I think you can expect to be on orals for at least a few months before they switch you to IV. That's just based on my own experience and what I've read. Again, your doctor may have a different approach.

cehansen said...

Doc-interesting about the appearance of babesia after some therapy has knocked down Lyme. Now I wonder: could babesia be subclinically causing symptoms in a patient who has not gotten better in five years -- who has attacked bartonella and Lyme aggressively as those symptoms seemed predominant -- with no progress? In other words, could babesia (asymptomatic, none of the classic symptoms you mention) be responsible for this situation?

DGalaxy said...

How does one get in touch with you. I would like to find a LLMD in Maryland.

Loakley said...

Did you see PMID 21112481? China's CDC requires only one band out of the specific bands (although the strain they use on the blot doesn't express the 34 kd band, so they don't include it. They say that they considered requiring two bands, as in Hauser et al, but it reduced sensitivity too much!

sue said...

Can someone tell me what antibiotic with an IV picc is the best one for lyme . Especially with symptoms of night sweats. How can I find this doctor in md?