Thursday, November 14, 2013

Babesia cerebritis

Psychiatric problems which accompany neuroborreliosis have largely been attributed to Borrelia and Bartonella like organisms within the central nervous system. This synergy has been linked to an array of psychiatric syndromes and symptoms. Many of these patients have irritability, mood swings, depression, mania, personality changes and even episodes of rage. "Lyme rage" seems to be closely linked to the affiliation of these two brain invading pathogens.

But I think the problem of cerebral babesiosis may present even greater challenges. I am thinking about a patient I have just started treating as well as several others in my practice. Some patients have incredibly severe psychiatric Herxheimer reactions whenever treatment for Babesia is instituted. Even minute amounts of antimalarial therapies are not tolerated. Several of my patients share certain characteristics. Their moods are particularly labile. They frequently cry at the drop of a hat or for no reason at all. They experience racing thoughts associated with severe anxiety which are frightening and difficult to control. They also may quickly develop suicidal thoughts. These reactions are intense and come on very quickly. And they leave just as quickly when anti-malarial therapy is withdrawn. These reactions may occur with even drops of Mepron or artemesinin. In treatment we (the patient and me) find ourselves repeatedly treating and backing off and never getting to therapeutic levels whichever drug we are attempting to use.

A current patient comes to mind. He has suffered with Lyme for more than 15 years.  His chief complaint relates to a muscle problem. When I looked at his blood smear I saw great examples of Babesia. And to firm up the diagnosis the WA1 titer was positive at 1:512. It was only after I gave him these results that he told me various doctors had been trying to treat Babesia for years but he could never get through therapy because it always made him crazy.

One of my observations is that it is easier to treat these patients when they are on IV Rocephin. I presume this is due to a neuroprotective effect.

Other strategies are needed for the treatment of these vexing patients.

3 comments:

Paula said...

Would an SSRI help to stabilize the patient's moods while in treatment for babesia? I had anxiety brought on by Lyme, and an SSRI helped that immensely.

jfheller said...

SSRI's sent me right over the edge, but benzos were hugely helpful in managing neuro herxes.

Careerist said...

In my 20 year illness, which had two serious periods lasting about 4 years each, I have had meningitis, severe memory loss, suicidal thoughts, severe neuropathic pain -- really the whole nine yards. Somehow I also have had a career which is astonishing to a lot of people.

Anyway, to my point -- in the course of my severe relapse the last 3 years, cognitively, I have been able to discern that my lyme symptoms are more judgement/memory oriented, my bart symptoms are more emotional (anger/thoughts of death and suicide) and my babesia symptoms are mostly about mental endurance, organization and communication.

All of these symptoms have improved with targeted treatment, however my babesia symptoms persist and have even escalated again. Something to note -- like your post, my most extreme herxes have been with babesia treatment.

My primary babesia symptoms at the moment are emotional liability and severe lack of concentration. I have tried adhd meds, mood stabilizers, and xanax. I continue to have treatment which includes high dose mepron/zithro and coartem for short periods.

I am posting to say that photosensitivity should not be underestimated in patients like me and the patient you posted about.

In speaking to my llmd about my lack of concentration and my continued obstacles in returning to work just last week, he remarked that I must be super-sensitive to sound and light too. While I noticed the sound sensitivity, I started to think about my reaction to light.

All this to say, I decided to try wearing sunglasses at work. Needless to say, it is a MIRACLE. While I was struggling to finish everything since my return to the office a few months ago, I have literally increased my productivity my 100% IN ONLY TWO DAYS.

I am not kidding. It appears the photophobia is cumulative for me in a way that is not so obvious. If you are a patient that fits this profile and/or are treating a patient that fits the profile, you should try just that. You might not need to take/prescribe a lot of supportive psych/neuro drugs nearly as much.

Obviously though, even though I have taken a lot of drugs for a long time, I still have babesia issues. It will still require treatment, but at least I won't ruin my career in the process. *sigh*