Monday, May 20, 2019

Posttreatment Lyme disease case


A 52-year-old female was seen in my office several months ago.  She has a history of tick bite and bull’s-eye rash treated with recommend "standard" doxycycline for 3 weeks and she felt well -- until she didn't.  Symptoms appeared gradually.  Eighteen months later18 months later she complained of: incapacitating fatigue, poor sleep, diffuse pain, weakness, numbness and tingling, headaches, cognitive impairments–trouble remembering words, impaired focus and attention and memory loss, to the point of disability. She was hanging onto her job by a thread.

She also experienced severe night sweats but had chalked it up to menopause. The  sweats however,  were new and drenching, occurred several days weekly and  were qualitatively different from previous night sweats -- primarily hot flashes. 

With further question she stated she had been experiencing gasping mid-sentence and thought  she had developed a tic. 

Lab testing was positive for Lyme (CDC, IgM and IgG) and Anaplasma.

Lyme was initially treated with a triple regimen, doxycycline, rifampin and Tindamax. Also covers Anaplasma. 

Within 4 months she reported getting her life back and regaining a high level of function. Babesia symptoms, well described above (night sweats, air hinger) persisted.

The treatment was changed.  Rifampin was discontinued.  Doxycycline, Zithromax and Mepron were prescribed. 

Notes:  Typical  posttreatment Lyme disease, relatively early presentation (in my practice). The role of coinfection has been ignored in clinical studies.  Lyme as sole infection, absent coinfection is rare. Coinfections may be difficult to diagnose because of poor diagnostic testing.
Human trials have used only doxycycline and Rocephin. In mice, triple IV therapy: daptomycin, doxycycline and Rocephin (ceftriaxone) was shown to eradicate Lyme spirochetes.  

Medical literature suggests that about 20% of early patients treated by CDC standards will have chronic symptoms.
Many reasons have been suggested, Including:

Tick inoculates human host with antibiotic resistant biofilms.
Coinfections.
Strain specific virulence factors.
Host specific immune responses. 
Host already infected but asymptomatic.

Standard therapy ineffective -- high failure rate unacceptable, leads to chronic illness and/or serious sequalae.

Clinical approaches may include: 

More aggressive cocktail therapy early
Careful monitoring of patient for persistent symptoms and symptoms suggesting coinfection and early treatment
Not telling patients: don't worry, symptoms will clear.

8 comments:

Erica Mlli said...
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Michelle B said...

Dr. Jaller - I recently came across an article attributing stevia as a possible treatment for Lyme. Here is the link: http://www.newhaven.edu/news/releases/2017/professor-and-her-students-may-have-found-a-cure-for-lyme-disease.php

Thought you might find it interesting.

Dr. Rebecca Knight said...

Dr. Jaller, I watched a podcast by Dr. Burrascano a month or so ago where he talked about getting blood levels of doxy to make sure it's being absorbed adequately. Problem is I can't find what level it needs to be anywhere and I have doubts that the labs designated level of 1-10 could be the right level to shoot for as it seems too broad. Do you know what level we need? Thanks! Great blog!

Lyme report: Montgomery County, MD said...

Many factors effect serum, tissue and central nervous system (brain or CSF) levels. In theory one might predict a desired level based. Probably not clinically useful.

Basic facts: Doxycycline has a long half life. A steady state serum concentration is reached after 4-5 doses. The rapidity of killing bacteria increases as the concentration increases. The dose of 200 mg twice daily is more effective. IV is more effective producing higher tissue concentration. Serum concentration is only part of the story. The pharmacology of the drug changes when combined with other antibiotics in a typical cocktail.

Quest lab (ARUP) offers a serum level. The lab provides a range of what is considered therapeutic. The number is going to be variable based on the susceptibility (MIC) of the bacteria targeted -- data unavailable with Lyme since culture unobtainable. A higher level may be more effective -- or not but risk toxicity.

Clinically the dose ranges from 200 to 400 mg daily either PO or IV. I don't recommend doses higher than 400 mg daily.

Doxycycline should be properly absorbed. It is virtually 100% bioavailable. I base decisions on clinical response. I don't expect doxycycline monotherapy to succeed in eradicating Lyme infection.

Doxycycline is combined with, for example, Ceftin, rifampin and/or Tindamax. When antibiotics are combined lower doses/concentrations are desired. Increased efficacy and lower toxicity.

Never ordered a serum level. I am not sure it would be clinically useful.

Its complicated.

Lizah Purity said...

I want to share my testimony on how i get cure of my HERPES GENITAL with the help of Doctor idahosa, i have being suffering for this disease for a very long time now.i have try several means to get rid of of the (HERPES) disease for the last five years and had constant pain, especially in my knees. During the first year,I had faith in God that i would be healed someday.This disease started circulate all over my body and i have been taking treatment from my doctor, few weeks ago i came on search on the internet if i could get any information concerning the prevention of this disease, on my search i saw a testimony of someone who has been healed from (Hepatitis B and Cancer) by this Man Dr idahosa and she also gave the email address of this man and advise we should contact him for any sickness that he would be of help, so i wrote to Dr idahosa telling him about my (HERPES Virus) he told me not to worry that i was going to be cured!! hmm i never believed it,, well after all the procedures and remedy given to me by this man few weeks later i started experiencing changes all over me as the Doctor assured me that i am cured,after some time i went to my doctor to confirmed if i have be finally healed behold it was TRUE, So friends my advise is if you have such sickness or any other at all you can email Dr idahosa on { dridahosasolutioncenter@gmail.com } sir i am indeed grateful for the help i will forever recommend you to my friends and to share this to every one that have any of this sickness you can call his whatssAp via +2348134261542

Lizah Purity said...

I want to share my testimony on how i get cure of my HERPES GENITAL with the help of Doctor idahosa, i have being suffering for this disease for a very long time now.i have try several means to get rid of of the (HERPES) disease for the last five years and had constant pain, especially in my knees. During the first year,I had faith in God that i would be healed someday.This disease started circulate all over my body and i have been taking treatment from my doctor, few weeks ago i came on search on the internet if i could get any information concerning the prevention of this disease, on my search i saw a testimony of someone who has been healed from (Hepatitis B and Cancer) by this Man Dr idahosa and she also gave the email address of this man and advise we should contact him for any sickness that he would be of help, so i wrote to Dr idahosa telling him about my (HERPES Virus) he told me not to worry that i was going to be cured!! hmm i never believed it,, well after all the procedures and remedy given to me by this man few weeks later i started experiencing changes all over me as the Doctor assured me that i am cured,after some time i went to my doctor to confirmed if i have be finally healed behold it was TRUE, So friends my advise is if you have such sickness or any other at all you can email Dr idahosa on { dridahosasolutioncenter@gmail.com } sir i am indeed grateful for the help i will forever recommend you to my friends and to share this to every one that have any of this sickness you can call his whatssAp via +2348134261542

kate said...

As a sign of gratitude for how my husband was saved from Lymes, i decided to reach out to those still suffering from this.
My husband suffered Lymes and it was really tough and heartbreaking for me because he was my all and the symptoms were terrible, we tried various therapies prescribed by our neurologist but none could cure him. I searched for a cure and i saw a testimony of so many people who was cured from Lymes , and so many other with similar body problem, and they left the contact of this doctor who had the herbal cure to Lymes. I never imagined Lymes has a cure not until i contacted him and he assured me my husband will be fine. I got the herbal medication he recommended and my husband used it and in one months he was fully okay even up till this moment he is so full of life.Lymes has a cure and it is a herbal cure contact the doctor for more info on drwilliams098675@gmail.com on how to get the medication. Thanks for reading my testimony .    

eMDs said...


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