Lyme and Alzheimer's Disease

Dr. Alan McDonald, a a pathologist and leading Lyme researcher, has studied autopsied brains of Alzheimer victims. He hypothesized that Lyme like late stage syphilis could cause a late stage dementia 40 years after infection. He has cultured Lyme spirochetes from the brain tissue of
Alzheimer victims. He has discovered colonies of spirochetes called biofilms. These biofilms help promote the survival of spirochetes in hostile or adverse conditions. In these colonies the spiral form is replaced by cystic forms, granular dot forms and L-forms. Dr. MacDonald does not believe that all cases of Alheimer's ware caused by Lyme disease. However it may be a significant cause of the disease. His web site: www.molecularalzheimer.org shows images of his work and links to his research. Dr. MacDonald has also done work on the vertical transmission of Lyme disease from mother to infant. He has demonstrated Lyme in autopsies of still born infants. This research has tremendous implication and needs to be introduced into the public arena.

Babesia revisited

Lab testing is unreliable. Antibodies against Babesia strains are considered very significant by most Lyme doctors but dismissed by infectious disease specialists. The IDSA paradigm looks only at acute Babesiosis while the ILADS paradigm considers Babesia infection as part of the Lyme disease complex associated with chronic Lyme disease. Some patients report that they only improved after intensive treatment for Babesia. The best indicator is a pattern of symptoms. Patient with this co-infection have recurrent chills, fevers, malaise or flu like symptoms. Other patients are those with more typical Lyme symptoms who have not responded to Lyme therapy as expected. Treatment normally should not be for more than two to four months. There may be exceptions. In addition to Mepron and Zithromax, many patients and doctors report that the herbal supplement, Artemesia is very effective. Babesia should be considered in the treatment of Lyme patients but I still feel the focus should be Lyme.

Bartonella revisited

I am getting a lot of questions about Bartonella. Many Lyme docs view chronic Lyme as a complex in which Bartonella and Babesia play a crucial role. This is my take on Bartonella. It is primarily an opportunistic infection. This means it causes infection in persons with significant immunosuppression, such as those with HIV, AIDS. Everyone is exposed to Bartonella on a regular basis. It comes from fleas, flies and mosquitoes in addition to ticks. If one's immune system is functioning reasonably well, I don't believe it should be a major player. It is a typical gram negative bacteria. It does not possess all the tricks of Lyme to circumvent the immune system. It may be hard to eradicate because we are constantly re-exposed to it. The conventional wisdom in Lyme therapy is that co-infections should be addressed when patients do not respond to Lyme therapy as expected. My experience has been that many patients are undertreated for Lyme. For example intravenous antibiotics are not used. And these same patients are extensively treated for Bartonella without getting better. Intensive Lyme therapy should probably include intravenous antibiotics before one starts to look seriously at Bartonella as an explanation for poor clinical response. It may make sense at some point to try Lyme drugs which are also known to be active against Bartonella: two for the price of one. For example Cipro covers both germs whereas Levaquin does not cover Lyme well. Rifampin covers Lyme, Bartonella and CPN. It is a useful add on. Bactrim only covers Bartonella so I do not use it.

Lyme and the gallbladder

This an area of Lyme medicine which deserves more attention. Many Lyme patients end up with removal of the gallbladder. Lyme can infect the wall of the gallbladder and cause chronic inflammation. This appears to happen with increased frequency when there is also evidence of Salmonella infection. In the past most gallbladder disease was related to gall stones. There has been a change. Most patients with gallbladder disease no longer have stones; they have chronic inflammation of the gallbladder. Patients with gallbladder disease have recurrent bouts of abdominal pain which starts out mild but gradually builds up to severe pain. The pain may be located in the right upper abdomen or be generalized to the entire abdomen. Nausea and vomiting may occur. In the past doctors have ordered a sonogram to evaluated the gallbladder. When the problem is related to infection this test will be normal. The diagnosis is made with a nuclear medicine scan called a HIDA scan, with the administration of a hormone called CCK. The hormone injection will likely cause the symptoms to recur and the test will showed a low ejection fraction, indicating abnormal functioning of the gallbladder. Generally, successful treatment requires removal of the gallbladder which can be done with a minimally invasive laparoscope. The fact that intravenous Rocephin is known to cause gallbladder attacks may suggest that this is a sort of Herxheimer reaction involving a gallbladder which is already infected with Lyme bacteria.

What are objective markers of chronic Lyme disease?

• Changes in mental status per physician exam
• Neurological abnormalities on careful exam: These include: a deviated uvula and or soft palate, decreased sensation on one side of the face, asymmetry of the face, restricted movement of eyes with extreme lateral gaze, hearing loss, deviation of the tongue with protrusion, Hoffman or Babinsky reflexes, decreased sensation to pinprick of the extremities in a "stocking and glove" pattern, a loss of vibration sense in the feet compared with the hands.
• A low CD57 count
• Some Western Blot bands which are positive or indeterminate on an IgneX test, in specific double asterisk locations
• A Lyme C6 peptide antibody index which exceeds 0.1
• Antibodies for co-infections such as Babesia, Ehrlychia and Bartonella
• Elevated markers of inflammation, including: sed rate, CRP, C3a and C4a
• Mild elevation of markers for auto-immune disease including: rheumatoid factor and ANA
• Low or borderline low vitamin B12 and folic acid
• A reversal of vitamin D levels with low vitamin D OH 25 and high vitamin D 1,25
• An abnormal brain MRI showing non-specific white matter disease
• An abnormal brain SPECT scan show changes in blood flow in the brain

All of my chronic Lyme patients have some combination of the objective markers for the disease as listed above. If one only considers CDC surveillance criteria as objective confirmation, then I believe more than 90% of cases will be missed. The testing is complex, expensive and cumbersome. It is only indicated when there are clear cut symptoms which suggest the diagnosis of chronic Lyme disease.

ILADS and Lyme symptoms

I am concerned about lists of symptoms listed by ILADS and others associated with chronic Lyme disease. My sense is that these lists are misleading. Lyme doctors are already practicing outside the box of mainstream medicine. I fear that all inclusive lists of possible symptoms diminish the credibility of practitioners of this new paradigm. It provides an opening for critics who will say: those doctors think everyone has Lyme disease. If we look at the symptom list, it includes a huge percentage of patients who are treated in a primary care office, most of whom do not have Lyme disease. The Lyme symptoms listed with the ILADS guidelines include: fatigue, low grade fevers, night sweats, sore throat, swollen glands, stiff neck, migrating joint pains, stiffness, arthritis, muscle pain, chest pain and palpitations, abdominal pain, nausea, diarrhea, sleep disturbance, poor concentration and memory loss, irritability and mood swings, depression, back pain, blurred vision and eye pain, jaw pain, testicular and pelvic pain, tinnitus (ringing in the ears), vertigo, cranial nerve disturbance, headache, hotheadedness and dizziness. There are many causes for most of these symptoms. When doctors evaluate a patient they first ask for a chief complaint. If a patient has a sore throat and swollen glands one first thinks about viral pharyngitis or Strep infection. Doctors in training frequently hear the expression: When you hear hoof beats in Central Park (New York) you think of horses not zebras. When a physician suggest an unusual diagnosis based upon a common complaint he is said to be looking for zebras. I do not deny that these symptoms and many others may be seen in chronic Lyme patients, but such a list is misleading. Chronic Lyme is a multi-system disorder that presents in a predictable way with a clear cut pattern. Of course there are exceptions to every rule, but zebras should only be considered when other diagnoses have been excluded. As has been said regard to science: When all the likely explanations have been excluded that that which remains, no matter how unlikely must be the explanation. Chronic Lyme patients have: fatigue, cognitive changes, numbness and tingling and muscle, joint, tendon or ligament pain. This constellation of symptoms is reliable in my experience. Patients with a chief complaint of a primary Lyme syptom such as joint pain or numbness and tingling should have Lyme diseased moved up on the list of possible diagnoses.Many other symptoms may exist, but they should be in addition to the basic symptom complex. If the only complaint is depression or back pain for example, both listed by ILADS as Lyme symptoms, Lyme disease should not be considered except as a zebra.
ILADS states that these symptoms may present without objective markers. Based on my experience this is not true. I believe that an expanded list of objective markers shows some abnormalities virtually in 100% of cases. In fact, a complete absence of objective markers would lead me to doubt the diagnosis of Lyme disease.

I have Lyme: should my kids be tested?

Only people who are symptomatic or sick should be tested. It can be challenging to decide if your child has symptoms. The symptoms of Lyme disease vary so much. There may be a tendency to over analyze things that are normal or ignore things that are abnormal. Whereas some parents are dismissive of symptoms, others may be overly paranoid. A child may have ADD. If it runs in the family then no further evaluation is required. If it atypical: it comes on later in childhood and seems to be progressive and there is no family history, then Lyme should be in the differential list of possibilities. Psychiatric and neurological symptoms do occur more frequently in children with Lyme disease. I have seen learning disabilities, tics, mood swings. anxiety, depression, OCD behavior and other neurological symptoms improve when Lyme is treated. Kids should not complain of joint pain and excessive fatigue. There is probably no such thing as "growing pains."
This would affect bones and muscles, not joints, if it were to occur. Children without symptoms should never be tested. Remember two things: testing is very difficult, controversial, and unreliable, and when patients are treated for Lyme disease, the treatment is continued until symptoms resolve. Someone who is without symptoms should not be treated no matter what the tests show. There is no way to prevent the appearance of future symptoms by treating a positive test. So testing people without symptoms is without benefit and could be potentially harmful if children are treated when it is not appropriate.