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Wednesday, March 25, 2009

Suspected Bartonella Psychiatric Herx

A 32 year old woman came to see me one month ago. She was diagnosed with LD in 2003.
At that time she presented with EM rash, stiff neck, and flu like symptoms. She tested positive by ELISA and WB criteria. She was treated with 29 days of Doxycyline.
Over the last 6 years she has experienced a progressive illness. At presentation she complained of: joint pains, muscle pains, head and neck pain, memory loss, anxiety, depression, light sensitivity, and sound sensitivity. Additional symptoms included: intermittent facial rash, dizzy spells, loss of balance, profound fatigue, and irritable bowel symptoms. There was also a history of an elevated rheumatoid factor. The neurological exam was normal save sensory loss of sensation of the lower extremities. Initial Labcorp testing, done at this time showed Lyme WB positive IgM 39 and 41 bands. Her rheumatoid factor and other autoimmune parameters were normal.

She was started on therapy with Omnicef, Mincin and Plaquenil.

Four weeks later she was unexpectedly profoundly depressed. She had increased irritability with mood swings and personality changes. All antibiotics were stopped and she began psychotherapy. She deferred the use of psychotropic medications.

One month later she was feeling much better. Not exactly following my instructions, she had stopped the Minocin and Plaquenil and resumed the Omnicef as solo therapy.
Pains and fatigue were essentially gone. Her mood improved. She still had some mood swings, but the major depression was gone. Her prominent complaints were: persistent dizzy spells, night sweats, neck pain and only right hip pain. Other joint pains had vanished. She noted that bowel changes- constipation and diarrhea had abated but she had increased heartburn.

What had happened?

The patient thought the psychiatric exacerbation was due to Plaquenil. I thought not.

Brain Herx: But- she was fine on Omnicef.

Based on her symptoms it seemed likely that she had Babesia. I had not prescribed any medications that would be active against this parasite- so this shouldn't be the issue.

The question then became: Why the Minocin pych herx but no reaction to Omnicef? Omnicef attacks cell wall synthesis of spirochetes, in this case Lyme. It is relatively ineffective against Bartonella and it has no affect on intracellular L-form disease. Bartonella, according to Psych/LLMD literature is frequently associated with pyschiatric disturbances.

My hypothesis then became: Minocin killed Bartonella, perhaps in the brain leading to this peculiar reaction.

With this in mind, I decided to give all drugs with known activity against Bartonella a wide berth for the time being. These drugs do include- Minocin, Doxycyline, Zithromax, Biaxin, Cipro, Levaquin and perhaps a few others including Bactrim.

Given the night sweats and neck pain I decided to approach the suspected Babesia. My inclination was to start with low doses Artemesin while continuing the Omnicef.
The patient told me should could not afford medications that would not be covered by her insurance drug plan-

With a little more trepidation, I decided to test the waters of Babesia and prescribed a low doses of Malarone.

Another option would have been to continue Omnicef alone. My experience tells me to treat Lyme first.

Side bar: The bowel symptoms were worse but there was increased GERD- heartburn symptoms. The most likely explanation is drug induced gastric irritation of the stomach, although this is not common with Omnicef. I am becoming more convinced that Lyme frequently inhabits the GI tract and can cause symptoms there. Perhaps acid blockers which decrease stomach acidity may help kill gastric Lyme; and, regarding a somewhat related issue, it certainly appears that Asacol, a bowel anti-inflammatory, helps colon related symptoms. I prescribed Prevacid- a proton pump inhibitor which decreases stomach acidity. This should improve symptoms and perhaps aid in killing Lyme in her stomach.

Bartonella psychiatric Herx? Perhaps. We shall see.


bobcat said...
This comment has been removed by the author.
Michele said...

I have not heard of Omnicef before. What family is it in and what have you found it useful for? Is it widely used for tick borne illness'?

lyme4achange said...

Omnicef is an oral ceftin.

Ceftins are used with Lyme...sure. I'd LOVE to try but, alas, allergies.

In this case..assuming it was a herx...couldn't it be simply that Mino was crossing the BBB more effectively than Omnicef?

Doxy, mino, and especially tertacycline gave me awful awful GERD (well, it made what is there worse). Protonix helped...its cheaper than prevacid and works just as well.

Lyme report: Montgomery County, MD said...

Other psych symptoms improved with Omnicef. Minocin might have a different cytokine response in the brain so it still might be Lyme.

Omnicef is a bit different from Ceftin. Both are cephalosporins.

Seibertneurolyme said...

I would venture to guess that as many if not more Lyme patients actually have low stomach acid rather than high stomach acid. Hard to make enough stomach acid with a deficiency in B vitamins.

There are even a couple of LLMD's who prescribe very large dose of betaine hydrochloride to patients and have had some success with this treatment.

Hubby has always done better with low doses of betaine hydrochloride. Tried many different prescription antacids to heal gastritis but only felt worse on those.

For any Lyme patients with G.I. issues do a search and read the "Bell's Palsy of the Gut" article to learn more about how tickborne infections can affect the entire gastrointestinal system.

cehansen said...

So was perhaps the patient correct and the Plaquenil caused the psychiatric "herx"? Wouldn't this mean that the psych symptoms were likely caused by babesia and Lyme, as Plaquenil isn't a first line bartonella drug?

cehansen said...

Another thought -- isn't Plaquenil an anti-malarial? Perhaps the Plaquenil was the tipping point in that it was hitting some babesia?

Lyme report: Montgomery County, MD said...

Stomach acid is made by the proton pump of the parietal cells in the stomach. Deficiencies in B vitamins do not decrease stomach acidity. Lower stomach acidity is seen in patients with pernicious anemia. This is an autoimmune disease which produces auto-antibodies directed against parietal cells. This is not the cause of B12 deficiency seen in many Lyme patients.

Anonymous said...

I was wondering if it was possible that these bugs would (normally) be kept under control by the immune system, if it weren't for all the cell phone and wifi towers and antennas? Please read the following excerpts from Dr. Robert O. Becker's books...

Cross Currents by Robert O. Becker M.D. (page 72)

In 1975, Professor Richard Blakemore, also of Woods Hole Marine Biological Laboratory, became intrigued by the strange behavior of some bacteria he was studying. Blakemore noticed that the bacteria always clustered at the north side of their culture dish. Even if he turned the dish so that they were at the south end and left it overnight, the next morning the bacteria were back at the north side. While such “magnetotrophic” bacteria had been described before, no one had ever done what Blakemore did next: he looked at them under the electron microscope. What he found was astonishing. Each bacterium contained a chain of tiny magnets! The magnets were actually crystals of the naturally magnetic mineral magnetite, the original lodestone of preliterate peoples. Somehow, the bacteria absorbed the soluble components from the water and put them together in their bodies as the insoluble crystalline chain.

Later studies showed that this arrangement was of value to these bacteria, which lived in the mud on the bottom of shallow bays and marshes. If they were moved by the tide or by storm waves, their magnetic chains were large enough (in comparison to their body size) to physically turn their bodies so that they pointed down at an angle corresponding to the direction of magnetic north. All the bacteria had to do was swim in that direction, and sooner or later they would be back in the mud. This was an interesting mechanism, but it did not contain any sophisticated information transfer. The bacteria did not “know” that north was the way to swim; they just did so. However, these observations opened up a much more interesting series of investigations.

The Body Electric by Robert O. Becker, M.D. (pages 276-278)

Subliminal Stress

After Howard Friedman, Charlie Bachman, and I had found evidence that "abnormal natural" fields from solar magnetic storms were effecting the human mind as reflected in psychiatric hospital admissions, we decided the time had come for direct experiments with people. We exposed volunteers to magnetic fields placed so the lines of force passed through the brain from ear to ear, cutting across the brainstem-frontal current. The fields were 5 to 11 gauss, not much compared with the 3,000 gauss needed to put a salamander to sleep, but ten to twenty times earth's background and well above the level of most magnetic storms. We measured their influence on a standard test of reaction time - having subjects press a button as fast as possible in response to a red light. Steady fields produced no effect, but when we modulated the field with a slow pulse of a cycle every 5 seconds (one of the delta wave frequencies we'd observed in salamander brains during a change from one level of consciousness to another), people's reactions slowed down. We found no changes in the EEG or the front-to-back voltage from fields up to 100 gauss, but these indicators reflect major alterations in awareness, so we didn't expect them to shift.

We were excited, eagerly planning experiments that would tell us more, when we came upon a frightening Russian report. Yuri Kholodov had administered steady magnetic fields of 100 and 200 gauss to rabbits and found areas of cell death in their brains during autopsy. Although his fields were ten times as strong as ours, we stopped all human experiments immediately.

Friedman decided to duplicate Kholodov's experiment with a more detailed analysis of the brain tissue. He made the slides and sent them to an expert on rabbit brain diseases, but coded them so no one knew which were which until later.

The report showed that all the animals had been infected with a brain parasite that was peculiar to rabbits and common throughout the world. However, in half the animals the protozoa had been under control by the immune system, whereas the other half they'd routed the defenders and destroyed parts of their brain. The expert suggested that we must have done something to undermine resistance of the rabbits in the experimental group. The code confirmed that most of the brain damage had occurred in animals subjected to the magnetic fields. Later, Friedman did biochemical tests on another series of rabbits and found that the fields were causing a generalized stress reactions marked by large amounts of cortisone in the bloodstream. This is the response called forth by a prolonged stress, like a disease, that isn't an immediate threat to life, as opposed to the fight-or-flight response generated by adrenaline.

Soon thereafter, Friedman measured cortisone levels in monkeys exposed to a 200-gauss magnetic fields for four hours a day. They showed the stress response for six days, but it then subsided, suggesting adaptation to the field. Such seeming tolerance of continued stress is illusory, however. In his pioneering lifework on stress, Dr. Hans Selye has clearly drawn the invariable pattern: Initially, the stress activates the hormonal and/or immune systems to a higher-than-normal level, enabling the animal to escape danger or combat disease. If the stress continues, hormone levels and immune activity gradually decline to normal. If you stop your experiment at this point, you're apparently justified in saying, "The animal has adapted; the stress is doing it no harm." Nevertheless, if the stressful condition persists, hormone and immune levels decline further, well below normal. In medical terms, stress decompensation has set in, and the animal is now more susceptible to other stressors, including malignant growth and infectious disease.

In the mid-1970's, two Russian groups found stress hormones released in rats exposed to microwaves, even if they were irradiated only briefly by minute amounts of energy. Other Eastern European work found the same reaction to 50-hertz electric fields. Several Russian and Polish groups have since established that after prolonged exposure the activation of the stress system changes to a depression of it in the familiar pattern, indicating exhaustion of the adrenal cortex. There has even been one report of hemorrhage and cell damage in the adrenal cortex from a month's exposure to a 50-hertz, 130-gauss magnetic field.

Soviet biophysicist N. A. Udintsev has systematically studied the effects of one ELF magnetic field (200 gauss at 50hz) on the endocrine system. In addition to the "slow" stress response we've been discussing, he found activation of the "fast" fight-or-flight hormones centering on adrenaline from the adrenal medulla. This response was triggered in rats by just one day in Udinstev's field, and hormone levels didn't return to normal for one or two weeks. Udinstev also documented an insulin insufficiency and rise in blood sugar from the same field.

One aspect of the syndrome was very puzzling. When undergoing these hormonal changes, an animal would normally be aware that its body was under attack, yet, as far as we could tell, the rabbits were not. They showed no outward signs of fear, agitation, or illness. Most humans certainly wouldn't be able to detect a 100-gauss magnetic field, at least not consciously. Only several years after Friedman's work did anyone find out how this was happening.

In 1976 a group under J. J. Noval at the Naval Aerospace Medical Research Laboratory at Pensacola, Florida, found the slow stress response in rats from very weak electric fields, as low as five thousandths of a volt per centimeter. They discovered that when such fields vibrated in the ELF range, they increased levels of the neurotransmitter acetylcholine in the brainstem, apparently in a way that activated a distress signal subliminally, without the animal's becoming aware of it. The scariest part was that the fields Noval used were well within the background levels of a typical office, with its overhead lighting, typewriters, computers, and other equipment. Workers in such an environment are exposed to electric fields between a hundredth and a tenth of a volt per centimeter and magnetic fields between a hundredth and a tenth of a gauss.

Cross Currents by Dr. Robert O. Becker (pages 194-197)

In the early 1980's, the U.S. Air Force School of Aerospace Medicine funded a very large, very expensive study at the University of Washington, under the direction of Dr. Arthur W. Guy. In this study, rats were continuously exposed to high frequency microwaves of 2.45 gigahertz (with one gigahertz equaling one billion hertz) at approximately 0.5mW/cm2, twenty times lower than the "safe" thermal level. The exposures lasted for as long as 25 months, and 155 different measures of health and behavior were collected.

This appeared to be a well-designed study that would finally answer the question of whether there were any potential hazards to human beings from chronic exposure to microwave radiation. According to Guy, "The results revealed few differences between the exposed and control rats, and those differences for the most part were either not statistically significant or came and went, suggesting that they may be due to chance."

However, one striking observation was noted: "Primary malignant tumors developed in eighteen of the exposed animals but in only 5 of the controls." Guy hastened to explain that the incidence of cancers even in the experimental group was actually lower than normally expected for the strain of rat used in the experiment. He suggested that no hasty conclusions should be drawn, and that a "consensus among most investigators that the only strong evidence for the hazards of microwaves is found at high levels of exposure" was still valid.

The project was wide reported in the press and discussed in scientific meetings, and it was the subject of a major article in the September 1986 issue of Scientific American (from which the quotes have been drawn). A significant aspect of the experiment was not reported either in that article or in the popular press - but at the scientific meeting at which the results of the study were first reported, it was revealed that all of the animals used, both experimental and control were gnotobiotic (a term meaning germ and virus free). This circumstance alone was responsible for a major part of the $5 million cost of the project.

To produce gnotobiotic animals, the young must be delivered by cesarean section under the strictest possible sterile operating-room conditions (much more stringent than those in use in operating or delivery rooms for people). Following delivery, the animals must be raised and then housed in totally sterile environments for the entire duration of the experiment. This type of environment is akin to the decontamination rooms used to house the astronauts after they returned from the moon, or the "bubbles" within which children born without immune systems are housed.

The use of gnotobiotic animals seems to be not only totally unnecessary, but undesirable as well. Neither we nor the laboratory rat normally live in a sterile world, devoid of bacteria or viruses. On the contrary, we live surrounded by uncountable numbers of organisms. We generally do not get sick unless we are injured and bacteria enter the body through the wound, or unless our immunity is inadequate and we get a communicable disease or infection. An experiment on germ- and virus-free animals has no relevance to the real world.

The point becomes even more apparent when two established facts are considered. First, present evidence shows that at least 20% of human cancers are caused by viral infection, and the percentage is considerably higher in animals. Therefore, animals that are maintained in a germ- and virus-free state have an incidence of cancer that is much lower than expected. Second, it is well-established that exposure to any abnormal electromagnetic field produces a stress response. If the exposure is prolonged, the stress-response system becomes exhausted, and the competency of the immune system declines to below normal. In such a state, animals and humans are more susceptible to cancer and infectious diseases.

One can only conclude that the experiment at Washington was deliberately designed to sharply reduce the incidence of cancer and infectious diseases in the exposed animals. There can be no other reason for the requirement that the animals be gnotobiotic.

Therefore, if we knew the facts in advance, and we wanted to set up a "scientific" project to expose animals to microwaves for a long time but were required to get negative results, we would have only one choice - to use germ- and virus-free test animals. Being gnotobiotic, both the unexposed control animals and the exposed experimental animals would be protected against the usual dangers of infection and cancer. In Guy's study, the fact that the experimental animals had a lower-than-normal incidence of cancer was totally expected. What was unexpected and highly significant was that even with this protection, the cancer incidence in the animals exposed to microwaves was four times that in the control animals.

The well-designed experiment that should have "proved" that microwaves are safe fell into a trap, and the nature of the trap is revealed by the types of cancer that occurred in the experimental group. These were mainly limited to cancers of the pituitary, thyroid, and adrenal glands; these cancers were accompanied by a significant number of pheochromocytomas, which are benign tumors of the adrenal glands. There were no significant cancers of any of the usual tissues.

The experiment was designed to prevent the results of stress, but the planners forgot that it would produce stress. Because stress resistance is mediated chiefly through the three glands just mentioned, we must conclude that the microwave exposure produced an extremely high level of stress - so much so that the resultant prolonged hyperactivity of these glands led to their becoming cancerous. Considering the extreme stress experienced by the exposed animals, if the animals had been normal (rather than gnotobiotic) the entire experimental group would have died of infection or cancer before the close of the experiment.

Some of the 155 biochemical determinations done by Guy in the course of the experiment confirm this interpretation. Plasma cortisol is one of the chemical substances produced by the adrenal glands under conditions of stress, and it was one of the substances measured in the experiment. At the start, the plasma cortisol was equal in both the control and experimental groups; in the early months of microwave exposure, however, cortisol in the experimental group was elevated above that in the control group, indicating that the experimental animals were reacting to stress. By the latter phase of the experiment, the plasma cortisol of the exposed animals was depressed below that of the controls, indicating that the stress response systems of the experimental animals had become exhausted. This result is exactly as expected for a condition of chronic stress.

These data, which are buried in a multivolume official Air Force report of the project, were first published in the July-August 1984 issue of Microwave News. The experiment was planned cleverly, but not cleverly enough. It clearly indicated that chronic exposure to microwaves at levels 20 times below the established safe thermal level, produced profound stress and ultimately exhaustion of the stress-response system. Because the experiment involved gnotobiotic animals, this resulted only in an increase in cancers of the stress-response glands. Had the experiment been performed under real world conditions, the result would have been catastrophic for the exposed group of animals.

mi familia said...

Please help! I am currently living in Costa Rica with my family. We are missionaries in language school and will be going to Mexico after this. We think that there is a possibility of me having Lyme as well as our three kids. We cannot leave the country to seek a second opinion or to be evaluated by a Lyme literate doctor. The doctors here do not agree with our concerns and have refused to look further into Lyme. If we choose to return for testing we will risk loosing our jobs. We are trying to gather as much information as possible about Lyme, collecting tests that are available here, but we need a second opinion via Skype, email and phone before we make any decisions. Our heart and our calling is to stay abroad and not go back to the States, but some concerning health issues have arisen and we feel it is our responsibility to follow up as much as possible. If you would be willing to respond to my message, please feel free to access our blog or contact us by email. Thank you

Unknown said...

I think the author as well as some LLMDs underestimate the effects of bartonella. The symptoms of Bartonella bacteremia can be severe, neurological, and hard to get rid of. Rifampin is the best med for this generally. For those of you wanting to be tested for the PCR of many strains, including henslae, koehlerae and many others uncommonly available send a sample to Galaxy Labs in NC. Previously this coule only be done while it was still in research domain with the university there but now they have a commercial lab. The upper gastric pain seems to me to not be due to omnicef but the bartonella, in my experience.

Unknown said...

Cefdinir is a semi synthetic broad spectrum antibiotic drug familiarly used for various kinds of bacterial infections such as bronchitis, otitis media, sinusitis etc. it is great anti biotic used kin and skin structure infections.