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Friday, July 5, 2013

Is STARI Lyme?

I will got on a limb; I think a short branch.  Lone star ticks transmit Lyme disease. My patients have pointed this out to me for quite some time.

 We have to ask the question, what is Lyme disease?

The answer is a little complicated.

Willie Burgdorer discovered the famous spirochete granting him "medical immortality." The spirochete we associate with Lyme is Borrelia burgdorferi. Over the past few decades the Lyme epidemic has spread throughout the US and become global.

But not all Lyme is the same.

Our standard Lyme germ is designated strictly Lyme:  B. burgdorferi (sensu strictu). Other forms of the bacteria causing Lyme disease(or something like it) are still called Borrelia burdoreri even if when they are a different species of Borellia. We do this by adding the suffice "sensu lato," meaning it is Lyme in a looser way. So bacteria with names like: B. garinii, B. afzelli, B. japonicum are called Borrelia burgdorferi (in the looser sense).

Normally a bacteria is only allowed to have one species name.  Scientists are particular about the way the group living organisms in a particular taxonomy.  KINGDOM, PHYLUM, CLASS, ORDER, FAMILY, GENUS, SPECIES.  Strains are variations within the same species.

With Lyme disease, we have made an exception and attach an extra species name in honor of our friend Willie Burdorfer.

Mainstream medicine informs that  STARI or Master's disease, caused by the lone star tick is no cause for alarm because it is not Lyme disease.

The particular bacterial cause of STARI has at times been elusive. But, some species of Borellia have been identified in STARI cases.  The first was B. lonestari , currently not considered one of the Lyme sensu lata species. More recently two Lyme "sensu lato" species have been connected to STARI:  B. adnersoni and B. americanum.  So STARI can be Lyme even by the CDC definition.

I think they need to update their website.

The rash seen with STARI is more dramatic than that seen with standard Lyme is more like to cause the classic "bull's eye" appearance. In other words: STARI is more Lyme than Lyme --  at least with regards to the rash.

Maybe STARI explains some sero-negative Lyme disease.

STARI is said to be milder than Lyme. Are we sure?

Anyway, it seems to me that B. lonestari should be part of the Lyme sensu lato family.

But we are cautioned to avoid bites from the lone star ticks because this may lead to meat allergy. True.

As Ixodes scapularis (deer tick) invades from the north and Amblyomma americanuum invades from the south, they both converge here, in the mid-Atlantic. 

It can be hard to tell the ticks apart.  Adult female lone stars have a distinctive white spot on their backs.  Nymphs cause most disease and are hard to tell apart.


Anonymous said...

This comment belongs under Adrenal or Pituitary issues post, but it seems it needs to be considered anytime.
I have Neuro Lyme, from the start, 14 years ago, with high CMV, EBV titers at onset. I have had progressive cognitive dysfunction-poor memory, comprehension, neurpoathy. Terrible blogging skills..I tested + IGM Western Blot Igenex in 2011. A year ago I was treated with 2 months high dose (400mg/day) oral Doxycycline, it resolved the neuropathy after 3 months, then all returned and seems permanent. I have developed symptoms Of Addison's, hypoadrenalism-waiting on ACTH level (had low and high salivary cortisols), hypogonadism (all sex hormones tanked very low suddenly last year, still menstruating, I'm 45), will get FSH/LH levels, and had sudden raise in TSH last year, also-normal for years, then went to 4. I believe the Naturthroid (thyroid med) worsened the adrenal insufficiency. I am an RN, and I believe the HPA dysfunction is from lymphocytic hypophysis, HYPOPITIUTARISM, that gradually manifests and is, like Lyme Disease and Co., difficult to diagnose until the damage has been done, and obvious end organ symptoms appear. I never thought that I would consider any steroid, but it may give me a life back. I have tried Isocort and it works well, and as soon as it wears off I am horizontal and in pain again. A well known LLMD in So. California says, "recent research has proven Lyme is never eradicated at later stages-it's either active or subacute." I have good results with reducing brain inflammation with weekly IV glutathione-I am documented as low, but I need corticosteroids to stop the cycle of inflammation and damage (fibrosis). Negative brain MRI-to be reviewed by Neuro Rad.
What say you? (Thank you )

Lyme report: Montgomery County, MD said...

I do not write these BLOGS to offer specific medical help for readers. Please keep this in mind.
I am sorry you are so ill. I don't have any suggestions about jogging a broken HPA axis. You need to replace all hormones to physiological levels.
Do not worry about taking cortisol -- you need it. You are not taking steroids when you take cortisol to achieve a physiologic concentration. I think it is important to time when you take cortisol and mimic the natural diurnal cycles as much as possible.

I have experience with neuropathy. IViG can be very effective. If the EMG is negative consider a skin biopsy to rule out small fiber neuropathy HBOT may help as well. I have experience with neuroborreliosis. I think much "Lyme brain" can be helped with long term antibiotics, especially ones like Flagyl.

It is true that you cannot eradicate all the spirochetes, but your immune system can be trained to hold them at bay. Also- liposomal glutathione may work - if not a replacement for IV treatment, an adjunct between doses.

I do not diagnose or treat patients with my BLOG. These are just some general thoughts based on some of my experiences. Each patient is unique: clinical decisions must be made through consultation with your doctor.

Anonymous said...

I agree with Dr. Jaller on the immune system comments. I had an immediate reaction to a tick bite, October 2011, fever, heart palps (tick bit me near the hear), swollen lymph nodes, etc. The bite occurred while sleeping and felt ill upon awakening and saw the bullseye, got on 200 Mg of doxy by a Texas LLMD who told me he couldn't give a higher dosage as it was not the standard. But My DOG who weighs 80 pounds was prescribed 400 mg doxy daily by the vet. IGENIX testing a month after the tick bite showed I was already infected, Highly positive! I had been walking around with a case of active lyme and never knew it until the tick bite caused a reinfection. The only symptoms I had prior to the tick bite was: numbness behind right knee where bitten by sand flies in Peru 3 years earlier, pain in right elbow ascribed to bursitis, once a month would just feel wierd which I thought was either allergies or hormones. I've been under treatment with a good Out of state LLMD and other practitioners using natural medicine.

it's the IMMUNE system and our biological terrains.