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Friday, February 27, 2015

Chronic fatigue, low grade fever and babesiosis

I have been treating this 45 year old woman for about a year. For the previous year she had been treated with pulsed, low dose antibiotics prescribed by another physician. She sought my help because she was not feeling better. She was well until 2010. At that time she had a tick bite and bull’s eye rash. Because the Lyme test and even a skin biopsy were negative she was told she did not have Lyme disease. Her symptoms started atypically with abdominal pain and sinusitis. Early on she experienced a loss of sense of smell. After this she developed more typical symptoms, cognitive issues, dizziness and hyperaccusis (extreme sensitivity to loud sounds). An MRI of her brain showed white matter disease. The diagnosis of MS was considered and dismissed. She developed palpitation but had a negative cardiac workup. In 2012 her previous physician diagnosed Lyme on clinical grounds. Western Blot testing for Lyme by various laboratories, including IgeneX was negative. She did however test positive through Pharmasan Labs on the ISpot test for Lyme. Coinfection testing was also negative. At the time I saw her previous antibiotic therapy had included: Omnicef, Mycobutin, Minocin, Biaxin and Flagyl. She had stopped antibiotics because of a lack of improvement. When we met chief complaints included: fatigue, nausea, vertigo, weakness, migratory joint pain, numbness and tingling and cognitive impairment. She also reported flulike symptoms with fevers and chills. She experienced low grade, daily, low grade fevers of 99.5 to 100 F. She was treated for chronic depression with medicine which was effective. She was worked as a professional writer, was functioning poorly and ultimately took a leave from work. 

Over the ensuing months Lyme was the working diagnosis. I treated her aggressively with a variety of antibiotics beyond those already prescribed. I treated her for coinfections. Including Babesia with Mepron and Malarone. Ultimately she did not improve. Over time the diagnosis of chronic fatigue syndrome was added to the top of her problem list. Viral causes were considered and she was treated with months of antiviral therapy; nothing helped substantially. 

During a recent office visit I thought about those persistent low grade fevers and suggested we repeat a blood smear (a prior one many months ago was negative). A photomicrograph is included here.  
Discussion: Did she have Lyme? I am frequently asked, can you just have a coinfection, like Babesia and not have Lyme. This is certainly possible but seems unlikely. A large percent of the population is silently infected with Babesia species. My sense is that the compromised immune system of Lyme tends to make Babesia more active and symptomatic. Usually you don’t get one with the other (probably others as well).

I have relied heavily on Lyme Western Blots, C6 ELISA tests and clinical judgment to diagnose Lyme. I have not used the ISpot which I thought was too nonspecific.  This test measures interferon responses of killer T-cells when provoked by specific Lyme antigens. The ISpot may be useful, especially when other tests yield negative results. 

No commercial tests are available for other common Borrelia species which I believe are more and more responsible clinical Lyme disease, Borrreliosis. Alternative Lyme species (like B. lonstari) may be tested by PCR but this is a low yield test.

Standard Babesia tests, antibodies for B. microti, B. duncani and FISH tests may detect only 2 species of Babesia; there are an untold varieties of Babesia which hold clinical importance. The CDC recognizes the existence of at least 3 other species of Babesia causes disease in the U.S.: B. CA1, B. MO1 and B. divergens. Countless species are known to cause animal illness (more than 100) and many non-speciated varieties of Babesia have been found in local ticks using broad DNA/PCR probes/primers. I am fairly sure that there are many, yet unknown, species of Babesia associated with human disease.I think the blood smear above is consistent with this phenomenon.

A lot is known about the 5 common species of Malaria including distribution patterns and drug resistance. These facts well known by organizations including: IDSA, CDC and WHO. This is not to say that Malaria is not one of the largest, if not the largest public health problem in the world.
It is said that Malaria has been eradicated in the US; still, about 2000 cases are reported to the CDC each years, mostly for foreign travelers. In 2013 the CDC states that 1700 cases of Babesia from 27 states was reported. From this data one can infer the CDC  thinks we have no Babesia problem.

This tremendous epidemic of human babesiosis of unimaginable proportion goes completely unseen by the CDC and Mainstream Medicine. One reason may be its association with the four letter word:  (Lyme) – guilt by association. 

This unknown epidemic, of which we know very little, is wildly out of control and ravaging the health of patients I see daily. 

Babesia, a blood parasite, is also a brain parasite. It is carried into the blood on the back of red blood cells, called the Trojan horse effect. The parasites are carried into tiny blood vessels where they become impacted and fixed. 

Brain parasites are mysteriously associated with reliably specific symptoms. Toxoplasmosis suicide and car accidents (published). Babesia depression. Bartonella irritability and rage. The mechanism may be specific effects on molecular signalling in the brain. Action at a distance. 

Bartonella enters the brain by the same mechanism. Bartonella is not limited to blood cells, it also invades the lining of blood vessels, endothelium, taking up residence.
My comments here are about Babesia.

Babesiosis is frequently intractable. It is resilient and becoming increasingly resistant to our standard drugs. Mepron is frequently ineffective. Malarone may work only a little better. Coartem seems to be more effective but it usually fails to eradicate the parasites. We add herbal remedies, artemisinin and a triple concoction recommended by Buhner. The parasites persist. Larium has been effective but side effects (depression) have frequently been intolerable. Babesia patients are depressed to start with. Recommended doses of quinine are intolerable. I have tried adding low doses of quinine adjunctively which seems to help some. The antiparasitic drug albendazole has anti-malaria activity and can also be helpful adjunctively for babesiosis. Babesia relapses are notorious.

The classic knee-jerk symptoms I always look for are night sweats and air hunger. Other common symptoms include muscle pain, headache, mood swings and depression. The depression seems to have a propensity for causing sudden tearfulness. A plethora of other symptoms may be associated with Babesia, include chronic, low grade fever. 

This seems to be relevant to the patient described above. 

Babesia brain Herxheimer reactions are frequently dreadful and very challenging to manage. 

This patient, as so many others, experience palpitations and other cardiac symptoms. I will explore this topic in my next post.


G said...

wait for the next post.

Paced Runner said...

I am eagerly awaiting your next post. I've been struggling severely with B. Duncani for years. I definitely have the depression and cardiac issues. I ended up with a pacemaker this past year at 28 years old. My heart was stopping in addition to SVT, PVC's, tachycardia to 200, and horrific BP drops (literally to 0). I wish I could get a handle on it. Unfortunately, I too am finding no relief with many of the medications and herbs you've mentioned.

G said...

...and thank you....

mb said...

Thank you thank you. I have been trying to pin a name on my symptoms for years. Known (many) tick bites. 1 rash, 1 month abx in 2003. Sudden uncontrollable tear-fullness began in 2007. Sweats this year. Migrating tingling. Depression. Feeling "just not right".
Recent palpitations, stress test being analyzed. I can give this article to my ND. It is one of your most crucial posts.

Unknown said...

Please let me know more!! I have been struggling with a daily, low grade fever (99.5-101) for 18 months. The first 12 months also included persistent, drenching night swears. I tested positive for Lyme in November 2014 (after a solid 12 months of being told I was making it up by one Dr and that it was fever of unknown origin and would resolve on its own by another).
I took two 30-day courses of Doxycyline, to no avail. The night sweats resolved, but the fever remains. It has exceeded 100.2 for 6 out of the last 7 days. I am constantly laying down because of chronic fatigue.
I am at my wits end and just need an answer!! Thank you for sharing the information here... I will be taking this to my doctor.

Jim medical detective said...

I have been treated successfully for Lyme and Babesia, each taking 8 months to treat, and am starting treatment for Bartonella today.

I am allergic to sulpha, so everything else was used. Nothing effective until I tried Super Artemisinin (Allergy Research Group) 4/day for 15 days which got rid of all my arthritis pain, all my myalgia, and about 60% of my muscle pain. Treatment followed up with 2 months of IV Artesunate 3 days on 11 days off (too long between treatments) which further reduced my muscle pain by 90%. Next went back to Super Artemisinin 6/day for 10 days, which resolved 90% of my fatigue. And a month later for the 3rd time Super Artemisinin 8/day for 7.5 days (there are 60 capsules in a bottle - each capsule 180 mg artemisinin). This resulted in a major herx about the 3rd day, then I was totally calm. Finally 450mg Clindamycin for 5 weeks resolved all my outstanding symptoms related to my lungs: lung irritation, cough, air hunger, night sweats. My LLMD and LLND worked together with me and only Bartonella to go. Jim

Sonja said...

Jim, I know it's been a long time since this post, but trying anyway. Are you still doing well? Did you heal from Bartonella too? It looks like you were basically pulsing the Super Artemesinin, correct? Thank you, and I do hope you are well.


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