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Wednesday, February 10, 2016

Borreliosis, new and emerging species

A 38-year-old male sought my attention this week because of strange neurological symptoms in the aftermath of a tick bite. He lives in a small town around Richmond VA.  He has had a lot of tick bites over a period of years, ticks of various sizes. He and his family love to hike, camp and generally spend a lot of time in wooded area. In the early Spring of 2015 he found a tick on his calf which he removed. Within days, he developed a red expanding rash on his upper thigh. The rash encompassed the entire anterior portion of the upper thigh. He never developed a bull’s eye rash. The rash was consistently red. The lymph nodes in the groin become swollen and slightly tender. Within days of the tick bite, he developed an array of symptoms: fast heartbeat, anxiety, headache, tingling sensations, poor concentration and others. He went to the ER at the local hospital. He was diagnosed with panic attack and cellulitis (infection of tissues under the skin). Lyme disease was dismissed as a possible explanation. Nonetheless, he was prescribed a week of doxycycline for the cellulitis. He did not improve. He experienced progressive symptoms: neck pain, back pain, muscle twitches, strange vibrations, electrical shooting pains, tingling sensations, zapping sensations. He had a strange feeling of heaviness. He eyes become very sensitive to light. He developed tinnitus (ringing) in both ears and he became very sensitive to loud sounds. He noticed poor endurance and fatigue. It became hard to fall asleep. His cognition felt foggy. Memory was not as good. He had episodes of spacing out and concentration and focus has been a problem.

He went to his family doctor after a couple of months of misery. He was quickly evaluated. A few blood tests were done. The patient was invited back to the doctor’s office after several days and told he had a post-viral syndrome because EBV (Epstein Barr Virus) titers were high. Lyme antibodies were negative. The doctor recommended he wait it out. Things would improve. They didn’t.

In July 2015 he talked his doctor into ordering a whole set of tickborne disease tests at IgeneX. He was told the results were negative. He found a local holistic doctor who prescribed a month of 2 antibiotics and natural therapies. He felt worse. Two doctors now had reviewed the IgeneX reports and read them as negative.

It is only now that he seeks my help.

At this point the reader might be thinking the Western Blot results were somehow positive. This would be incorrect. Two doctors had not looked very carefully at the report. The PCR test for Lyme DNA was positive. IgeneX notes that the test is not specific for Borrelia burdorferi but may also pick other forms of Lyme, including B. andersonii, a contender for STARI.

News Flash. As I have been saying, there are other, mostly unknown species of Lyme. Just this week it was announced: new Lyme organisms discovered by researchers at the Mayo Clinic, modestly named, B. mayonii.

I believe this patient is infected with a variant Lyme strain. Therefore, the minimal reactivity on the Western Blot test would be expected.  The positive PCR was a stroke of luck. Likely vector: lone star tick;  likely pathogen alternative form of borrelia, not B burdorferi.

The diagnosis for this patient could be called Lyme disease. Borreliosis is a better term as it announces the fact that essentially the same illness can be caused by other Borrelia species.

By the way: Check out Fitzpatrick’s color atlas of dermatology. All of the images of EM rash are red patches, just like the patient had. None are bull’s eye.


Christian said...

What I don't get about Borrelia is the immense variation to antibiotic response.
I don't really know in what world Doxycycline would have zero impact on spirochetes.
The tetracycline class is probably the best broad spectrum antibiotic class of all.

I can agree that doxy might induce blebs, lessen the immune response, kill motile ones and so on.
But no response what so ever?
This antibiotic divergence shows up in lab work too. Zhang claims Tinidazole has little effect in vitro. Sapi and Brorson claim otherwise. How can the results be so different?

I can't take doxy. It causes symtomps to explode. Betalactams work fine however. I had a month of Rocephine, best I ever felt... Some patients are just the opposite.

Brian said...

What treatment are you considering for this patient?

lymie said...

A study some years back done for the now-withdrawn vaccine, with Steere as an author, found that the most common lyme rash was not a bullseye. Somehow that information has never gained any traction. We are still told by the "authorities" that a high percentage of rashes are bullseye, even though the entry to case reporting is a positive two tier test or a bullseye rash. Then a lot of reported cases have bullseye. Gee, if you have to have this to get in the door, obviously the people inside will have it. Once again we ask if this is stupidity or deliberate on the part of the officials.

My rash was small, irregular, red, not expanding. For a long time, I did not associate it with the rest of the symptoms until a doctor showed me an identical rash on his arm where he had removed a tick and then developed lyme symptoms.

Anonymous said...

Harder to find a rash if you're dark-skinned like myself. or if the bite is on a limb or other area where the shape is not easily discernible.
I've had any number of mysterious small non-bullseye rashes in various places, and at least two such rashes associated with new tick bites and which coincidentally (?)closely preceded the onset of new Sx.

Fallen Star Reaching For The Sky said...

Why did you remove your most recent post dated March 3, 2016, and titled "What the Lyme Western Blot really means, understanding the big picture"? I thought it was very informative and well-written. Now that I no longer have access to it, I wish I had saved it for future reference.

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