Archive for the ‘Babesia’ Category

10 Top Causes of Symptoms in Chronic Lyme Disease

https://www.prohealth.com/library/ten-common-causes-of-symptoms-in-chronic-lyme-disease-8558

10 Top Causes Of Symptoms In Chronic Lyme Disease

(Please see link above for full article.  Excerpts below)

1) Mold toxicity

Real Time labs is among the most accurate of labs for mold testing. Effective mold toxin binders include the medication cholestyramine and activated charcoal.

2) Parasitic Infections

Parasitic infections are often not detectable on conventional lab tests, and may not even show up in sophisticated stool tests; therefore, using multiple forms of testing to detect parasites, such as electrodermal screening tools such as the Zyto or muscle testing, is important, along with lab testing with reputable labs such as Doctors’ Data.

3) Hormone and Neurotransmitter Imbalances

Replenishing the body’s stores of these chemicals can therefore profoundly support the healing process and Lyme doctors will commonly prescribe bio-identical hormones such as pregnenolone, DHEA and thyroid hormone to their patients, along with amino acids such as L-tyrosine, GABA and 5-HTP, which the body uses to make neurotransmitters. To make these amino acids work in the body, supplemental co-factors such as P5P, SAMe, and methyl B-12 are also sometimes important.

4) Vitamin and Mineral Deficiencies

Common deficiencies include magnesium, Vitamins D, C and B-vitamins; zinc and iron—among others. Supplementation with these nutrients can help to support the body during healing. (For more information on common nutritional deficiencies in Lyme disease and supplements that support the body, I encourage you to check out my 2012 book Beyond Lyme Disease).

5) Inflammation

Reducing inflammation involves mitigating all of its causes, such as removing pathogens and toxins from the body, and downregulating the immune response with nutrients and tools such as low-dose immunotherapy. High-quality, natural anti-inflammatory substances such as curcumin may also be helpful for supporting the body’s inflammatory response.

6) Mitochondrial Dysfunction

Supporting the mitochondria with supplements such as L-carnitine and CO Q-10 can help to mitigate fatigue and other symptoms related to mitochondrial dysfunction.

7) Emotional Trauma

Many studies have proven that trauma suppresses immune function and when prolonged, can open the door to chronic health challenges.

8) A Poor Diet

Removing allergenic foods and consuming fresh, organic “real” food, such as non-GMO, antibiotic, pesticide, and hormone-free meats, poultry, eggs, and other proteins; non-starchy veggies and low-glycemic fruits, along with healthy fats such as olive and coconut oil, can help to alleviate symptoms caused by food.

9) Poor Gastrointestinal Function

Supplementing with GI nutrients such as hydrochloric acid, digestive enzymes and probiotics may help to support gastrointestinal function in those with Lyme.

10) Environmental Toxicity

Sauna therapy, rebounding, coffee enemas, liver cleanses, and taking toxin binders such as zeolite, chlorella, EDTA, activated charcoal—among others, are just a few ways to remove toxins from the body.  Ideally, you’ll want to work with a practitioner who can test your body for toxins and prescribe a regimen in conjunction with Lyme disease treatment based on your needs. The same holds for the other causes of symptoms described here.

This article was first published on ProHealth.com on April 26, 2016 and was updated on September 22, 2020.


Connie Strasheim is the author of multiple wellness books, including three on Lyme disease. She is also a medical copywriter, editor and healing prayer minister. Her passion is to help people with complex chronic illnesses find freedom from disease and soul-spirit sickness using whole body medicine and prayer, and she collaborates with some of the world’s best integrative doctors to do this. In addition to Lyme disease, Connie’s books focus on cancer, nutrition, detoxification and spiritual healing. You can learn more about her work at: ConnieStrasheim.

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**Comment**

Not mentioned is Lyme itself, and the many other potential players.  While parasites apart from Lyme is mentioned, dealing with the infections is paramount.  Of course these infections are indirectly affected by the things listed in the helpful article, but never underestimate the infection(s) themselves.  Good, effective, savvy treatment is required.

For more:

What Are Lyme Disease Co-Infections?

https://danielcameronmd.com/lyme-disease-co-infections/

WHAT ARE LYME DISEASE CO-INFECTIONS?

lyme disease co-infections

When Lyme disease was first discovered in 1975, it was the only known tick-borne illness recognized by clinicians. The disease, which is caused by an infection with the bacterium Borrelia burgdorferi, is transmitted through the bite of a black-legged (I. scapularis) tick.

Today, ticks harbor multiple infectious pathogens that can be transmitted to humans through a tick bite or tainted blood transfusion. The Centers for Disease Control and Prevention (CDC) now reports that “a single tick can transmit multiple pathogens, including bacteria, viruses, and parasites.” [1] This can result in patients developing what is referred to as Lyme disease “co-infections.”

In fact, between 2004 and 2016, the CDC identified 7 new tick-borne microbes capable of infecting humans. [1]

While most Lyme disease co-infections are acquired through the bite of an infected tick, several can be transmitted through contaminated blood transfusions. One investigation concluded, “Aside from a Babesia infection, Anaplasma is the most frequent transfusion-transmitted [tick-borne agent] with rapidly increasing clinical cases.” [2]

Ticks harbor multiple pathogens

According to a study in Suffolk County, Long Island, more than half (67%) of the ticks collected were harboring at least one pathogen. The causative agent of Lyme disease, Borrelia burgdorferi was the most prevalent (57% in adults; 27% in nymphs), followed by Babesia microti (14% in adults; 15% in nymphs).

Another study indicates that “co-infection occurs in up to 28% of black-legged ticks” in Lyme endemic areas of the United States.

Furthermore, researchers found that among infected ticks collected, 45% were co-infected and carried up to 5 different pathogens. The most prevalent co-infections included Bartonella henselae (17.6%) and Rickettsia of the spotted fever group (16.8%).

Lyme disease with co-infections

Researchers from Columbia University, Tufts Medical Center, and Yale School of Medicine examined the extent of co-infections in patients diagnosed with Lyme disease. Their findings are alarming.

  • 40% of Lyme disease patients had concurrent Babesia
  • 1 in 3 patients with Babesia had concurrent Anaplasmosis
  • Two-thirds of patients with Babesiosis experienced concurrent Lyme disease and one-third experienced concurrent Anaplasmosis

Recognizing and treating co-infections

As tick populations explode and expand into new geographic regions and cases of Lyme disease continue to soar, there is growing and warranted concern surrounding the medical communities’ ability to recognize, diagnose, and treat Lyme disease co-infections.

Sanchez-Vicente points out that nearly 1 in 4 black-legged ticks tested in their study had multiple infections. This finding “justifies the modification of the clinical approach to tick-borne diseases to cover all infection possibilities.”

Unfortunately, testing for co-infections rarely occurs. One study found that out of nearly 3 million specimens, only 17% were tested for non-Lyme tick-borne diseases.

Yet, an accurate diagnosis is critical, given that patients may require different treatment depending upon the type of co-infection. For instance, antibiotics prescribed for Lyme disease may be ineffective in treating parasitic or viral tick-borne diseases such as Babesia.

Most common co-infections

Lyme disease is the most common tick-borne illness in the United States. But it’s no longer the only threat. Lyme disease co-infections are becoming the norm, not the exception. The most frequently diagnosed tick-borne co-infections include Babesia, Anaplasmosis, Ehrlichia, Bartonella, Southern Tick-Associated Rash Illness (STARI), and Borrelia miyamotoi.

BABESIA

Babesia is a parasite that infects red blood cells. This parasitic infection is usually transmitted by a tick bite but can be acquired through a contaminated blood transfusion. There have also been reports of congenital transmission of Babesiosis, although rare.

Saetre describes two cases of infants with congenital babesiosis born to mothers with prepartum Lyme disease and subclinical Babesia microti infection. [3] Additionally, congenital transmission has been described in 7 previous cases, in which the infants presented with fever, anemia, and thrombocytopenia. [3]

Read more: Transfusion-transmitted Babesiosis popping up in more states in USA

Most cases of Babesia involve the strains: Babesia microti and Babesia duncani.

Symptoms typically include irregular fevers, chills, sweats, lethargy, headaches, nausea, body aches, fatigue, and in some cases, shortness of breath. But manifestations can vary.

A case series published in the Nurse Practitioner Journal demonstrates the difficulty in diagnosing the disease, as it can cause a wide range of clinical presentations.

Babesia and Lyme disease

Babesia is often present with Lyme disease and can increase the severity of Lyme disease. One study found patients co-infected with Lyme disease and Babesia experienced fatigue, headache, sweats, chills, anorexia, emotional lability, nausea, conjunctivitis, and splenomegaly more frequently than those with Lyme disease alone.

Listen to PODCAST: Delayed onset of Babesia in a Lyme disease patient

Babesia can also increase the duration of illness with Lyme disease. One study found that 50% of co-infected patients were symptomatic for 3 months or longer, compared to only 4% of patients who had Lyme disease alone.

Testing and treatment

Babesia can also be difficult to diagnose with current testing. The parasite was detected microscopically in as few as one-third of patients with Babesia. Specific amplifiable DNA and IgM antibody were more likely to be positive.

The reliability of tests for Babesia in actual practice remains to be determined.

Babesia is treated with a combination of anti-malaria medications and antibiotics such as Atovaquone with azithromycin.

EHRLICHIA

Ehrlichia is a tick-borne bacteria that infects white blood cells, but it has been found in spleen, lymph node, and kidney tissue samples. An infection with Ehrlichia can lead to Ehrlichiosis.

The infection is caused by Ehrlichia chaffeensis and Ehrlichia chagrins. The bacteria is transmitted by the Lone Star tick (Amblyomma americanum) and the black-legged tick (Ixodes scapularis).

Ehrlichia is typically transmitted by a tick bite. Only rarely, has the infection been associated with blood transfusion or organ transplant cases. According to the CDC, there have been two confirmed instances of infection occurring after kidney transplants from a common donor.

Symptoms and Treatment

Symptoms may include fatigue, fevers, headaches, and muscle aches. It can be treated with antibiotics doxycycline, minocycline, and Rifampin.

If left untreated, the disease can become severe and require hospitalization.

ANAPLASMOSIS

Anaplasmosis was previously known as Human Granulocytic Ehrlichiosis or HGE. The disease can be difficult to distinguish from Ehrlichiosis, Lyme disease, and other tick-borne illnesses.

This emerging infectious disease remains under-recognized in many areas of the United States. [4] It is caused by the bacteria Anaplasma phagocytophilum.

Anaplasmosis is spread by tick bites from the black-legged tick and western black-legged tick. Although it is reportedly rare, anaplasmosis has been transmitted through contaminated blood transfusions.

In fact, Mohan and Leiby contend that aside from a Babesia infection, “Anaplasma is the most frequent transfusion-transmitted [tick-borne agent] with rapidly increasing clinical cases.” [2]

In general, most infections with anaplasmosis are mild, “however, up to 36% of patients require hospitalization, with 3% of those having life-threatening complications.” [5]

Symptoms may include headaches, fevers, chills, malaise, and muscle aches. There have been a few reported cases describing pulmonary complications, as well. In fact, one study recommends that “anaplasmosis be included in the differential diagnosis for atypical respiratory presentations.” [5]

And although uncommon, there have been patients with anaplasmosis who did not exhibit any symptoms (asymptomatic). “It is, therefore, crucial for clinicians to be aware of potential asymptomatic anaplasmosis following a tick bite,” writes Yoo and colleagues. [6]

Anaplasmosis can be treated with antibiotics such as doxycycline, minocycline, and Rifampin.

BARTONELLA

Various Bartonella species have been found in black-legged ticks in northern New Jersey and in western black-legged ticks in California.

Bartonella can be contracted through a cat scratch or bite, causing “cat scratch fever.” But it can also be transmitted by a tick bite. In fact, “ticks and small rodents are known hosts of Bartonella and play a significant role in the preservation and circulation of Bartonella in nature.” [7]

Psychiatric presentations and other symptoms

Some patients exhibit a streak-mark rash that resembles stretch marks. Symptoms may include fever, headaches, fatigue, and swollen glands.

Several studies indicate an association between Bartonella and psychiatric symptoms. Investigators describe case studies of patients with new-onset psychiatric symptoms such as sudden agitation, panic attacks, and treatment-resistant depression possibly due to Bartonella.

Another case study highlights a young boy with a Bartonella infection who developed neuropsychiatric symptoms and was later diagnosed with pediatric acute-onset neuropsychiatric syndrome (PANS), a type of basal ganglia encephalitis. [8]

Bartonella can be treated with antibiotics such as doxycycline, minocycline, azithromycin, trimethoprim-sulfamethoxazole, clarithromycin, and Rifampin.

SOUTHERN TICK ASSOCIATED RASH ILLNESS (STARI)

STARI is an emerging tick-borne illness related to Lyme disease and was identified in the southeastern and south-central United States.

STARI is believed to be transmitted by the Lone Star tick; however, it is not officially confirmed as of yet.

The hallmark sign of STARI is an EM-like rash similar to that seen in Lyme disease. Symptoms may include fevers, headaches, stiff neck, joint pain, and fatigue.

The long term consequences and treatment of the illness have not been established.

It is not known whether antibiotic treatment is necessary or beneficial. Nevertheless, because STARI resembles early Lyme disease, physicians will often treat patients with oral antibiotics.

BORRELIA MIYAMOTOI

B. miyamotoi is increasingly being recognized as the agent of a nonspecific febrile illness often misdiagnosed as acute Lyme disease without rash, or as ehrlichiosis.” [9]

Borrelia miyamotoi (BMD) is a spiral-shaped bacteria that causes tick-borne relapsing fevers. However, investigators point out, Borrelia miyamotoi “should not be assumed to be biologically similar to the true relapsing fever spirochetes maintained by argasid (“soft”) ticks, nor to cause typical relapsing fever.” [9]

It appears to be a common infection in areas endemic for Lyme disease. [9]

Symptoms and prevalence

A 2011 study found the disease to generally present with more systemic signs and symptoms, particularly headache and fever, compared to Lyme disease. [10]

“Virtually all patients presented with fever … fatigue, and headache …. The next most common signs and symptoms were myalgia, chills, nausea and arthralgia, characterizing 30%–60% of the patients.” [10]

Other investigators report that “patients infected with B. miyamotoi in the United States typically do not have a rash.” But they may present with “a fever in conjunction with headache (96%), myalgia (84%), arthralgia (76%), and malaise/fatigue (82%).”

READ MORE: Tiny larval ticks can transmit Borrelia miyamotoi

The prevalence of the disease is unknown but investigators report that  “studies in New England suggest that Borrelia miyamotoi infection may be as common as anaplasmosis and babesiosis.

They also point out:

  • “Human cases are likely to be found wherever Lyme disease is endemic.”
  • “B. miyamotoi may cause serious complications, including meningoencephalitis in immunocompromised hosts.”
  • “Several studies suggest that B. miyamotoi may be transmitted through blood transfusion, consistent with the high levels of spirochetemia that occur with Borrelia species that cause relapsing fever.”

Borrelia miyamotoi is particularly concerning given that the bacterium can be transmitted to a person within the first 24 hours of tick attachment. And “the probability of transmission increases with every day an infected tick is allowed to remain attached.”

Diagnostic testing is limited. Although the CDC recommends using PCR and antibody-based tests to confirm a diagnose of B. miyamotoi, a recent study finds blood smears have poor sensitivity for confirming the disease. [9] And there is no FDA approved diagnostic test for the disease.

Treatment thus far is similar to that of Lyme disease. Studies show that doxycycline and amoxicillin have effectively treated B. miyamotoi infection in patients.

Remember, tick-borne co-infections are the norm, not the exception.

Editor’s Note: Practitioners should consider co-infections in the diagnosis when a patient’s symptoms are severe, persistent, and resistant to antibiotic therapy. Physicians have found that co-infections typically exacerbate Lyme disease symptoms.

References:
  1. CDC Vital Signs, Weekly / May 4, 2018 / 67(17);496–501. https://www.cdc.gov/mmwr/volumes/67/wr/mm6717e1.htm
  2. Mohan KVK, Leiby DA. Emerging tick-borne diseases and blood safety: summary of a public workshop. Transfusion. 2020 Jul;60(7):1624-1632. doi: 10.1111/trf.15752. Epub 2020 Mar 24. PMID: 32208532.
  3. Kirsten Saetre, Neetu Godhwani, Mazen Maria, Darshan Patel, Guiqing Wang, Karl I Li, Gary P Wormser, Sheila M Nolan, Congenital Babesiosis After Maternal Infection With Borrelia burgdorferi and Babesia microti, Journal of the Pediatric Infectious Diseases Society, Volume 7, Issue 1, March 2018, Pages e1–e5, https://doi.org/10.1093/jpids/pix074
  4. Rocco JM, Mallarino-Haeger C, McCurry D, Shah N. Severe anaplasmosis represents a treatable cause of secondary hemophagocytic lymphohistiocytosis: Two cases and review of literature. Ticks Tick Borne Dis. 2020 Sep;11(5):101468. doi: 10.1016/j.ttbdis.2020.101468. Epub 2020 May 23. PMID: 32723647.
  5. Jose E Rivera, Katelyn Young, Tae Sung Kwon, Paula A McKenzie, Michelle A Grant, Darrell A McBride, Anaplasmosis Presenting With Respiratory Symptoms and Pneumonitis, Open Forum Infectious Diseases, Volume 7, Issue 8, August 2020, ofaa265, https://doi.org/10.1093/ofid/ofaa265
  6. Yoo J, Chung JH, Kim CM, Yun NR, Kim DM. Asymptomatic-anaplasmosis confirmation using genetic and serological tests and possible coinfection with spotted fever group Rickettsia: a case report. BMC Infect Dis. 2020;20(1):458. Published 2020 Jun 30. doi:10.1186/s12879-020-05170-9
  7. Hao L, Yuan D, Guo L, et al. Molecular detection of Bartonella in ixodid ticks collected from yaks and plateau pikas (Ochotona curzoniae) in Shiqu County, China. BMC Vet Res. 2020;16(1):235. Published 2020 Jul 9. doi:10.1186/s12917-020-02452-x
  8. Breitschwerdt EB, Greenberg R, Maggi RG, Mozayeni BR, Lewis A, Bradley JM. Bartonella henselae Bloodstream Infection in a Boy With Pediatric Acute-Onset Neuropsychiatric Syndrome. J Cent Nerv Syst Dis. 2019;11:1179573519832014. Published 2019 Mar 18. doi:10.1177/1179573519832014
  9. Telford SR, Goethert HK, Molloy PJ, Berardi V. Blood Smears Have Poor Sensitivity for Confirming Borrelia miyamotoi Disease. J Clin Microbiol. 2019 Feb 27;57(3):e01468-18. doi: 10.1128/JCM.01468-18. PMID: 30626663; PMCID: PMC6425185.
  10. Telford SR, Goethert HK, Molloy PJ, Berardi V. Blood Smears Have Poor Sensitivity for Confirming Borrelia miyamotoi Disease. J Clin Microbiol. 2019 Feb 27;57(3):e01468-18. doi: 10.1128/JCM.01468-18. PMID: 30626663; PMCID: PMC6425185.

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For more:

Case Report: Delayed Onset Babesia

https://danielcameronmd.com/case-report-delayed-onset-babesia/

CASE REPORT: DELAYED ONSET BABESIA

delayed-onset-babesia

Hello, and welcome to another Inside Lyme Podcast. I am your host Dr. Daniel Cameron. In this podcast, I will be discussing an unusual case of delayed onset Babesia.

Podcast:  https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5idXp6c3Byb3V0LmNvbS83NzIx

The case, involving a 19-year-old Hispanic man, was published in the Italian Journal of Pediatrics.1

Ten weeks after travelling to New York, the patient was diagnosed with the tick-borne illness Babesia. Initially, he presented with a 4-day history of fever, generalized weakness, and flu-like symptoms.

His fever was 104.8 F. His hemoglobin dropped from 9.3g/dL to 6.7g/dL within 5 hours. He was diagnosed with hemolysis and transfused with 2 units of packed red blood cells. A peripheral blood smear revealed a Maltese cross typically seen in Babesia.

Babesia is more likely to be symptomatic in individuals with a history of a splenectomy. This young man had a history of a splenectomy for hereditary spherocytosis when he was 3 years old.

Early in the disease, Babesia is more likely to be diagnosed with a thick blood smear under the microscope. But later in the course of the disease, a polymerase chain reaction (PCR) or antibody test can confirm the infection.

Babesia is more likely to be contracted in the Northeastern region of the United States. This young man had returned from a trip to New York. The disease is less likely to be contracted in Florida where the young man presented to an emergency room.

The patient was prescribed Quinine, but it was stopped due to headache, tinnitus, and blurred vision. Instead, he was successfully treated with Atovaquone, clindamycin, and azithromycin.

Two newborns with delayed onset Babesia 

During their third trimester, two mothers were treated for Lyme disease with amoxicillin. Both babies were born and discharged home. But several weeks later, the babies became ill with Babesia.²

The following questions are addressed in this Inside Lyme Podcast.

  1. What is Babesia and where are you more likely to contract the disease?
  2. How is Babesia diagnosed and treated?
  3. Can Babesia be transmitted through blood transfusions?
  4. What are the most common symptoms of Babesia?
  5. Is treatment different from Lyme disease?
  6. How frequently does Babesia co-occur with Lyme disease?
  7. Do patients with Babesia and Lyme disease present differently?
  8. Could Babesia explain why some Lyme disease patients relapse after initially improving with treatment?
  9. What is a Maltese cross?
  10. What is the importance of a splenectomy?
  11. Why is delayed onset Babesia important?

Editor’s note:  Delayed onset Babesia in two newborns is discussed in another Inside Lyme podcast.

    Thanks for listening to another Inside Lyme Podcast. You can read more about these cases in my show notes and on my website @DanielCameronMD.com. As always, it is your likes, comments, reviews, and shares that help spread the word about Lyme disease. Until next time on Inside Lyme.

Please remember that the advice given is general and not intended as specific advice as to any particular patient. If you require specific advice, then please seek that advice from an experienced professional.

Inside Lyme Podcast Series

This Inside Lyme case series will be discussed on my Facebook and made available on podcast and YouTube.  As always, it is your likes, comments, and shares that help spread the word about this series and our work. If you can, please leave a review on iTunes or wherever else you get your podcasts.

References:
  1. Patel JK, Tirumalasetty K, Zeidan B, Jr., Desai P, Frunzi J. A Case Report of Babesiosis Seen Outside of its Endemic Area and Incubation Period. Cureus. Dec 5 2020;12(12):e11926. doi:10.7759/cureus.11926
  2. Saetre K, Godhwani N, Maria M, et al. Congenital Babesiosis After Maternal Infection With Borrelia burgdorferi and Babesia microti. J Pediatric Infect Dis Soc. Feb 19 2018;7(1):e1-e5. doi:10.1093/jpids/pix074

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For more:  https://madisonarealymesupportgroup.com/2016/01/16/babesia-treatment/

https://madisonarealymesupportgroup.com/2020/07/31/cipro-derivatives-show-promise-against-babesia-in-vitro/

https://madisonarealymesupportgroup.com/2020/07/21/babesia-in-dogs-implications-for-people/

https://madisonarealymesupportgroup.com/2021/01/08/rising-geriatric-babesia-cases-may-require-longer-treatment/

Stealth Infections & Their Detection

Dr.-Schwarzbach-Stealth-Infections-and-their-Detection (1)  pdf here

iu-105

Armin Schwarzbach PhD

Medical doctor and Specialist for Laboratory Medicine

Augsburg, Germany

AONM Annual Conference London, November 19th 2017

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**Comment**

Excellent presentation on the following stealth pathogens:

  • Mycoplasma
  • Bartonella
  • Babesia
  • Ehrlichia/Anaplasma
  • Chlamydia pneumoniae
  • Yersinia
  • Coxsackie viruses (B1, A7, A16) and many others 
  • Borrelia burgdorferi , in all its forms

While Dr. Schwarzbach wants to blame “ecosystem disruption” for the mess we are in, I think it more likely to be due to laboratory experimentation/manipulation (bioweaponization), dropping ticks from airplanes, and migratory birds and animals transporting ticks far and wide:

https://madisonarealymesupportgroup.com/2020/09/25/why-should-we-care-about-lyme-disease-a-colorful-tale-of-government-conflicts-of-interest-probable-bioweaponization-and-pathogen-complexity/

Rising Geriatric Babesia Cases May Require Longer Treatment

https://danielcameronmd.com/geriatric-babesia-rising-longer-treatment/

GERIATRIC BABESIA CASES ARE RISING AND MAY REQUIRE LONGER TREATMENT

woman with geriatric babesia receiving medication from nurse

The number of Babesia cases among the elderly in the U.S. appears to be growing. According to a study by Menis and colleagues, published in the journal Open Forum Infectious Diseases, 19,469 Medicare beneficiaries had a Babesia diagnosis recorded between 2006 – 2017, with the highest rates occurring in babesiosis-endemic states. [1]

Overall, the number of individuals contracting Babesia is rising, as well. The annual number of cases per year climbed from 4 per 100,000 to 9 per 100,000 in the U.S. between 2006 and 2017. The annual number of cases of Babesia per year for individuals over the age of 85 was 4 out of 100,000. In comparison, the number of Lyme disease cases among the elderly was 15.98 per 100,000.

Most of the cases of Babesia occurred in the Lyme-endemic states of Massachusetts, Rhode Island, Connecticut, New York, and New Jersey, according to the authors. Other states recording Babesia cases included Florida, Pennsylvania, California, Maryland, and Virginia. Some cases of Babesia were also reported in New Hampshire, Maine, Vermont, Minnesota, Wisconsin, Texas, North Carolina, and Illinois.

The most common test used to diagnose Babesia was a blood smear in the institutional setting, wrote Menis in a related paper. [2] The intracellular parasite in the red blood cell clears after a few days. The most common tests used in a physician’s office involved antibody or PCR testing. [2]

Co-infections can be deadly

A Babesia infection can be serious for patients.

Patients co-infected with Lyme disease experienced more symptoms and a more persistent episode of illness than did those (n=10) experiencing babesial infection alone,” wrote Krause and colleagues [3]. In another paper, the authors explain, “Immunocompromised people who are infected by B. microti are at risk of persistent relapsing illness.” [4]

For some patients, including the elderly, a Babesia infection can be more serious. “Babesiosis can be life threatening, particularly for persons who are asplenic, immunocompromised, or elderly,” wrote Krause et al. [4]

85-year-old dies from Babesia and Ehrlichia

Javed and colleagues describe the case of an 85-year-old man who died of a concurrent Babesiosis and Ehrlichiosis infection. [5]

He was an avid gardener and golfer in good health except for hypertension. He did not have a tick bite or rash. The man was hospitalized with weakness and jaundice. He had mild anemia, a very low platelet count, a mildly elevated bilirubin, and mildly reduced renal function.

The doctors diagnosed Babesia based on a bone marrow biopsy revealing intraerythrocytic inclusions (tetrads), typical of babesiosis. In retrospective, his admitting bloods from admission revealed parasitemia in 8% of the red blood cells. The Babesia antibody IgM and IgG were positive for Babesia.

READ MORE: Elderly Lyme disease patients more likely to have unfavorable treatment outcomes

The elderly man was treated with IV clindamycin and IV quinine. His anemia worsened despite transfusion of two units of blood and he was transferred to a tertiary hospital for possible exchange transfusion. The doctor added azithromycin but not Atovaquone.

His condition worsened. His oxygen saturation dropped to 84% and he subsequently developed bilateral pneumonia, renal failure, hepatic failure, and a coma. He was too ill to tolerate exchange transfusion.

He died within 60 hours of admission to the tertiary care center.

Post-mortem tests were positive for Human Monocytic Ehrlichiosis, the cause of Ehrlichia. He was never treated with doxycycline, the most commonly prescribed medication for Ehrlichia.

Treatment of Babesia

Krause and colleagues reported that a 10-day course of Mepron and Zithromax would be as effective as clindamycin and quinine and have less side effects. [3] The Medicare beneficiaries were far more likely to be prescribed Mepron with Zithromax than clindamycin and quinine. [1]

Some patients with Babesia require longer treatment. Krause and colleagues reported immunocompromised and elderly patients were more likely to need longer term therapy.” [4]

In another paper, the authors point out that,

“Such patients generally require antibabesial treatment for >or=6 weeks to achieve cure, including 2 weeks after parasites are no longer detected on blood smear.” [4]

More than one-third of elderly Babesia patients were not treated with anti-Babesia treatment during their evaluation. The study was not designed to determine if the elderly were subsequently treated.

IDSA position

The 2020 Infectious Diseases Society of America (IDSA) guidelines for Babesia highlighted concerns regarding severe Babesia in the elderly.

“Numerous immunodeficiencies and comorbidities have been associated with severe babesiosis, including asplenia and hyposplenism, cancer, congestive heart failure, HIV infection, immunosuppressive drugs, and advanced age.” [6]

For immunocompromised patients, we suggest monitoring Babesia parasitemia using peripheral blood smears even after they become asymptomatic and until blood smears are negative. PCR testing should be considered if blood smears have become negative but symptoms persist (weak recommendation, moderate-quality evidence).

In addition, the IDSA guidelines advised longer treatment for immunocompromised Babesia patients.

“A subgroup of highly immunocompromised patients reported in a case control study required at least 6 consecutive weeks of antibiotic therapy, including 2 final weeks during which parasites were no longer detected on peripheral blood smear.” [6]

However, some patients can relapse.

“A few cases of relapse despite at least 6 consecutive weeks of atovaquone plus azithromycin demonstrate that resistance to atovaquone and/or azithromycin can emerge in highly immunocompromised patients during an extended course of this antibiotic combination,” wrote Krause et al. [6]

Editor’s note: I share the same concerns regarding Babesia in the elderly, and I base the length of antibiotics on the patient’s response to treatment.

References:
  1. Menis M, Whitaker BI, Wernecke M, et al. Babesiosis Occurrence among the U.S. Medicare Beneficiaries Ages 65 and Older, During 2006-2017: Overall, and by State and County of Residence. Open Forum Infectious Diseases. 2020
  2. Menis M, Forshee RA, Kumar S, McKean S, Warnock R, Izurieta HS, Gondalia R, Johnson C, Mintz PD, Walderhaug MO, Worrall CM, Kelman JA, Anderson SA. Babesiosis Occurrence among the Elderly in the United States, as Recorded in Large Medicare Databases during 2006-2013. PLoS One. 2015 Oct 15;10(10)
  3. Krause PJ, Telford SR, 3rd, Spielman A, et al. Concurrent Lyme disease and babesiosis. Evidence for increased severity and duration of illness. JAMA. Jun 5 1996;275(21):1657-60.
  4. Krause PJ, Gewurz BE, Hill D, et al. Persistent and relapsing babesiosis in immunocompromised patients. Clin Infect Dis. Feb 1 2008;46(3):370-6. doi:10.1086/525852
  5. Javed MZ, Srivastava M, Zhang S, Kandathil M. Concurrent babesiosis and ehrlichiosis in an elderly host. Mayo Clin Proc. May 2001;76(5):563-5. doi:10.4065/76.5.563
  6. Krause PJ, Auwaerter PG, Bannuru RR, et al. Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA): 2020 Guideline on Diagnosis and Management of Babesiosis. Clin Infect Dis. Nov 30 2020;doi:10.1093/cid/ciaa1216

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For more:  https://madisonarealymesupportgroup.com/2016/01/16/babesia-treatment/

Mainstream medicine still does not believe the seriousness of this complex illness that thousands upon thousands are suffering from.  The interaction of confections make cases extremely difficult to treat.  Do not mess around with this, get to a Lyme literate doctor asap:  https://madisonarealymesupportgroup.com/2020/11/25/what-makes-a-doctor-lyme-literate/  These doctors typically layer treatment to reduce any potential of resistance to treatment.  We often took 4 things simultaneously.