Archive for the ‘Babesia’ Category

Complete Guide to Lyme Disease & Coinfection Tests

https://rawlsmd.com/health-articles/just-how-reliable-are-lyme-disease-lab-tests

Dr. Rawls’ Complete Guide to Lyme Disease and Coinfection Tests

This is a newly updated excerpt taken from Dr. Rawls’ best-selling book Unlocking Lyme. This installment focuses on how reliable diagnostic testing is for Lyme disease and Lyme coinfections.

by Dr. Bill Rawls
Updated 3/1/21

An Introduction to Lab Testing

Lyme disease tests can serve as valuable resources for the diagnosis and treatment of tick-borne disease. But it’s important not to get too hung up on the results.

The problem of chronic Lyme disease, can’t be solved exclusively by looking at lab results, which is something I know from personal experience. In fact, becoming overly obsessed with lab results can hinder the recovery process.

Lab work provides a snapshot of what’s going on inside your body. But multiple other factors — including your symptoms, the length of time you’ve had them, and clinical presentation, as well as the environments in which you live, work, and travel — all factor into making an accurate diagnosis.

Furthermore, the human body is an immensely complex biological machine, with millions of different biochemical functions happening simultaneously. Lab tests provide an ever-so-small glimpse at certain key functions of different systems in the body. From those indicators, determinations can be made about how well the body is functioning and whether illness is present.

Laboratory assessment, however, is far from absolute. Because the human body is so complex, the ability of lab testing to predict a specific chronic illness, such as one from a tick-borne disease, is often limited. All labs are subject to variability and different interpretations.

There are literally thousands of different lab tests that can be performed, but only a fraction of them are well understood. Many should be left for research purposes only. Problems arise when doctors order obscure tests that are still poorly understood. Before you have labs drawn, ask your doctor to explain the purpose of each test and why they would be helpful in addressing your health situation.

The information provided by labs is only valuable if it is put to good use. Millions of dollars are wasted every year on labs, with the resulting information never used. Before you have labs drawn, ask yourself and your doctor: “Will the information from this lab — or any other diagnostic test — influence my approach to getting well?” If the answer is no, then you may want to reconsider having that particular test performed.

For chronic illnesses like chronic Lyme disease, fibromyalgia, and chronic fatigue syndrome, general lab evaluations are usually unremarkable. In these cases, the greatest value of labs is ruling out the possibility of a more threatening condition. Mildly abnormal labs generally return to normal as your health improves.

The following is a guide to the labs that I’ve found to be most valuable in evaluating chronic illnesses like chronic Lyme and fibromyalgia. It is, by no means, an absolute or exclusive list.

Basic Lab Tests Everyone Needs

side view of scientist writing down test results while working in laboratory

There are certain basic tests and a few specialized ones that have great value. These are the tests that everyone who suspects they have Lyme should consider getting. In addition to taking a detailed medical history, the following list of labs can be ordered by any healthcare provider. Typically, these tests are covered by health insurance.

Complete Blood Count (CBC with Differential)

This test measures cellular components of blood:

  • White Blood Cell count (WBC): Low WBC (< 4,000) can indicate chronic infection with a virus or low-virulence bacteria such as mycoplasma, but it can also occur in healthy people. Elevated WBC (>11,500) can indicate an active infection.
  • Differential (diff): This measures different types and ratios of white blood cells present. Sometimes, it can be helpful for defining a particular type of infection (bacteria vs. viral vs. parasite), but it is not always absolute.
  • Hemoglobin (Hb): Anemia is indicated by Hb < 12.0. Anemia can be caused by blood loss due to factors like heavy periods, inadequate production of red blood cells (RBCs), and increased destruction of RBCs from malaria, babesia, bartonella, or other infections. Hb levels > 16.0 can be associated with smoking, living at altitude, and excessive iron stores in the body (hemochromatosis).

Blood Chemistries

These are a measure of common chemical components of the body, including:

  • Electrolytes: Sodium, potassium, chloride, CO2; these are generally normal, unless you are really sick.
  • Liver function: Abnormal values suggest an elevated rate of liver compromise, possibly from toxins or viruses such as hepatitis. Elevated bilirubin suggests increased breakdown and turnover of red blood cells (babesia, bartonella). Certain low-virulence microbes (bartonella) destroy red blood cells.
  • Kidney function: BUN (blood urea nitrogen) and creatinine screen for kidney disease.

Glucose Metabolism

Excessive carbohydrate consumption is a major system disrupter that must be controlled before recovery is possible. Three primary tests — fasting blood glucose, hemoglobin A1c, and fasting insulin — define insulin resistance and abnormal glucose metabolism:

  • Fasting blood glucose: Levels >100 mg/dl suggest pre-diabetes. Levels >126 mg/dl suggest overt diabetes.
  • Fasting insulin: Levels defined as elevated suggest insulin resistance (normal range varies depending on the lab). Insulin resistance is a factor contributing to immune dysfunction and hormone imbalances.
  • Hemoglobin A1c (HbA1c): HbA1c measures the cumulative damage done by excessive carbohydrate consumption. Ideal is 4.8-5.2%. Levels > 5.6% indicate pre-diabetes. Levels > 6.4% indicate overt diabetes.

Minerals

Magnesium and calcium are the primary minerals measured:

  • Magnesium: Magnesium levels are often low during chronic illness. Aggressive magnesium supplements, however, can often worsen Lyme symptoms. Generally, magnesium levels will return to normal as health improves.
  • Calcium: Persistently elevated calcium levels can indicate the presence of a small benign tumor producing excessive parathyroid hormone (PTH). Symptoms can mimic fibromyalgia and chronic Lyme. Follow-up testing should include PTH levels.

Thyroid Function

Complete thyroid function should include thyroid stimulating hormone (TSH), free T4, free T3, and thyroid antibodies. Illnesses associated with chronic immune dysfunction are commonly associated with abnormal thyroid function. Correcting abnormal thyroid function can accelerate recovery. Testing for thyroid antibodies (TPO and thyroglobulin) is important to identify Hashimoto’s disease, a form of autoimmune thyroid dysfunction.

Lipid Panel

This is a basic evaluation for cardiovascular risk. Cholesterol commonly increases with age and/or a decline in liver function. Cholesterol can be lowered by following specific nutritional guidelines. Significantly elevated cholesterol, however, should be addressed by your healthcare provider and may require medication.

Autoimmune Testing

Chronic immune dysfunction and stealth microbes like borrelia play a major role in autoimmunity. The type of autoimmune illness that occurs is related to the factors that disrupt immune function, the person’s genetics, and the spectrum of stealth microbes.

Though diagnosis of specific autoimmune illnesses is complex and requires extensive testing, basic screening for autoimmunity can be done with two tests:

  • Rheumatoid factor: A standard test, it reveals if severe arthritis is present
  • ANA titer: Positive in many types of autoimmune disease

C-Reactive Protein (CRP)

CRP is a measure of inflammation. It is probably more valuable for monitoring health habits than anything else. High levels (>10) correlate with poor health habits and increased risk of disease.

Normal CRP levels, however, are often present in individuals who follow good dietary habits and yet still suffer from a chronic illness.

Vitamin D

Vitamin D is not only important for healthy bones, but also very important for normal immune function. There are several forms of vitamin D; calcidiol (25 OH vitamin D) is the most commonly measured form in blood tests.

Both normal ranges for blood levels of vitamin D and indications for supplementation are controversial, and various medical organizations and nonprofit groups don’t seem close to reaching a consensus just yet. For example, the Institute of Medicine (IOM) considers up to 4,000 IU of vitamin D3 a safe dosage for most adults. But the Endocrine Society suggests a safe dose for most adults can go all the way up to 10,000 IU.

With the differing viewpoints, how do you know what to do? For starters, know that levels of >40 ng/ml have been associated with reduced risk for many cancers and for chronic disease in general. And achieving consistent vitamin D levels of >40 ng/ml is also important for Lyme disease, chronic fatigue syndrome, and fibromyalgia recovery.

Ultimately, the best way to stay on top of your vitamin D levels is to work with your healthcare provider to determine which dose is right for you. Ideally, have your levels checked every six months.

Vitamin B12

Low B12 levels (normal ranges vary between labs) can be a sign of low intake (sometimes seen in vegetarians), but more commonly it’s a sign of inadequate absorption and gastric dysfunction. Vitamin B12 generally increases spontaneously with improved health habits, but in the short term, B12 injections or sublingual (under the tongue) supplements can improve energy levels. Activated forms like methylcobalamin or hydroxocobalamin of B12 are better absorbed orally than the more common inactive form, cyanocobalamin, used in most multivitamin products.

Ferritin

Ferritin measures iron stores. Low ferritin levels can indicate low stores of iron in the body, which can be associated with fatigue. High ferritin levels indicate abnormal retention of iron in the body (called hemochromatosis), which can be associated with liver damage and nonspecific symptoms. High levels can also be associated with autoimmunity and chronic infection.

Urinalysis

Test strips for urine testing can be obtained online without a prescription. Here’s what they measure for:

  • pH: Urine pH should be consistently alkaline, reflecting high consumption of vegetables and fruit. A normal range is 4.5 to 7.8.
  • WBCs, nitrites: These tests show evidence of a urinary tract infection.
  • Protein: Elevated levels can indicate kidney disease.
  • Bilirubin: Elevated levels show increased turnover or destruction of red blood cells.

Mold and Mycotoxins

Evaluation for mold is indicated anytime there is any suspicion of mold. It is possibly the most important evaluation you can do. Mycotoxins (mold toxins) are potent immune disruptors and cause a wide spectrum of nonspecific symptoms, including a chronic inflammatory response, neurological symptoms, and persistent insomnia. If mold sensitivity is an issue, the only option for complete relief is eradicating mold from your environment.

The first step in evaluating for mold is using your nose and eyes to search for it. Moisture is necessary for mold to grow. Mold, however, can be hidden in walls, crawl spaces, attics, and more. It is possible to test for mold with simple kits that can be ordered online. It is also possible to test for mycotoxins in urine or the potential for mold exposure through blood tests. Ones that could potentially be useful include:

  • HLA-DR: This genetic blood test determines whether a person has the genes that trigger the immune system to properly recognize and excrete mycotoxins from the body.
  • C4a: C4a is a complement protein known as an anaphylatoxin, a substance that creates a response similar to an allergic reaction. It also executes tasks related to the immune system and inflammation. An elevated C4a may be present in individuals who have been exposed to mycotoxins. Note that C4a levels may also be elevated in patients with Lyme disease and lupus.
  • MSH (Melanocyte-Stimulating Hormone): The hormone MSH is produced in the hypothalamus and the pituitary gland. It regulates neuroimmune pathways, including melatonin, cortisol, cytokines, sex hormones, and the integrity of mucous membranes. Among mold patients who developed Chronic Inflammatory Response Syndrome (CIRS), 95% have decreased MSH functioning.
  • VCS (Visual Contrast Sensitivity): A VCS test measures your ability to detect changes in visual contrast, a function that may be impaired in individuals who have been exposed to biotoxins. The test is available online or can be completed in a doctor’s office.

However, with or without testing, the solution to a mold problem is completely avoiding mold. Testing may only be needed if you’re not getting better within weeks or months after complete elimination of the mold problem.

Advanced Laboratory Testing

Laboratory tests in glass flasks closeup. Chemical reagents in medical lab

The following tests are discussed because they are often recommended, but they seldom influence the status of recovery. These tests should be reserved for special circumstances or when recovery is not progressing, but not performed routinely.

Omega-3/Omega-6 Ratio

The ratio of omega-3 fatty acids to omega-6 fatty acids is a marker for balance of inflammatory factors in the body. Proper diet and supplementation generally result in satisfactory omega fatty acid ratios.

Cytokine Testing (Th1/Th2)

Cytokines are the messengers of the immune system. Cells of the immune system use cytokines to signal to each other and pass directions. Stealth microbes manipulate cytokines to generate inflammation and redirect immune functions in favor of the microbe.

Though the immune system and its interactions with different microbes is extremely complex (still beyond our complete understanding), effort has been made to simplify immune functions into two pathways important for chronic illnesses associated with stealth microbes. Below, “Th” stands for T helper cells:

  • Th1 pathway: Associated with cell-mediated immunity and intracellular pathogens. When the Th1 pathway is overactive, it’s associated with inflammation and autoimmunity.
  • Th2 pathway: Associated with antibody-mediated immunity and extracellular parasites. When overactive, the Th2 pathway is associated with asthma and allergies.

This is, of course, an oversimplification of a very complex process. In general, chronic Lyme and other illnesses associated with chronic immune dysfunction and stealth microbes are Th1 dominant.

Many herbs help balance this dysfunction by reducing overactive cytokines associated with inflammation and enhancing antibody and functional cell mediated immunity. A few herbs that stimulate Th1 functions (astragalus, echinacea) should be avoided during the early stages of recovery. Generally, measuring cytokines is unnecessary for recovery.

Adrenal Hormone Testing

Adrenal dysfunction or adrenal fatigue is a given in any chronic illness. Elevated cortisol levels, associated with increased physical and emotional stress, contribute to sleeplessness, stress intolerance, agitation, and anxiety. Prolonged adrenal stress can deplete cortisol, with resulting symptoms of extreme fatigue, total stress intolerance, and excessive sleeping (but sleep is dysfunctional and not restful).

Because adrenal dysfunction is always present in chronic illness and generally normalizes with proper therapy, measurement of adrenal hormone levels is generally not necessary. On rare occasions when a patient is not improving, measurement of cortisol can be beneficial.

  • Salivary cortisol: Measured four times over 24 hours, it’s the best measure of adrenal function, but symptoms are often a better guide.
  • Dehydroepiandrosterone sulphate (DHEAS): DHEAS measures adrenal function; high levels indicate excessive function, and low levels indicate inadequate function. This test is often performed, but it is not as reliable as cortisol measurement (which is also usually unnecessary, as symptoms are generally adequate to evaluate adrenal function). It is useful in only select circumstances.

Reproductive Hormones

Menopause can exacerbate the symptoms of any chronic illness. Though usually obvious (with the absence of periods), menopause can be confirmed by an elevated pituitary hormone called FSH: levels >25 indicate menopause. Other hormone levels, including estrogen and progesterone, are generally not necessary to measure, but may be recommended by your healthcare provider. In men with fatigue, total and free testosterone are sometimes indicated.

  • Female: Salivary or blood E1, E2, E3, free testosterone, progesterone, FSH (screening FSH, Estradiol levels)
  • Male: Free testosterone, total testosterone

Testing for Toxins

Build-up of heavy metals and other toxins can be a hidden factor in chronic illness. However, every person living on the planet today is carrying some heavy metals, and no one really knows how much is enough to cause disease. The biggest source of concern is amalgam dental fillings (though recent opinions are suggesting that amalgam fillings do not shed as much mercury as once thought).

A healthful diet and lifestyle along with key supplements will generally reduce heavy metals in the body. Save heavy metal testing for last on the list; if you are still not getting better, ask your doctor about testing.

  • Hair samples: This is the least reliable method of testing for heavy metals.
  • Blood test: It’s valuable only for testing acute exposure.
  • 24-hour urine after DMSA: This is the most accurate assessment. Urine is collected for 24 hours after use of 100 mg of DMSA (Dimercaptosuccinic acid, a chelation medication) to pull heavy metals out of tissues.

The presence of organic toxins (pesticides, plastic residues) is almost a given and can be addressed with dietary and lifestyle modifications. Chlorella is excellent for pulling organic toxins out of the body.

Food Sensitivities

Chronic gastrointestinal dysfunction is often associated with sensitivities to commonly consumed foods (which is not the same as food allergies, like a peanut allergy). Symptoms associated with food sensitivities are commonly delayed for 1-2 days after the food is consumed. Typical symptoms include fatigue, joint pain, muscle pain, and general achiness — in fact, food sensitivities alone can be the root of many symptoms.

  • Food sensitivities are best determined by an elimination diet — a diet designed to selectively eliminate and identify problem foods.
  • Problem foods can also be delineated with specific IgG and IgA testing. Currently, there are several food sensitivity tests on the market, and many of them can be customized to test a range of foods, preservatives, medications, and more, and some can be delivered to your home. Depending on the company used and number of items tested, prices vary from just under $200 to several hundreds of dollars.

Comprehensive Stool Analysis

Stool analysis is valuable for defining gastrointestinal dysfunction and diagnosing parasites and yeast overgrowth. This expensive test is generally reserved for extreme cases when dietary modifications and supplements are not enough to overcome gastrointestinal problems. It is rarely necessary.

Folate and Methylation

There are about 40 different genetic mutations that can affect MTHFR, a gene that plays an important role in the body’s ability to use folate or folic acid. About 40% of the population has one abnormal gene and are moderately affected. About 12% of the population has two abnormal genes and is more significantly affected.

Problems associated with MTHFR mutations include elevated risk of stroke and heart attack, increased cancer risk, defects in embryo development (spinal tube defects), and neurological symptoms including insomnia, irritability, depression, brain fog, neuropathy (burning tingling feet and hands), and restless legs syndrome. It also can be a factor in recovery from fibromyalgia and Lyme disease.

For folks who want the technical details:

MTHFR is a gene that codes for an enzyme called methylenetetrahydrofolate reductase. This enzyme is vital for creating 5-methyltetrahydrofolate, an essential substance for converting the amino acid homocysteine into the amino acid methionine.

Methionine is essential for amino acid synthesis, formation of glutathione (an important intracellular antioxidant), formation of DNA, and detoxification. Methionine is also important for formation of SAMe, which plays a key role in metabolism of dopamine, serotonin, and melatonin. Without this important enzyme, all these pathways are blocked.

Testing for MTHFR mutations involves a simple blood test or DNA cheek swab that costs about $100 to $200; the blood test may be covered by insurance. Checking for elevations of homocysteine and RBC folate in the blood is an indirect way to check for the problem.

The best solution for elevated levels is getting plenty of natural 5-methyltetrahydrofolate (methylfolate for short). Leafy greens are a great source, but if you have a mutation, supplementing is a good idea. Folic acid, found in most multivitamin products, will not work because it must be converted by the deficient enzyme.

You must supplement with 5-methyltetrahydrofolate; 400-800 micrograms daily is generally adequate for anyone with a single mutation (especially if you eat plenty of leafy greens). If you have a double mutation, it is a good idea to take an extra 400-800 micrograms. For additional benefit, you can add 400-800 mg of SAMe daily, in the evening. SAMe supports detoxification and can improve sleep.

Chemical components called “methyl groups” that are essential for proper detoxification can also be supplied by vitamins B6 and B12. It is, however, important to get the activated forms of these important vitamins. The activated form of vitamin B6 is pyridoxal 5-phosphate, and the active form of vitamin B12 is methylcobalamin.

Healthful diet and adequate supplementation of methyl donors is generally adequate for recovery. MTHFR testing is only necessary if recovery is not progressing.

In my medical practice, I had the fortune of working with a lab that measured MTHFR for no charge. For the five years it was available, I tested all my patients. Surprisingly, I found it played a more minor role in recovery than I expected. I had chronic Lyme sufferers who were severely symptomatic who had no mutations, and perfectly healthy people who had double mutations.

Testing Beyond the Lab

Doctor checking brain scan for Lyme euro symptoms

Certain types of symptoms require evaluation by diagnostic procedures conducted by specialists in their respective fields. These symptoms include:

  • Neurological symptoms: Severe neurological symptoms are evaluated with a nerve conduction test and MRI of the brain to assess the nervous system. The purpose is ruling out multiple sclerosis.
  • Cardiac symptoms: Heart symptoms like chest pain and irregular heartbeat are evaluated by EKG and Holter monitor (a wearable device for tracking your heart rhythm). Findings may lead to cardiac catheterization.
  • GI symptoms: Stomach pain and symptoms are often evaluated by an upper endoscopy. Lower intestinal and colon symptoms are evaluated by colonoscopy. Routine colon cancer screening with colonoscopy is recommended every 10 years for everyone over 50.

Testing for Microbes

bacterias and microbes under microscope. Viral disease. 3d illustration

Testing for microbes in chronic illness is often like opening up a can of worms. Detection of a microbe in the body is only as good as the technology, and right now, the technology for diagnosing borrelia and other low-virulence stealth microbes is fair at best (they’re called “stealth” microbes for a reason).

And that’s for the species of microbes we know about. Research continues to press on in the search for stealth microbes that play a role in Lyme disease, including new forms of borrelia.

The long and the short of it is, all ticks carry potentially pathogenic microbes. If you have ever been bitten by a tick, you have been exposed to microbes, and you likely harbor one or more stealth microbes in your body. If you have all the signs and symptoms of chronic Lyme disease, then the chances that you are carrying some species of borrelia is high — no matter what the testing shows.

When you consider that borrelia has been prevalent in ticks worldwide for thousands of years, and that asymptomatic carriers are extremely common, borrelia is probably much more prevalent than is widely accepted.

The other side of the story is that as testing gets better and better, it will likely reveal that many healthy people have borrelia, and that everyone harbors some stealth microbes — Lyme coinfections like mycoplasma, bartonella, chlamydia, and many others are remarkably common.

The key to being healthy is robust immune function.

When you start seeing chronic Lyme disease for what it is — chronic immune dysfunction, with a pot of stealth microbes boiling over — the compulsion to test for specific microbes becomes less relevant. There are always possibilities that can’t be accounted for.

When I evaluate a person with possible chronic Lyme disease, it’s easier to just assume that borrelia and other stealth microbes are present. This allows me to have less reliance on unreliable lab results.

To Test or Not To Test

Sick man wrapped into blanket sitting on sofa in front of table with papers while staying at home

Our ability to test for microbes species is limited to a small piece of a much larger pie of unknowns. The total microbiome of the body consists of many thousands of microbe species; who knows how many of them are stealth microbes or opportunistic pathogens. A comprehensive herbal protocol covers for most possibilities, both known and unknown.

Which brings up the question: “Why test at all?”

Frankly, the most pressing reason to test is academic — that “need to know” quality that we all share as humans.

If you choose a conventional route of therapy, however, testing will likely be necessary. In fact, many doctors will not consider writing a prescription until testing is done and results are available. Considering the extreme limitations of the present state of testing for stealth microbes, it is one of the major drawbacks to pursuing a conventional route of therapy.

If you choose a natural route of therapy, testing is much less necessary. A comprehensive herbal protocol covers for borrelia and most other possibilities (without the toxicity associated with drugs and synthetic antibiotics). Many people have gotten well without doing any testing at all.

The biggest reason to test is if you are not improving. Sometimes testing can uncover the presence of other vector-borne diseases (babesia, ehrlichia, rickettsia, anaplasma), or viral reactivation of a herpes-type virus for which a prescription antimicrobial may provide benefit.

That nagging need to know, however, is a fundamental characteristic of human nature. “Could there be something present that could be easily treated?” is a question that often lingers in the back of everyone’s mind. Before proceeding any further, however, know that testing for microbes can unnecessarily complicate your recovery.

There are no absolutes when it comes to stealth microbes. A negative test does not rule out the possibility of a certain microbe being present or the possibility of other microbes being present. Diagnosis should not rely on labs alone. It’s a matter of adding up all the clues, including the symptom profile, prevalence of possible microbes in the geographic area, and any other factors that may be helpful in making the diagnosis.

If you decide to do lab testing, the place to start is with labs covered by your medical insurance. Insurance policies are highly variable, however, and it is up to you (not your doctor) to find out what is and isn’t covered.

Most healthcare insurance policies will cover testing for borrelia and possible coinfections with in-network labs. Most in-network labs, however, only do basic-level testing, which often carries a low probability of actually diagnosing an offending microbe.

Specialty labs do more advanced and sophisticated lab testing, but are generally not covered by insurance, and they can be pricey. Expense is the primary reason these tests are not covered by insurance. Testing for borrelia alone is not sufficient; if you are going to do testing, you really need to test for all the known possibilities. This can run $1,000 or substantially more.

Because of demand, there is a proliferation of specialty labs doing testing. The oldest and possibly best-known is IGeneX, but there are many new and innovative testing labs coming on the scene. Blood can be drawn at the doctor’s office and sent to a specialty lab, but you will probably be responsible for the bill.

Reasons to Test

Here are some of the more compelling arguments in favor of testing:

  • Needing to know
  • Some stealth microbes are more virulent than others and respond better to antibiotic therapy; a positive test can help direct therapy.
  • Obtaining lab tests for microbes supports research and increases the knowledge base of stealth microbes.
  • Financial support for labs and institutions doing testing.
  • Testing for a specific microbe is primarily valuable for acute symptoms after a tick bite.
  • Testing for Epstein-Barr virus (EBV), cytomegalovirus (CMV), and other herpes-type viruses (there are eight that commonly infect humans) can be valuable because high titers associated with reactivation of these viruses may respond to antiviral therapy.

Limitations of Testing

Current testing options are indeed limited, and results often don’t contribute to faster or more successful recovery. Here’s a summary of testing limitations:

  • Multiple microbes are always present; a positive test for one does not rule out the presence of others.
  • During chronic infection, stealth microbes occur in very low concentrations in isolated areas of the body, making diagnosis by any means very challenging.
  • Stealth microbes commonly live inside cells, and some can exist in cyst forms (especially when they are under pressure). Both are factors that make diagnosis a real challenge.
  • Stealth microbes readily manipulate the immune system — detection depends on antibody production.
  • Cross-reactivity with other bacteria is common, including normal flora.
  • Most testing is species specific; many species of each type (genera) of microbe are possible, for which there is no available testing.
  • Symptoms of chronic Lyme can occur without the presence of borrelia and can be caused by other stealth microbes (though borrelia may be present with a false negative test).
  • Everyone harbors stealth microbes; the microbiome is extremely complex.
  • The concept of testing for chronic infections with stealth microbes is relatively new; most testing is focused on acute illness.
  • False negative rates are high for all forms of testing; false positives are also possible.
  • Testing for the many possibilities can run several thousands of dollars, often not covered by insurance.
  • A positive test for a specific microbe can provide false peace of mind.
  • A negative test does not exclude the presence of a microbe (especially during chronic illness).

Common Types of Testing for Microbes

Close up of unrecognizable scientist dropping blood samples in test tubes while working on research in laboratory, copy space

Testing is getting better, and there are a variety of different ways to test, but none of them are anywhere near 100% accurate. Testing is mostly useful for diagnosing acute illness. This is especially true when symptoms of illness suggest infection with a higher virulence microbe that might respond to acute treatment with antibiotics. New innovations may gradually improve testing for chronic illness associated with stealth microbes.

Direct Testing

Direct testing includes visualizing the microbe directly in tissue or blood samples, or growing the microbe out of tissue or blood samples in a media that is specific for that microbe. Direct testing is not species specific, so any species of the microbe can be diagnosed. Polymerase chain reaction (PCR) tests look directly for the microbe’s DNA and are species specific (uncommon species may be present but will not be diagnosed).

These forms of testing are most useful for diagnosing acute infections. Direct methods are not reliable for chronic infections because stealth microbes occur in such low concentrations in the body during chronic infection, are not present in the blood in high numbers, can occur in dormant or cyst forms, live inside cells, and gravitate toward isolated recesses of the body.

Examples of direct testing:

  • Tissue/Blood: Direct visualization
  • Tissue/Blood Culture: Uses culture media specific for the microbe to grow the microbe in culture
  • Polymerase Chain Reaction (PCR): Direct detection of microbe DNA in tissues, blood, and urine

Indirect Testing (Serology)

Indirect testing relies on antibody production to the microbe (serology). Evidence of acute infection is best evaluated with IgM antibodies and late acute or chronic infection with IgG antibodies. Some testing regimens require serial titers (testing at different time intervals) to distinguish between acute and chronic infections.

Different types of serology are available for different microbes. Accuracy for testing chronic illness associated with stealth microbes is greatly limited by low concentrations of the microbe in the body with reduced or inadequate antibody response for testing.

Examples of indirect testing include:

  • Enzyme-Linked Immunoassay (ELISA test, EIA): It measures antibodies in the patient’s serum that are specific to microbial antigens (part of the microbe) by using labeled enzymes to bind the antibodies for measurement.
  • Immunofluorescence Assay (IFA): This test utilizes fluorescent dyes to identify the presence of microbe-specific antibodies in the patient’s serum.
  • Western Blot: Detects antibodies to multiple different microbial antigens by measuring different protein bands. Collectively, the presence of multiple bands allows diagnosis of infection with a specific microbe. A Western Blot is more sensitive than ELISA for borrelia.

Diagnosing Borrelia

The stealth nature of Borrelia burgdorferi makes it very difficult to diagnose. Developing tests to detect it is a real challenge because it:

  • Stays deep in tissues
  • Has the ability to live inside cells (intracellular)
  • Has elaborate ways of tricking the immune system
  • Changes its genetic signature readily
  • Doesn’t require high concentrations of microbes to cause illness

In the United States, mainstream Lyme testing is specific for Borrelia burgdorferi, but there are presently 21 other species of Borrelia that can cause Lyme disease. In Europe, two other species of borrelia — Borrelia afzelii and Borrelia garinii — are more common than Borrelia burgdorferi as a cause of Lyme disease.

Because of the mobility of people, different borrelia species are circulating around the world. This contributes to another layer of difficulty in diagnosis. It is becoming evidence that other species are much more common than once thought.

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Bull’s-Eye Rash (Erythema Migrans)

The classic bull’s-eye rash is signified by redness extending outward from the tick bite site with an outer, more prominent red ring. Symptoms of Lyme disease associated with a history of tick bite and bull’s-eye rash are the most reliable way to diagnose infection with borrelia, but even that is far from absolute.

There are likely other types of microbes that can cause a bull’s-eye rash. Only ⅓ of people with Lyme disease will have bull’s-eye rash, and only 10% of bull’s-eye rashes are associated with the presence of borrelia in the blood.

Blood/Tissue Culture

The most definitive test for proving the presence of a microbe is growing it in a lab from a tissue or blood sample. Because borrelia exists in such low concentrations in blood and tissues, and because borrelia is so difficult to grow under artificial conditions, cultures are generally not useful for diagnosing Lyme disease.

EIA tests (ELISA and ELFA)

This tests the host for antibodies produced against borrelia. It is recommended as a screening test for Lyme disease. The Centers for Disease Control (CDC) defines this test as an important screening test for Lyme disease. But in clinical practice, most healthcare providers who treat Lyme disease find that this Lyme disease test has poor predictive value and limited usefulness. It has no value for diagnosing chronic Lyme.

PCR for B. burgdorferi

Short for Polymerase Chain Reaction, a PCR tests directly for borrelia DNA in the host’s blood, tissues, or urine. Historically, PCR has had limited accuracy, but improvements in technique are allowing PCR for microbial DNA to be the future of testing. At some point, it may be possible to define a person’s entire microbiome.

For now, testing is available for the most common species of borrelia and many common species of coinfections with other stealth microbes. Testing is most accurate during acute infection, and much less accurate during chronic infection.

Again, the bottom line is that if you have many or most symptoms of chronic Lyme disease, then you are likely harboring at least one species of borrelia and several other species of stealth microbes — no matter what the testing shows.

Many companies are offering microbial DNA testing, but a few are taking the lead. DNA Connexions tests DNA in either blood or urine specimens for three species of borrelia and several of the most common coinfections. Testing kits are available online.

Western Blot

The Western Blot for Borrelia burgdorferi relies on production of antibodies by the host’s immune system for different parts (antigens) of the bacteria. Antibody production does not occur until the body’s secondary defense kicks in, and it’s dependent on the host’s ability to mount an immune response.

The Western Blot test may provide a more accurate diagnosis of Lyme disease than most of the other available tests, but testing is more valuable for the late acute than chronic illness. In addition, the test is oriented toward diagnosis of Borrelia burgdorferi, and not other species of borrelia that may cause Lyme disease.

Because borrelia shares antigens with other bacteria, multiple positive antibodies (called bands) are required for a true positive test. Western blot is performed for both IgM and IgG antibodies in an effort to separate acute from chronic illness.

IgM antibodies show acute Lyme disease. IgM testing can be positive as early as one week after infection, and remains positive for six to eight weeks after initial exposure. CDC guidelines require two positive bands out of three (23-25, 39, 41). IGeneX labs add three extra bands (31, 38, 83-93), the first two of which were removed from the CDC criteria during the development of an unsuccessful vaccine and were never replaced.

The IgG antibody is typically present a few months following initial infection. IgG antibodies are more indicative of chronic disease. CDC guidelines require five positive bands out of 10 (18, 23-25, 28, 30, 39, 41, 45, 58, 66, 83-93). The IGeneX criteria is two bands out of six (18, 23-25, 28, 30, 39, 41, 45, 58, 66, 83-93). Band 41 is specific for the flagella (tail) of spirochetes (corkscrew bacteria), but is not absolutely specific for borrelia.

Acute viral infections can cause false positive results. Data reported from IGeneX supports that some Lyme patients may have only restricted IgM response to Borrelia burgdorferi. Because Lyme patients have different immune systems, only approximately 70% of those with Lyme disease will generate a positive Western Blot. Patients who test positive for rheumatoid factor or Epstein-Barr virus may have false negative tests.

IGeneX Western Blot is around $125. IGeneX is now offering PCR testing for Borrelia miyamotoi (associated with relapsing fever) for $265, as well as immunofluorescence testing (FISH) for babesia, anaplasma, ehrlichia, and rickettsia.

Aperiomics

Aperiomics testing uses metagenomic sequencing with blood samples, tissue swabs, urine specimens, or fecal samples to identify every known bacteria, virus, fungus, and parasite — their database alone contains more than 37,000 microorganisms.

This test helps target which pathogens may be causing your symptoms. For example, if you have an ongoing gastrointestinal problem, and treatments haven’t brought you relief, you might benefit from the fecal testing kit, which could identify one or more pathogens responsible for making you ill.

Also, Aperiomics tests for Lyme disease and coinfections, but it will likely come with a hefty price tag. Since stealth microbes often hide in various tissues throughout the body, the company recommends testing kits that collect blood, swab, urine, and fecal samples, which can cost upwards of $2700. However, if your symptoms are more specific, you may be able to do less testing, and ultimately, save some money.

Although it’s tempting to gain as much information as you can about what’s making you feel ill, remember that no test is completely definitive, and the results might not change the trajectory of your treatment. Before you splurge on costly testing, talk with your healthcare provider about how new information can be used to advance your recovery.

Direct Tick Testing

If you actually kept the tick that bit you, it is possible to have the tick checked for certain microbes. The testing, however, does not check for all possibilities. Tic-Kit will check the tick for borrelia, bartonella, babesia, and ehrlichia.

Also, IGenex has a tick-test kit, which looks for pathogens like borrelia, tick-borne relapsing fever (TBRF), babesia, anaplasma, ehrlichia, bartonella, and rickettsia.

Finally, local or state agencies, such as universities, may offer tick testing at little to no cost as part of research and data collection projects.

STARI

The bite of the Lone Star tick is associated with a Lyme-like illness named STARI (southern tick-associated rash illness). STARI can be associated with a bull’s-eye rash and all the symptoms of Lyme disease, but tests for borrelia are always negative. The cause of STARI is presently unknown, but another form of borrelia is suspected.

Testing and Diagnosing Coinfections and Related Microbes

Blood test tubes in woman hands, modern laboratory background

There are quite a few microbes spread by blood-sucking insects (ticks, mosquitoes, fleas, lice, chiggers, biting flies, scabies) that have stealth characteristics similar to those of Borrelia burgdorferi; some we know about, and others still waiting to be discovered.

They all have stealth characteristics and the ability to infect and thrive inside cells. They are masters of evading the immune system, and can be even harder to diagnose than borrelia. Symptoms profiles are similar to borrelia and related mostly to stimulation of cytokine cascades, not concentrations of microbes. Though they each have slightly different strategies, their motive is the same: complete a lifecycle stage within the host and move on.

The primary known players in chronic Lyme include mycoplasma, bartonella, and chlamydia species. The most well-known species of babesia, anaplasma, ehrlichia, and rickettsia are more apt to cause acute illness and less apt to be associated with chronic illness, but research is discovering lesser known and lesser virulent species of these microbes that are associated with chronic Lyme. Reactivation of herpes-type viruses is common in chronic Lyme.

Though testing is possible for some species of these microbes, when a natural route of recovery is chosen, extensive testing is not necessary and can actually be very misleading.

Mycoplasma

Diagnosis of mycoplasma is challenging, especially if it’s a chronic infection. Most commonly, amplified Polymerase Chain Reaction (PCR) tests are used for diagnosis, which look at a blood sample for DNA that is specific to the microbe.

PCR is species specific and focused on diagnosing acute respiratory or genital mycoplasma infections. When testing for mycoplasma, ask to be tested for all the possible species (M. fermentans, M. genitalium, M. penetrans, M. hominis, M. pneumoniae, M. synoviae, Ureaplasma urealyticum). Note that 75% of acute infections show cold agglutinins (clumping of red blood cells).

Serial titers testing for antibodies with enzyme-linked immunosorbent assays can be used to test for acute infection. Persistent elevated titer may indicate a chronic infection or an asymptomatic carrier, but in general, chronic infection with mycoplasma is difficult to diagnose. A low WBC count is found in 25% of chronic infections.

Bartonella

The best test for bartonella is an amplified version of PCR called ePCR by Galaxy Diagnostics. The company, located in Research Triangle, North Carolina, offers both ePCR and serology testing for bartonella. Standard PCR for bartonella costs $260; ePCR costs $650 or more.

Testing is species specific; the most common species are included in the testing protocol. The company also offers standard PCR for anaplasma, babesia, ehrlichia, and rickettsia (the most common species) for $230 each (or $615 for a total tick panel).

Note that if you have private insurance, you will be asked to pre-pay for the test, which you may submit to your insurance carrier for reimbursement. Galaxy Diagnostics is a Medicare provider, so you will not need to pay upfront. However, if Medicare denies the claim, you’ll be responsible to pick up the cost of the test.

Babesia

An Indirect Immunofluorescent Assay (IFA) tests for IgG and IgM antibodies produced by the body against babesia. Diagnosis relies on a four-fold rise in antibody titer over several weeks. The first sample should be taken as early in the disease process as possible, and the second sample taken two to four weeks later.

A PCR (Polymerase Chain Reaction) detects microbial DNA in a blood sample. IGeneX uses an amplified version of PCR and FISH together for improved accuracy of testing for B. microti and B. ducani.

Ehrlichia, Anaplasma, and Rickettsia

These microbes have the potential to cause severe illness; therapy should not await laboratory diagnosis if acute infection with any of these microbes is suspected. Blood can be drawn when therapy is initiated to confirm the infection.

The most accurate test is serial serology using Indirect Immunofluorescent Assay (IFA). Diagnosis relies on a four-fold rise in antibody titer over several weeks. The first sample should be taken as early in the disease process as possible, and the second sample taken two to four weeks later.

PCR is 60-85% effective for diagnosing ehrlichia and 70-90% effective for diagnosing anaplasma, but it’s less valuable for diagnosing Rocky Mountain spotted fever (RMSF). Accuracy for diagnosing chronic infection is unknown. There are many new species of these microbes being discovered for which routine testing is not yet available.

Chlamydia

Pelvic infection associated with C. trachomatis is diagnosed by vaginal swab in females (either patient or clinician collected) and urine sample in males. Nucleic acid amplification tests (NAATs) are the most sensitive. Yearly screening for females under age 25 is recommended by the CDC.

Testing for C. pneumoniae (respiratory infection) is performed with PCR specific for C. pneumoniae DNA from a blood sample. Present testing includes only the two most common species out of nine known species.

Viruses

The list of viruses that can cause chronic infection with chronic reactions in the human body is long. A partial list includes Epstein-Barr virus (EBV), cytomegalovirus (CMV), HSV-1, HSV-2, herpes zoster virus, HHV-6a, HHV-6b, HHV-7, parvovirus B-19, adenoviruses, and hepatitis B and C.

Reactivation of dormant viruses is commonly associated with immune dysfunction that occurs with fibromyalgia, Lyme disease, and similar chronic illnesses. Testing for specific viral reactivation is generally not necessary, but if you are interested, the best source of information about testing is Lab Tests Online.

The two most common reactivated viruses associated with chronic flu-like symptoms include Epstein-Barr virus and cytomegalovirus.

Epstein-Barr Virus (EBV)

To evaluate acute and chronic infection for EBV, four antibodies are commonly tested including viral capsid antigen (VCA) IgG, VCA IgM, D early antigen (EA-D), and Epstein-Barr nuclear antigen (EBNA). Here’s how to interpret results:

    • The presence of VCA IgG antibodies indicates recent or past EBV infection.
    • The presence of VCA IgM antibodies and the absence of antibodies to EBNA indicates recent infection.
    • The presence of antibodies to EBNA indicates infection sometime in the past.

Antibodies to EBNA develop six to eight weeks after the time of infection and are present for life.

  • The presence of VCA-IgG, EA-D, and EBNA may indicate reactivation of the virus.

Cytomegalovirus (CMV)

To evaluate acute and chronic CMV infection, a blood sample is tested for IgG and IgM antibodies to CMV. Here’s how to interpret findings:

  • The presence of CMV IgM indicates a recent active infection.
  • The presence of both CMV IgM and CMV IgG can indicate active primary infection or reactivation of dormant virus.
  • The presence of CMV IgG only indicates past exposure.

Intestinal Parasites

Intestinal parasites are common in third world countries where sanitation and waste disposal systems are poor, but much less common in developed countries. Parasite eggs are consumed with contaminated food, hatch inside the body, go through a lifecycle, lay eggs, and then die. The eggs do not hatch inside the body, but are shed in feces. Chronic parasite re-infestation requires continual consumption of contaminated food.

People in developed countries do occasionally consume parasite eggs from eating raw foods and can occasionally harbor very low levels of parasites, but rarely enough to cause symptoms of infestation. Infections are always self-limited unless contaminated food is again consumed.

Testing is rarely indicated. Testing stool for eggs and parasites is not very sensitive and is almost always negative unless infestation is large.

Transmission of Vector-Borne Diseases: How Stealth Microbes Make Their Way

Deer Tick on fingertip, zoomed in

Different stealth microbes have different transmission routes. Knowing the mode of transmission can sometimes be helpful in diagnosis. Many of them can be transmitted by ticks. For borrelia, STARI, babesia, ehrlichia, and anaplasma, this is a major route of transmission.

If the type of tick is known, sometimes it can be helpful in defining types of microbes present. This is not absolute, however. Most tick-borne microbes can be spread by a variety of ticks.

In addition, many stealth microbes are also spread by other biting insects (mosquitoes, fleas, lice, biting flies, chiggers), sexual contact, blood transfusions, and some by air droplets. Mycoplasma and bartonella are more commonly spread by other means and can already be present but silent at the time of infection with a different tick-borne microbe. Mycoplasma and bartonella are probably more common in individuals diagnosed with fibromyalgia and chronic fatigue (along with other stealth microbes).

Here are some common microbe-tick connections:

  • Borrelia: The black-legged deer tick (Ixodes scapularis), most common in the Northeastern, Mid-Atlantic, and North-Central U.S., and the western black-legged tick (Ixodes pacificus) on the Pacific U.S. coast
  • STARI: The Lone Star tick (Amblyomma americanum), most common in the Southern U.S. extending out to Oklahoma and Texas, and in the Mid-Atlantic extending up into Northeastern U.S.
  • Mycoplasma: Mostly passed via respiratory and sexual transmission, but mycoplasma can be spread by biting insects, including ticks (probably numerous species). Numerous species of mycoplasma are widely distributed worldwide. Mycoplasma may be a primary factor in fibromyalgia, chronic fatigue syndrome, and autoimmune disease.
  • Bartonella: Most commonly associated with a scratch of an infected animal (cat, dog), bartonella can also be spread by fleas and lice. Ticks are a vector, but specific tick species have not been specified. Bartonella may be a primary factor in fibromyalgia and chronic fatigue.
  • Babesia: Black-legged deer ticks (Ixodes scapularis), most common in New England (Maine, Vermont, New Hampshire, Massachusetts, Connecticut, and Rhode Island), New York, New Jersey, Wisconsin, Minnesota, but spreading southward. Also present in the Southeastern U.S., with Georgia as the epicenter.
  • Ehrlichia: Most common in Northeast and Southeast U.S., it’s most concentrated in a band stretching from North Carolina to Oklahoma (South, South-central, Southeast), which is the distribution of the Lone Star tick (Amblyomma americanum). Ehrlichia is also transmitted by black-legged (Ixodes scapularis) and western black-legged (Ixodes pacificus) ticks, along with other tick species worldwide.
  • Anaplasma: Black-legged tick (Ixodes scapularis) in the Northeast and Upper Midwest and western black-legged tick (Ixodes pacificus) in northern California.
  • Rickettsia (Rocky Mountain spotted fever): American dog tick (Dermacentor variabilis), which has the most common distribution in the mid-states east of the Rockies; Rocky Mountain wood tick (Dermacentor andersoni); and brown dog tick (Rhipicephalus sanguineus), which is commonly found in Arizona. But RMSF is widely distributed across the U.S. and can occur in any state.

Hallmark Signs and Symptoms of Infection

Elderly woman suffering with parkinson's disease symptoms

Chronic infection with any stealth microbe is associated with nonspecific symptoms (it is their very nature). Even the symptoms that are considered classic for a particular microbe do not always occur. There are numerous species and strains of all of the different microbes, each of which have slightly different characteristics. If a classic symptom is present, however, it may help with diagnosis and treatment.

  • Borrelia: Microbes bore into areas of the body with collagen (skin, joints, brain) leading to a bull’s-eye rash (in 1/3 of cases), migrating arthritis, and brain fog
  • STARI: Probably another species of borrelia with the same characteristics as Lyme; symptoms include bull’s-eye rash (in 1/3 of cases) and migrating arthritis
  • Mycoplasma: Infect tissues that line areas in the body leading to initial respiratory or pelvic symptoms (depending on infection site), fatigue, and intestinal issues
  • Bartonella: Infect white blood cells and cells lining blood vessels and scavenge red blood cells for food; can result in bone pain from infection in bone marrow and pain in the soles of feet (from damage to blood vessels when walking)
  • Babesia: Infect red blood cells, liver, spleen; symptoms can include relapsing high fevers with drenching sweats and liver/spleen enlargement
  • Ehrlichia/Anaplasma: Infect specific types of white blood cells; symptoms can include high fever, headache, and muscle pain. It is mostly associated with acute disease; chronic disease is not as common
  • Rickettsia (Rocky Mountain spotted fever): Infect cells that line blood vessels, causing severe vasculitis. Symptoms can include high fever, spotted rash (90% of cases), and severe swelling in the extremities. It is mostly associated with acute disease; chronic disease is not common
  • Chlamydia: Chlamydia trachomatis can be spread by ticks, but is more commonly spread by sexual contact or respiratory infection. It can, however, be present at the time of infection with other microbes by tick bite. It is a common stealth microbe associated with chronic fatigue. It also has possible links to multiple sclerosis. Chlamydia is spread as a sexually transmitted disease and has been associated with chronic pelvic pain in women, infertility, and chronic fatigue. Chlamydia pneumoniae, which is associated with acute respiratory infection, has also been associated with chronic fatigue

Where to Get Lyme Disease Tests

Locating a healthcare provider who’s knowledgeable about Lyme disease to order the appropriate labs and test kits can be very overwhelming. You may find that you need more than one practitioner to help you. For starters, if you have a relationship with a primary care physician (PCP), even one who might not understand Lyme, they can order the routine lab tests so that you’re more likely to get them reimbursed by your health insurance.

The specialized test kits, such as coinfection panels, mycotoxin tests, or food sensitivities, will often be ordered by a Lyme-literate medical doctor (LLMD) or a functional medicine doctor who has some familiarity with Lyme. Ultimately, you’ll want to find a doctor you can trust, so they can identify the cause of your symptoms and how to help you on the road to recovery.

Dr. Rawls’ understanding of the treatment of Lyme disease, coinfections, and the value of diagnostic testing comes from his medical expertise as a doctor, as well as his personal experience as a Lyme sufferer. To learn more about Dr. Rawls, read his post about his chronic Lyme disease journey and his book Unlocking Lyme.

Dr. Rawls is a physician who overcame Lyme disease through natural herbal therapy. You can learn more about Lyme disease in Dr. Rawls’ new best selling book, Unlocking Lyme.  You can also learn about Dr. Rawls’ personal journey in overcoming Lyme disease and fibromyalgia in his popular blog post, My Chronic Lyme Journey.

REFERENCES
1. Abbas AK, Lichtman AH. Basic Immunology: Functions and Disorders of the Immune System. Philadelphia, PA Saunders/Elsevier. 2011.
2. Barbour AG, Hayes SF. Biology of Borrelia Species. Microbiology Reviews. 1986;50(4):381-400.
3. Bralley A, Lord RS. Laboratory Evaluations in Molecular Medicine. Institute for Advances in Molecular Medicine. 2001.
4. Castro C, Gourley M. Diagnostic Testing and Interpretation of Tests for Autoimmunity. Journal of Allergy and Clinical Immunology. 2010 Feb; 125(2 Suppl 2): S238–S247. doi: 10.1016/j.jaci.2009.09.041
5. Lab Tests Online. American Association of Clinical Chemistry website. https://labtestsonline.org/
6. Murray PR, Rosenthal KS, Pfaller MA. Medical Microbiology. 8th ed. Philadelphia, PA. Elsevier. 2015.

FREE Virtual Lyme Disease Conference

Free Virtual Lyme Disease Conference

Hear from top Lyme disease doctors, researchers, organization executives, and more!

Featured speakers include Global Lyme Alliance’s Chairman, Paul Ross and GLA’s Chief Scientific Officer, Dr. Tim Sellati, who will present on Transformative Discoveries Resulting from GLA. See the full list of speakers here.

Event Details:

  • Sunday, March 27, 2022
  • 9 am – 9 pm EST
  • Free to register
  • Suggested donations will support Global Lyme Alliance

Click below to register for free today!

About the Event

Registration closes on Friday, 3.25.22

Band Aid Lyme, LLC
Band Aid Lyme is a Social Enterprise company serving non-profits by fundraising for Lyme Disease research and treatments by planning and hosting events. As a Social Enterprise, all net profits at this time will go directly to a chosen organization.  

The First Fundraising Event Beneficiary: Global Lyme Alliance (click for more info)

The Lyme Disease Conference will be on Sunday, March 27th, 2022 from 9 AM – 5 PM. 
The location will be held online ONLY, as a virtual conference. All are welcome to attend.

Schedule of Speakers

BONUS TIME and additional speakers have been added to the schedule!
It is going to be a Lyme Conference Marathon!!
**Please note that the air time will be Eastern Standard Time.**

9:00am – 9:06am:
Band Aid Lyme, LLC welcome
9:07am – 9:14am:
Global Lyme Alliance welcome from Paul Ross, Chairman of Global Lyme Alliance
9:15am – 9:40am:
Global Lyme Alliance presentation by Tim Sellati, Chief Scientific Officer of Global Lyme Alliance on “Transformative Discoveries Resulting from GLA
9:41am – 10:42am: 
Karen Vanderhoof-Forschner, President of Lyme Disease Foundation, presenting on the “History of Lyme Disease”
10:43am – 11:36am:
Dr. Richard and Mrs. Lee Horowitz, Lyme Literate Medical Doctor and His Wife, presenting on Lyme Disease, generally
11:37am – 12:33pm: 
Dr. James Schaller, Advisory Board Member for Band Aid Lyme and Lyme Literate Medical Doctor, presenting on Bartonella
12:34pm – 1:03pm: 
Choukri Ben Mamoun, PhD, Professor of Medicine and Microbial Pathogenesis at Yale University School of Medicine, on Babesia Pathogenesis, Diagnosis and Therapy
1:04pm – 1:51pm: 
David Zuckerman, former Vermont Lieutenant Governor and State Senator, advocating for Lyme Disease Sufferers & wife, Rachel Nevitt, Lyme Sufferer and devoted Lyme Disease Advocate; And they own and operate a large Vermont farm!
1:52pm – 2:27pm: 
Brandi Dean and Tommy Farnsworth, on the nonprofit, Ride Out Lyme, LLC; Kerry Ann Lang, on support groups and mental health for Lyme sufferers
2:28pm – 2:49pm: 
Michelle McKeon, President of Lyme and Cancer Services & Licensed Clinical Nutritionist at Balancing Pathways
2:50pm – 3:49pm
Dr. Kenneth Liegner, Lyme Literate Doctor, presenting on “A Call for Collaboration in the Field of Vector-Borne Diseases”
3:50pm – 4:23pm: 
Mr. Gregg Skall, Esq. and Mrs. Monte Skall, Founders of non-profit NatCapLyme, “On the Front Lines – A NatCapLyme Perspective”
4:24pm – 5:24pm: 
Adina Bercowicz, Founder & Executive Director & Yan Zelener, PhD, from LymeTV
5:25pm – 6:00pm
Lindsay Keys & Winslow Crane-Murdoch, Directors of The Quiet Epidemic documentary film about Lyme Disease
6:01pm – 6:22pm
Christine Lorentzen, Functional Medicine Health Coach Candidate (2/22) & Lyme Patient Advocate;
6:23pm – 6:48pm:
Dr. Roni DeLuz, on Lyme Disease treatments and detox protocols from Martha’s Vineyard, MA, at the Healed Therapy Clinic
6:49pm – 7:38pm:
Kelly Franks, PharmD, Advisory Board Member for Band Aid Lyme, Lyme Awareness Advocate and Lyme Sufferer; Jennifer Crystal, Lyme Awareness Advocate, Lyme Sufferer, and Blogger for Global Lyme Alliance; John Zito, Father of deceased Lyme Sufferer
7:39pm – 8:08pm:
Dr. Felix Scholz, PhD Immunology, of Infectolab Americas on Blood Testing for Lyme & Co-Infections
8:09pm – 8:47pm:
Brian Karr of We Inspect, “How to Find Out if Hidden Mold is Impacting Your Health”
8:48pm – 9:03pm:
Joan Randall, on Magnet Therapy for Lyme Disease and Co-Infections from Integrative Wellness in Woodstock, VT
9:03pm – 9:04pm:
Closing statements

Doctors Debate, Patients Suffer: The Fight Over Chronic Lyme Disease in Wisconsin

https://wisconsinwatch.org/2022/03/doctors-debate-patients-suffer-the-fight-over-chronic-lyme-disease-in-wisconsin/

Doctors debate, patients suffer: The fight over chronic Lyme disease in Wisconsin

Mainstream medicine says the tick-borne infection is a short-term ailment. But some patients insist they have Lyme-caused symptoms that last for years.
Maria Alice Lima Freitas
Maria Alice Lima Freitas is pictured at her home in Middleton, Wis., on Oct. 6, 2021. Freitas believes she has been suffering from Lyme disease since 2015. She has seen a large number of doctors, who she says have varying degrees of belief in her diagnosis. She is among thousands of patients in Wisconsin who believe they have a long-term version of the disease called chronic Lyme. Mainstream medicine considers Lyme a short-term illness that generally resolves quickly with antibiotics. (Coburn Dukehart / Wisconsin Watch)
Reading Time: 12 minutes

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If life had gone as planned, Maria Alice Lima Freitas would be in medical school, inspired by the career of her father, a surgeon who practiced in Brazil. But instead of changing careers, the 49-year-old therapist retired from University of Wisconsin-Madison.

Freitas says her undiagnosed Lyme disease has sapped her energy, fogged her thinking and caused pain in her neck, shoulders, hands and right knee. She has three times deferred her entrance into medical school while struggling with myriad symptoms that she attributes to Lyme.

Most of her doctors say she is mistaken, and that her symptoms, which began in 2015, are due to rheumatoid arthritis.

Maria Alice Lima Freitas is pictured at her home in Middleton, Wis., on Oct. 6, 2021, with her husband John Oppenheimer. Freitas’ life and career have been upended by a series of symptoms — including joint pain and brain fog — that she blames on chronic Lyme disease. (Coburn Dukehart / Wisconsin Watch)

Freitas is among thousands of Wisconsinites who say they are suffering from a chronic or long-term version of the disease. The infection comes from tiny ticks primarily found in the northeastern United States, including in Wisconsin — which is a hot spot for Lyme, ranking No. 5 among states for Lyme cases in 2019.

Nationally, Lyme disease infects an estimated 476,000 people a year. The Wisconsin Department of Health Services reports the state had 3,076 estimated cases of Lyme disease in 2020 — a doubling in the past 15 years. But medical entomologists say Lyme cases in the state could be 10 times higher than reported.

The medical establishment calls Lyme a short-term disease that usually quickly resolves with antibiotics. Self-described “Lyme-literate” practitioners argue patients like Freitas suffer from a long-haul version of the disease, often called chronic Lyme disease.

The orthodox position held by most scientific experts and some professional associations — and endorsed by U.S. Centers for Disease Control and Prevention — is that Lyme disease is an acute infectious disease. Clinical diagnosis is based on a “bull’s-eye” rash, other specific symptoms and two-tiered antibody tests. Treatment is by short courses of oral antibiotics. And persistent symptoms rarely occur.

The standard antibody testing for Lyme disease, cleared by the Food and Drug Administration and endorsed by insurance companies, has been criticized by patients and practitioners as inadequate to detect all cases of the disease. Some practitioners offer alternative tests and treatments, but insurance does not cover the cost of their care. And in extreme situations, such doctors risk disciplinary action.

For most people, Lyme disease is treatable and curable. Most patients report their symptoms cleared after a short course of antibiotics if the infection is recognized and treated early. Another 10-20% of patients develop more severe cases whose symptoms include debilitating pain, fatigue, brain fog, irritability and sleep disorders.

Dark-skinned patients face particular difficulties in getting a Lyme diagnosis. Identifying the red target symbol over light skin tone is easy for light-skinned people, but not so with dark skin tones. A recent UCLA study found that 34% of Black patients with Lyme disease had neurological complications compared to just 9% of whites, suggesting the disease may not have been recognized for many Black patients in earlier stages when it’s easier to treat.

Patients with persistent symptoms struggle to get a diagnosis. Wisconsin Watch has spoken with five people in addition to Freitas whose persistent, subjective symptoms fall outside of the mainstream definition of Lyme as an acute disease. Caught in the middle of the debate, they face emotional, physical, mental and financial exhaustion as they bounce between specialists in search of explanations for their pain.

“The best way I can explain…I’m going through hell, (and) keep on going,” Freitas said.

Diagnoses: Viral infection, arthritis 

Freitas’ Lyme journey began in March 2019 as she battled monthly bouts of fever. She had trouble falling back to sleep late at night. Her hair rapidly fell out. And her body ached and her neck was stiff. She suffered from severe pain in her joints, bones and chest. She also felt tired. At first, Freitas attributed the exhaustion to the bladder surgery she had undergone in April. Fevers hit her in June and again in July.

The unbearable pain made it hard for her to work. It felt like someone was scraping the inside of her right knee with a knife. By August of that year, Freitas took a medical leave, unable to work.

The black-legged tick, or deer tick, is the vector of the bacteria that cause Lyme disease. Deer ticks are present everywhere in Wisconsin where there is forested habitat. Pictured clockwise from top left: nymph, larva, adult male, adult female. Deer ticks have three life stages, the larva becomes a nymph, which then becomes an adult. (Courtesy of UW-Madison Department of Entomology)

She checked into a Madison hospital for a couple of days. She said the doctor ordered a variety of tests — but not for Lyme. Freitas was diagnosed with a viral infection, which she said failed to explain her full slate of symptoms, including electric sensations on her face and arms and forgetfulness.

Four summers earlier, Freitas said she similarly felt eye pain, knuckle pain, fatigue, forgetfulness and headaches. She recalled a rash that had stayed on her leg for at least three weeks. Freitas saw a rheumatologist at St. Mary’s in early July 2015.

The doctor noticed a red spot on her leg, but it was not the classic Lyme sign of “bull’s-eye” rash. She recalls being tested for Lyme, but the two-step testing came back negative.

The doctor deemed the red spot a likely spider bite and diagnosed her with arthritis. After taking pain medication for a month, Freitas began to feel better. When more symptoms took hold in 2019, she sensed that viral infection alone did not explain them. Freitas started reading articles about Lyme disease.

Her husband, John Oppenheimer, recalled his wife devouring medical journal articles. Freitas has a bachelor’s degree in biology from UW-Madison and a master’s in marriage and family therapy from Edgewood College. In late 2018, a Florida-based medical school had admitted her to a pre-med program, but her declining health disrupted those plans.

Freitas floated the Lyme hypothesis to a rheumatologist, who felt the joint pain and hand swelling looked more like rheumatoid arthritis (RA). Test results also suggested Freitas may have RA.

Questions about testing

Freitas was not convinced.“I have other symptoms that can’t be explained by RA,” she said. She had read journal articles about the difficulty in Lyme diagnosis, finding the recommended tests are “pretty fallible.”

CDC recommends a two-step testing process for determining whether a person has Lyme disease. Both blood tests must come out positive — or at least indeterminate — for a Lyme diagnosis to be made, the agency recommends.

The two tests measure antibodies that can remain in a person’s system for months or even years and therefore may not indicate an ongoing infection.“It cannot tell when you got infected,” said Elitza Theel, who directs Mayo Clinic’s Infectious Diseases Serology Laboratory.

Maria Alice Lima Freitas is comforted by group leader Alicia Cashman during a meeting of the Madison Area Lyme Support Group at the East Madison Police Station in Madison, Wis., on Feb. 8, 2020. Freitas believes she suffers from chronic Lyme disease but has struggled to find doctors who agree. She wept frequently throughout the meeting — the first one she had attended— as other participants shared their personal experiences. She later said she became emotional after realizing she was not imagining her symptoms. She attended the meeting with her husband John Oppenheimer, left. (Coburn Dukehart / Wisconsin Watch)

And the testing has other drawbacks. “It cannot tell what disease severity (is), and it cannot tell whether or not you responded to treatment,” Theel said. “It’s important to remember that we’re not making a diagnosis based on a test result alone.”

She went on to say that the testing also cannot be used to detect other infections that may cause Lyme-like symptoms. “You would have to test for those other infections,” she said.

Freitas tested positive in the first stage of testing but not the second, showing three bands instead of the five that the CDC says are proof of Lyme disease.

She asked the rheumatologist to order a different type of test from IGeneX, a California-based commercial laboratory, hoping that the insurance company would at least cover some cost. It didn’t.

“It’s expensive. I don’t have the money. I’ve been out of my job since August,” Freitas recalled.

The results from that $2,600 test came in December 2019. It indicated she did have Lyme disease. However, the IGeneX testing is not conclusive, either, Theel said. “Their criteria are less stringent than the CDC,” she said, “which will lead to a higher number of false positive results.”

Her rheumatologist refused to accept the result, Freitas and Oppenheimer said, calling it a “shit test.”

Health woes lead to self-doubt

Oppenheimer said Freitas, once wildly independent, increasingly depends on him as she struggles with her health. The two met when she was a single mom driving a Madison Metro bus and juggling classes at the UW-Madison. Oppenheimer had overheard her speaking in Portuguese, and he tried to put together a phrase that he could speak in the same language. That led to a first date — and in 2011, marriage.

But these days, Oppenheimer said, his wife is “very drained.”

And even friends and family members question whether the symptoms Freitas describes are real.

Maria Alice Lima Freitas is pictured at her home in Middleton, Wis., on Oct. 6, 2021, with her husband John Oppenheimer. “The best way I can explain … I’m going through hell, (and) keep on going,” Freitas says. (Coburn Dukehart / Wisconsin Watch)

“When everybody is saying that it is not Lyme,” Freitas said, “you start to question yourself.”

She tried a four-week course of doxycycline, the first-line antibiotics therapy for treating Lyme disease, prescribed by another rheumatologist. She began to feel better, with less pain and less brain fog. However, the symptoms returned once she completed the treatment. She even found herself starting to stutter.

Oppenheimer himself was diagnosed with Lyme disease as a 19-year-old. At the time, he was living less than 50 miles from Lyme, Connecticut, the community for which the disease was named.

He described an “arrogant unwillingness” by the medical establishment to recognize what he believes are his wife’s ongoing symptoms of Lyme disease.

“(I’m) just trying to be there with her and seemingly nothing to be able to do, and it’s horrible to watch,” he said.

Lyme controversial from the start

In autumn 1975, Polly Murray, an artist and mother of four in Lyme, reported to the state health department that she and her children were suffering from mysterious maladies, including stiff and swollen knees and rashes. And neighboring children were having similar hard-to-explain symptoms.

Physicians diagnosed the children with juvenile rheumatoid arthritis. Another mother from the area, Judith Mensch, also contacted the state health department. Finally, the cluster aroused the attention of the Connecticut public health authorities. Yale University’s Dr. Allen Steere, who was still a rheumatologist-in-training, began searching for a cause.

The following year, Steere told the Journal of the American Medical Association, that he strongly suspected the illness came from some type of infection. 

Each dot represents one case of Lyme disease and is placed randomly in the patient’s county of residence. The presence of a dot in a state does not necessarily mean that Lyme disease was acquired in that state as the place of residence is sometimes different from the place where the patient became infected. (Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Vector-Borne Diseases

In the early 1980s, Willy Burgdorfer, a medical entomologist at Rocky Mountain Laboratories, identified the bacterium that caused the mysterious affliction. It was named Borrelia burgdorferi after him.

Robert A. Aronowitz, a medical historian at the University of Pennsylvania, said the divide between mainstream medicine and Lyme patient advocates started early — with Patty Murray herself.  He noted that Murray created local Lyme support groups starting in the 1980s that began to position themselves “in opposition to the leading Lyme disease physicians and scientists and their view of the disease.”

In her 1996 book, The Widening Circle, Murray warned of long-term cases of the disease. “To me, the fact that some cases seemed to be chronic, lasting for many years, meant that somehow the infection smoldered in some patients and was set off by an immune reaction, perhaps patients were being repeatedly re-infected by the organism,” she wrote.

Two camps, two approaches

Freitas saw a long string of mainstream physicians for a diagnosis — rheumatologists, an infectious-disease specialist, family medicine doctors and emergency room physicians.Then, in the spring of 2020, she began seeing out-of-network doctors in and outside of Wisconsin, and many of them didn’t take insurance.

A survey of more than 2,400 U.S. patients found that 50% of the respondents reported seeing at least seven physicians before a Lyme diagnosis, and more than half continued to suffer symptoms for at least six months after the recommended short course of antibiotics.

Maria Alice Lima Freitas pays about $1,200 a month for medicine, vitamins and treatment for her chronic Lyme disease. She is pictured at her home in Middleton, Wis., on Oct. 6, 2021, with her husband John Oppenheimer. Freitas is now being treated by Dr. Samuel Shor of the Tick-Borne Illness Center of Excellence in Woodruff, Wisconsin. She says her brain is still sometimes foggy but emotionally she is much better and feels optimistic that a doctor is finally taking her symptoms seriously. (Coburn Dukehart / Wisconsin Watch)

In January 2021, Freitas borrowed $4,000 from her mother-in-law and flew to Washington, D.C., to receive intravenous antibiotic therapy. The treatments failed to help; in fact she dropped 30 pounds in a matter of weeks. “I thought I was gonna die because I couldn’t eat,” Freitas said.

She continued to search for doctors.

On May 19, Oppenheimer and Freitas drove from their house in a quiet neighborhood in Middleton to northern Wisconsin.

They were on their way to a virtual visit with Dr. Samuel Shor. The Virginia-based internist works for the Tick-Borne Illness Center of Excellence in Woodruff, Wisconsin. Shor, who also is a clinical associate professor at George Washington University, sees patients in Wisconsin via telemedicine, charging $490 for an initial consultation.

As the former president of the International Lyme and Associated Diseases Society (ILADS), Shor adheres to diagnoses and treatments that the mainstream Infectious Diseases Society of America (IDSA) generally rejects. Dr. Paul Auwaerter of Johns Hopkins Medicine, a former president of IDSA, calls physicians who treat patients for chronic Lyme “antiscience” and a danger to patients and the medical profession.

“It is disappointing to me that people resort to name-calling from either side,”

said Dr. Elizabeth Maloney, a family physician from Minnesota who helped write the latest guidelines on Lyme disease treatment. “It’s not helpful, and it does undermine patients’ confidence in our profession as a whole.”

The guidelines issued by IDSA maintain the group’s recommendations against antibiotic treatment for patients with persistent symptoms. It has also removed a previously endorsed term — Post-Treatment Lyme Disease Syndrome (PTLDS) — for defining patients with persistent symptoms after short courses of antibiotic therapies.

“They don’t even want to go into that quagmire anymore,” said Maloney, who leads the Partnership for Tick-Borne Diseases Education. “They do not really talk about what to do with patients who do not fully recover. It’s kind of a black box.”

The disease is complex. If untreated, Lyme can have wide-ranging effects on skin, joints, nervous system or the heart. The infectious agents attack connective tissue and can move around and “find their own way to … various parts of the body,” said Dean Nardelli, an associate professor who studies later-stage Lyme disease at the UW-Milwaukee’s Biomedical Sciences Lab Programs.

In a 2019 article in the journal Antibiotics, Shor said chronic Lyme is “often dismissed as a fictitious entity.” He and his co-authors consulted more than 250 peer-reviewed articles pointing to “a multisystem illness with a wide range of symptoms,” either continuously or intermittently, lasting at least six months.

“Signs and symptoms may wax, wane and migrate,” they wrote.

Other pathogens to blame?

Shor and his co-authors, including Maloney, propose that the lingering symptoms are caused by several pathogens from the Borrelia burgdorferi family or other tick-borne pathogens.

Nardelli said there’s a variety of symptoms and severity in Lyme disease patients, and those symptoms can be caused by the inflammatory responses against the microbes.

“Inflammation is a huge part of the immune response. It’s one of the frontline defenses we have, and it has this negative connotation, but it is intended for good,” he said. “Your immune response (is) trying to kill the bug … and in doing so, can cause damage, essentially.”

Maria Alice Lima Freitas is pictured at her home in Middleton, Wis., on Oct. 6, 2021, with some of the treatments she takes for Lyme disease and other co-infections. She says she currently pays about $1,200 a month in medicines, vitamins, supplements and treatment costs.(Coburn Dukehart / Wisconsin Watch)

Some theories suggest that variants of the Lyme bacteria are resistant to antibiotics. Others argue that chronic Lyme is caused by a powerful immune reaction — or it may even trigger an autoimmune disease. The central neural networks may be altered, having a significant impact on symptoms — or a combination of these factors.

Nardelli is investigating Lyme-related arthritis that persists after treatment with antibiotics. He said science can be a slow process of acquiring new knowledge, and it’s “tough” for patients who are suffering with no clear answers.

That can lead them to seek out untrustworthy practitioners or fall for costly treatments that don’t work. “You go out and find doctors that diagnose everything as Lyme disease,” Nardelli said.

For complicated cases, Maloney said physicians should approach patients as a detective would, whittling away other possibilities until getting to a diagnosis.

“The whole goal is to get people the right diagnosis so they can get the therapy that they need,” she said.

Freitas said she trusts Shor, who has embraced her IGeneX test results for Lyme and has also diagnosed her as having several afflictions: babesiosis, which has some of the same symptoms as Lyme and can come from the same ticks; bartonella, also known as cat scratch fever; and chronic fatigue syndrome.

Alternate treatments offer relief

Freitas now takes Epsom salt baths on Mondays, Wednesdays, and Fridays and uses an infrared sauna for “detoxification,” saying it makes her body feel better.

And she now takes 30 pills each day, interspersing antibiotics with herbs and dietary supplements, which cost upwards of $1,200 a month.

Maria Alice Lima Freitas says since starting treatment for chronic Lyme disease, she has begun to regain weight and her mind has become a bit clearer. “I’m getting out of the graveyard,” she says. She is seen at her home in Middleton, Wis., on Oct. 6, 2021. S. (Coburn Dukehart / Wisconsin Watch)

“For babesia … I’m taking liquid gold … Mepron,” said Freitas. “It’s really expensive. It’s 50 bucks for 80 milliliters, which lasts two weeks.”

She gave up dairy, gluten, and sugar to reduce inflammation.

And she meets with Shor monthly online from her house at a charge of $250 per visit, which insurance does not cover.

“It was to me (that) the money is well paid. I’m having peace of mind,” Freitas said. “I feel like I’m getting better.”

Freitas said she started gaining back some weight in June. Her mind has become a bit clearer. Her long-term memory seems back a bit, too. “I’m getting out of the graveyard,” she said.

Said Oppenheimer to his wife: “What I’m seeing is you’re better relative to the beginning of (2021), because you’re still not good.”

For Freitas, the struggle for recognition — and relief from her symptoms — continues. She and her husband remodeled their home over the summer, refurbishing their two-story house with a plan to rent out one level to pay for Freitas’ ongoing treatments.

And she still holds out “a little flame of hope” of one day becoming a doctor — just like her dad.

Former WPR/Wisconsin Watch reporter Bram Sable-Smith contributed to this story. The nonprofit Wisconsin Watch (www.WisconsinWatch.org) collaborates with WPR, PBS Wisconsin, other news media and the University of Wisconsin-Madison School of Journalism and Mass Communication. All works created, published, posted or disseminated by Wisconsin Watch do not necessarily reflect the views or opinions of UW-Madison or any of its affiliates.

Republish our articles for free, online or in print, under a Creative Commons license.

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**Comment**

Probably one of the most thorough, well-researched articles I’ve read to date.  Please share with others and drop Ms. Wang a “Thank you” note.  She has cut through the Chronic Lyme debate with a sharp knife, revealing the human suffering it causes.  Also, a big “Thank you” to Maria who was willing to share her story in the hopes of helping others bypass the pain she’s had to go through.

And a quick reminder that in my experience, people get help due to the efforts of other patients willing to take the time to educate others.  You are truly needed and important in this war.

Lyme & Babesia – A Potent Combination That’s Frequently Missed

https://www.lymedisease.org/wendy-adams-lyme-babesia/

Lyme and Babesia–a potent combination that’s frequently missed

By Wendy Adams, Bay Area Lyme Foundation

Unless you’ve been living under a rock for the last few years, you’ll have learned that tick-borne diseases are on the rise across the United States.

Many theories exist as to why this is the case. However, most scientists that study ticks and their habitats agree that a combination of reasons—including climate change and human encroachment into tick habitats—are at least partially to blame.

Although Lyme disease (caused by the bacterium Borrelia burgdorferi) is the most common disease that humans acquire from tick bites, ticks can unfortunately transmit several other bacteria, viruses, and parasites to humans.

Multiple infections can even be transmitted during the same bite. The confusing and overlapping disease symptoms caused by multiple infections makes it extremely difficult for doctors to recognize, diagnose and treat the different infections.

Borrelia burgdorferi and Babesia

The most commonly reported tick-borne disease after Lyme disease is babesiosis, caused by infection with the parasite Babesia. This parasite, just like its cousin, Plasmodium falciparum (malaria), infects red blood cells and can cause anemia, thrombocytopenia (low platelets) and other serious, sometimes life-threatening symptoms.

Babesia microti, the most common infectious parasite in the US, is typically found where Lyme disease is found—the Northeast, Mid-Atlantic, and Midwest, although most reported cases come from the Northeast.

But why the overlap in this geography with Lyme disease? It turns out that the presence of B. burgdorferi in an ecosystem facilitates the establishment of B. microti in ticks.

Co-infections likely

This means that ticks in locations infected with Babesia are also more likely to be co-infected with B. burgdorferi. At least one study in mice co-infected with Babesia and Borrelia showed that Babesia hindered the acquired immune response, including B and T cell production, such that Borrelia (Lyme) symptoms were enhanced.

Notably, Borrelia can affect the innate immune system—meaning that a co-infected individual might not be able to mount a sufficient immune response at either stage to fight either pathogen optimally.

Babesia is of special concern to doctors and scientists for a few reasons. Like Borrelia, the parasite can be transmitted by an infected mother across the placenta to an unborn child. The resulting infection can be dangerous in a newborn and has been documented in a case where the pregnant mother was not tested for babesiosis despite a Lyme diagnosis.

Another reason Babesia is concerning is its invasion of the blood supply. Babesia can survive blood banking conditions and hundreds of cases have been documented through blood transfusions.

Infected organ transplantation has also led to Babesia transmission and infection by this route is especially problematic. Transplant patients must take immunosuppressants in order not to reject the new organ, leaving them even more susceptible to opportunistic infections.

Babesia duncani—“Left Coast” Babesia?

As noted earlier, Babesia is a specific family or “genus” of pathogens and there are different species within the genus in different regions of North America.

The West Coast of the US has at least one species which infects humans: Babesia duncani (Babesia divergens has also been found in Washington state).

B. duncani doesn’t seem to be closely related to B. microti. Rather, it is more closely related to Babesia gibsoni, a species found in canines, and a parasite called Theileria.

Although there are very few reported cases of B. duncani, some research suggests that it has been found in human infections in other North American locales as well and there are transfusion-associated cases in the literature.

Interestingly, the strains from California—while looking the same under the microscope—differ in genetic sequence from other known Babesia strains (notably, a strain called WA1) on the West Coast. Therefore, there is significant genetic diversity even within the same B. duncani species.

Seroprevalence studies (which measure antibodies from a large population of blood serum samples) done in the 1990s showed that 3% of people in a Lyme-endemic community in Mendocino county had antibodies, and 16% of soldiers stationed at Fort Ord in Monterey county had antibodies to B. duncani.

Yet, strangely, despite the overlap in regionality of B. duncani and Lyme Borrelia in California, Oregon and Washington, B. duncani has not been found in Ixodes pacificus (western blacklegged) ticks. These are the ticks that harbor and transmit B. burgdorferi in the western US.

Found in a different tick

Scientists have found one tick, Dermacentor albipictus, the winter tick, that harbors B. duncani. D. albipictus is not known to bite humans often, instead spending almost their whole life on large mammals like deer or moose. These ticks also have been found to parasitize horses, cats and dogs in different parts of the country.

(A) Adult female Dermacentor albipictus. (B) Adult Female Ixodes pacificus
(A) Adult female Dermacentor albipictus. (B) Adult female Ixodes pacificus, image courtesy of TickEncounter, University of Rhode Island.

Clinically in humans, B. duncani can be very serious. It has been difficult to even study this species because the parasite could not be grown in a lab setting until very recently, and lab-infected mice and hamsters die within a few weeks of being infected.

The first human cases included two patients who died of the infection. Yet most doctors on the West Coast have never heard of it.

New studies show that B. duncani has acquired resistance to regular antiparasitic drugs including atovaquone, azithromycin, clindamycin, and quinine.

But recent in vitro studies sponsored by Bay Area Lyme Foundation have shown that an herbal compound studied and used in Africa against malaria (cryptolepis sanguinolenta) has shown positive treatment effects against both B. duncani and B. burgdorferi in in vitro studies.

Some physicians are already using this herbal medicine in their patients in the US. (Please note: this herb has shown some toxicity and should not be taken without physician supervision)

Doctors need to suspect additional tick-borne infections—many do not

While Babesia has only been a CDC-reportable disease for a decade, we do know it is the most commonly reported tick-borne infection after Lyme disease.

Despite that knowledge, babesiosis is typically not discovered until later, if at all. Obviously when a patient is infected with both a bacterium and a parasite, multiple drugs are usually required for effective treatment.

Research from the MyLymeData patient registry confirms the finding that Babesia is the most common co-infection among chronically ill patients.

Prompt and complete diagnosis of patients with tick-borne infections—bacteria, viruses and parasites, is paramount to giving patients the best chance at full recovery.

While Lyme disease is the most common tick-borne infection, there are others that can also cause congenital infections, severe disease and even death.

Testing for babesiosis is somewhat better than for Lyme, since a pathologist can actually see a Babesia parasite in red blood cells on a blood smear. However, it requires the doctor to suspect an additional tick-borne infection and order the blood smear analysis by the pathologist, which many do not.

Until we have more sensitive testing, (preferably unbiased, direct pathogen testing which detects ALL tick-borne infections), and more targeted, effective therapeutics, thousands of cases of Lyme and co-infections, including Babesia, will be misdiagnosed yearly, with sometimes fatal consequences.

Wendy Adams is Research Grant Director for the Bay Area Lyme Foundation and on its Advisory Board. She has served as a member of the federal Tick-Borne Disease Working Group and is a member of the Lyme Disease Advisory Committee of the California Department of Health.

References

Abraham, Amanah, et al. “Establishment of a Continuous in Vitro Culture of Babesia Duncani in Human Erythrocytes Reveals Unusually High Tolerance to Recommended Therapies.” Journal of Biological Chemistry, vol. 293, no. 52, 2018, pp. 19974–19981., https://doi.org/10.1074/jbc.ac118.005771.

“CDC – Babesiosis.” Centers for Disease Control and Prevention, 31 Mar. 2020, https://www.cdc.gov/parasites/babesiosis/index.html.

Djokic, Vitomir, et al. “Protozoan Parasite Babesia Microti Subverts Adaptive Immunity and Enhances Lyme Disease Severity.” Frontiers in Microbiology, vol. 10, 2019, https://doi.org/10.3389/fmicb.2019.01596.

Duncan, Kathryn T., et al. “Recent Reports of Winter Tick, Dermacentor Albipictus, from Dogs and Cats in North America.” Veterinary Parasitology: Regional Studies and Reports, vol. 22, 2020, p. 100490., https://doi.org/10.1016/j.vprsr.2020.100490.

Handel AS;Krugman J;Hymes S;Inkeles S;Beneri C; “A Case of Relapsed Vertically Transmitted Babesiosis.” Journal of the Pediatric Infectious Diseases Society, U.S. National Library of Medicine, https://pubmed.ncbi.nlm.nih.gov/32964924/.

Persing, David H., et al. “Infection with a Babesia-like Organism in Northern California.” New England Journal of Medicine, vol. 332, no. 5, 1995, pp. 298–303., https://doi.org/10.1056/nejm199502023320504.

Renard, Isaline, and Choukri Ben Mamoun. “Treatment of Human Babesiosis: Then and Now.” Pathogens, vol. 10, no. 9, 2021, p. 1120., https://doi.org/10.3390/pathogens10091120.

Research, MyLymeData Lyme Disease. “MyLymeData Chart Book Released – Information about Patients with Chronic Lyme Disease That Was Previously Unknown.” LymeDisease.org, 28 Feb. 2021, https://www.lymedisease.org/mylymedata-lyme-disease-research-report/.

Sanders, Lisa. “He Passed out Three Times in 10 Days. What Was Wrong?” The New York Times, 26 Aug. 2021, https://www.nytimes.com/2021/08/26/magazine/lyme-disease-babesia-tick.html.

Swei A; O’Connor KE; Couper LI; Thekkiniath J; Conrad PA; Padgett KA; Burns J; Yoshimizu MH; Gonzales B; Munk B; Shirkey N; Konde L; Ben Mamoun C; Lane RS; Kjemtrup A; “Evidence for Transmission of the Zoonotic Apicomplexan Parasite Babesia Duncani by the Tick Dermacentor Albipictus.” International Journal for Parasitology, U.S. National Library of Medicine, https://pubmed.ncbi.nlm.nih.gov/30367862/.

“Western-Blacklegged Tick.” TickEncounter, https://web.uri.edu/tickencounter/species/western-blacklegged-tick/.

Zhang, Yumin, et al. “Botanical Medicines Cryptolepis Sanguinolenta, Artemisia Annua, Scutellaria Baicalensis, Polygonum Cuspidatum, and Alchornea Cordifolia Demonstrate Inhibitory Activity against Babesia Duncani.” Frontiers in Cellular and Infection Microbiology, vol. 11, 2021, https://doi.org/10.3389/fcimb.2021.624745.

Harry E. Prince, et al. “Comparison of the Babesia Duncani (WA1) IGG Detection Rates among Clinical Sera Submitted to a Reference Laboratory for WA1 IGG Testing and Blood Donor Specimens from Diverse Geographic Areas of the United States.” Clinical and Vaccine Immunology, 1 Nov. 2010, https://journals.asm.org/doi/10.1128/CVI.00256-10.

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For more:

Babesia & Lyme: Missed Diagnosis Can Have “Dire Consequences”

https://danielcameronmd.com/co-infections-babesiosis-lyme-disease-dire-consequences/

Co-infections Babesiosis and Lyme disease, missed diagnosis can have “dire consequences”

Woman being examined for co-infections with Babesiosis and Lyme disease

In a recently published article, “A Case of Tick Bite Induced Babesiosis With Lyme Disease,” Bhesania and colleagues [1] describe a 72-year-old woman with atypical symptoms, who was found to have co-infections with Lyme disease and Babesiosis.

 

The woman had a three-week history of a fever (maximum temperature, 104 F], chills, nausea, and productive cough of yellow sputum.

Six weeks prior to her onset of symptoms, the woman had been vacationing in Connecticut, an area endemic for Lyme disease. She reported having 2 tick bites during the previous year.

Her examination and tests were normal, except for pancytopenia and manual peripheral blood smear showed Babesia microti in her red blood cells. Initially, 1.7% red blood cells were infected with Babesia microti.

“The unique feature of our case was the atypical presentation with no rash and no joint pain, but the patient had only constitutional symptoms like weakness and occasional fever…”

“The patient was started on azithromycin, atovaquone for Babesiosis, and doxycycline to treat Lyme disease with initial suspicion of co-infection and a plan to deescalate once the Lyme disease was ruled out,” the authors state.

She was discharged home with the combination of the three oral treatments.

Dire consequences with delayed treatment

“Cases with severe hemolytic anemia, disseminated intravascular coagulation, respiratory failure, renal failure erythrocyte apheresis should be considered,” they suggest.

And, “Clinicians should consider co-infection when suspecting tick-borne disease which can lead to fatal consequences if not addressed promptly.”

“If there is delayed initiation of therapy in these kinds of patients, there may be dire consequences that may require aggressive therapy.”

The authors cited another case report to highlight the importance of a timely diagnosis.

A 67-year-old woman was treated for Lyme disease. But her fever, rash, and myalgias persisted despite a 21-day course of amoxicillin. The patient was also found to have pancytopenia and evidence of Babesia. Once she began treatment for Babesia, her symptoms improved.

References:
  1. Bhesania S, Arora KS, Tokarski M, et al. A Case of Tick Bite Induced Babesiosis With Lyme Disease. Cureus. Aug 2021;13(8):e17401. doi:10.7759/cureus.17401

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