Archive for the ‘Babesia’ Category

With Three Invasive Tick Species Thriving in Connecticut, State Scientist Warns of Major Public Health Hazard

https://www.courant.com/news/connecticut/hc-news-ct-more-ticks-20210816-eafwrhehkbhspacc7r5qrw4m4m-story.html

With three invasive tick species thriving in Connecticut, state scientist warns of major public health hazard

HARTFORD COURANT

AUG 16, 2021

Stratford, Ct. - 08/13/2021 - Dr. Goudarz Molaei, with Connecticut's Agricultural Experiment Station, searches for ticks trapped on a canvas dragged through shoreline vegetation. Photograph by Mark Mirko | mmirko@courant.com — Stratford, Ct. – 08/13/2021 – Dr. Goudarz Molaei, with Connecticut’s Agricultural Experiment Station, searches for ticks trapped on a canvas dragged through shoreline vegetation. Photograph by Mark Mirko | mmirko@courant.com (Mark Mirko/The Hartford Courant)

State scientist Goudarz Molaei pulled a square of cloth through brush and grass on the Stratford coast recently, then stopped and pointed to a crawling smear of larvae on the white fabric.

The tiny arachnids were either Gulf Coast or lone star ticks, two of three invasive species, along with the Asian long-horned tick, that have recently established footholds in Connecticut.

First seen only in pockets near the coast, the blood-sucking, disease-carrying ticks have spread into other parts of the state. Compared with past years, many more worried residents and visitors have submitted ticks to the Connecticut Agricultural Experiment Station, mostly deer ticks that may carry Lyme disease, Molaei said. The tally so far in 2021 is 4,700 tick submissions to the testing laboratory, compared with a total annual average of 3,000 submissions.

Milder winters and warmer temperatures overall are helping the ticks survive and thrive in Connecticut.

“This is going to be a major public health concern in the near future, if it is not already,” Molaei said. (See link for article)

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**Comment**

Important takeaways:

Previously only .2% of submitted ticks were lone star ticks which increased to 4.2% this year. They transmit ehrlichiosis, STARI, spotted fever rickettsiosis, tularemia, Alpha-gal allergy, and Heartland and Bourbon Viruses.
The researcher states that it’s a matter of time before the entire state of Connecticut will be infested with Asian long-horned tick – the tick that can reproduce by cloning. It is supposedly less attracted to human skin but can spread diseases that make both animals and humans seriously ill.
The Gulf Coast tick overwintered successfully in Connecticut but currently is limited to coastal areas. Thirty percent tested there were infected with rickettsiosis, which is similar to but less serious than Rocky Mountain Spotted Fever.
The deer tick, or blacklegged tick transmits Lyme disease and is active any time temperatures are above freezing. All life stages bite humans.
The following percentages of ticks were sent to the Experiment Station this year:
- 72.8% deer ticks (32% were positive for Lyme, 10% for Babesia, 4% for Anaplasmosis – and 2% tested positive for at least 2 disease agents concurrently)
- 23.1% American dog ticks
- the rest were lone star ticks

Category:

Alpha Gal Meat Allergy, Anaplasmosis, Babesia, Ehrlichiosis, Lyme, research, Rickettsia, Testing, Ticks, Tularemia, Viruses

Babesia Symptoms Can Be Deadly: A Family’s Story

https://danielcameronmd.com/babesia-symptoms-can-be-deadly-a-familys-story/

BABESIA SYMPTOMS CAN BE DEADLY: A FAMILY’S STORY

The number of Babesia cases appears to be rising and as a recent article in the Washington Post reports, the tick-borne infection can be deadly when symptoms go unrecognized.

By Dr. Daniel Cameron

Babesia symptoms can be wide-ranging and difficult to recognize by clinicians and a missed or delayed diagnosis can be deadly.

In hopes of raising awareness, one family shares their story of a Babesia diagnosis that came just a little too late.

Jeff, a 51-year-old husband and father, was hospitalized with symptoms of jaundice, agitation and inability to urinate. It took 3 days before he was diagnosed with Babesia. But his symptoms had been present for at least one month — unrecognized, as the infection progressed.

Tiny tick leads to deadly infection

As his wife tells writer Abby Schwartz from the Washington Post,¹ Jeff frequently hiked outdoors near their home in Bucks County, Pennsylvania. About a month prior to being admitted into the hospital, he had removed a tick, “no bigger than a poppy seed.”

In hindsight, “he may have had Babesia for a month,” Schwartz writes.

Diagnosis comes too late

For several weeks, Jeff reportedly had Babesia symptoms including fevers and night sweats. But clinicians presumed he had a kidney infection and prescribed a course of antibiotics. He improved briefly.

Then, he took a turn for the worst. “Jeff was weaker, sweating, unable to sleep,” his wife explains. “His breathing was labored. The whites of his eyes had yellowed, and his bilirubin was climbing, a sign that red blood cells were breaking down at an unusual rate or of liver trouble.”

He was moved to the ICU and placed in a medically-induced coma and put on a ventilator. Doctors noted that his symptoms resembled malaria, but still did not suspect a tick-borne infection.

“His team periodically woke him, and he would squeeze his wife’s hand.”

On Tuesday, an infectious disease doctor shared some positive news. “We think we have a diagnosis.”

They suspected that Jeff had Babesiosis, a potentially deadly infection caused by parasites Babesia microti, which is typically transmitted through a tick bite.

He was prescribed an antibiotic (azithromycin) and antiparasitic (Atovaquone) medication for 7 to 10 days.

On Thursday, he died — just 2 days after starting treatment.

“If Jeff had been diagnosed early, when he first complained of night fevers, it might have been different for him,” writes Schwartz.

Since Jeff’s death, his wife and family have worked to raise awareness about Babesia.

Babesia signs and symptoms

Most people infected with Babesia do not show symptoms or have mild to moderate flu-like symptoms such as fatigue, chills, sweats, headache, body aches, nausea, and loss of appetite, which can appear days or even months later. (There is no telltale rash as with Lyme disease.)

Individuals most at-risk include the elderly and people with immunocompromised conditions. In fact, the death rate among those with an impaired immune system is as high as 20%, explains Peter Krause, a senior research scientist at Yale School of Public Health and Yale School of Medicine.

Although it is usually transmitted through a tick bite, Babesia can be acquired through a tainted blood transfusion.

Babesia cases are reported mostly in the Northeast and Upper Midwest but the disease is “increasing in frequency and geographic range,” warns Krause.

Babesia: Not recognized by all doctors

“It has to step up to the level of an infectious-disease specialist being brought in before it might get diagnosed, whereas in an area where it’s more prevalent, some of the front-line people, the emergency room doctors or urgent care doctors, might be a little more attuned to it,” says Sorana Segal-Maurer, an infectious-disease specialist at New York-Presbyterian Queens Hospital.¹

Editor’s notes:

I disagree with three statements made by doctors interviewed for the story:

I have Babesia patients who do not improve with only 7 to 10 days of treatment.
I have Babesia patients who are sick who do not meet the risk criteria described above.
I have Babesia patients who removed the tick in less than 24 hours and still became ill.

Babesia infections transmitted through blood supply

Podcast: Babesia infection after Lyme disease treatment

Podcast: Tick bite with Lyme disease, babesia and anaplasmosis

References:

Babesiosis, a dangerous tick-borne infection that attacks red blood cells, appears to be a growing problem. Abby Schwartz, Washington Post, 5/29/21.

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For more:

Category:

Babesia, research, Treatment

Tickborne Illnesses “Can Look Like Anything” Podcast

https://www.mindbodygreen.com/articles/physical-and-psychological-signs-of-tick-borne-illness Podcast in link

I’m A Functional MD & These Sneaky Signs Can Signal A Tickborne Illness

By Jason Wachob

July 28, 2021

Here’s the thing about tickborne illnesses: According to functional medicine doctor Kenneth Bock, M.D., they can cover different organ systems, and so patients often present myriad symptoms. “It can look like anything,” he shares on this episode of the mindbodygreen podcast, which poses a problem in clinical settings: If a patient comes in with a laundry list of complaints, some professionals may resort to a psychological diagnosis (especially if those said symptoms are, in fact, psychological, which we’ll get into later).

However, says Bock, “If you listen, and you look, and you think hard…these tickborne diseases can cause this myriad of complaints.” Meaning, it’s important not to rule out the possibility of a tickborne illness, even if you don’t necessarily live in a hotbed state. Below, he explains some of the most common signs he has seen.

Physical symptoms.

“It can range from skin rashes to heart palpitations, shortness of breath, brain fog, numbness, tingling, burning, dysesthesias (which is pain), and also general fatigue and headaches,” Bock says.

He also mentions that some ticks can carry Bartonella bacteria, which can “give you these purple-ish, reddish stretch marks” in uncommon areas you wouldn’t typically have stretch marks—like in the middle of the back or behind the knee. (We should note: There is little evidence to suggest the transmission of Bartonella from ticks to humans directly; most of the data shows that the bacteria can be transmitted from ticks to pets to a person during a scratch.)

He continues that Babesia, another tickborne illness that often goes hand-in-hand with Lyme disease, can cause symptoms like fever, chills, sweats, and air hunger (aka, feeling like you can’t get enough air).

The purpose of listing these symptoms isn’t to scare you—Bock emphasizes that when people point out their multiple symptoms, he takes tickborne illnesses into account. “Rather than [saying], ‘Oh, the person has air hunger, so they’re just anxious,’ these are clues to some of the tickborne illnesses.”

Psychological symptoms.

We mentioned brain fog, but Bock says tickborne illnesses can manifest as a host of psychological symptoms—sometimes for younger folks, the only symptoms at all are psychological.

“The thing about kids and adolescents is that sometimes the only symptoms of tickborne disease are neuropsychiatric,” Bock explains. “All you see is anxiety, or OCD, or panic attacks, or depression, and sometimes rage.” In fact, studies show that a portion of Lyme disease patients can experience explosive anger and aggressiveness (commonly referred to as “Lyme rage”).

All that to say: It’s important we don’t rule out tickborne illnesses, even if someone only presents psychological symptoms. “They can carry a diagnosis of mood disorder, [like] anxiety and panic attacks, but if they have a tickborne disease, they’ll never get better. All the psychotropics in the world and all the therapy will not [help them] get better,” says Bock.

The takeaway.

Tickborne illnesses can be scary—understandably so. Again, explaining all of these symptoms is not to spook you into thinking you have a tickborne illness. But if you present myriad symptoms, it’s important to get to the root of the issue and make sure a tickborne illness is not the driver.

“The key is to recognize that they exist,” notes Bock.

Enjoy this episode! And don’t forget to subscribe to our podcast on iTunes, Google Podcasts, or Spotify!

**Comment**

Regarding ticks transmitting Bartonella directly to humans, I personally asked Dr. Breitshwerdt if this is true. He strongly believes ticks transmit it. Info here. There are many people with Bartonella who have not had cat or pet exposure, although it is known that Bartonella is transmitted by numerous insects and arachnids. BTW: you can have Bartonella without the purplish stretch-mark looking rashes.

For a nifty coinfection symptom chart go here, although it’s important to remember there are symptoms not on this chart, as well as the fact you may not present with the typical symptoms. I appreciate the fact he said some peoples’ only symptoms are psychiatric. This is very true but not considered by mainstream medicine.

One of the most telling quotes within the article is the phrase about having a “laundry-list” of symptoms. Dr. Jemsek gives the following quote when speaking about Lyme:

“You either have 20 diseases or you have Lyme disease.”

I would add that you should also suspect other coinfections as well.

For more:

One thing the article did not mention is testing, which nearly all mainstream doctors will use, even though these tests have been proven to be a joke. This isn’t discussed and you have to be your own advocate and understand this. I would seriously bypass mainstream medicine and head directly to a Lyme literate doctor, who will diagnose and treat you clinically based upon symptoms.

From my perspective with helping patients, mainstream doctors continue to utilize faulty testing, take a “wait and see” approach which is dooming patients to a life-time of suffering, and even IF they miraculously test positive on an abysmal test, treat them inappropriately with no more than the insufficient monotherapy of 21 days of doxycycline.

You can look up more articles by typing in key words into the search bar on the website. For instance, if you want to know more about Bartonella, just type Bartonella into the search bar and other articles will pop up.

Category:

Babesia, Bartonella, Lyme, Psychological Aspects

Tickborne Illnesses in Finland

https://www.lymedisease.org/ticks-finland-2/

TOUCHED BY LYME: Tick-borne illnesses in Finland

April 28, 2021

Guest blogger C.M. Rubin interviews two European scientists about the prevalence of Lyme disease and other tick-borne infections in Finland.

The Global Search for Education: Finland — Ticks

by C M Rubin as featured in the Huffington Post

Lyme disease is caused by a bacterium transmitted to humans via a tick bite. The CDC (Center for Disease Control) claims that Lyme Borreliosis is the most common and fastest growing infectious illness in the United States. The disease can cause a variety of flu-like symptoms such as fever, achy joints, fatigue and headache. Additionally, Anaplasmosis/Ehrlichiosis, Babesiosis, Rocky Mountain Spotted Fever, Bartonella, Tularemia, and more recently, Borrelia Miyamotoi (a distant relative of Lyme Borreliosis) are other recognized tick-borne infectious diseases in the United States.

Experts have been unable to agree for decades on whether a case definition called chronic Lyme disease exists. Yet, some Lyme victims, even after taking the standard treatment of antibiotics, continue to suffer from long-term and often serious health problems for years after they first contract the disease. Does chronic Lyme disease exist, or is the condition which some patients experience an autoimmune or nervous system response triggered by the infection, or indeed is it a bit of both? These are some of the major questions researchers are trying to figure out as they take on the enormous challenges of identifying better Lyme diagnostic tools and treatment plans for what is becoming a growing global public health crisis.

Today in The Global Search for Education, I take a look at tick-borne illnesses in Finland. I am joined by Docent Jarmo Oksi, Finland’s leading researcher in the field of Lyme disease, who is based at the University of Turku in Finland. In addition, I welcome Markku Kuusi, Chief Medical Officer from Finland’s National Institute for Health and Welfare.

“The weakness of the Finnish surveillance system is that we don’t collect any clinical information on patients, we only get notifications from laboratories.” — Markku Kuusi
What is the annual incidence of Lyme disease in Finland and in Europe at large?Jarmo: Laboratory reports on Lyme Borreliosis cases (based on positive serology) have doubled in 10 years and are now about 1,500. The estimated number of Lyme Borreliosis infection cases is about four times this number — i.e. estimated incidence in Finland is 5,000-6,000 annually (population 5.5 million), which is about 100 per 100,000 inhabitants per year. However there are areas in the Southwestern Archipelago with incidence of 1000 per 100,000 inhabitants per year.

Markku: Based on the National Infectious Disease Register, the incidence of Lyme disease in Finland has been about 30/100,000 during the past few years. In terms of the annual incidence in other Nordic countries, in Norway it has been about 6/100,000 and in Denmark, 1 – 2/100,000. It is hard to believe that there is such a difference in actual incidence, so that is why I believe the diagnostic criteria are truly different. The weakness of the Finnish surveillance system is that we don’t collect any clinical information on patients, we only get notifications from laboratories; so it is difficult to say whether the symptoms of our cases really are compatible with Lyme Borreliosis.

Would you comment on the annual incidence of any of the other tick-borne illnesses which are endemic in Finland in addition to Lyme.

Markku: Tick-borne Encephalitis (TBE) is another important tick-borne disease in Finland. The incidence has been particularly high on Aland Island and therefore TBE vaccination is included in the national immunization program. Before the vaccination program, the annual incidence was up to 100/100,000 population. Now it has decreased substantially. It seems that in other parts of Finland (apart from Aland Island), the incidence is increasing, and therefore other areas may also be included in the immunization program in the near future (for example, the Archipelago around the city of Turku).

Do you believe that chronic Lyme disease exists or that it is a misnomer for other diseases triggered by Lyme disease?

Markku: This is a difficult question. I think it is clear that some patients have a prolonged course of the disease which may last several months. The most experienced clinicians in Finland think that a continuing Borrelia infection is possible if the patient has not received adequate treatment for the illness, resulting in disseminated infection. Even after adequate treatment, some patients have symptoms due to immunological mechanisms, but it is very hard to say whether these symptoms are related to Borrelia infection or to some other causes.

2013-04-25-cmrubinworldlabra_182.JPG_3420500.jpg “The most experienced clinicians in Finland think that a continuing Borrelia infection is possible if the patient has not received adequate treatment for the illness, resulting in disseminated infection.”— Markku Kuusi
If you believe in chronic Lyme disease, what do you believe are the most effective ways to treat it?Jarmo: If you mean chronic infection, I think that this entity after standard antibiotic therapy is very very seldom (I see about one case in five years). However, if detected –e.g. with cultivation or PCR (the most specific way to detect), the treatment I give is individual antibiotic treatment — maybe double the length compared to the initial treatment.

What do you believe is the most effective way to treat symptoms triggered by the infection, e.g. chronic auto-immune reaction?

Jarmo: During the first months I wait for gradual improvement. If there is no improvement after six to 12 months, I then start low-dose corticosteroid treatment for a certain subset of patients. Some other subsets may get help from, for example, amitriptyline, which raises the threshold for pain sensation.

What tests currently available to the general public, other than the Western Blot test, do you believe provide a better degree of certainty?

Jarmo: PCR (and culture) are useful in some situations (culture only in research settings), but even PCR is not sensitive enough to detect all cases — e.g. in CSF (cerebrospinal fluid) of neuroborreliosis cases. Besides Western Blots, ELISA tests based on C6 peptide are generally good as confirmatory tests.

2013-04-25-cmrubinworld_P6Q5372.JPG_198500.jpg “We are currently enrolling patients into a study on neuroborreliosis: comparison of IV Ceftriaxone for 3 weeks vs. oral Doximycin for 4 weeks. Hopefully this study will give us new knowledge on markers of how to identify patients with reactive symptomatology triggered by Lyme neuroborreliosis.”— Jarmo Oksi
Are you aware of any other promising tests in development?Markku: Last year, a Finnish group reviewed the diagnostic tests in our country. It is my understanding that right now there are not unfortunately any new reliable tests available. So we shall have to wait awhile for them.

To what research do you believe scientists around the world must give priority in order to overcome the challenges the public faces with finding a cure for Lyme disease?

Markku: I think it is important to better understand the mechanism behind the sequelae of acute borreliosis. Therefore, we need more research on the immunology of the disease. In other words, how does the bacteria actually cause joint symptoms or neurologic symptoms. I think this will help us to develop better diagnostic tests and hopefully better drugs. I believe antibiotics are not the only solution.

What is the focus of your research and how does it relate to the challenges of identification and cure of Lyme disease and diseases triggered by Lyme?

Jarmo: We are currently enrolling patients into a study on neuroborreliosis: comparison of IV Ceftriaxone for three weeks vs. oral Doximycin for four weeks. Hopefully this study (with control CSF specimens) and long follow-ups of patients also will give us new knowledge on markers of how to identify patients with reactive symptomatology triggered by Lyme neuroborreliosis.

How can technology help us find a cure for Lyme disease faster?

Markku: This is not really a field in which I am knowledgeable, but I believe that better molecular and immunological methods may give possibilities for new diagnostics and for the development of new drugs. What I really hope is that there will be better and more specific laboratory tests for Lyme Borreliosis in the future. I think that one of the key issues is to harmonize the laboratory methods so that we can get a better understanding of the epidemiology of Lyme disease in Finland.

C M Rubin is a child and family health and education advocate. She is the author of a number of award winning books as well as the widely read online series THE GLOBAL SEARCH FOR EDUCATION.

Follow C. M. Rubin on Twitter: www.twitter.com/@cmrubinworld

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**Comment**

I disagree with two tenets in this paper:

Chronic Lyme is rare. I personally, as well as my husband, and most I deal with have improved immensely or even reached remission with lengthy treatment utilizing numerous antimicrobials and other modalities. As they say, “The proof is in the pudding.” Lyme spirochetes have been found in the autopsied brain despite treatment. There are also extensive global research showing the persistence of the organism in 700 peer-reviewed papers (as well as coinfections that often come with Lyme): Peer-Reviewed Evidence of Persistence of Lyme:MSIDS copy Please keep in mind that everything is rigged against reporting chronic infection. Globally, doctors work under the CDC/IDSA’s myopic focus on the acute phase and frank denial of persistent infection. It doesn’t surprise me at all that a Finnish researcher also cow-tows to this thinking. It’s rampant.

That we need yet more research on the acute phase of Lyme. Frankly, that’s about all we have. We desperately need researchers to quit myopically focusing on this phase of the illness and study the thousands upon thousands with chronic/persistent symptoms who often do to not test positive on the abysmal CDC 2-tiered testing, which is rigged to not pick up chronic infection, and do not have the “classic” EM rash. These two variables have kept the sickest patients from being studied.

Category:

Anaplasmosis, Babesia, Bartonella, Borrelia Miyamotoi (Relapsing Fever Group), Lyme, Rocky Mountain Spotted Fever, Ticks, Tularemia

Pediatric Bipolar Disorders & Tick-borne Illnesses

https://www.lymedisease.org/pediatric-bipolar-disorders/

Pediatric bipolar disorders and tick-borne illnesses

July 23, 2021

By Rosalie Greenberg, MD

Pediatric Bipolar Disorder (PBD) refers to a child or adolescent experiencing a distinct period of time in which he or she has changes in mood, energy, thought and behavior that can have a significant effect on the youngster’s ability to function.

This diagnosis, like most, is on a spectrum. A young person can have manic episodes with or without depressive episodes. This is called Bipolar I. Or, the child can have episodes of depression with only mild hypomanic episodes (not as severe as mania and which don’t require psychiatric hospitalization.) This is called Bipolar II.

Other Specified or Unspecified Bipolar and Related Disorder are two other categories that are used when the full criteria for the diagnosis are not met. In the past, this was called Bipolar Disorder Not Otherwise Specified (NOS).

Making a diagnosis

The symptoms required to make the diagnosis of a manic episode are the following: a clear period of abnormally elevated or irritable mood and heightened energy or activity lasting at least a week (or less if hospitalized) accompanied by three or more of the symptoms below (four if only irritable):

Decreased need for sleep
increased self-esteem or grandiosity
More talkative or pressured speech
Flight of ideas (loosely connected thoughts) or feeling like one has racing thoughts
Distractability
Increase in goal-directed activity or overall heightened psychomotor agitation
Increased impulsivity that can cause excessive involvement in activities that have a high potential for painful consequences

In the majority of cases, the cause of bipolar disorder is uncertain. But it is probably a mixture of genetics, the environment (including exposure to certain infections) and immune system dysfunction.

A few infectious agents have been accepted as being directly associated with bipolar disorder symptoms. Two of these are:

the parasite Toxoplasmosis Gondii which causes toxoplasmosis
the spirochetal (corkscrew shaped) bacteria, Treponema Pallidum which causes syphilis

Of note, both syphilis and Lyme disease (caused by Borrelia burgdorferi), are caused by a spirochete-shaped bacteria and they share a variety of other commonalities.

The Borrelia bacteria has more DNA and is much more complex in composition and function. Individuals who experience late stage, or tertiary, syphilis can exhibit manic-like behavior, which also can be seen at times in those with neurologic Lyme disease.

PANDAS/PANS

For a while, I was looking at new patients for any evidence of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS) or Pediatric Acute-onset Neuropsychiatric Syndrome (PANS).

The former refers to a group of psychiatric symptoms precipitated by a Group A Beta Hemolytic Streptococcal infection. In the latter, the cause remains unspecified and might include factors such as infections, trauma and environmental toxins.

Because of the similarities I observed between PANDAS/PANS and PBD, I started to check some of my PBD patients for evidence of infection.

One such patient was P, an 11-year-old, who came to see me following four psychiatric hospitalizations over the course of one year, because of difficulty with mood shifts, oppositional behavior and verbal and physical aggressive outbursts.

He was diagnosed as having PBD, attention-deficit hyperactivity disorder (ADHD) – combined type and oppositional defiant disorder. His difficulties had only mildly improved despite multiple psychiatric medication trials.

I first saw him after his last hospitalization. At that point, he was no longer acutely dangerous to himself or others but had limited self-control and awareness.

I learned that his family history was strongly positive for bipolar disorder in at least three generations. Alcoholism was present in both maternal and paternal relatives. Furthermore, there were a variety of autoimmune disorders in relatives on both sides of the family tree.

After eight months of medication treatment under my care as an outpatient, he suddenly once again became highly agitated, argumentative and threatening. It was clear that he could not continue to live at home unless his behavior drastically changed

High strep titers

Despite the fact he had been healthy, with no known medical history of a Streptococcal infection (the bacteria responsible for causing strep throat), I decided to check him for evidence of infection causing PANDAS or PANS. To my surprise, his strep titers were quite high and he was subsequently diagnosed with PANDAS.

A few months of treatment with antibiotics eventually resulted in a dramatic change. His mood was happier and more even, he was much less oppositional, more affectionate and he even became a more diligent student.

He was on a low dose antibiotic prophylactically to protect against recurrent streptococcal infection. This protective approach is similar to what occurs in those with rheumatic heart disease.

Over time, P’s negative behavior would return and escalate on occasion if he was exposed to someone who was sick. But his symptoms usually responded quickly with anti-inflammatory treatment or, if needed, a change in antibiotic.

Bartonella

When P was in the 8th grade, he had a severe angry depressive episode. By this time, I had become familiar with tick-borne disorders and their potential neuropsychiatric effects. On testing, he was positive for the bacteria Bartonella henselae.

Once again, proper antibiotic treatment resulted in a significant lessening of his psychiatric symptoms. It is important to note that he also needed an antipsychotic and anticonvulsant for mood maintenance whether or not he was taking antibiotics.

Given the observation that P’s mood and behavior dramatically changed once his infections were identified and properly treated, I decided to screen many of my new patients for evidence of infection.

To my surprise, I found evidence of infections in the majority of those newer patients who underwent blood testing during psychiatric evaluation.

I am known as being an expert in pediatric bipolar disorder, having written Bipolar Kids: Helping Your Child Find Calm in the Mood Storm, as well as having lectured to the public and professionals and written a variety of articles for both groups.

It’s important to keep in mind that my practice is somewhat atypical in that it experiences what is called “a referral bias,” with many parents coming to see me to determine whether or not their child really has bipolar disorder.

Once I kept finding evidence of infections, and often positive mood or behavioral changes when the newly discovered illnesses were addressed, I decided that it was important that I go back and check for infections in my bipolar patients with whom I had worked for years.

Again, I was surprised to find that many of these kids also tested positive for evidence of infection, especially tick-borne illnesses (TBIs).

Tick-borne illnesses

Ten years ago, I learned that New Jersey, where my practice is located, is a Lyme-endemic state. But how was it possible that so many of my patients tested positive? Maybe the testing was wrong? I even submitted samples of my own blood to two of the specialty laboratories (Igenex and Galaxy Diagnostics) to check the accuracy of the testing and found the results quite credible for a variety of reasons.

I also noted that as I kept learning more and more about Lyme and the other TBIs at different specialized meetings, I often heard presentations of adult patients who were diagnosed with bipolar disorder and later found to be suffering from some form of tick-borne illness. This sounded just like “my kids.”

With this experience as my background, I decided to do a retrospective chart review to determine the rate of evidence of tick-borne infection exposure in 27 consecutively seen bipolar youth whom I treated between February 2013 and July 2015.

Of the 27, 81% (22/27) were males and 19% (5/27) were females with an average age of 7.3 years. Fifteen of the kids were diagnosed as having Bipolar I (had manic episodes) and 12 had Bipolar II (episodes of depression with periods of hypomania).

Using a variety of different laboratories, blood testing was done to check for evidence of exposure to Group A Beta Hemolytic Streptococcal bacteria, and other infectious agents including Mycoplasma pneumoniae (which can cause walking pneumonia), Borrelia burgdorferi (Lyme disease), Babesia, Bartonella, Anaplasma and Ehrlichia.

24 out of 27 bipolar children had TBIs

In the end, 89% (24/27) showed evidence of exposure to one or more of these pathogens (infectious agents). The frequency of the positive testing results in the 27 bipolar child patients were as follows:

Babesia =16
Mycoplasma pneumoniae = 11
Bartonella = 8
Lyme = 6
Anaplasma + Ehrlichia = 1

All individuals who had a positive test were recommended to see a doctor familiar with TBIs to determine if the patient should receive the clinical diagnosis and get appropriate treatment.

Twenty-two of the 24 agreed to this assessment. All of those children who followed the recommendation and sought consultation were found by the evaluating physician to meet the clinical criteria for the diagnosis of having TBIs.

In the end, 20/27 or 74% of those with PBD were positive for TBIs by both laboratory testing and clinician assessment. Four of the 27 (23.5%) patients tested were positive for PANDAS. Another important observation is that only three of the 27 with PBD had a known tick bite.

The results are clearly quite provocative. It’s important to keep in mind that the association found between TBIs and PBD does not mean there is a causal relationship. Interestingly, for some children, treatment of their TBIs resulted in variable degrees of improvement of their psychiatric symptoms.

The case of P, presented earlier, is a clear example of how treating the infection improved the child’s mental health. Studies are needed before making a definitive statement regarding the neuropsychological effects of treating underlying infections. It would be wrong to generalize the results from a small, specialized psychiatric practice without more evidential support from other pediatric populations.

“Bipolar-like” symptoms

I also noted that some of the kids in my practice exhibited what I call “bipolar-like” symptoms. They clearly do not fit the full criteria for a bipolar mood disorder. Yet, they exhibit definite elements consistent with a significant amount of mood unsteadiness, especially depression, as well as exhibit similar co-morbidity to youth with PBD.

The potentially accompanying psychiatric illnesses include anxiety disorders (e.g. obsessive-compulsive disorder [OCD] and separation anxiety), ADHD and behavioral disturbances with intense temper outbursts.

I can’t help but wonder how many of these children have been given the diagnosis of Disruptive Mood Dysregulation Disorder (DMDD) by other psychiatrists.

This particular diagnosis was created as a way to help identify children who did not show clear mania or hypomania but who struggle with long standing temper dysregulation, sadness and irritability. Could many of them be in this “bipolar-like “ group? Again, the answer requires more study.

The natural question from these findings for both parents and professionals is: Does treating the TBIs make any difference in how these kids actually end up functioning in real life?

Observations

Without more research, I can only comment about what I have observed in my practice with these children. There appears to be three groups:

Kids who are treated for their bipolar symptoms as well as TBIs who at some point are able to do well once the infections are resolved or at least controlled. Their psychiatric symptoms appear to have been eliminated or significantly lessened enough that over time they can stop all psychiatric medication. This group is fairly small but definitely exists.
Kids who are treated for BPD and TBIs but require less psychiatric medication (yet still need some) when their infections are under better control. One clue that the psychiatric medication can be lowered is the occurrence of side effects from the psychiatric medication (e.g. new onset of lethargy and sleepiness) that were previously not present while the child appeared to benefit from that dose of medication in the past.
Kids who are treated for BPD and TBIs but still require significant doses of psychiatric medications as their infections come under better control.

Therefore treating the underlying psychiatric illness has the potential to change the long-term outcome in some youngsters who manifest bipolar disorder symptoms and were exposed to tick-borne illnesses.

The true prevalence of TBIs in youth who reside in the geographical area where my practice is located is unknown. This data is crucial to be able to interpret properly what I’ve found in my patients.

To what extent do infectious agents and autoimmune processes contribute to the present escalation in child and adolescent mental disorders? The mounting evidence supporting the connections of infections, autoimmune processes and mental disorders appears significant and demand more scientific investigation.

Dr. Rosalie Greenberg is a Board-Certified Adult, Child and Adolescent Psychiatrist, known for her expertise in the diagnosis and management of complex psychiatric problems in children, and pediatric psychopharmacology. For the past few years, she has focused on the psychiatric manifestations of infectious diseases, especially, tick-borne illnesses in children and adolescents. Her website is rosaliegreenbergmd.com.

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