Archive for the ‘Ehrlichiosis’ Category

Ticks Bite Leads to GBS

https://danielcameronmd.com/tick-bite-leads-to-guillain-barre-syndrome/

Tick bite leads to Guillain-Barré Syndrome

tick-bite-Guillain-Barre

Welcome to another Inside Lyme Podcast with your host Dr. Daniel Cameron. In this episode, Dr. Cameron will be discussing the case of a 71-year-old woman who was initially diagnosed with Ehrlichia, a tick-borne illness but later developed Guillain-Barré Syndrome.

The study, entitled “Case of ehrlichiosis induced Guillain-Barre Syndrome in a 71-year-old female,” was published by Malhis and colleagues in the journal IDcases

The woman’s initial symptoms occurred over a 3-week period and included: generalized weakness, dizziness, visual changes, chills, a fever, neck and abdominal pain.

After presenting to the hospital, she was diagnosed with Ehrlichia, a tick-borne illness, based on a low platelet count, elevated liver function tests, an insect bite, a positive Ehrlichia test by PCR, and absence of another illness.

The woman was treated with doxycycline and her symptoms improved.

Click top link to watch a video discussing Ehrlichia-induced Guillain-Barre Syndrome 

However, approximately one week later, she returned to the hospital with worsening symptoms and “numbness and areflexia in her lower extremities which progressed since her first encounter,” the authors write.

She developed an unsteady gait, which required a walker and had tingling in her feet and difficulty urinating. She required a straight foley catheterization.

“Although ehrlichiosis is not a common cause for GBS, the pathogenesis is like Lyme disease or Campylobacter jejuni,” the authors write.

“This patient had clinical symptoms that were like tick-borne illness yet as her disease progressed, it illustrated the need for an expanded differential diagnosis.”

The woman was diagnosed with an acute inflammatory demyelinating polyneuropathy, often referred to as Guillain-Barré Syndrome.

There was no evidence of another tick-borne illness including Lyme disease, Babesia, Heartland or Bourbon Virus.

The patient improved significantly with IVIG and was discharged to a rehabilitation center.

“Although ehrlichiosis is not pathognomonic for Guillain-Barre, it is important to not rule out as a cause,” the authors point out. “With the COVID-19 outbreak, there have been reported cases of GBS induced by COVID. It too can cause an immune response to the nervous system.”

Bourbon virus

“There have been reported cases of tick-borne illness that have not recovered despite tetracycline treatment,” reports Kosoy et al.2

They cite the case of a 50-year-old male from Eastern Kentucky who was found to have several tick bites, enlarged Lymph nodes, a macular papular rash, low platelets, low white count, and complaints of nausea, vomiting and diarrhea, followed by fever, myalgias, headaches and arthralgias.

The patient’s labs were negative for known tick-borne pathogens and he failed tetracycline treatment.

“Multiorgan failure developed, and he died 11 days after illness onset from cardiopulmonary arrest,” the authors write.

The man was later diagnosed with the Bourbon virus, a newly recognized tick-borne illness.3

Guillain-Barré Syndrome

 Guillain-Barré Syndrome (GBS) is an acute autoimmune demyelinating polyradiculoneuropathy that induces rapid and progressive flaccid weakness, according to Malhis.1 GBS can be life threatening if it progresses to involving the diaphragm.

 There are a number of causes of GBS. Respiratory and gastrointestinal infections can lead to GBS.  Lyme disease, tick-paralysis, HIV, and West Nile Virus can also lead to GBS.  There is also a very slim chance (1 in a million) that a flu vaccine can lead to GBS.

Treatment for GBS includes intravenous immunoglobulin (IVIG) therapy or plasma exchange. Steroids have not been helpful in treating the condition. An estimated 85% of patients recover their independent ambulation.

The authors conclude: “It is important to keep a broad differential as sometimes common syndromes do not always come from common pathogens and with the COVID-19 pandemic having similar results, we are learning new things that may potentially be new standards in medical education.”

The following questions are addressed in this Podcast episode:

  1. What is the Guillain-Barré Syndrome?
  2. What is the treatment for Guillain-Barré Syndrome?
  3. What is the Bourbon and Heartland virus?
  4. Why are there concerns for individuals with COVID-19?

Thanks for listening to another Inside Lyme Podcast. Please remember that the advice given is general and not intended as specific advice to any particular patient. If you require specific advice, please seek that advice from an experienced professional.

Inside Lyme Podcast Series

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

References:
  1. Malhis JR, Mahmoud A, Belote A, Ebers A. Case of ehrlichiosis induced Guillain-Barre Syndrome in a 71 year-old female. IDCases. 2021;26:e01301. doi:10.1016/j.idcr.2021.e01301
  2. Kosoy OI, Lambert AJ, Hawkinson DJ, et al. Novel thogotovirus associated with febrile illness and death, United States, 2014. Emerg Infect Dis. May 2015;21(5):760-4. doi:10.3201/eid2105.150150
  3. Hearland and Bourbon Virus Disease. CDC. https://www.cdc.gov/ticks/tickbornediseases/heartland-virus.html Last accessed 12/12/21.

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**Comment**

This article states that COVID can also induce GBS, which begs the question – why would Dr. Cameron believe and encourage Lyme/MSIDS patients to get the COVID injections?  The article admits that COVID can cause an immune response to the nervous system, which Lyme/MSIDS patients are already struggling with.  Illogical.

Please read and understand the risks of the COVID injections – and there are many:

What it Means For a Patient to Be Heard

https://www.globallymealliance.org/blog/what-it-means-for-a-patient-to-be-heard

What it Means for a Patient to Be Heard

Dec. 15, 2021

A friend experiencing unusual fatigue finally went to see a doctor recently. “I was so nervous,” she told me. “I was afraid he wouldn’t believe me.”

As a patient with several chronic illnesses that took years to diagnose, I knew exactly how my friend felt. Before being accurately diagnosed with chronic active Epstein Barr virus, Lyme disease, babesiosis, ehrlichiosis, and possible bartonella, I’d been passed off by countless medical practitioners who couldn’t figure out the derivation of my nebulous symptoms including bone-crushing exhaustion, migraine headaches, brain fog, insomnia, and hallucinogenic nightmares. I became so used to hearing, “Well, your bloodwork looks normal, so there’s nothing wrong with you” and “You must just be stressed/depressed/run down,” that I began to question my understanding of my own body. I started to think maybe I was just crazy.

Over the years, I continued to seek answers for the increasing physical symptoms I experienced, but began arriving in doctor’s offices not just nervous, like my friend, but defensive. As women, our fear and defensiveness were not unfounded; a study entitled “The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain” shows that women are more likely to have their pain characterized as “emotional,” “psychogenic,” and “not real.[i] And regardless of gender, a 2019 study in the Journal of Internal Medicine found that the average amount of time it takes a doctor to interrupt a patient is 11 seconds[ii]. Within 11 seconds, a doctor is already placing a patient into a cookie-cutter box, not hearing important details that could help them make an accurate diagnosis.

To her great surprise, my friend had a different experience with her recent doctor visit. “Not only did he listen,” she told me, “but he was compassionate.” After hearing my friend explain that her fatigue was not normal sleepiness, that she was feeling sick all the time and was sick of it, the doctor said, “That sounds awful. I’m so sorry you’re experiencing that. Let’s try to figure out what’s going on.”

Before even getting a diagnosis—and not knowing if she would even get one—my friend got something else she really needed: validation. In order to trust her doctor, she needed to know that he believed her.

I felt the same way when, years after my symptoms began, I went to see a naturopathic physician. Before the appointment, I wrote out my entire medical history, and carried it like a shield against my chest when I entered the office. That doctor read my entire written account. He underlined points. He jotted notes in the margins. He stopped to ask clarifying questions. He made me feel heard before he even really spoke.

The naturopathic physician was only able to figure out a portion of my diagnosis—chronic active Epstein Barr virus—but he still sticks out as one of the best practitioners I saw, because he didn’t write me off. He wanted to work with me to get me back to health, even if he didn’t have all the answers. In fact, when he suspected underlying tick-borne infection when I presented with erythema migrans (EM) rashes on my elbows a year after first seeing him, he admitted that such an infection was out of his wheelhouse, and sent me instead to a Lyme Literate Medical Doctor (LLMD). Rather than put the responsibility on me when he couldn’t solve the problem, this doctor sent me to someone who could. Unlike so many physicians I’d seen before him, his hubris did not cloud his Hippocratic Oath to first do no harm.

Being heard is critical to all patients, especially those with diseases like Lyme that are steeped in controversy and misunderstanding. These patients need first and foremost for their suffering to be acknowledged—and not just by physicians. Many Lyme warriors fight to be believed by family members, friends, and coworkers. Patients don’t need people to be fully Lyme literate, or to have the magic answer. We just need people to try to understand. To listen. To offer compassion. To take our hands and offer to walk with us, even if we’re not sure of the destination.

[i] Hoffmann, Diane E. and Tarzian, Anita J., The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain (2001). Available at SSRN: https://ssrn.com/abstract=383803 or http://dx.doi.org/10.2139/ssrn.383803

[ii] Singh Ospina, N., Phillips, K.A., Rodriguez-Gutierrez, R. et al. Eliciting the Patient’s Agenda- Secondary Analysis of Recorded Clinical Encounters. J GEN INTERN MED 34, 36–40 (2019). https://doi.org/10.1007/s11606-018-4540-5

Jennifer Crystal

Opinions expressed by contributors are their own. Jennifer Crystal is a writer and educator in Boston. Her work has appeared in local and national publications including Harvard Health Publishing and The Boston Globe. As a GLA columnist for over six years, her work on GLA.org has received mention in publications such as The New Yorker, weatherchannel.com, CQ Researcher, and ProHealth.com. Jennifer is a patient advocate who has dealt with chronic illness, including Lyme and other tick-borne infections. Her memoir about her medical journey is forthcoming. Contact her via email below.

Email: lymewarriorjennifercrystal@gmail.com

Best Tests & Laboratory For Lyme & Coinfections

https://www.treatlyme.net/guide/best-lyme-bartonella-babesia-tests  Video Here

Best Tests & Laboratory for Lyme & Coinfections

In the video in the top link and in the following article I discuss why IGenex offers the best tests for Lyme, Bartonella, Babesia, Ehrlichia and Anaplasma versus other lab systems. IGenex has a variety of tests that it offers for each tick-borne infection. I take the guesswork out of determining which IGenex test is best – I tell you which test to get for each infection.

Watch why I prefer IGenex testing over Galaxy Labs, Vibrant Labs and DNA Connexions. In addition to what I describe in the video, I also prefer IGenex antibody tests over T cell activation tests, also called elispot tests, offered by Infectolab, Armin labs, and IGenex. T cell tests are not as accurate at finding tick borne infections as the IGenex testing techniques I recommend in the video.

Resources

Watch the video in the top link for a detailed list and test codes for the IGenex tests I recommend.

IGenex Tests I Recommend

In the video I recommend the following specific IGenex tests.

Lyme (Borrelia)

  • IGM and IGG Immunoblot – Test Code 325 and 335

Bartonella

  • IGM and IGG Immunoblot – Test Code 374 and 384

Babesia

  • B. microti IgM & IgG IFA – Test Code 200
  • B. duncani IgM & IGG IFA – Test Code 720
  • Babesia FISH – Test Code 640

Ehrlichia

  • HME (Ehrlichia chaffeensis) IgM & IgG IFA – Test Code 203

Anaplasma

  • HGA (Anaplasma phagocytophilum) IgM & IgG IFA – Test Code 206

See full profile: on LinkedIn
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About the Author

Marty Ross, MD is a passionate Lyme disease educator and clinical expert. He helps Lyme sufferers and their physicians see what really works based on his review of the science and extensive real-world experience. Dr. Ross is licensed to practice medicine in Washington State (License: MD00033296) where he has treated thousands of Lyme disease patients in his Seattle practice. 

Marty Ross, MD is a graduate of Indiana University School of Medicine and Georgetown University Family Medicine Residency. He is a member of the International Lyme and Associated Disease Society (ILADS) and The Institute for Functional Medicine.

Adjunct Therapies That Have Helped With My Tick-Borne Illneses

https://www.globallymealliance.org/blog/adjunct-therapies-that-have-helped-with-my-tick-borne-illnesses

Jen Crystal discusses the adjunct therapies that helped her in her Lyme disease journey.

Patients write to me every day asking what helped me achieve remission from tick-borne illness. I wish there was a magic answer I could give them, but since every single case is different, there is no set protocol. What worked for me might not work for someone else. Moreover, what worked for me five years ago is not what works for me now. Each case changes over time as spirochetes are killed off and symptoms improve. My Lyme Literate Medical Doctor (LLMD) is always fine-tuning my protocol.

That said, there are several adjunct therapies that have worked in conjunction with my ever-changing protocol of medication and supplements. I call these adjunct or complementary therapies because they supported, but did not replace, my medical protocol. These therapies would not have worked alone, because first and foremost I needed to treat the infections of Lyme disease, babesiosis, ehrlichiosis, and possible bartonella. In fact, before I was accurately diagnosed with these tick-borne illnesses, I tried some alternative therapies and they did not help, because the underlying infections were too severe. Once I started appropriate treatment, the following therapies helped me heal:

Integrative Manual Therapy

Developed by Sharon Giammatteo, Ph.D., this hands-on technique uses light touch to facilitate healing. The therapy combines cranial therapy and neurofascial processing. In her book Body Wisdom: Light Touch for Optimal Health, Giammatteo explains that cranial therapy is “a manual approach to correcting problems of the cranium, as well as the tissues and structures within in. Cranial therapy works by exerting a gentle force on the head and the body. The force decompresses dysfunctional areas and facilitates proper biological rhythms.”[1]

Don’t be alarmed by the word “force”; it’s simply someone gently placing a hand on your head or body, making barely perceptible movements. The technique is lighter than massage. When I’m struggling with brain fog or other symptoms of Lyme brain, my integrative manual therapist might place one hand on my forehead and one hand on my lower back, to enable drainage. This is part of neurofascial processing, which is just placing hands on different parts of the body to get systems working in sync.

The great part about Integrative Manual Therapy is that a lot of it can be done at home, either by yourself or with the help of someone else. Techniques are outlined in Giammatteo’s book. You can also work with a trained facilitator. Some D.O.’s (Doctors of Osteopathic Medicine) do manual therapy, and some physical therapists do it. This means these appointments might be covered by insurance. You can also pay out-of-pocket for a private practitioner. At the height of my illnesses, I did Integrative Manual Therapy twice a week; now I do it twice a month.

Neurofeedback

You may have heard of biofeedback, which uses the body’s own feedback to regulate systems. Neurofeedback works in the same way, except on the brain instead of the body. This non-invasive technique uses your brain’s own feedback to help it work optimally, whether that is being able to rest, thinking more clearly, or having less intrusive thoughts.

During neurofeedback appointments, I sit in a comfortable lounge chair. The practitioner affixes small sensors on my head and ears. These sensors are connected to a computer that receives feedback from my brain, and then relays information back to my brain that helps it work better. During this process, I watch kaleidoscope-style images on a screen (though it’s fine to close your eyes), and listen to soft music. Sometimes as certain feedback is being sent, the music skips. That’s all I notice during the entire session. Otherwise I just sit and relax, and let my brain do its work.

I started neurofeedback when I saw a sleep specialist for insomnia. In conjunction with sleep medication, neurofeedback helped my brain retrain itself to turn off for rest. It toned down, though did not eliminate, my hallucinogenic nightmares. It also helped me to be able to fall asleep for a nap during the day, which my exhausted body desperately needed.

There are different types of neurofeedback. Some work on just one part of your brain at a time, while others work on the whole brain. I do NeurOptimal, which helps the whole brain at once. My practitioner thinks that working on only one part of my brain at a time might actually exacerbate, not help, some of my neurological issues.

Some sleep specialists do neurofeedback, which can be covered by insurance. There are also private practitioners that you can find through NeurOptimal. When my insomnia was raging, I did neurofeedback three times a week. Now that I am in remission, I do it once a month.

Physical Therapy

Physical therapy is an important way to rebuild muscle strength and stamina—when you are ready. I made the mistake of starting physical therapy too early in my treatment, and paid for it. Because infections were ravaging my body, exertion only made them worse. Before my babesiosis was adequately treated, thirty seconds on a stationary bike gave me a migraine and sent me straight back to bed.

When I was bedridden, people used to say to me, “You should get up and go for a walk. It’ll make you feel better.” Just walking to the end of the driveway made me feel much, much worse. You know your body best. If you had the flu, you would not go for a walk. You would wait until you felt better. I had to wait until my infections were cleared up enough before I could do physical therapy consistently, and have it make a positive difference. Talk with your LLMD about when physical therapy would be appropriate for you.

Make sure your physical therapist understands the way your illnesses impact your body, and has you go at a slow pace. You likely won’t be able to do a typical graded physical therapy program where you steadily increase time and weights. Instead, you’ll make progress, take some down turns, then make progress again. When I first started physical therapy, all I did were some gentle stretches and slow manipulations with my fingers and toes. It took months to work up to twelve minutes on a stationary bike. I added weights very, very slowly. Now, after regaining strength and learning to pace myself, I am able to ski, walk, paddleboard, kayak, and swim. (For more on my slow but steady physical therapy, see my poem “Never Say Never”).

Talk Therapy

Being sick, especially for an extended period of time, can take an emotional toll. Moreover, Lyme disease can cause anxiety and depression. Your LLMD or a psychiatrist may prescribe medication to help your mood, but it’s also really helpful to talk about your feelings with an objective professional. You want someone who believes your illness and believes in you. Someone who will allow you to vent on the tough days and, more importantly, give you some coping skills to handle those hard times. My own therapist also helped me examine relationships and patterns from my past that informed my response to illness. She helped me to accept and love my illnesses, and myself. By encouraging me to be gentle with myself, she helped me not to wallow in the past, but to learn from it so I could move forward.

These are the therapies that have helped me. It is not an exclusive or exhaustive list; other therapies that I haven’t tried, like reiki, light massage, rife machines, and hyperbaric oxygen chambers, may be helpful to other patients. I encourage you to discuss possible adjunct therapies with your LLMD to determine which would be best for you.

[1] Giammatteo, Sharon, Ph.D. Body Wisdom: Light Touch for Optimal Health. Berkeley, California: North Atlantic Books, 2002 (21).

Jennifer Crystal

Writer

Opinions expressed by contributors are their own. Jennifer Crystal is a writer and educator in Boston. Her work has appeared in local and national publications including Harvard Health Publishing and The Boston Globe. As a GLA columnist for over six years, her work on GLA.org has received mention in publications such as The New Yorker, weatherchannel.com, CQ Researcher, and ProHealth.com. Jennifer is a patient advocate who has dealt with chronic illness, including Lyme and other tick-borne infections. Her memoir about her medical journey is forthcoming. Contact her via email below.

Email: lymewarriorjennifercrystal@gmail.com

 

New Guidance for Treatment of Lyme & Other TBD in Pregnancy

https://www.lymedisease.org/lyme-pregnancy-guidance/

New guidance for treatment of Lyme and other TBD in pregnancy

Oct. 27, 2021

from the Lyme Disease Association website:

In a recently published review article,* authors provide a comprehensive summary of treatment options for pregnant patients with less common bacterial, fungal, and viral infections, including several tick-borne diseases (Lyme disease, ehrlichiosis, human granulocytic anaplasmosis, human monocytic ehrlichiosis, babesiosis, and Rocky Mountain spotted fever).

This review provides guidance to clinicians based on the most recently published evidence-based research and expert recommendations.

The review included a search of MEDLINE (inception to March 2021); clinical practice guidelines (both national and international); the CDC website; and additional references from bibliographies of noteworthy articles. The review also provides a list of medications on the WHO Essential Medications List that are used to treat the above infections (*Alyssa P. Gould et al., Drugs in Context-peer reviewed).

A summary of key treatment recommendations from the review article for several tick-borne diseases during pregnancy are as follows:

Lyme disease:

  • Treatment of gestational Lyme disease is essential to reduce adverse outcomes in pregnancy. The data shows adverse outcomes in treated pregnancy is (11–16%) compared to untreated disease (50–60%).
  • Doxycycline should not routinely be used in pregnancy for Lyme disease in order to avoid adverse side effects including transient suppression of bone growth and staining of developing teeth, especially with proven alternatives.
  • Amoxicillin is the preferred treatment in the absence of neurological manifestations or atrioventricular heart block.
  • Ceftriaxone is typically reserved for patients with severe neurological or cardiac manifestations.
  • One study noted a non-significant increase in adverse pregnancy outcomes, such as pregnancy loss, among orally treated (31.6%) compared to parenterally treated (12.1%) pregnant patients.
  • Alternative oral therapy is cefuroxime axetil and parenteral therapies include penicillin G or cefotaxime.
  • Late Lyme disease (often manifesting as Lyme arthritis) may be managed with oral or parenteral β-lactams.

Ehrlichiosis & Anaplasmosis:

  • If infections with anaplasmosis or ehrlichiosis is suspected, treatment should be initiated due to the likelihood of complications and potential for vertical transmission of disease.
  • Rifampin has shown in vitro activity against ehrlichia and has been used successfully in limited case reports of pregnant women with anaplasmosis.
  • Doxycycline has been used successfully to treat ehrlichiosis.
  • Due to a lack of data, these pregnant patients should be closely monitored for resolution of disease.
  • The addition of amoxicillin or cefuroxime is suggested if coinfection with Lyme disease is suspected, as rifampin does not have activity against B. burgdorferi.

Babesiosis:

  • Patients with suspected babesiosis should be treated due to potential complications, including possible vertical transmission to the fetus.
  • Combination therapy is preferred with clindamycin plus quinine.
  • Longer treatment courses or retreatment may be needed in cases with symptoms and/or parasitaemia persisting >3 months. Resolution of parasitaemia should be used to determine treatment course.

Rocky Mountain spotted fever (RMSF):

  • RMSF cases are associated with poor outcomes for the fetus, regardless of the treatment.
  • Prevention is crucial for pregnant patients, and treatment should be provided within 3–5 days of exposure.
  • Doxycycline is the preferred therapy. Treatment course is typically 5–7 days or 3 days after fever resolution.
  • Chloramphenicol is a proposed alternative treatment; but there are concerns for significant adverse effects, including myelosuppression, aplastic anaemia, and grey baby syndrome, specifically at or near birth, and it is associated with higher mortality in RMSF. (chloramphenicol is not available orally in the US).

Read the full review article here.

Read other LDA articles regarding treatment here