Archive for the ‘Mycoplasma’ Category

ArminLabs (EliSpot) With Dr. Schwarzbach – Podcast

http://www.betterhealthguy.com/episode93

Why You Should Listen

In this episode, you will learn about EliSpot testing and the various testing options available through ArminLabs in Germany.

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About My Guest

My guest for this episode is Dr. Armin Schwarzbach.  Armin Schwarzbach, MD, PhD is a medical doctor and a specialist in laboratory medicine from the laboratory ArminLabs in Augsburg, Germany.  Dr. Schwarzbach began by studying biochemistry at Hoechst AG in Frankfurt, Germany and pharmacy at the University of Mainz in Germany in 1984. In 1985 he studied medicine for 6 years at the University of Mainz and finished his MD in 1991.  Dr. Schwarzbach developed the worldwide first Radioimmunoassay (RIA) for human Gastric Inhibitory Polypeptide from 1986 – 1991, getting his PhD in 1992.  He is member of the Swiss Association for tick-borne diseases, the German Association of Clinical Chemistry and Laboratory Medicine, and the German Society for Medical Laboratory Specialists.  He is an Advisory Board member of AONM London, England, and Board member of German Borreliosis Society, and Member and former Board Member of the International Lyme and Associated Diseases Society (ILADS) and has served as an expert on advisory committees on Lyme Disease in England, Australia, Canada, Ireland, France, and Germany.  Dr. Schwarzbach is the founder and CEO of ArminLabs in Augsburg, Germany and has specialized in diagnostic tests and treatment options for patients with tick-borne diseases for over 20 years.

Key Takeaways

  • What is an EliSpot?
  • What organisms can be tested for using EliSpot technology?
  • How specific is the EliSpot in testing for Borrelia, Bartonella, Babesia, and other organisms?
  • Does the state of the immune system matter when considering EliSpot results?
  • Which infections are the most persistent?
  • Can the EliSpot be used to track progress or success of treatment?
  • What is Yersinia and where might it be encountered?
  • Can EliSpot testing be used in newborns and infants?
  • What role do viruses such as EBV, CMV, Coxsackie, and others play in chronic illness?
  • Can Mast Cell Activation Syndrome be triggered by viruses?
  • Why are Mycoplasma and Chlamydia so important to explore?
  • Why is IgA testing a promising new direction in laboratory medicine?
  • Is CD57 helpful clinically?
  • What microbes are more commonly associated with specific medical conditions?
  • How common are Rickettsial organisms?
  • What is “Post Lyme Syndrome”? Is it real?

Connect With My Guest

http://arminlabs.com

Disclaimer

The content of this show is for informational purposes only and is not intended to diagnose, treat, or cure any illness or medical condition. Nothing in today’s discussion is meant to serve as medical advice or as information to facilitate self-treatment. As always, please discuss any potential health-related decisions with your own personal medical authority.

Chronic Inflammatory Demyelinating Polyneuropathy as an Autoimmune Disease – but Associated with Bartonella, Mycoplasma & Viruses

https://www.ncbi.nlm.nih.gov/pubmed/31072742

2019 May 6. pii: S0896-8411(19)30043-5. doi: 10.1016/j.jaut.2019.04.021. [Epub ahead of print]

Chronic inflammatory demyelinating polyneuropathy as an autoimmune disease.

Abstract

Chronic inflammatory demyelinating polyneuropathy (CIDP) is an autoimmune disease characterized by neurological symptoms and signs of progressive weakness, paresthesias, and sensory dysfunction. Other symptoms include reduced or absent tendon reflexes, cranial nerve involvement, autonomic symptoms, ataxia, and neuropathic pain. Unlike other autoimmune diseases, CIDP generally affects older individuals and has a male predominance. The onset is generally insidious and can take up to 8 weeks with a relapsing-recovery pattern. Like all autoimmune diseases, the etiology is multifactorial, with both genetic and environmental factors contributing to it.

Case reports of CIDP have found associations with multiple pathogenic organisms including Hepatitis B and C viruses, Bartonella henselae, Mycoplasma pneumoniae, Human immunodeficiency virus, Cytomegalovirus and Epstein-Barr virus. Possible antigenic self-targets include myelin protein 0, myelin protein 2, peripheral myelin protein 22, Connexin 32, and myelin basic protein. Antibodies targeting the Ranvier node proteins such as contactin-1, contactin-associated protein 1, and neurofascin 155 have been described. CIDP is treated with rehabilitation and pharmacological modalities. Pharmacological treatments target autoimmune dysfunction and include corticosteroids, intravenous immunoglobulin, subcutaneous immunoglobulin, plasma exchange, immunosuppressive and immunomodulatory agents such as methotrexate, cyclophosphamide, rituximab, and mycophenolate mofetil. Although there are few observational studies and randomized clinical trials with limited evidence supporting the use of immunosuppressive drugs, they are widely used in clinical practice. A comprehensive review of CIDP is presented herein in light of the autoimmune tautology.

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**Comment**

It’s a bit of a head-scratcher to me why they call this an autoimmune disease when it’s associated with multiple pathogenic organisms.  From everything I know – treat the infection and the symptoms improve:  https://madisonarealymesupportgroup.com/2017/10/03/treat-the-infection-psychiatric-symptoms-get-better/

That’s not to say the immune system doesn’t need to be addressed.

Lyme/MSIDS treatment includes both aspects as well as detoxification and addressing imbalances within the body which requires supplementation with whatever is lacking.

It is common knowledge that immunosuppressive drugs worsen Lyme/MSIDS patients, so they need to be used scrupulously and along with antimicrobials or the pathogens are in an environment where they are allowed to thrive, ultimately worsening the patient’s condition.

For more:  https://www.ninds.nih.gov/Disorders/All-Disorders/Chronic-Inflammatory-Demyelinating-Polyneuropathy-CIDP-Information-Page  Excerpt:  

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a neurological disorder characterized by progressive weakness and impaired sensory function in the legs and arms. The disorder, which is sometimes called chronic relapsing polyneuropathy, is caused by damage to the myelin sheath (the fatty covering that wraps around and protects nerve fibers) of the peripheral nerves….It often presents with symptoms that include tingling or numbness (beginning in the toes and fingers), weakness of the arms and legs, loss of deep tendon reflexes (areflexia), fatigue, and abnormal sensations. CIDP is closely related to Guillain-Barre syndrome and it is considered the chronic counterpart of that acute disease.

The NIH link states the treatment is corticosteroids, but again, you’ve been warned that IF you have Lyme/MSIDS, that mono-therapy will make you worse.

Tingling, numbness, and stabbing pain are quite common in Lyme/MSIDS and many people with Epstein Barr (EBV) have misdiagnosed Lyme:  https://madisonarealymesupportgroup.com/2017/04/11/diagnosed-with-ebv-had-lyme/

https://madisonarealymesupportgroup.com/2017/11/04/24514/  EBV – A Key Player in Chronic Illness.

Neuropathy is also common with Lyme/MSIDS:  https://madisonarealymesupportgroup.com/2019/03/12/small-fiber-neuropathy-ptlds/

https://madisonarealymesupportgroup.com/2018/02/07/cranial-neuropathy-severe-pain-due-to-bb-infection/

 

 

Breaking Free From Lyme’s Grasp: How Writer Mira Carroll Reclaimed Her Creative Life

https://rawlsmd.com/health-articles/breaking-free-from-lymes-grasp-how-writer-mira-carroll-reclaimed-her-creative-life?

Mira-Carroll-Reclaimed-Life-from-Lyme-2

Breaking Free From Lyme’s Grasp: How Writer Mira Carroll Reclaimed her Creative Life

By Mira Carroll
Image Credit: Elaine Mays
Posted 5/10/19

Lyme pounced when I was vulnerable, in 2011, a year when I did a little too much. My immune system surely faltered under the weight of my normal workload, plus that of publishing my first book, and three significant trips — one to each coast and a third across the pond.

The overt assault started with a bad case of “the flu” on the tail-end of a week at a California retreat where deer (and likely, ticks) were ever present. The significance of this timing flew under my radar. In the aftermath, the microbes surreptitiously installed a fortress inside me, using weakness and prior injury for cover.

Around the same time, I had landed in menopause, the life stage I was calling my “less extreme youth,” and my whole body was starting to deteriorate. The diet and exercise habits I’d honed to stay slim stopped working, and I gained weight for no reason. Not a lot of weight, but noticeable on my small frame. It disturbed me, so I mentioned it at my annual physical.

The doctor opined that the only thing that works for women in my age bracket is extreme dieting and exercise. But I couldn’t fathom such a plan — I’d noticed I was experiencing more fatigue lately, and the mere mention of extreme exercise set off sirens in my joints. Besides, “extreme dieting” sounded unhealthy. My suspicions chimed in: Maybe I was just aging badly?

Still, aware of many sparkling, energetic oldsters, I knew the “just getting old” hypothesis had to be wrong. Until recently, I had enjoyed vibrant good health that I credit to several good habits. I kept my weight down, gave up smoking and drinking many years before, and exercised regularly. I had been a vegetarian for more than 35 years, and had stopped consuming most processed foods. I made sure to consume food and drink that also gave me pleasure — no cardboard food substitutes and nothing solely because “it’s good for you.” You could call it a dynamic, sustainable diet.

My work was fulfilling, too. As a massage therapist and spiritual counselor, I had the privilege of helping others find their way to feeling better. I was spiritual and had cultivated positive mental habits. I had close, supportive friends and beloved animal companions.

“I knew the ‘just getting old’ hypothesis had to be wrong.”

And yet my body no longer responded to this nurturing. Instead, I slowly got worse, with stiffening muscles, roving painful joints, creeping brain fog, and a shrinking capacity for stress of any kind. Things I’d been able to take in stride became more irritating, and my fuse felt perilously short.

Soon other symptoms mushroomed: seasonal allergies, and an allergy to some preservative in multiple eye products. Persistent floaters. Difficulty fully emptying my bladder. My cognitive abilities also took a hit, as I had more trouble recalling words (especially when speaking), limited short-term memory, and less ability to learn and remember new things. Then came neuropathy in one arm, then one leg, and finally, a crashing fatigue with muscle weakness that materialized with customary (to me) exertions.

Eventually my entire body felt inflamed. I woke up tired every morning, mentally and muscularly. My eyelids looked like I’d just emerged from a 12-hour, face-down sleep. It got so bad that holding my body upright felt like work. Whatever I did wiped me out sooner or later.

Being self-employed, I couldn’t afford extended exhaustion, so I contracted my world. I curtailed all optional activities and stuck close to home. I drank more coffee. I quit my most strenuous and stressful work, expecting to recover in the resulting ease. I limited my schedule to only one client per day. I added or increased supplements for joints and overall health. I tackled my diet. Over a couple of years, I cut out carrageenan (a common food additive), wheat/gluten, corn, and peanuts, hoping I’d finally find the answer in food sensitivities.

Mira Carroll on laptop, searching for answers about Lyme disease

These measures brought some improvement, but I still felt bad with a lot of pain. A pound or two came off, but nothing fixed my ailing mind and body. I skirted stressors like a water-phobic child evades a bath. It felt like there was three feet of clear, rubbery gel between the world and me. There was a hitch of pain and difficulty to little things: crouching down to pick up a cat, pouring from a full pitcher, going up and down stairs. Somewhere along the way, life had become hard.

But I wasn’t paying for my partying past; I was settling some bug’s bar tab. Undiagnosed chronic Lyme disease had conga-lined me into the clink with no notice or formal charges. It had been happening for six years. The cell door was swinging shut, yet I didn’t know what country I was in, much less the path to release.

Lyme disease, one of several common stealth microbe infections, is enemy territory. Symptoms can flare and recede as the bacteria dart around the body using guerrilla tactics. If, like me, you tend to minimize what’s not happening right now as well as tune out routine impediments, it can sneak up on you. I found myself infiltrated and surrounded.

Borrelia burgdorferi, Lyme’s stealth microbe, punished capriciously. It poisoned my food, starved my body of energy, and hooded me in brain fog. It sabotaged my sleep. It sprinkled pain dust on my insides. It let me out on a short tether only to work, leaving me spent and wondering how long I’d be able to keep it up.

By the time I was sure something was wrong, a single explanation for my many diverse symptoms was hard to come by. No one looked at all of them as possibly related, including myself. I thought I was full of arthritis, but imaging showed it was “mild” and “age appropriate.” I worried about my numb arm and leg, but EMG testing asserted my nerves were fine. Aside from my usual high cholesterol, I had normal blood values on standard tests.

If you judge me by my symptoms, I’m infected with Borrelia and Mycoplasma. Considering my history of cat scratches, I should also have Bartonella, but physical manifestations have not specifically suggested it. I haven’t had a positive Western Blot assay for Borrelia or any coinfection. By the time I was tested, my body may have lacked the ability to produce enough antibodies to trigger a response.

“Like a shrewd abuser, Lyme disease punches where it doesn’t show.”

My gamma globulin — immune proteins that generate antibodies — was low. Borrelia and coinfections hack the immune system and turn it to their purposes; disrupted antibody production is one havoc these masterful bacteria can cause. I did have some laboratory results associated with Lyme disease — low CD57 and high TGF-Beta 1 — but these are not diagnostic in themselves. And how can a body be full of inflammation, yet C-reactive protein values are normal?

It is in this sense that my good health almost cost me everything, because standard lab tests didn’t yield results that prompted my doctors to consider infectious disease. Instead, these tests also functioned as a cover for Lyme. Like a shrewd abuser, Lyme disease punches where it doesn’t show. I was sick, but from the outside my life looked normal.

The stories you read about Lyme don’t typically portray an undramatic decline like mine. Most medical information streams seem preoccupied with the bulls-eye rash, doxycycline, and new ways to “eradicate” Borrelia with antibiotics. The popular press loves dramatic, life-and-death Lyme stories. Rightly so — they’re compelling because of the terrible consequences, and it’s important for us to understand that Lyme et. al. (coinfections) can be both highly debilitating and fatal.

But there is a vast sea of lesser suffering. Due to poor diagnostics and unsuited treatment of stealth microbe infections, many of us are more quietly sick. Countless lives are severely limited, and millions of healthcare dollars are wasted on treatments aimed in the wrong direction. And then there are the sick people offered nothing but dismissal, often with a psychiatric referral.

Enter my liberators, the gifts of nature and Dr. Bill Rawls.

Rather than fling my shrinking resources at the sieve of a positive laboratory test, I chose to invest in my health. By then I’d had undiagnosed Lyme for at least six years; to wait longer for proof that might never come while getting sicker made no sense. I began Dr. Rawls’ herbal protocol, tailored for symptoms like mine. It has been my core protocol for almost a year and a half; I’ve also added other herbs as appropriate.

The first chains to loosen were the dastardly brain fog. I’d been taking Dr. Rawls’ protocol for three months when I added chlorella for detox. Around the same time, I also added chia seeds to my diet, one tablespoon per day. Three weeks into this expanded protocol I had a moment of mental clarity. Standing in my kitchen that morning I thought: This is how I used to feel. Clear-headed. Brain power rumbling and ready to roar.

It didn’t last, but it lifted me. This tiny event could have been strung with lights and announced by fanfare, it was so foreign to my experience the past many years. In the next several months I had more and longer clear-headed periods until, at about nine months on continuous herbal therapy, the cloud around my mind was gone.

Mira Carroll playing piano, happy, Lyme symptom freeMy health on herbs has leapt from caged to free. It’s the difference between store brand instant decaf coffee with lukewarm non-fat milk and a fresh, coffee-bar, full-fat, turbo-charged latte. I wake up with energy for life. I no longer hold the walls to protect my knees while descending stairs. The stiffness caused by being still is all but gone, and so is the bent-over crone who used to hobble up from sofas, chairs and bed.

I’ve lost 10 pounds without dieting. I can do gentle yoga without triggering pain. Overall, pain is greatly decreased and manageable — most days I forget about it most of the time. Viral nerve pain still comes and goes, but may be settling down. What a contrast to the achy, roving pain of active Lyme disease.

Dr. Rawls’ herbal protocol works best with his supportive diet — the notion that diet is irrelevant to healing is naïve at best. The raw materials (and detritus) from what we eat can’t be separated from health, so diet is the other key part of my protocol. I choose foods that support my healing, and avoid those that are problematic, especially highly-processed fake foods and engineered components the human body doesn’t recognize as nutrients.

It bears mentioning that even though I’m gluten- and corn-free, I still get to eat pizza, thanks to the tasty cauliflower crusts available in the freezer section. All this said, my diet isn’t perfect and probably never will be. I choose to be at peace with that. The perfect part of humanity isn’t in how well we do what we do, it’s in what God created. That perfection is an intrinsic gift we each can choose to cover up or let shine.

I’ve been able to use an obsessive-compulsive energy, a common facet of chronic Lyme, to my benefit. Like many others, I obsessively read about Lyme disease. (In our defense, people with Lyme are in critical need of information most doctors don’t have — yet. I was confused until I found Dr. Rawls’ comprehensive and readable book, Unlocking Lyme, which became my core resource.)

“Due to poor diagnostics and unsuited treatment of stealth microbe infections, many of us are more quietly sick.”

Unlike some other methods, Dr. Rawls’ protocol doesn’t require me to devote all my waking hours to the healing protocol. I’m in control of my treatment, which gives me more control in life. I’m able to stay at home, see clients, handle important responsibilities, and care for my two cats. (Had I known the future, I’d have named them “Bart” and “Ella.”)

Although some days were very challenging, I’ve been able to work throughout my illness. Herbs haven’t caused such bad side effects that I had to give up and just be sick for weeks, months, or years. I can safely stop any of them at any time. Being in charge of my own schedule is important to my life working while taking treatment, but the gentler nature of herbal therapy is key.

Mira Carroll playing with pet cat outside, Lyme symptom freeHerbs are one of God’s gifts to humankind, for our healing, comfort, and pleasure. We can choose to embrace this gift, or insist that our own creations are better. With pure, high-quality supplements, we can benefit from modern technologies that make herbs even more effective, easy to use, and accessible to inhabitants of the concrete jungles and far away corners.

I’m grateful for the steady, reassuring voice of Dr. Rawls in Lyme’s swamp of complexity and contradiction. All the information and resources his team puts together for our use is a priceless gift.

The improvement in my health over 18 months is amazing! My digestion is fully recovered from the ill effects of five weeks of antibiotic treatment. My biggest sleeping problems are bedtime (my bad) and when I wake up (my indoor kitty’s one fault). Before, my body woke me up because all comfortable positions had expired after six hours horizontal.

My hands don’t hurt when I play the piano anymore. My memory may be sub-par, but an ease has returned to my writing process. If I’ve lost a word, Google is easy to find. I start each client session full of energy, and no longer fear that I’ll crash before it’s complete. My “oomph” is great!

“Without the wise and kind healing of herbs, life as I’ve known it would have been over.”

My stamina is still precarious, though. Too much of any kind of stress can cause a major crash. At least now I recognize some warning signs. If I feel sleepy during the day and a little movement doesn’t erase it, I’m wise to take a nap. Another early sign I’m close to the edge of exhaustion is weakness in my thigh muscles.

I use this information to not push myself, and soon my strength will return. The stealth microbe takeover didn’t happen overnight, and I don’t expect such a formidable foe to let go overnight.

Without the wise and kind healing of herbs, life as I’ve known it would have been over. I was on track to be ruined financially while my mind and body painfully crumbled. I know now that the devastation of loss is surmountable. Loss always comes with gifts we can choose to claim. Nonetheless, I am grateful beyond words that I didn’t have to experience the sweeping losses of unchecked Lyme disease.

Welcome to the #MeAgain Story Series. Our aim is to share stories from people who have recovered, or are recovering, from chronic disease in order to give you hope that healing is within your reach. This series will highlight their struggles and triumphs to inspire you to take action and reclaim your life. Enjoy!

Hank’s Story | Shawn’s Story | Julie’s Story | Ron’s Story | Stephanie’s Story
Donna’s Story | Brad’s Story | Mira’s Story

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**Comment**

For desperate patients: please know that what works for one, may not work for another.  Just because one person is improving on one particular treatment, doesn’t mean you will.  If you want to try different things, chat with your doctor and get his/her perspective.

FYI: I did Dr. Rawl’s treatment (as well as my husband) and we both relapsed.  I don’t tell you this to dissuade you but to present another side for your consideration.

We ALL desperately want to be well and would stick a needle in our eye if we thought it would work.  Stick with what works for you.  Stay the course.  Nothing about treatment is easy or simple:

For more:  https://madisonarealymesupportgroup.com/2016/02/13/lyme-disease-treatment/

Tick Data – 76% Infected With One Organism, 20% Have Three or More Pathogens

https://www.tickcheck.com/statistics?

Each tick submitted for testing contributes to the research being conducted at TickCheck. By keeping records of all the results generated, we have been able to gain valuable insights into disease prevalence and co-infection rates. The comprehensive testing panel has been especially helpful in contributing to this research by ensuring all diseases and coinfections are accounted for when examining a tick.

Our current research shows:
  • 76% of ticks tested have at least one disease causing organism
  • 49% are co-infected with two or more organisms
  • 20% carry three or more
  • 9% of the ticks tested carry four or more

Infection Visualization by Tick Species

All Ticks Tested
76% Positive for Infection
Negative (24%)
_____________________________
  • 93% Positive for Infection
  • Negative (7%)
  • 63% Positive for Infection
  • Negative (37%)
  • 48% Positive for Infection
  • Negative (52%)

Coinfection Visualization

  • 2+ coinfection 49%
  • No coinfection 51%

Pathogenic Prevalence

The information below shows the positive/negative prevalence ratio of selected pathogens we test for. These pathogens were observed in ticks from the United States and Canada. Data set includes tests performed since TickCheck’s founding in 2014 and is updated in real time. (

Go to link at beginning to filter by state.  I’ve added the 3 listed for Wisconsin next to the entire sample size.  Please note the small sample sizes of WI ticks. 

Borrelia burgdorferi (deer tick) associated with Lyme disease

Sample size of 3,280 ticks.           70 Wisconsin ticks
  • 30% postive                                           33% positive
  • 70% negative                                         67% negative

Borrelia burgdorferi (western blacklegged tick) associated with Lyme disease

Sample size of 279 ticks.
  • 4% positive
  • 96% negative

Borrelia burgdorferi (lone star tick) associated with Lyme disease

Sample size of 899 ticks.
  • 8% positive
  • 92% negative

Borrelia burgdorferi (American dog tick) associated with Lyme disease

Sample size of 901 ticks.
  • 2% positive
  • 98% negative

Anaplasma phagocytophilum associated with anaplasmosis

Sample size of 2,146 ticks.           36 Wisconsin ticks
  • 8% positive                                           11% positive in Wisconsin
  • 92% negative                                        89% negative in Wisconsin

Babesia microti associated with babesiosis

Sample size of 1,894 ticks.           32 Wisconsin ticks
  • 4% positive                                            6% positive
  • 96% negative                                        94% negative

Bartonella spp. associated with bartonellosis

Sample size of 1,060 ticks.
  • 47% positive
  • 53% negative

Ehrlichia chaffeensis associated with ehrlichiosis

Sample size of 857 ticks.
  • 2% positive
  • 98% negative

Rickettsia spp. associated with Rocky Mountain spotted fever

Sample size of 944 ticks.
  • 23% postive
  • 77% negative

Francisella tularensis associated with tularemia

Sample size of 1,028 ticks.
  • 1% positive
  • 99% negative

Borrelia miyamotoi associated with B. miyamotoi

Sample size of 1,091 ticks.
  • 6% postive
  • 94% negative

Borrelia lonestari associated with STARI

Sample size of 831 ticks.
  • 19% postitive
  • 81% negative

Babesia spp. associated with babesiosis

Sample size of 564 ticks.
  • 5% positive
  • 95% negative

Mycoplasma spp. associated with Mycoplasma spp.

Sample size of 948 ticks.
  • 8% positive
  • 92% negative

Borrelia spp. associated with Borrelia spp.

Sample size of 612 ticks.
  • 17% postive
  • 83% negative

Powassan virus Lineage II associated with Deer tick virus

Sample size of 102 ticks.
  • 24% positive
  • 76% negative

Borrelia mayonii associated with Lyme disease

Sample size of 376 ticks.
  • 100% negative

Ehrlichia ewingii associated with ehrlichiosis

Sample size of 283 ticks.
  • 100% negative

Rickettsia amblyommii associated with Rocky Mountain spotted fever

Sample size of 177 ticks.
  • 46% positive
  • 54% negative

__________________

For more about Tickcheckhttps://www.tickcheck.com/about

You can request free tick identification by sending in a quality picture of your tick. Using real-time PCR (Polymerase Chain Reaction), Tickcheck can determine the presence of certain pathogens with an accuracy level of over 99.9%.  All information about how to send in your tick, costs of various tests, time for results, etc. is found here:  https://www.tickcheck.com/info/faq

Jonathan Weber is the founder and CEO of TickCheck and became acutely aware of the dangers of tick-borne diseases after his father caught Lyme during a family trip on the Appalachian Trail.

___________________

**Comment**

This information supports current research showing many patients are infected with numerous pathogens causing more severe illness & requiring far more than the CDC’s mono therapy of doxycycline:  https://madisonarealymesupportgroup.com/2018/10/30/study-shows-lyme-msids-patients-infected-with-many-pathogens-and-explains-why-we-are-so-sick/

It also supports previous work showing coinfections within ticks:  https://madisonarealymesupportgroup.com/2017/05/01/co-infection-of-ticks-the-rule-rather-than-the-exception/

What I want to know is WHY nothing’s being done about this?  Why are people STILL given 21 days of doxycycline when that particular med will not work on numerous pathogens?
Lastly, a word about statistics – this tick data should be used with caution & never to turn sick patients away due to a statistic. If you are the sorry sucker who gets bit by that ONE tick carrying a “statistically insignificant” pathogen, you still got bit and have to deal with it.  
Shame on doctors for turning sick people away due to statistics and maps.
There’s no such thing as an “insignificant” tick bite!

But, Patients are STILL being turned away:  https://madisonarealymesupportgroup.com/2019/04/22/its-just-crazy-why-is-lyme-disease-treatment-so-difficult-to-find-in-mississippi/

https://madisonarealymesupportgroup.com/2019/03/19/jacksonville-family-shares-daughters-9-month-diagnosis-of-rare-disease-which-isnt-rare-lyme/

https://madisonarealymesupportgroup.com/2018/05/31/no-lyme-in-the-south-guess-again/

https://madisonarealymesupportgroup.com/2017/10/24/no-lyme-in-oklahoma-yeah-right/

https://madisonarealymesupportgroup.com/2016/09/24/arkansas-kids-denied-lyme-treatment/  “They had the classic symptoms, they had the bulls eye rash, they had the joint pain, they had fevers and had flu like symptoms, yet we were denied treatment for at least two of them and I don’t understand how this is legal,” said Bowerman.

According to Dr. Naveen Patil, Director of the Infectious Disease Program, ADH,

“We don’t have Lyme Disease in Arkansas, we have the ticks that transmit Lyme Disease but we don’t have any recorded cases of Lyme Disease.” 

Bowerman also received a letter from the clinic stating doctors would no longer treat her children because she consistently questioned their medical advice and recommendations.

This is getting to be way beyond ludicrous.

 

When Lyme Hurts Your Heart: Warning Signs & Solutions

https://rawlsmd.com/health-articles/lyme-hurts-heart-warning-signs-solutions?

When Lyme Hurts Your Heart: Warning Signs + Solutions

When Lyme Hurts Your Heart: Warning Signs + Solutions

by Jenny Lelwica Buttaccio
Posted 3/8/19

Ryan Stewart, a speech-language pathologist (SLP) in Virginia, developed a strange set of symptoms in 2009 that baffled one doctor after another. Included among those symptoms were a racing heartbeat following minimal physical exertion, heart palpitations, shortness of breath, and chest pain.

“It felt like an elephant was sitting on my chest,” she explains.

Over the next 10 years, Stewart’s symptoms waxed and waned. Some days, they would let up; other days, a sudden episode of rapid heartbeats or dizziness would frighten her — sending her to the emergency room or an urgent care clinic.

Unfortunately, she always left those healthcare facilities without answers. Though Stewart believed her symptoms stemmed from her heart, repeated electrocardiograms (EKG), a cardiac MRI, and a couple week-long stints of wearing heart monitors all came back as normal.

“They could never catch a cardiac episode,” she says.

Determined to live a normal life, Stewart continued her work as an SLP and began planning a family with her husband. After a series of fertility treatments, she became pregnant only to suffer a miscarriage in the early weeks — a devastating loss, she says.

Shortly after the miscarriage, a new group of debilitating symptoms emerged, which included crushing fatigue, heaviness and weakness throughout her whole body, postural orthostatic tachycardia syndrome (POTS), numbness, and tingling. By now, it was 2013, and at the recommendation of a family friend, Stewart rallied the strength to see another doctor — a Lyme-literate one, though she didn’t realize it at the time.

This appointment, however, was different than the previous ones, and she received some surprising, but much-needed news: Stewart had Lyme disease, along with Babesia, Bartonella, and a high Epstein-Barr viral load.

“Lyme wasn’t even on my radar!” she recalls.

Simply having these diagnoses was a relief, but it wasn’t enough to solve the issues affecting her cardiovascular system.

“I have a heart arrhythmia, which was finally diagnosed in 2016,” she says. “And now I had a feeling in my heart and chest that I had never had before. My heartbeat had no rhythm, and it was fluttering.”

Stewart likens the feeling she experienced in her chest to a switchboard in which electrical lights pop up in many different directions, one right after the other.

“I knew this was a new symptom, and I had to go to the ER,” says Stewart. “They discovered I had ventricular tachycardia, and gave me a diagnosis of idiopathic ventricular tachycardia. ‘Idiopathic’ meaning they didn’t know what the cause was.”

Since then, Stewart has tried numerous ways to address her symptoms. Her current treatment involves using beta blockers; she tried antiarrhythmic drugs, but the side effects were intolerable. She’s currently pursuing treatment for Lyme disease, too, and she’s investigating herbal therapies, stress reduction, and other lifestyle modifications in the hopes of improving her overall health.

Stewart’s story highlights some of the signs and symptoms associated with Lyme disease and the cardiovascular manifestations of the illness. To date, there’s no absolute consensus on the prevalence of cardiac involvement in people with Lyme disease. But new research suggests heart symptoms may be present in 0.4% to 10% of Lyme disease cases, according to a 2019 study in the Journal of the American College of Cardiology.

To understand what happens to a heart impacted by Lyme, it helps to first know how a healthy heart functions.

An Overview of the Cardiovascular System

In a healthy person, the heart pumps blood like a well-oiled machine, which delivers critical nutrients and oxygen to every cell, tissue, and organ in the body, and it removes carbon dioxide and other waste products from those tissues. Blood flows in the same direction throughout the body — arteries carry oxygenated blood away from your heart, and veins return oxygen-poor blood back to the heart.

The average heart is larger than the size of an adult fist, and it’s the hardest working muscle in the body, pumping approximately 115,000 times a day. Here are some important points to remember about the heart:

  • It consists of four chambers, including two atria and two ventricles.
  • There are two atria, known as the right and left atrium. The right atrium receives deoxygenated blood from a large vein called the vena cava; the left atrium receives deoxygenated blood from the lungs.
  • The ventricles’ job is to collect and expel blood that comes from the atria. The right ventricle pumps deoxygenated blood into the vascular tree of the lungs where it receives oxygen. Then, the left ventricle pumps the oxygen-rich blood back to the tissues of the body.
  • The upper wall of the right atrium houses a cluster of cells known as the sinoatrial node (SA node). The SA node is referred to as the “heart’s natural pacemaker,” because it produces the electrical activity that’s responsible for the rate and rhythm of your heartbeat.

Your heart and your circulatory system, which contain a vast network of blood vessels that circulate blood through your body and return it to the heart, function as one unit known as the cardiovascular system. The cardiovascular system has such an expansive network of blood vessels that if they were laid out from end to end, they would cover roughly 60,000 miles — that’s enough to go around the globe more than two times.

When Lyme Disease Enters the Picture

Like many other Lyme experts and patients, Dr. Bill Rawls, Medical Director of Vital Plan, believes many more than one in 10 people with Lyme disease may have some degree of heart issues. The symptomatology can vary from person to person, and exist on a spectrum of mild to severe.

The likely bacterial and viral culprits causing cardiovascular symptoms include Borrelia (the primary bacteria implicated in Lyme), Bartonella, Mycoplasma, cytomegalovirus (CMV), and probably many others. These stealth microbes enter the body and spread throughout the tissues by various mechanisms. They have one goal: Survival, notes Dr. Rawls. And they migrate or set up camp anywhere they can in the body, including the heart.

“There’s a growing body of evidence showing that we have microbes throughout our body and brain, including on heart valves,” says Dr. Rawls. “Often, I think these microbes are present without causing harm. They stay dormant in tissues until a disruption in the immune system occurs and depresses it, allowing the microbes to flourish.”

When stealth pathogens thrive, they can alter the electrical signaling to the heart, affecting the heartbeat or causing irritation to the heart itself.

“In a healthy heart, the SA node starts an electrical wave that spreads from cell to cell throughout the heart — the electrical impulses are such that the valves are opening and closing in proper order, or in other words, the heart is beating correctly,” explains Dr. Rawls. “But if another area of the heart gets irritated or inflamed by an infection or stealth pathogen, it may fire first and overwhelm the SA node, disrupting the heart’s regular impulses.”

The result: The heart beats irregularly, and the contraction becomes less efficient at pumping blood.

Additionally, an abnormal heart rate isn’t the only way microbes can affect the heart. As the pathogens disseminate throughout the organ and further irritate the heart muscle, the heart can become oxygen-deprived, leading to angina (chest pain), heart attack, shortness of breath, and more.

Signs That Lyme is At Play in the Heart

For most people with Lyme disease and other chronic illnesses like fibromyalgia and chronic fatigue syndrome, we become accustomed to symptoms that fluctuate from one day to the next. We’re so used to it, in fact, that we often adopt a wait-and-see approach to the newest symptom du jour.

But there are times when our bodies give us warning signs — red-flag symptoms that we should get checked out as soon as possible, even if going to the doctor seems uneventful or inconvenient. The primary symptoms to seek medical attention for include irregular heartbeats that aren’t going away, persistent chest pain, or shortness of breath associated with exertion, says Dr. Rawls.

However, cardiac issues may not always be so apparent, because the symptoms can range from mild to more severe, or they can be easily confused with other causes. Other signs to be aware of include:

  • Dizziness
  • Lightheadedness
  • Fainting
  • Shortness of breath
  • Pressure or tightness in the chest
  • Pain radiating to the neck or down the arm
  • Heart palpitations
  • Cold sweats
  • Fatigue
  • Nausea or vomiting

Let’s look at three conditions that can be caused when Lyme, coinfections, or other stealth pathogens affect the heart, including the most well-known one called Lyme carditis.

1. Lyme Carditis

Most people with Lyme are aware that Lyme carditis (LC), which causes inflammation in the heart, is the most serious cardiac manifestation of Lyme disease. Symptoms may develop and progress rapidly, even as quickly as one week after the bite of an infected tick.

No parts of the heart are off limits to these insidious microbes. They can affect the heart’s muscle tissues (myocardium), the membrane that encases the heart (pericardium), the tissues that line its chambers (endocardium), the valves, the aorta, and sometimes a combination of the different parts of the heart.

An inflamed heart impacts the way the SA node operates the heart’s electrical system. It tends to slow the heart down due to a condition known as a heart block, or atrioventricular block (AV block), which varies in severity from first-degree to third-degree.

  • In first-degree heart block, the electrical impulses reach the ventricles — the bottom chambers of the heart — at a slower than normal pace.
  • The condition can progress to a second-degree heart block, where the heart produces electrical signals, but they only partially reach the ventricles. In some cases, they don’t reach it at all.
  • In a third-degree or complete heart block, the electrical signals are completely obstructed from reaching the ventricles. One sign of complete heart block is a pulse of less than 60 that doesn’t increase with exertion, and intolerance to exertion.

When the heart is unable to pump blood efficiently, it can’t provide the body with adequate, oxygenated blood. If caught early, a heart block can often be resolved with antibiotics and occasionally, the use of a temporary pacemaker to maintain the electrical activity of the heart. If not swiftly and adequately treated, the result could be the placement of a permanent pacemaker or sudden cardiac death (SCD).

Generally, most cases of Lyme carditis occur during June through December, according to an article in the journal Circulation, and it seems to occur slightly more in males than in females. Additionally, LC is more likely to be found in individuals who fall into the age groups of 5 to 14 and 44 to 59 years of age.

At the present time, researchers are unsure of whether an underlying cardiac condition poses an increased risk of developing LC compared to those in the general population who contract Lyme disease.

2. Myocardial Infarction

A myocardial infarction (MI) is commonly known as a heart attack. It happens when a part of the heart is unable to receive oxygen due to a blockage in the coronary artery, which causes damage to the heart muscle. The journal, Infectious Disease Clinics of North America, lists it as another possible cardiac manifestation of Lyme disease. However, it’s difficult to know how common heart attacks are among Lyme patients, especially since many cases of the illness are misdiagnosed in both the acute and chronic stages of the disease.

3. Heart Arrhythmias

An abnormal heartbeat where the heart is beating too slowly, too rapidly, or irregularly is categorized as an arrhythmia. There are several types of arrhythmias. For instance, when the heart beats too slowly, it’s called bradycardia; when it beats too quickly, it’s referred to as tachycardia.

Some arrhythmias may be benign or harmless. But others, such as the type experienced by Stewart, can bring about a distressing set of symptoms. Because arrhythmias can have the potential to be life-threatening, you should be persistent about visiting your doctor and getting a proper diagnosis.

When diagnosing Lyme-related cardiac conditions, there are a battery tests your doctor might want you to undergo, such as those that Stewart was required to do. Common testing methods may include blood work, an EKG, an echocardiogram, a cardiac MRI, wearing various heart monitors, and more. And, like Stewart’s case, testing doesn’t always capture problems on the first go-around, so it might take multiple efforts to get the right diagnosis.

Could other conditions impact cardiac function as a result of Lyme disease, too? Probably: medical literature names coronary artery aneurysms, QT-interval prolongation, and congestive heart failure (CHF) among other reported heart manifestations.

However, very few statistics, if any, exist regarding the prevalence of these conditions among Lyme patients. The medical community still has a lot to learn about the way Lyme disease, co-infections, and other microbes impact the heart.

How to Improve Heart Health

“Anytime you have something irregular with the heart, you should have someone check it out,” advises Dr. Rawls. “The threshold for being evaluated for heart symptoms should be pretty low.”

In other words, if your heart feels off — you’re experiencing chest pain, shortness of breath, an irregular heartbeat, or something else — get to a doctor as soon as possible.

While testing can help pinpoint what’s going on, it may not always be spot on the first time you’re evaluated, and you might need to be persistent in pursuing a diagnosis. From one patient to another, Stewart says,

“When it comes to something serious like your heart, don’t stop searching for answers. Trust your instincts, and don’t ignore it.”

Once you know what you’re dealing with, you and your doctor can establish a plan of care, which may include antibiotics, particularly in the acute stages of Lyme disease. Other drug therapies include beta blockers and antiarrhythmic drugs, which might be necessary to stabilize your heart rate and prevent abnormal rhythms. However, those drugs can come with a long list of side effects, and the length of time you could be required to take them will differ from physician to physician and the severity of your illness.

Some people may need to have a temporary pacemaker implanted into the heart to regulate heart rhythms. Additionally, another treatment you may hear mentioned is a catheter ablation for arrhythmias. This procedure destroys the abnormal cells in the heart that are misfiring. Fortunately, neither of these procedures are needed very often.

It’s important to note that lifestyle modifications and herbal interventions can also play a critical role in managing cardiac symptoms and helping the heart heal. Because herbs have a normalizing effect on the body and a low chance of toxicity, they can be used in conjunction with many medication regimens.

“Herbs may allow a person the ability to take less medication and reduce the side effects of drugs. I think it’s important for people to note that herbs are restorative to the body and support healing,” says Dr. Rawls.

But of course, making the decision to take any natural regimen should be in partnership with your healthcare provider. Here are some of the herbs Dr. Rawls recommends:

1. To improve the heart’s electrical rhythms and the strength of its contractions, and to enhance blood flow:

2. To increase oxygenation of the tissues in the body and bolster the immune system:

3. To help decrease your microbial load:

4. For additional support:

  • Magnesium, a mineral that helps the heart maintain a steady heartbeat
  • CoQ10, a powerful antioxidant
  • Krill oil or fish oil, potent anti-inflammatories

Words of Encouragement

Why do some people have heart issues with Lyme disease and others don’t? Dr. Rawls postulates that some of us may have a genetic predisposition or a certain spectrum of microbes that, when combined with lifestyle factors like high stress levels, poor diet, a toxic environment, and inactivity, makes us more vulnerable to cardiovascular involvement.

Also, “It depends on immune system functions,” Dr. Rawls says. “Some combinations of these factors may be more concerning than others, and that’s a part of the puzzle that we don’t know yet.”

For those who do face the daily stress of dealing with Lyme disease and cardiac symptoms, it can be overwhelming and scary at times — it’s easy to feel like the illness has stolen precious parts of your life, and coping can be a struggle. For them, Stewart offers these hard-earned words of encouragement:

“Try as hard as you can not to lose yourself in your diagnosis,” she says amid her own personal struggles. “Surround yourself with the things that you love and try to do one thing daily. You can still do things, but you may have to adapt them. There’s always another way to pursue your dreams — I believe you can still achieve them.”

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. Arrhythmia. Medline Plus website. https://medlineplus.gov/arrhythmia.html
2. Basic Anatomy of the Heart. Johns Hopkins Medicine website. https://www.hopkinsmedicine.org/healthlibrary/conditions/cardiovascular_diseases/basic_anatomy_of_the_heart_85,P00192
3. Pinto DS. Cardiac manifestations of Lyme disease. The Medical Clinics of North America. 2002 Mar;86(2):285-96. doi: 10.1016/S0025-7125(03)00087-7
4. Heart Chambers. Medline Plus website. https://medlineplus.gov/ency/imagepages/19612.htm
5. Fish AE, Pride YB, Pinto DS. Lyme carditis. Infectious Disease Clinics of North America. 2008 Jun; 22(2): 275-88, vi. doi: 10.1016/j.idc.2007.12.008
6. Jackson JW, Sparer T. There Is Always Another Way! Cytomegalovirus’ Multifaceted Dissemination Schemes. Viruses. 2018 Jul; 10(7): 383. doi: 10.3390/v10070383
7. Krause PJ, Bockenstedt LK. Lyme Disease and the Heart. Circulation. 2013;127:e451–e454. doi: 10.1161/CIRCULATIONAHA.112.101485
8. Scheffold N, Herkommer B, Kandolf R, May AE. Lyme Carditis—Diagnosis, Treatment and Prognosis. Deutsches Ärzteblatt International. 2015 Mar; 112(12): 202–208. doi: 10.3238/arztebl.2015.0202
9. Yeung C, Baranchuk A. Diagnosis and Treatment of Lyme Carditis: JACC Review Topic of the Week. Journal of the American College of Cardiology. 2019 Feb 19; 73(6): 717-726. doi: 10.1016/j.jacc.2018.11.035
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**Comment**
Great article on heart involvement with Lyme/MSIDS, which is far more common than acknowledged.
LET’S SUFFICE IT TO SAY, HEART PROBLEMS WITH TICK BORNE ILLNESS IS NOT RARE.

 

 

 

 

 

Gestational Lyme & Other Tick-borne Diseases – Dr. Jones

Dr. Charles Ray Jones – Rock Star

FB_IMG_1541741969447From left, Sherry Sievewright, Wisconsin Lyme Network, Dr. Charles Ray Jones, Alicia Cashman, Madison Lyme Support Group

Dr. Charles Ray Jones specializes in treating Lyme/MSIDS patients.  He has treated over 12,000 children with Lyme/MSIDS, and spoke recently at the Chicago ILADS convention.

Here is the executive summary of his presentation:

  • Borrelia burgdorferi (Bb) can be transmitted via ticks, gestationally, breast milk, and semen (yes, that means sexually).  While there isn’t a large NIH double-blind study, clinically LLMD’s are finding infected couples.  For more data on animals:  https://madisonarealymesupportgroup.com/2017/02/24/pcos-lyme-my-story/  (Scroll down to info on sexual transmission)

 

  • Gustafason & Burgess demonstrated gestational Bb infection in dogs.  Of the inoculated bitches, 80% became infected who then birthed mostly infected pups.1

 

  • A retrospective study showed 480 children with gestational Lyme/MSIDS. Diagnosis was based on clinical physical and history. 3

 

  • About 10% of Dr. Jones’ patients are infected gestationally.

 

  • Two cases of in vitro fertilization caused embryonic infection.

 

  • Mothers not treated resulted in 50% gestational transmission compared to mothers treated with 1 antibiotic resulting in a 25% transmission.  70% of infected mothers reported a difficult pregnancy.  ALL children improved with appropriate antibiotic treatment.  

 

  • Antibiotic treatment for Pregnant mothers:
  1. Amoxil 1000mg every 8 hours
  2. Ceftin 500 mg every 12 hours
  3. Omnicef 300 mg-600mg twice daily
  4. Mepron 750mg twice daily
  5. Zithromax 500mg twice daily
  • Other options for those who can not tolerate oral antibiotics:
  1. Bicillin 1.2 million units IM 1-3 times weekly
  2. Ceftiaxone 2 gms IV daily
  3. Cefotaxime 6 gms daily either continuous infusions or 2gms IV every 8 hours
  • Top 6 gestational Lyme symptoms:
  1. 90% low muscle tone (delays in motor skills, excess flexibility, drooling)
  2. 80% irritability (impulsive, risky behavior, interrupts, anger/mood swings)
  3. 72% fatigue
  4. 69% pain
  5. 60% low grade fevers with pale skin & dark circles under eyes
  6. 50% painful joints with stiffness & decreased range of motion
  • Coinfection rate found in study.3
  1. 30% Bartonella
  2. 20% Babesia
  3. 7% Strep
  4. 6% Ehrlichiosis
  5. 5% Leptospirosis
  • Male Child Case Study Findings.  Daily fevers between 101-102 degrees with severe joint pain, could not process stimuli, and poor muscle control.  Mother was infected with Bb during pregnancy and child had numerous tick bites.  Was initially diagnosed with a virus and was told he’d “grow out of it.”  Grandparents in desperation hired a priest to exorcise him.  Within 3 months of a clinical diagnosis of Bb (Western Blot positive) and multiple TBI’s (Babesia, Bartonella, Mycoplasma) and appropriate antibiotic treatment, he was doing well in school & athletics, and improved on all perimeters.  Treatment is ongoing.

 

  • Gestational treatment options:
  1. Combination of penicillin, cephalosporins, macrocodes, atovaquone (tetracycline, doxycyline & minocycline not usually used in those under 8) 

 

  • A 1995 study by Gardner showed 15% abnormal babies in treated mothers vs 67% of abnormal babies in mothers not treated.4

 

  • A 1989 study by MacDonald showed the following Lyme infection outcomes during pregnancy.5
  1. prematurity
  2. fluid in the brain
  3. blindness
  4. Sudden infant death syndrome
  5. blood infection
  6. Fetal death
  7. cardiovascular system anomalies
  8. growth retardation
  9. respiratory distress
  10. excess of bilirubin in the blood

References:

  1. Gustafson, J.M., E.C Burgess, et al.(1993). “Intrauterine transmission of Borrelia burgdorferi in dogs. “Am J Vet Res 54(6): 882-890
  2.  Xiao, J., et al. 2011. “How Different Strains of Parasite Infection Affect Behavior Differently”. Infection and Immunity. March 2011 . Quoted in science daily, March 22, 2011.
  3.  Jones, Charles Ray, Smith, Harold, Gibb, Edina and Johnson, Lorraine JD, MBA, “Gestational Lyme Disease Case Studies of 102 Live Births, Lyme Times, 2005”. 
  4. Gardner, T. (1995). Lyme disease. Infectious disease of the fetus and newborn infant. J. S Remington and J.O Klein. Philadelphia, Saunders. Chapter 11:447- 528. 
  5. MacDonald, A.B. (1989) “Gestational Lyme Borreliosis. Implications for the fetus. “Rheum Dis Clin North Amer 15(4): 657-677. 
  6. Goldenberg, R.L and C. Thompson (2003) “The infectious origin of stillbirth”. Am J Obstet Gynecol 189(#): 861-873.

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More on Pregnancy with Lyme/MSIDS:

https://madisonarealymesupportgroup.com/2018/06/19/33-years-of-documentation-of-maternal-child-transmission-of-lyme-disease-and-congenital-lyme-borreliosis-a-review/

https://madisonarealymesupportgroup.com/2018/05/24/new-berlin-mom-given-life-altering-lyme-disease-diagnoses-after-pregnancy/

https://madisonarealymesupportgroup.com/2017/10/15/pregnancy-in-lyme-dr-ann-corson/

https://madisonarealymesupportgroup.com/2018/07/24/congenital-transmission-of-lyme-myth-or-reality/

https://madisonarealymesupportgroup.com/2018/02/26/transplacental-transmission-fetal-damage-with-lyme-disease/  (Great videos here)

https://www.lymedisease.org/lyme-basics/lyme-disease/children/  Great read on Lyme/MSIDS in children.

https://www.lymedisease.org/wp-content/uploads/2014/08/Image15-Jones-ABT.pdf  “Rationale for Prolonged Antibiotic Therapy in Treating Lyme Disease.”  By Charles Ray Jones, M.D.

Humana Bartonellosis: Perspectives of a Veterinary Internist

https://dta0yqvfnusiq.cloudfront.net/galax57722929/2018/03/Human-Bartonellosis-5ab03952a5057.pdf

HUMAN BARTONELLOSIS:  PERSPECTIVES OF A VETERINARY INTERNIST

Edward B. Breitschwerdt, DVM, DACVIM
Chief Scientific Officer, Galaxy Diagnostics, Inc.
Professor, Internal Medicine, NCSU, Raleigh, NC
Adjunct Professor of Medicine, Duke University Medical Center
INTRODUCTION
Bartonella species are fastidious gram-negative bacteria that are highly adapted to a mammalian reservoir host and within which the bacteria usually cause a long-lasting intraerythrocytic bacteremia.  1-3  These facts are of particular importance to veterinarians and physicians, as an increasing number of animal reservoir hosts have been identified for various Bartonella species. Among numerous other examples, Bartonella henselae has co-evolved with cats, Bartonella vinsonii subsp. berkhoffii has co-evolved with dogs and wild canines, and Bartonella bovid has co-evolved with cattle.  1-2  Importantly, the list of reservoir-adapted Bartonella species, including a large number of rodent species that might serve as “pocket pets,” continues to grow exponentially, as new Bartonella spp. are discovered. Prior to 1990, there were only two named Bartonella species, whereas there are now at least 24 named and numerous unnamed or candidatus species, based upon deposited Gen Bank sequences or preliminary reports, respectively, seventeen Bartonella spp. including B.alsatica, B. bacilliformis, B. clarridgeiae, B. doshiae, B. elizabethae, B. grahamii, B. henselae (Houston 1 and San Antonio 2 strains), B. koehlerae, B. melophagi, B. quintana, B. rochalimaea, B. tamiae, B. vinsonii subsp. berkhoffii (Genotypes I, II and III), and B. washoensis have been associated with an expanding spectrum of human diseases.
Epidemiological evidence and experimental flea transmission studies support an important role for fleas in the transmission of B. henselae, B. clarridgeae and most likely B. koehlerae among cats. 1  Three other Bartonella species, B. bovid, B. quintana and B. vinsonii subsp. berkhoffii have been isolated from cat blood, but the modes of transmission and the reservoir potential of these species in felids has not been definitively established. Recently, we isolated Bartonella vinsonii subsp. berkhoffii from a cat with recurrent osteomyelitis spanning an eighteen month time period. 2  Thus, cats can maintain a chronic bacteremia with at least six Bartonella spp., of which five are known zoonotic pathogens.  1-3 In addition to fleas, an increasing number of arthropod vectors, including biting flies, keds, lice, sandflys and ticks have been implicated in the transmission of Bartonella species. Although there is clinical and epidemiological evidence to support tick transmission of B. vinsonii subspecies berkhoffii to dogs and coyotes, the mode of transmission of this Bartonella subsp. to cats and dogs has not been determined. Recent evidence supports tick transmission of B. henselae by Ixodes scapularis and Ixodes ricinus. Considering the diversity of Bartonella species and subspecies, the large number of reservoir hosts and the spectrum of arthropod vectors, the clinical and diagnostic challenges posed by Bartonella transmission in nature may be much more complex than is currently appreciated in human and veterinary medicine.
In the natural reservoir host, such as a cat or rodent, chronic bacteremia with a Bartonella species can frequently be detected by blood cultre or PCR in outwardly healthy individuals.  1-3  In contrast, the diagnostic detection of a Bartonella spp. in a non-reservoir adapted host, such as a dog, horse or human patient, can be extremely difficult. Most, although not all diseases caused by Bartonella spp. occur in accidental hosts and these organisms are being increasingly implicated as a cause of zoonotic infections.  4-8  It is important to recognize that strains of a Bartonella sp. vary in their virulence. Therefore, highly pathogenic strains of B. henselae, for which the cat is the primary reservoir, can induce granulomatous myocarditis in cats, presumably following flea transmission.  Until recently, mechanisms that facilitate persistent Bartonella bacteremia in mammals were not well understood. Recent reports have identified an intra-endothelial, as well as intra-erythrocytic localization for these bacteria, which represents a unique strategy for bacterial persistence. Non-hemolytic intracellular colonization of erythrocytes in conjunction with the ability to invade and replicate within endothelial cells would preserve the organisms for efficient vector transmission, protect Bartonella from the host immune response, and potentially contribute to decreased antimicrobial efficacy. Although the clinical implications are not understood, other in vitro studies indicate that Bartonella spp. can infect dendritic cells, microglial cells, monocytes and CD34+ bone marrow progenitor cells.
CAT SCRATCH DISEASE
For over a century regional lymphadenopathy has been associated with animal contact, particularly cat scratches. Over the years, numerous microorganisms were implicated as the cause of CSD. In 1992, Regnery and colleagues at the Centers for Disease Control, identified seroreactivity to B. henselae antigens in 88% of 41 human patients with suspected CSD compared to 3% of controls.  Subsequently, additional support for B. henselae as the predominant cause of CSD was provided when Bartonella DNA was amplified from lymph node samples of 21 of 25 (84%) patients with suspected
CSD, using a polymerase chain reaction assay. A similar study from Sweden identified B. henselae DNA, but failed to identify A. felis DNA, in a large number of patients with suspected CSD. Prior to the
recognition of B. henselae as the cause of CSD, Afipia felis, named for the Armed Forces Institute of Pathology, was considered the sole cause of CSD. Subsequently, we blood cultured B. henselae or B. clarridgeae
from 17 of 19 cats owned by 14 patients with CSD, which indicated that bacteremia is a frequent occurrence in cats that transmit B. henselae
to a human being. 1-2
Historically, atypical manifestations of CSD have included tonsillitis, encephalitis, cerebral arteritis, transverse myelitis, granulomatous hepatitis and/or splenitis, osteolysis, pneumonia, pleural effusion, and thrombocytopenic purpura. With the advent of specific diagnostic techniques, (culture, serology, and PCR), there has been a dramatic increase in reports describing human patients with “atypical” manifestations of CSD. Osteomyelitis, granulomatous hepatitis and granulomatous splenitis have been increasingly recognized in children infected with B. henselae, who frequently lack the classical lymphadenopathy of CSD. Previously, Bartonella infection would not have been considered a likely differential diagnosis by the physician in patients lacking a history of lymphadenopathy or animal contact. As evidenced by reports in the past four years, the spectrum of human disease associated with the genus Bartonella continues to expand, requiring periodic reassessment as new information becomes available. On a comparative medical (“One Health”) basis, our research group has documented many of the same CSD atypical manifestations in cats or dogs, including encephalitis, transverse myelitis, granulomatous hepatitis, osteolysis, pleural effusion, and thrombocytopenic purpura. In this context, a highly prevalent, naturally-occurring human disease (CSD) can be used as a “model” to determine the potential behavior of these bacteria in companion animal patients.
Because cat scratch disease generally denotes a self-limiting illness characterized by fever and lymphadenopathy and because the recognized spectrum of human disease manifestations associated with Bartonella infections (which may not include fever or lymphadenopathy) has expanded considerably in recent years, it is becoming obvious that the designation CSD lacks clinical, microbiologic and zoonotic utility. Although cats are a major reservoir for B. henselae, B. clarridgeiae, and B. koehlerae, some patients deny the possibility of a cat scratch or bite wound, or indicate no contact with cats. Transmission from environmental sources, various arthropod vectors, perinatally or by other animal hosts is probable and the more inclusive term bartonellosis may facilitate enhanced future understanding of diseases caused by members of the genus Bartonella. As physicians have been taught that CSD is self-limiting, there is an ongoing lack of appreciation that B. henselae can cause chronic, asymptomatic or intermittently symptomatic illness, accompanied by persistent bacteremia in people. In this context, the documentation of chronic, relapsing bacteremia in cats, dogs and other animal species provides a “model” for better understanding human bartonellosis.
BARTONELLA ENDOCARDITIS
Endocarditis can be induced by a spectrum of Bartonella species in dogs and human patients and is the best example of documented disease causation for this genus. Historically, Bartonella species have been a cause of culture-negative endocarditis in people and dogs because the diagnostic methods used by microbiology laboratories were not adequate to isolate these bacteria. Now, by using
specialized techniques, a spectrum of Bartonella species have been identified in research and diagnostic laboratories in different parts of the world—in heart valves or in blood cultures from dogs
and people with endocarditis. 3  It is important for physicians and veterinarians to recognize that some of these Bartonella species are found in the blood of cats, dogs, rats, ground squirrels, and rabbits.
ISOLATION AND MOLECULAR DETECTION OF BARTONELLA SPECIES
Because conventional microbiological techniques lack sensitivity, bartonellosis is usually diagnosed by PCR amplification of organism specific DNA sequences and/or through serological testing. Recently, the development of a more sensitive isolation approach, using BAPGM (Bartonella alpha Proteobacteria growth medium) followed by PCR has greatly facilitated the molecular detection or isolation of Bartonella species from the blood of sick or healthy animals, including cats, dogs, horses and human beings. Most importantly, the use of this enrichment growth medium prior to PCR testing has allowed our research group to confirm that immunocompetent human patients, in particular veterinarians and veterinary technicians, can have chronic intravascular infections with Bartonella spp. 4-5 Information relative to this EnrichmentPCRTM testing platform for animal and human patients is available at www.galaxydx.com.
It is increasingly clear that no single diagnostic strategy will confirm infection with a Bartonella sp. in the immunocompetent patient population.  As described in studies from our NCSU laboratory, B. henselae, B. koehlerae and B. vinsonii subsp berkhoffii seroreactivity was found in only 58.6% of the patients in which Bartonella spp. infection was confirmed by EnrichmentPCR TM and sequencing. Therefore, Bartonella serology lacks sensitivity and can only be used to implicate prior exposure to a Bartonella sp. Even when serum from cat scratch disease patients, which is caused by B. henselae, is used in various diagnostic laboratories for IFA testing, test sensitivities have ranged from 14 to 100%.
EVOLVING IMPLICATIONS OF CHRONIC BARTONELLA SPP. BACTEREMIA IN IMMUNOCOMPETENT PEOPLE
Previously, we described B. quintana bacteremia in a woman who was tested following the development of an infected cat bite lesion involving the hand. 6  Two months later, the feral cat that had
induced the bite wound was captured and was also shown to be B. quintana bacteremic. In a cumulative study involving 392 patients with occupational animal contact or extensive arthropod exposure 31.9% were bacteremic with one or more Bartonella spp., when blood, serum and BAPGM enrichment culture PCR results were combined. Although this high prevalence of bacteremia is biased by testing at risk, sick individuals, it clearly demonstrates that intravascular infection with Bartonella sp. is much more common in immunocompetent patients, than was previously suspected. By IFA testing, only 75 out of 128 (58.6%) PCR positive patients were seroreactive to a panel consisting of five Bartonella sp. test antigens.
In a recent study, Bartonella vinsonii subsp. berkhoffii, Bartonella henselae or DNA of both organisms were amplified and sequenced from blood, BAPGM enrichment blood cultures or autopsy tissues from four family members. 7  Historical and microbiological results derived from this family support human perinatal transmission of Bartonella species. To date, there have been a limited number of studies that address the potential impact of intravascular infection with a Bartonella sp. on reproductive performance, however, studies involving experimentally-infected cats, rodents and naturally-infected cows with various Bartonella sp. have identified decreased reproductive performance involving both males and females. The parents of these children had attempted to conceive children for several years prior to resorting to in vitro fertilization.
We have also described a veterinarian, who experienced a needle stick while obtaining a fine needle aspiration sample from a cutaneous histiocytic neoplasm. 8  Subsequently symptoms, including headaches, fatigue and intermittent paresthesias (numbness) developed. This patient seroconverted to B. vinsonii subsp. berkhoffii genotypes I and III and B. vinsonii subsp. berkhoffii genotype I DNA was amplified and sequenced from sequentially obtained blood samples, whereas genotype III DNA was amplified from the cytological specimen. All symptoms resolved following antibiotic treatment.
It is increasingly evident that dogs can serve as a source for human infection with B. vinsonii subsp. berkhoffii. Bartonella vinsonii subsp. berkhoffii genotype II was amplified and sequenced from
a liver biopsy from a patient with epithelioid hemangioendothelioma (soft tissue tumor considered a vascular cancer), after which the organism was isolated by BAPGM blood culture. 9  The unique capability of Bartonella to invade and induce long lasting intraerythrocytic and intraendothelial infections, in conjunction with the ability of at least three Bartonella spp. (Bh, Bq, and B. bacilliformi) to induce VEGF-mediated vasoproliferative disease in immunocompromised or immunocompetent individuals suggests that these novel emerging bacterial pathogens might contribute to the development of vascular tumors.
Bartonella koehlerae bacteremia was documented in eight immunocompetent patients by PCR amplification and DNA sequencing, either prior to or after BAPGM enrichment blood culture.10  Presenting symptoms most often included fatigue, insomnia, joint pain, headache, memory loss, and muscle pain. Four patients were also infected with Bartonella vinsonii subsp. berkhoffii genotype II. Bartonella koehlerae antibodies were not detected (titers<1:16) in 30 healthy human control sera, whereas five of eight patient samples had B. koehlerae antibody titers of 1:64 or greater. Studies are needed to determine if B. koehlerae is a cause or cofactor in the development of arthritis, peripheral neuropathies or tachyarrhythmias in human patients. Co-infection with B. henselae and two hemotropic Mycoplasma variants resembling Mycoplasma obis were also found in the blood of a veterinarian with a historical diagnosis of multiple sclerosis. 11
PUBLIC AND OCCUPATIONAL HEALTH CONSIDERATIONS
Due to extensive contact with a spectrum of animal species, veterinary professionals appear to have an occupational risk of infection because of frequent exposure to Bartonella spp., therefore these individuals should exercise increased precautions to avoid arthropod bites, arthropod feces (i.e. fleas and lice), animal bites or scratches and direct contact with bodily fluids from sick animals. As Bartonella spp. have been isolated from cat, dog or human blood, cerebrospinal fluid, joint fluid,aqueous fluid, seroma fluid and from pleural, pericardial and abdominal effusions, a substantial number of diagnostic biological samples collected on a daily basis in veterinary practices could contain viable bacteria.
The increasing number of defined Bartonella spp., in conjunction with the high level of bacteremia found in reservoir adapted hosts, which represent the veterinary patient population, ensures that all veterinary professionals will experience frequent and repeated exposure to animals harboring these bacteria. Therefore, personal protective equipment, frequent hand washing and avoiding cuts and needle sticks have become more important as our knowledge of this genus has improved and various modes of transmission have been defined.
Physicians should be educated as to the large number of Bartonella spp. in nature, the extensive spectrum of animal reservoir hosts, the diversity of confirmed and potential arthropod vectors, current limitations associated with diagnosis and treatment efficacy, and the ecological and evolving medical complexity of these highly evolved intravascular, endotheliotropic bacteria.
REFERENCES
1  Chomel BB, et al. Vet Res 2009;40:29.
2  Breitschwerdt EB, et al. J Vet Emerg Crit Care 2010; 20:8.
3  Chomel BB, et al. Ann N Y Acad Sci 2009;1166:120.
4  Breitschwerdt EB, et al. J Clin Microbiol 2008;46:2856.
5  Breitschwerdt EB, et al. Parasit Vectors 2010;3:29.
6  Breitschwerdt EB, et al. J Clin Microbiol 2007;45:270.
7  Breitschwerdt EB, et al. J Clin Microbiol 2010;48:2289.
8  Oliveira AM et al. J Vet Intern Med 2010;24:1229.
9  Breitschwerdt EB, et al. J Clin Microbio 2009;47:1957.
10 Breitschwerdt EB, et al. Parasit Vectors 2010;3:76.
11 Sykes JE, et al. J Clin Microbiol 2010;48:3782.
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