This case report describes 3 pediatric patients presenting with acute calf or knee pain, calf swelling, and a ruptured popliteal cyst diagnosed by magnetic resonance imaging. Lyme disease was serologically confirmed in each case. In all instances, treatment was delayed because of atypical presentation. All patients responded favorably after antibiotic therapy.
Conclusion:
The differential diagnosis of Lyme disease should be considered in the context of children presenting with atraumatic unilateral calf pain and a ruptured popliteal cyst. Otherwise, this unusual presentation could delay diagnosis or result in unnecessary surgical intervention, particularly in pediatric patients.
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**Comment**
Again, I’m not sure just how “unusual” this presentation is. Remember that “rarely reported” is quite different that rarely occurs. I’ve had a Baker’s Cyst for a year and it’s not fun.
https://madisonarealymesupportgroup.com/2022/05/04/why-do-some-people-develop-severe-lyme-arthritis-others-dont/See comment section. For me, getting rid of gluten was huge, as is drinking plenty of water, taking MSM, systemic enzymes, LDN, niacinamide & vitamin C daily. All of these are anti-inflammatories. While I do not have Lyme/MSIDS symptoms, I believe this Baker’s Cyst is damage done by the infections. I also believe you can have an active infection cause a Baker’s Cyst directly. While anti-inflammatories will help both, it’s imperative you treat the underlying infections as well if you are symptomatic.
This current research also shows CoQ10 to be a relevant antioxidant for preventing mitochondrial dysfunction in Lyme.
James L. Occi, PhD: 4 New Published Articles on Ticks
James L. Occi, PhD
James L. Occi, PhD, is the lead author of four new published articles regarding ticks over the last three years that have added to the scientific data necessary to understand the spread of ticks and the diseases they carry and transmit in the Northeast and that have provided a basis for moving the field of tick-borne diseases forward.
Jim has been on the Lyme Disease Association’s (LDA) Scientific & Professional Advisory Board since its inception in 1999. He has been an invaluable resource to the LDA providing lectures, blogs, tick images, and consultations on ticks and the diseases they carry.
LDA Congratulates James Occi (Jim), who recently received his PhD at Rutgers University, the Center for Vector Biology (New Brunswick), and wishes him every success with his future endeavors. He studied tick-borne diseases in New Jersey tick populations under the direction of Dr. Dina Fonseca and co-authored the below four published research articles for his dissertation.
“Annotated List of the Hard Ticks (Acari: Ixodida: Ixodidae) of New Jersey,” J Med Entomol., April 2019, examines documented cases of hard ticks found in NJ. After a thorough review of the scientific literature, government documents, and evaluation of tick collections (vouchers) in museums and other repositories, the authors determined there were 11 verifiable species of ticks found in NJ. Nine are native to North America, while two are invasive (Asian longhorned tick and brown dog tick). In addition, there are seven tick species that may be present or become established in the future, but confirmation with existing NJ vouchers was not found.
Five tick species were reviewed that were reported in NJ but not found in NJ vouchers or that were found within neighboring states. The importance of vouchers for tick research and surveillance is discussed.
A detailed statewide tick surveillance program would give public health professionals and physicians information to help protect the public from tick-borne diseases. They would be knowledgeable about what tick species were present, what the principal hosts were and what pathogens the ticks carry and transmit. (Click here for published article)
“New Jersey-Wide Survey of Rickettsia (Proteobacteria: Rickettsiaceae) in Dermacentor variabilis and Amblyomma americanum (Acari: Ixodida: Ixodidae)” was published in Am J Trop Med Hyg., Sept. 2020, and concludes the increase in Spotted Fever Group Rickettsioses (SFGR) in NJ is unlikely to come from D. variabilis. Infection with the tick-borne R. rickettsia bacterium causes Rocky Mountain spotted fever (RMSF) which can be fatal if left untreated.
Two tick species, that are considered Rickettsia vectors, were collected from all 21 NJ counties. 560 Dermacentor variabilis Say, American dog tick; 245 Amblyomma americanum L., lone star tick; and an additional 394 D. variabilis were collected at different time periods. Zero D. variabilis and zero A. americanum were found to be infected with Rickettsia rickettsia. They detected R. montanensis in D. variabilis and R. amblyommatis in A. americanum.
Collaboration among medical doctors, public health professionals, medical entomologists, and diagnostic laboratories will be needed to understand the causes of SFGR east of the Mississippi. What is causing human cases of SFGR in NJ remains unanswered. (Click here for published article)
‘Carios kelleyi’ on hand (Photo Credit: J. Occi, Center for Vector Biology, Rutgers Univ.)
“First Record of Carios kelleyi (Acari: Ixodida: Argasidae) in New Jersey, United States and Implications for Public Health,”J Med Entomol., March 2021. Carios kelleyi is a soft tick that is almost exclusively a parasite of bats and had been found in at least 29 states, Canada, Mexico, Costa Rica, Cuba, and now in New Jersey. The nymphs and adults take several short blood meals (min. to hrs.), while the larvae remain attached for several days. Relapsing fever Borrelia is known to come from soft ticks that feed on small rodents, and when bats are removed, ticks begin to seek blood meals from humans.
C. kelleyi has been found infected with a novel spotted fever Rickettsia; a novel relapsing fever-related Borrelia; Bartonella henselae; and a novel relapsing fever spirochete, identified as Borrelia johnsonii.
Although C. kelleyi is not thought to be an important vector of pathogens, its prevalence in bats in New Jersey is increasing. This creates the possibility for transmission to humans, animals, and livestock. New Jersey bats and the pathogens they carry should be monitored to assess the risk to the public. (Click here for published article)
“Ixodes scapularis (Ixodida: Ixodidae) Parasitizing an Unlikely Host: Big Brown Bats, Eptesicus fuscus (Chiroptera: Vespertilionidae), in New York State, USA,” was published in J Med Entomol, Jan. 2022. I. scapularis is a three-host tick found throughout the Northeast, Southeast, and Upper Midwest in the U.S and is the most common vector of tick-borne diseases to humans in North America. It feeds on over 150 species of terrestrial vertebrates, yet it had not previously been reported to feed on bats. During 2019 and 2020, injured big brown bats in four locations in rural NY had larvae and nymphs attached to them. Bats are known to carry a large number of pathogens and these ticks could go from hosting on a bat to hosting on a human. This poses a significant epidemiological risk and should be investigated further. It also threatens bat species that are at risk. (Click here for published article)
Research shows the oft-misdiagnosed tick-borne disease can lead to serious mental health problems that can erode a person’s quality of life, especially if left untreated. Psychologists are among those working to improve care for these patients.
Long before the SARS-CoV-2 virus was linked to a syndrome we now call long COVID, researchers and clinicians were already debating over how to best assist patients experiencing lingering symptoms from Lyme disease. For reasons that are unclear, 10% to 20% of people who contract Lyme disease report ongoing or intermittent symptoms at least a year after completing antibiotic treatment, including fatigue, muscle aches, difficulties with memory, irritability, and other symptoms, according to a review of the research (Marques, A., Infectious Disease Clinics of North America, Vol. 22, No. 2, 2008).
For patients, these ongoing and sometimes debilitating symptoms can erode their quality of life, potentially leading to depression, anxiety, and other mental health issues. But over the past few decades, researchers have also determined that the tick-borne infection itself, along with related inflammatory and other physiological effects, may directly cause mental health disorders.
One recent study, conducted by researchers from the Columbia University Irving Medical Center and the Copenhagen Research Centre for Mental Health, found that patients who received a hospital diagnosis of Lyme disease had a 28% higher rate of mental disorders and were twice as likely to have attempted suicide post infection than individuals without a Lyme diagnosis (Fallon, B. A., The American Journal of Psychiatry, Vol. 178, No. 10, 2021).
Patients diagnosed with Lyme report a range of mental health-related symptoms. Some experience panic attacks for the first time, which can sometimes extend for hours at a stretch, said Sheila M. Statlender, PhD, a clinical psychologist in Newton, Massachusetts, who has been working with patients with Lyme disease for more than 15 years. Some report frustrations with “brain fog,” cognitive difficulties that can include impaired concentration or trouble with tracking words on a page. In rarer instances, they develop auditory hallucinations. “They hear music, or they hear a radio that’s not playing,” she said.
(See link for article)
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A few points:
The article falsely regurgitates that only 10-20% experience lingering symptoms when this only includes those diagnosed and treated early. A far larger group of 30-40% are diagnosed and treated late. By combining the two groups, a whopping 60% suffer lingering symptoms. Numbers matter.
The article falsely regurgitates that at least 70% of adults and children will develop some type of skin irritation around the bite including the EM rash when this is highly variable and in the first patient group was only 25%. While having the rash is diagnostic for Lyme (no testing required – start treatment asap) not having the rash means nothing. You can still be infected without a rash.
Dr. Fallon states that antibody blood testing is required for those with late stage Lyme to help “clarify” the diagnosis. The testing he speaks of misses 70 – 86% of cases. That is hardly clarifying. Lyme/MSIDS has been and always will be a “clinical diagnosis” that demands proper understanding and education of tick-borne diseases, something that is sorely lacking in medical training.
The article points out one of the problems with CDC testing – if it’s done too soon, antibodies may not have had time to develop. Taking a “wait and see” approach (waiting for testing or waiting for symptoms, or both) has doomed patients to a life-time of suffering.
The CDC’s statement that “most people recover after treatment” is complete and utter propaganda. They are so hopelessly lost in their own corruption and hubris they wouldn’t know facts if they were hit squarely in the face with them.
Please note one of the doctors got involved treating Lyme patients due to having to go through the gauntlet with her three children becoming ill with tick-borne illness (TBI). This is a common refrain. Our best doctors and researchers have “been there, done that.”
Further complicating things are misdiagnoses, such as in Lorraine Johnson’s case where she was misdiagnosed with psychiatric illness and was put on psychotropic drugs, which didn’t work. She lost 5 years of her life essentially due to doctor bias. Please note that the “proof is in the pudding” because when she was properly treated for Lyme her symptoms cleared – including psychiatric illness. But mainstream medicine/research only sniffs at case studies with clinical outcomes like Johnson’s.
One of the psychologists in the article recommends they should refer any patient they are concerned about to a physician for testing to rule out Lyme but there are three problems with this advice: 1) testing sucks 2) other organisms besides Lyme are at play and a test only can pick out what it is designed to look for 3) mainstream medicine is is the Dark Ages regarding all things TBI. The only true help will come from an ILADS-trained doctor who understands that TBI diagnosis is a clinical diagnosis.Testing is essentially futile.
The point made about a potential “red flag” when a patient’s symptoms change while they are taking antibiotics for another medical reason, such as treating an infection, is an important, crucial point that mainstream medicine has denied for far too long.
Some excellent psychiatric observations are made and I highly recommend reading the article for these nuances that show some differences between ordinary mental health issues and those caused by Lyme/MSIDS. (Lyme/MSIDS tends to cause intense, prolonged, nonstop, very high anxiety without any underlying triggers and gives the patient sensitivities to light, sound, touch, and smell. I would add food and environmental issues as well.) This explains my husband to a T.
I’m thankful for the Lyme researcher’s advice to psychologists on the importance of reading up on Lyme controversies since patients struggle with abuse from doctors, family, and co-workers and often suffer from isolation, depression, and demoralization on top of the effects of the infections.
This researcher teamed up with psychologists who treat Lyme and came up with a screening tool.
They also discovered that cognitive behavior therapy’s (CBT) homework-intensive approach overwhelms these patients due to their brain fog, fatigue, and cognitive issues
CBT’s identifying and changing dysfunctional and distorted thought processes also doesn’t work as well on these patients as many of their thoughts are not distorted (they truly lost their job, they are really sick, they can’t do the things they used to do, they actually are isolated, etc.)
Acceptance and commitment therapy (ACT); however, which relies less on restructuring one’s thought patterns and more on adapting to current reality, has helped these patients. The patient still identifies and notices thoughts but they focus more on learning to coexist with or accept those thoughts.
Important quote:
“There is no question, it is a very, very challenging population to work with,” Trunzo said. “It also can be very rewarding. You can have an immeasurably profound impact on someone’s life by doing this work. Because you may very well be the only person who is listening to them.”
Unilateral knee swelling in a child due to Lyme disease
In their case report, “Pediatric unilateral knee swelling: a case report of a complicated differential diagnosis and often overlooked cause,” Guardado et al. describe a 3-year-old girl who presented to a hospital in Pennsylvania after two weeks of limping from a swollen right knee.¹
According to the authors, “The mother initially denied history of a tick bite, yet after focused questioning, the mother stated that the child had ticks on her approximately 9 months ago.”
Unfortunately, the child was not taken to her clinician because she did not develop any skin rashes which could indicate Lyme disease.
The child demonstrated right knee effusion with signs of crepitus and decreased range of motion secondary to swelling, the authors explain. “In addition, she had an unsteady gait without joint tenderness, crepitus, or overlying skin pathology.”
A Western blot test for Lyme disease was positive.
“Lyme arthritis is a diagnosis that is often missed, even in children, who are the population with the highest incidence of Lyme disease,” the authors point out.
“When this diagnosis is missed, it can result in long-term morbidity, which is generally refractory to intravenous antibiotic therapy, oftentimes requiring synovectomy.”
The child had a complete resolution of symptoms following a 2-day treatment with IV Rocephin and 21 days of oral amoxicillin.
“This case demonstrates the importance of including Lyme arthritis as part of the differential diagnosis of joint swelling regardless of the recollection of a tick bite,” the authors suggest.
Furthermore, the case raises awareness of mono- or oligoarticular arthritis as one of the signs of Lyme disease.
Related Articles:
References:
Guardado KE, Sergent S. Pediatric unilateral knee swelling: a case report of a complicated differential diagnosis and often overlooked cause. J Osteopath Med. 2022 Jan 6;122(2):105-109. doi: 10.1515/jom-2020-0332. PMID: 34989214.
Efficacy of Short-Term High Dose Pulsed Dapsone Combination Therapy in the Treatment of Chronic Lyme Disease/Post-Treatment Lyme Disease Syndrome (PTLDS) and Associated Co-infections: A Report of Three Cases and Literature Review
Lyme disease and associated co-infections are increasing worldwide and approximately 20% of individuals develop chronic Lyme disease (CLD)/Post-Treatment Lyme Disease Syndrome (PTLDS) despite early antibiotics.
A 7–8-week protocol of double dose dapsone combination therapy (DDDCT) for CLD/PTLDS results in symptom remission in approximately 50% of patients for one year or longer, with published culture studies indicating higher doses of dapsone demonstrate efficacy against resistant biofilm forms of Borrelia burgdorferi. The purpose of this study was therefore to evaluate higher doses of dapsone in the treatment of resistant CLD/PTLDS and associated co-infections. Twenty-five patients with a history of Lyme and associated co-infections, most of whom had ongoing symptoms despite several courses of DDDCT, took one or more courses of high dose pulsed dapsone combination therapy (200 mg dapsone X 3-4 days and/or 200 mg BID x 4 days), depending on persistent symptoms.
The majority of patients noticed sustained improvement in 8 major Lyme symptoms, including:
fatigue
pain
headaches
neuropathy
insomnia
cognition
sweating
where dapsone dosage, not just treatment length, positively affected outcomes. High dose pulsed dapsone combination therapy may represent a novel therapeutic approach for the treatment of resistant CLD/PTLDS, and should be confirmed in randomized, controlled clinical trials.
10-20% of Lyme disease patients who are promptly diagnosed and treated with an antibiotic within the first few weeks of infection, still end up with chronic disease. This is PTLDS.
30-40% of Lyme disease patients who have been infected for weeks to months before getting diagnosed, and THEN treated with an antibiotic, still end up with a chronic disease. This subgroup has no specific label but it has been referred to as “chronic Lyme disease,” or CLD.
60% of Lyme patients end up with chronic symptoms
And this, of course, doesn’t even take coinfections into consideration.
Madison Area Lyme Support Group 