Archive for the ‘research’ Category

Mitral Valve Dysfunction from Lyme Carditis

https://danielcameronmd.com/mitral-valve-dysfunction-lyme-carditis/

Mitral valve dysfunction from Lyme carditis

Man being examined with stethescope for mitral valve problems from Lyme carditis.

Lyme carditis is an uncommon but important manifestation of Lyme disease. In their study, Malik and colleagues describe the case of a young man with Lyme carditis with left ventricular dysfunction and valvular involvement occurring one week after a tick bite. [1]

By

The 22-year-old man was admitted to the hospital with cardiac problems. He suffered from morbid obesity and  complained of chest pain and lightheadedness for several days. During his examination, he was sweaty with a fast pulse of 115. He also reported having an erythema migrans (EM) rash.

Clinicians initially suspected the patient had non-segment elevation myocardial infarction (STEMI) and prescribed intravenous heparin, the authors explain in the case report, “Early Onset Lyme Myopericarditis With Left Ventricular Dysfunction and Mitral Regurgitation.”

“Echocardiogram was done which showed a left ventricular ejection fraction (LVEF) of 49% with mild diffuse hypokinesis, and moderate to severe mitral regurgitation,” the authors wrote.

Test results were positive for Lyme disease and the man was treated with intravenous ceftriaxone.

“If left untreated, Lyme carditis can lead to acute heart failure and sudden cardiac death thus prompt diagnosis and treatment are essential in management.”

“A repeat echocardiogram was performed, which showed an improvement of the previously visualized mitral regurgitation and normalization of LVEF,” the authors wrote.

The patient had a marked improvement in his symptoms and resolution of his rash. He was discharged home with a 3-week course of oral doxycycline.

“On a 1-month follow-up, patient remains asymptomatic and is back to his previous baseline,” according to the authors.

Cardiac manifestations in Lyme disease typically occur 1 to 2 months after the onset of infection, the authors wrote.  “In our patient, however, Lyme carditis was seen a little over 1 week after known tick exposure.”

A growing number of cardiac manifestations due to Lyme disease have been described. “Clinical manifestations of Lyme carditis include arrhythmias, conduction abnormalities, myopericarditis, ventricular dysfunction, and acute heart failure,” the authors wrote.

“Left ventricular dysfunction, as seen in our patient, has been reported to have an incidence of 0.5%.”

Valvular dysfunction due to Lyme carditis is rare. “To date, about 7 cases of valvular involvement in Lyme carditis have been reported making this phenomenon exceedingly rare.”

“If there is a high suspicion for Lyme carditis, empiric treatment with antibiotics should be started while the initial evaluation is pending.”

Death from Lyme carditis is rare. “A case series published by the CDC reported 3 individual deaths that were attributed to Lyme disease by postmortem examination indicating that lack of treatment can lead to fatalities.”

Shen and colleagues described the death of a 25-year-old man with Lyme carditis. “He presented with syncope and second-degree Mobitz type 2 heart block, as well as disseminated erythema migrans rash.”²

The patient received a temporary pacemaker and was discharged after 4 days of intravenous ceftriaxone.

“The patient returned home to a different state and reportedly died at home about 1 week after discharge.” There was no autopsy report or records to determine the cause of death.

Related Articles:

Podcast: Young man dies from Lyme carditis
Lyme carditis diagnosis: 18 cases
Patients can die when Lyme carditis is not treated

References:
  1. Malik MB, Baluch A, Adhikari S, Quraeshi S, Rao S. Early Onset Lyme Myopericarditis With Left Ventricular Dysfunction and Mitral Regurgitation. J Investig Med High Impact Case Rep. Jan-Dec 2021;9:23247096211045267. doi:10.1177/23247096211045267
  2. Shen RV, McCarthy CA, Smith RP. Lyme Carditis in Hospitalized Children and Adults, a Case Series. Open Forum Infect Dis. Jul 2021;8(7):ofab140. doi:10.1093/ofid/ofab140

__________________

For more:

Category:

Heart Issues, Lyme, research, Treatment

Tick Bite Leads to Multiple Co-infections

https://danielcameronmd.com/tick-bite-multiple-co-infections/

Tick bite leads to multiple co-infections

Man in hospital bed with co-infections from a tick bite.

In their case report “One man, three tick-borne illnesses” Grant and colleagues describe a 70-year-old man who was admitted to the emergency department with ongoing fevers, ankle edema and nausea. [1] One month earlier he noticed a small raised red lesion on his left ankle, which he believed was an insect bite.

By

“Two days after noting this ankle lesion, the patient noticed an erythematous rash on his neck and chest,” the authors explain. He was prescribed an antihistamine and 7-day course of trimethoprim–sulfamethoxazole.

The rash resolved after 5 days of antibiotic treatment, but the man continued to have pain and swelling in his ankle.  The pain spread to his left hip and he was “diagnosed with sciatica and prescribed gabapentin.”

The patient had reportedly travelled to an endemic area of the United States. And was therefore, suspected of having a tick-borne illness.

“Physicians must maintain a high level of suspicion for co-infection, as untreated disease can result in long term and sometimes life-threatening sequelae,” the authors suggest.

He tested positive for Borrelia burgdorferi, Anaplasma phagocytophilum and Babesia microti serologies.

The patient’s symptoms improved with treatment, but one year later, he continued to have symptoms of neuropathy at the site of the presumed insect bite.

References:
  1. Grant L, Mohamedy I, Loertscher L. One man, three tick-borne illnesses. BMJ Case Rep. 2021 Apr 16;14(4):e241004. doi: 10.1136/bcr-2020-241004. PMID: 33863772; PMCID: PMC8055128.

__________________

**Comment**

A perfect example of how mainstream medicine is hopelessly lost in its own hubris.

  1. Seven days of treatment of anything will not solve this
  2. trimethoprim–sulfamethoxazole, commonly known as Bactrim DS will not touch Babesia at all
  3. Bactrim DS, while a great drug, should not be the first choice for Lyme disease – and he had a clear EM rash, which is diagnostic for Lyme – no testing required
  4. It is common knowledge that the EM rash will wax and wane all on its own and should never be used to determine if treatment is working or not
  5. Doxycycline is still the best front-line drug for both Lyme and Anaplasmosis, but is far from sufficient in and of itself
  6. It is not surprising at all that this poor man continued to suffer with neuropathy, which they will undoubtedly blame on anything but tick-borne illness and it will never occur to them in a million years to treat him with numerous antimicrobials simultaneously for far longer than 7 days.  Myopia is a a very real condition

For more:

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

For Anaplasmosis treatment:  https://madisonarealymesupportgroup.com/category/anaplasmosis-treatment/

For Babesia Treatment:  https://madisonarealymesupportgroup.com/category/babesia-treatment/

Category:

Anaplasmosis, Babesia, Lyme, research

Advocates Call on IDSA to Retract False Information on Congenital Lyme

https://www.lymedisease.org/advocates-call-for-idsa-retraction/

Advocates call on IDSA to retract false information on congenital Lyme

Nov. 9, 2021

Mothers Against Lyme, a group of advocates concerned about the impact of Lyme disease and its co-infections on pregnant women, children and families, is calling for retraction of a statement in the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), American College of Rheumatology (ACR) 2020 Clinical Practice Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease that contributes to misdiagnosis and harm to pregnant women and children who are congenitally infected.

On October 20, Mothers Against Lyme sent a retraction request letter to the editors of the journals that published the guidelines and the leadership of the sponsoring organizations. Copies were sent to the clinical practice guidelines committees of the sponsoring organizations and the co-authors of the guidelines. The guidelines were published in Clinical Infectious Diseases, Neurology, Arthritis Care & Research, and Arthritis & Rheumatology.

Page e12 of the guidelines “Treatment of Lyme Disease” section states:

“To date, Lyme disease in pregnancy has not been found to result in congenital infection or a syndrome of congenital abnormalities, and no additional treatment or monitoring of the mother or infant is recommended beyond the standard of care.”

According to the letter, the statement “To date, Lyme disease in pregnancy has not been found to result in congenital infection” is not true.

40 peer-reviewed articles

The letter cites more than 40 peer-reviewed articles, including a systematic review co-authored by a CDC epidemiologist, that provide evidence of congenital infection with Lyme disease.

The letter also cites studies and review articles that show adverse birth outcomes are common for both treated and untreated pregnant women with Lyme disease.

Adverse outcomes include fetal death, newborn death, and newborns with an abnormal outcome (e.g. birth defects, hyperbilirubinemia, respiratory distress).

According to Mothers Against Lyme Chair Isabel Rose:

“Correction of this error is vital and warrants an expedited review and notice of correction. The potential harm to mothers, children, and families from the inaccurate information in the IDSA, AAN, ACR Guidelines is significant. Providers who rely on the guidelines will fail to diagnose and treat Lyme disease in pregnancy and fail to recognize the offspring of women with Lyme disease as infants and children at risk. Countless tragic births and fetal losses will result, with a lifetime of harm to the children and their families.”

Authors contradict their own work

The letter also cites eight articles co-authored by IDSA, AAN, ACR Guidelines authors that “clearly contradict what they’ve written in the guidelines, and which address the issue of intrauterine transmission and fetal abnormalities head-on.”

Following are examples.

“It is clear that B. burgdorferi can be transmitted in the blood of infected pregnant women across the placenta into the fetus. This has now been documented with resultant congenital infections and fetal demise.”

“The precise risk to the developing fetus of maternal Lyme disease during pregnancy is unknown, although it is well documented that fetal infection can occur and may have deleterious outcomes, including malformations and death.”

“The aim of treatment of early Lyme disease during pregnancy is not only to treat the infection and prevent long-term sequelae but to eliminate the infection as quickly as possible so as to prevent congenital transmission to the fetus.”

Ignoring their own research

According to Rose:

“It is disheartening and alarming that the authors of medical guidelines that direct the care of pregnant women with Lyme disease are ignoring their own research to put forward guidelines based on ‘expert opinion’ rather than their own discoveries. Their own work conclusively proves that perinatal transmission of B. burgdorferi during pregnancy does occur and may have dire consequences for the pregnant mother and her fetus.”

The IDSA, AAN, ACR Guidelines say that “no additional treatment or monitoring of the mother or infant is recommended beyond the standard of care.”

Instead of denying the existence of congenital Lyme, the letter says “the Guidelines should acknowledge that Lyme bacteria can cross the placenta, both infecting and causing harm to unborn children, and describe the manifestations of Lyme in pregnancy that the research has uncovered and advise screening and treatment according to the knowledge we have to date.”

Research funding

Rose points out that researchers who depend on the IDSA, AAN, ACR Guidelines for information will be less likely to submit grant applications for much needed research if they rely on the statement that congenital Lyme disease does not exist.

She notes that this is especially important since more than $29 million in new annual funding for NIH has been appropriated that could support this type of research. NIH has also issued several notices of special interest to encourage research on Lyme and other tick-borne diseases. A recent notice includes a section that calls for research on “gestational Lyme disease” and the impact on pregnancy on immune response.

Rose says, “Correcting this error does not undo the harm. In addition to making this correction in a timely manner, the sponsoring organizations should encourage their members to conduct research on congenital Lyme that will improve health outcomes for pregnant women with Lyme disease and children who are congenitally infected.”

About Mothers Against Lyme

We’re a group of mothers and mother-advocates who are concerned about the impact of Lyme disease and its co-infections on pregnant women, children and families. Our focus includes awareness, education, advocacy and community building, as we promote research that advances diagnosis, treatment and prevention.

SOURCE OF PRESS RELEASE: Mothers Against Lyme

Related posts:

  1. Advocate asks IDSA to remove false statement about Lyme transmission
  2. IDSA removes inaccurate Lyme document from website
  3. TOUCHED BY LYME: CDC allows “possibility” of mother-fetus Lyme transmission
  4. IDSA lists complaints against TBD Working Group; advocates push back

Category:

Activism, Lyme, research, Transmission

Bell’s Palsy From Lyme Misdiagnosed, Patient Bedridden Due to Myth That it is ‘Rare’

https://danielcameronmd.com/bells-palsy-lyme-disease-misdiagnosed/

Bell’s palsy due to Lyme disease misdiagnosed, patient bedridden

Woman in hospital bed with Bell's palsy due to Lyme disease.
In their study “Bilateral Facial Nerve Palsy in a Young Woman From West Bengal: Do Not Forget Lyme Neuroborreliosis,” Kayal and colleagues describe the case of a 23-year-old woman, living in India, who was misdiagnosed with bilateral facial nerve palsy. [1]
By

Until recently, India has been considered a non-endemic region for Lyme disease, the authors point out. And, “Although it had been considered extremely rare in India, a recent study conducted in Nagarahole and Bandipur in South India surprisingly revealed a high seroprevalence (19.9%) of Borrelia burgdorferi infection in a population at risk (forest workers and staff).”

According to the case report, the young woman was admitted to the hospital with “rapidly evolving progressive weakness of all four limbs, and lancinating pain over the back of the neck and lower back, radiating to upper and lower limbs.”¹

Her symptoms had developed over a 1-week period and left the patient bedridden. Ten days prior, she had developed a fever, which resolved within 2 days.

Two months before the onset of symptoms (during the last months of her pregnancy), she developed a “slight deviation of her angle of the mouth toward the left side, along with grossly decreased taste sensation and difficulties in closing eyes, blowing, and whistling.” This lasted for one month.

She was diagnosed with right-sided Bell’s palsy but Lyme disease was not considered, initially.

The woman was treated with methylcobalamine and prednisolone. However, her symptoms did not improve.

Further testing revealed the patient was positive for Lyme disease by ELISA and PCR.

She was treated with intravenous ceftriaxone (2 g/day) and oral azithromycin (500 mg/day) for 14 days.

Three months after her discharge from the hospital, the woman was able to walk without assistance. And, at the 6-month follow-up visit, she had “no demonstrable neurological deficit.”

Currently, only 10 cases of Lyme disease have been reported in India. Four of these cases involved lower motor neuron–type facial paresis.

In this case, the patient “also had an asymmetric lower motor neuron–type bilateral facial paresis, which was misdiagnosed by her treating physicians as right-sided Bell’s palsy leading to a delay in diagnosis.”

Interestingly, the authors point out, none of these patients exhibited an erythema migrans (bull’s-eye) rash.

The authors’ suggest:

“The possibility of Lyme neuroborreliosis should be considered more often from now on because in the last year four cases with the kindred clinical syndrome have been described from a so-called “non-endemic zone.”

Related Articles:

Treatment varies for Bell’s palsy in children with Lyme disease

Patient with facial palsy from Lyme disease fails treatment

Can Bell’s palsy lead to nonflaccid facial palsy in Lyme disease?

References:
  1. Kayal N, Ghosh R, Mazumdar PS, Das S, Ghosh S, Pandit A, Benito-Leon J. Bilateral Facial Nerve Palsy in a Young Woman From West Bengal: Do Not Forget Lyme Neuroborreliosis. Neurol India 2021;69:997-1001

Category:

Lyme, research

Does Lyme Carditis Differ in Children vs. Adults?

https://danielcameronmd.com/lyme-carditis-children-vs-adults/

Does Lyme carditis differ in children vs. adults?

lyme carditis in child being examined by doctor
In their article, “Lyme Carditis in Hospitalized Children and Adults, a Case Series,” Shen and colleagues compare, for the first time, the presentation, management, and outcomes of Lyme carditis in the pediatric versus adult populations.
By

The authors analyzed charts of pediatric and adult patients with heart block and a positive Western Blot test for Lyme disease, who were hospitalized at Maine Medical Center. The study included 10 children and 20 adults who were admitted for Lyme carditis between January 2010 and December 2018.¹ The children’s mean age was 12.4 years. The adult mean age was 41.4 years.

The case series found:

  • 90% of the Lyme carditis patients were male, with 87% having no prior cardiac history.
  • All cases presented between June and October.
  • Of the 13 cases who noted symptom onset, 76% presented within 3 weeks of illness.
  • Out of 30 patients, 17 were evaluated at an outpatient facility. “Of these, a minority (41%) had Lyme disease suspected in the outpatient setting, and fewer (12%) were initiated on Lyme disease treatment.”

“Improved early recognition and treatment of Lyme disease may decrease Lyme carditis.”

  • Children with Lyme carditis were more likely to present with disseminated erythema migrans and fever. Otherwise, children and adults had similar symptom presentations, exhibiting predominantly presyncope and syncope.
  • “There was no statistical difference between pediatric and adult cases with regards to heart block type or other cardiac complications,” the authors write. “However, the most common heart block in pediatric cases was first-degree (40%) vs second-degree Mobitz type 2 in adult cases (55%).”
  • Adults were more likely to require a pacemaker (60%) compared with 20% of children. “Proportionately more adults needed temporary pacing,” the authors write, while “Children had shorter antibiotic durations…”

“… there is room for improving outpatient diagnosis and treatment of early Lyme disease, even in a high-incidence state like Maine.”

  • Out of the 30 cases, 27 had improved heart block, while 3 adults required a pacemaker at discharge. One patient died.

The authors point out that the majority of these cases were evaluated by an outpatient provider before carditis developed. However, only 41% of the patients were diagnosed with or suspected to have Lyme disease at that visit.

Furthermore, even fewer (12%) of those patients received appropriate antibiotics.

“Overall, there were no major differences seen between the presentations or outcomes of pediatric and adult Lyme carditis cases,” the authors write.

“Earlier diagnosis and treatment would likely have prevented carditis and the need for hospital admission,” the authors conclude.

“… there is room for improving outpatient diagnosis and treatment of early Lyme disease, even in a high-incidence state like Maine.”

Related Articles:

Lyme carditis diagnosis: 18 cases

Patients can die when Lyme carditis is not treated

Study identifies 189 children with Lyme carditis

References:
  1. Richard V Shen, Carol A McCarthy, Robert P Smith, Lyme Carditis in Hospitalized Children and Adults, a Case Series, Open Forum Infectious Diseases, Volume 8, Issue 7, July 2021, ofab140, https://doi.org/10.1093/ofid/ofab140

_________________

For more:

Category:

Heart Issues, Lyme, research