Archive for the ‘research’ Category

Can A Tick Be Tested For Lyme Disease? And How I Overcame My Fear of Ticks

https://danielcameronmd.com/cant-count-testing-engorged-ticks/

CAN A TICK BE TESTED FOR LYME DISEASE?

Researchers examined the prevalence of ticks in the Quebec region, along with the frequency of engorged ticks carrying Borrelia burgdorferi (Bb), the causative agent of Lyme disease. Their findings suggest that tick testing may not always be an effective tool in determining the risk of infection.

By 
Ticks can be tested for the Lyme disease bacteria and other tick-borne pathogens. But the accuracy of test results may depend on a ticks lifecycle stage.

A study by Gasmi et al. found that results may not be accurate when testing ticks which are engorged. [1] The authors examined 4,596 I. scapularis (blacklegged) ticks removed from individuals living in Quebec.

They found that 24.9% of the non-engorged blacklegged ticks were infected with Borrelia burgdorferi (Bb), the causative agent of Lyme disease.

Engorged ticks were expected to have an even higher rate of infection with the Lyme disease bacteria. But the prevalence was much lower with only 8.9% of engorged ticks testing positive for the Lyme disease agent. These findings are consistent with those from another Canadian study. [2]

Engorged ticks were expected to have an even higher rate of infection with the Lyme disease bacteria. But the prevalence was much lower.

It is still unclear why testing of engorged ticks is not accurately revealing the higher prevalence of Bb infection. The authors suggest that it could be due to the presence of inhibitors in the blood meal [3] or problems with the collection and transportation of engorged ticks.

Perhaps these findings were “due to simpler reasons such as the greater likelihood that un-engorged ticks remained alive up to DNA extraction, while engorged ticks may well have died days or weeks before testing,” noted Gasmi.

In other words, a tick can be tested for Lyme disease but it isn’t always a reliable tool in determining your risk of infection. If an engorged tick is removed and tested, it is likely to be negative for the Borrelia burgdorferi bacteria.

References:
  1. Gasmi S, Ogden NH, Leighton PA, Lindsay LR, Thivierge K. Analysis of the human population bitten by Ixodes scapularis ticks in Quebec, Canada: Increasing risk of Lyme disease. Ticks Tick Borne Dis. 2016.
  2. Dibernardo A, Cote T, Ogden NH, Lindsay LR. The prevalence of Borrelia miyamotoi infection, and co-infections with other Borrelia spp. in Ixodes scapularis ticks collected in Canada. Parasit Vectors. 2014;7:183.
  3. Wilson IG. Inhibition and facilitation of nucleic acid amplification. Appl Environ Microbiol. 1997;63(10):3741-3751.

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**Comment**

Great reminder that yet again, testing is an imperfect tool for all things Lyme/MSIDS related. This inability to positively identify the presence of infections has plagued doctors and patients alike, but must be accepted and contended with, which is why experienced doctors understand the importance of diagnosing patients clinically based upon symptoms.

Further, I often remind frustrated patients that even IF their test or tick test were to come back positive, it’s highly unlikely they will be treated appropriately as there is often coinfection involvement which requires different medications as well as the fact 28 days or less of the doxycycline monotherapy has failed repeatedly – yet is still used despite evidence to the contrary.  

If you suspect you are infected, get to a Lyme literate doctor asap.  It will save you money, time, and heartache in the end.

For more:

https://rawlsmd.com/health-articles/overcome-your-fear-of-ticks-and-get-outside?

by Dr. Bill Rawls
Updated 6/25/21

Considering that my life was totally disrupted by chronic Lyme disease for more than ten years, you might find it alarming to learn that I walk in the woods with bare legs. And although this might sound risky, I haven’t had any tick bites since my recovery. I’ve had ticks on me, but I haven’t been bitten.

Like many people who contract Lyme, my aversion to ticks kept me removed from nature. So what finally changed my fear?

I became tick aware — doubling down on prevention and keeping tabs on where I go, how I go, when I go, and what I do before and after I go to minimize risk factors. And in the end, my love of the outdoors prevailed. Being in nature is where I’ve always gained strength, and I had to find my way back to heal fully.

Finding My Way Back Nature

My first foray back into nature began at the beach at a state park near my home. Long walks were perfect for generating endorphins, and the sea air did me good. However, as my strength improved, I needed more of a challenge, so I began venturing onto the trails that wove through the tall grasses of the sand dunes and maritime forests of the park.  (See link for article)

Category:

Lyme, research, Testing, Ticks

Science Journals Engaged in Massive Disinformation Campaign

**UPDATE Sept. 2022**

This important article shows how medical journals and 86% of clinical trials are funded by Big Pharma, which means journal articles are nothing more than marketing machines.

https://takecontrol.substack.com/p/science-journals-disinformation-campaign

Science journals engaged in massive disinformation campaign

July 13, 2021

These highly regarded scientific journals got caught censoring important facts and stifling scientific debate, deriding anything that didn’t protect their Chinese interests

by Dr. Joseph Mercola

STORY AT-A-GLANCE

  • The Lancet and Nature have both promoted the natural origin theory for SARS-CoV-2, and protected the theory by refusing to publish counter arguments and/or publishing scientific statements by individuals with serious conflicts of interest
  • The Lancet’s COVID-19 Commission included Peter Daszak, Ph.D., president of EcoHealth Alliance, a nonprofit organization that collaborated with various universities and organizations on research in China, including the Wuhan Institute of Virology (WIV). He was recently taken off the Commission due to controversy over his large number of conflicts of interest
  • The Lancet’s COVID-19 Commission also includes Danielle Anderson, an Australian WIV virologist who left Wuhan shortly before the pandemic broke out. Anderson says she “does not believe” the virus is manmade. Anderson’s Commission biography does not mention that she worked at the WIV
  • In January 2021, 14 global experts submitted a letter to The Lancet in which they argued that “the natural origin is not supported by conclusive arguments and that a lab origin cannot be formally discarded.” The submission was rejected with the justification that the topic was “not a priority” for the journal
  • Richard Horton, the editor-in-chief of The Lancet is now being criticized for his long defense and support of the Chinese regime, and is accused of using The Lancet to pursue political causes and stifle scientific debate

More than a year ago, in February 2020, a group of 27 scientists wrote a letter published in The Lancet condemning “conspiracy theories suggesting that COVID-19 does not have a natural origin.”1

Although The Lancet — like other medical journals — requires contributors to disclose financial or personal interests that might be viewed as possible conflicts of interests with their submissions, the 27 authors declared they had “no competing interests.”

June 21, 2021, The Lancet published an addendum admitting that “some readers have questioned the validity of this disclosure, particularly as it relates to one of the authors, Peter Daszak.”2

As a result, The Lancet asked the 27 signers to “re-evaluate” their competing interests and to declare any “financial and nonfinancial relationships that may be relevant to interpreting the content of their manuscript.” So far, Daszak has updated his previous claim of having no competing interests to include a 416-word disclosure statement clarifying that, indeed, he had several conflicts of interest.

First, he is the president of EcoHealth Alliance, a nonprofit organization that receives funding from a “range of U.S. Government funding agencies and non-governmental sources.”

Second — and most importantly — Daszak also explained that, although its work with China is currently unfunded, he and the Alliance have collaborated with various universities and organizations on research in China, including the Wuhan Institute of Virology (WIV). Specifically, this work includes studies of bats and viruses, including “the isolation of three bat SARS-related coronaviruses that are now used as reagents to test therapeutics and vaccines.”

The Lancet Accused of Kowtowing to China

The COVID pandemic has brought attention to any number of problems within the academic arena. Disturbingly, we’ve discovered that scientific journals held in high regard for many decades — The Lancet has been around for 198 years — are colluding to censor important facts and stifle scientific debate. The Lancet statement deriding the lab leak theory as a conspiracy theory to be ignored is a prime example. As reported by the Daily Mail, June 26, 2021:3

“The Lancet letter, signed by 27 experts, played a key part in silencing scientific, political and media discussion of any idea that this pandemic might have begun with a lab incident rather than spilling over naturally from animals.

It was even reportedly used by Facebook to flag articles exploring the lab leak hypothesis as ‘false information’ … Yet it emerged later that The Lancet statement was covertly drafted by British scientist Peter Daszak — a long-term collaborator with the Wuhan Institute of Virology, which was carrying out high-risk research on bat coronaviruses and had known safety issues …

Four months later, The Lancet set up a ‘Covid-19 Commission’ to assist governments and scrutinize the origins. It was led by Jeffrey Sachs … Incredibly, he backed Daszak to lead his commission’s 12-person taskforce investigating Covid’s origins — joined by five fellow signatories to The Lancet statement …

Last week The Lancet finally ‘recused’ him from its commission and published an ‘addendum’ to its statement detailing some of his Chinese links. Yet critics say the journal has still failed to admit that six more signatories to that February statement have ties to Daszak’s EcoHealth Alliance as directors or partners.

‘It would have been better for The Lancet to have stated that Daszak’s and other signers’ previous declarations were untruthful and to have attached an editorial expression of concern,’ said Richard Ebright, a bio-security expert and professor of chemical biology at Rutgers University in New Jersey.

Now The Mail on Sunday has learned that The Lancet is set to publish a second statement by these signatories that presses the case that Covid probably emerged through natural ‘zoonotic’ transmission from animals to humans.”

Richard Horton, the editor-in-chief of The Lancet is now being criticized for his long defense and support of the Chinese regime, and is accused of using The Lancet to pursue political causes and stifle scientific debate.4

In January 2021, 14 global experts submitted a letter to The Lancet in which they argued that “the natural origin is not supported by conclusive arguments and that a lab origin cannot be formally discarded.” Horton rejected the submission, stating it was “not a priority” for the journal.5

“The Lancet also published an entirely made up study claiming hydroxychloroquine was dangerous. This fraudulent paper made the media rounds and led to countries banning the drug’s use against COVID-19.”

Any medical journal worthy of a good reputation needs to be an open platform for wide-ranging debate. Horton’s refusal to publish the other side of the origins argument has without a doubt damaged the credibility and reputation of the journal. Tory MP Bob Seely told the Daily Mail:6

“The claims of a cover-up over the most important scientific issue of our time grow stronger by the day. It is vital we get to the truth over what appears to have been a cover-up on the pandemic origins with the collusion of journals such as The Lancet.”

Let’s also remember that The Lancet published an entirely fake study claiming hydroxychloroquine was dangerous. This paper using completely fabricated data made the media rounds and led to countries banning the drug’s use against COVID-19.

This too raises serious questions about the journal’s credibility. How was this fraud not discovered during the peer review process? Could it be that The Lancet allowed it because it would help protect the roll-out of profitable new COVID drugs and “vaccines”?

What’s Behind Science Journals’ Censorship?

What could possibly be behind science journals’ decision to silence debate in what appears to be a concerted effort to protect Chinese interests? In a June 18, 2021, article,7 Matt Ridley suggests it might have to do with the fact that “scientific papers have become increasingly dependent on the fees that Chinese scientists pay to publish in them, plus advertisements from Chinese firms and subscriptions from Chinese institutions.”

The Lancet is not alone in its less than objective stance on China. In 2017, the Nature journal admitted it censors articles containing words like “Taiwan,” “Tibet” and “cultural revolution” in its Chinese editions at the request of the Chinese government.8 “In April 2020 Nature ran an editorial apologizing for its ‘error’ in ‘associating the virus with Wuhan’ in its news coverage,” Ridley writes.9

Nature also attached an editorial note to several old articles, saying they were being misused “as the basis for unverified theories that the novel coronavirus causing COVID-19 was engineered,” and that “there is no evidence that this is true; scientists believe that an animal is the most likely source of the coronavirus.”

One of those articles, published in 2015, was titled “Engineered bat virus stirs debate over risky research.” The research being questioned was done by WIV researchers.

Gaslighting Alert: Abusers Now Play the Victim Card

For the past year and a half, scientists, doctors, reporters and anyone else who dared point out blatant discrepancies in the natural origins narrative have been attacked and painted as quacks and dangerous conspiracy theorists. They’ve been censored, deplatformed and publicly defamed and shamed. Many a fine career has been ruined or seriously tarnished by baseless personal attacks.

Now that undeniable evidence is finally reaching critical mass, natural origin defenders are playing the victim card. For example, Amy Maxmen, Ph.D., a journalist for Nature for the past 13 years, has been covering the SARS-CoV-2 origin debate. In a May 26, 2021, tweet, she stated the “debate over a lab-leak has become toxic and risky.”10

Angela Rasmussen, Ph.D., a natural origin proponent, responded saying that “the origins debate has become a toxic milieu dominated by opportunists, dilettantes, racist/misogynist assholes, and trolls.”11 Rasmussen claims she’s been personally attacked and abused for trying to explain the natural origin theory.

The irony is that the same people who abused others for talking about the lab leak theory are now getting a taste of their own medicine, and they don’t like it. They’re the ones who have been peddling misinformation all along, and as the masses are catching on to the deceit, they’re catching heat.

To deflect and finger-point yet again, abusers are now playing the victim. Another tactic is to claim that attacks on them are attacks on science itself. Dr. Anthony Fauci, for example, has stated this on more than one occasion already.12 13 In a June 2021 MSNBC interview, Fauci said criticizing him was “very dangerous,” and that: 14 15

“A lot of what you’re seeing as attacks on me quite frankly are attacks on science because all of the things I have spoken about from the very beginning have been fundamentally based on science … If you are trying to get at me as a public health official and scientist, you’re really attacking not only Dr. Anthony Fauci, you are attacking science.”

His comments didn’t go over well, based on social media responses.16 Reporter Glenn Greenwald’s Tweet will suffice to summarize the general consensus:17

“Beyond the dangerous arrogance and pomposity of proclaiming ‘anyone who criticizes me is attacking Science’ — thus placing himself off-limits from questioning — he *admitted* he purposely issued false, anti-science, politicized claims … Once you *admit* that you made false statements in violation of The Science™, you don’t then get to equate yourself to The Science™ such that attacks on you are attacks on it.”

Another example is that of Dr. Peter Hotez, one of the most shockingly hateful people in the medical field who has publicly stated he wants to “snuff out” vaccine skeptics and has called for cyberwarfare measures to be deployed against me and others who share vaccine safety information. Coincidentally, this public plea was published in the journal Nature.18

This man, who has spewed all sorts of vile language at parents of vaccine-injured children and called for physical harm and imprisonment of people who don’t agree with the one-size-fits-all vaccine agenda is now complaining about getting bombarded with “anti-vaxx hate speech.”19

Billions of Dollars at Stake

To circle back to the question of why prominent and previously respected science journals are publishing propaganda and suppressing open discussion, the most likely reason — aside from their dependence on Chinese publishing fees and advertising dollars — is the fact that if SARS-CoV-2 is proven to be a manmade virus that escaped from a lab (regardless of its location), billions of dollars in funding for gain-of-function research and even vaccine research could evaporate.

As a publisher of research, it makes sense that journals would be willing to protect the research industry as a whole, and provide a platform for chosen spokespeople — such as Hotez — who shamelessly promote the official narrative, no matter how tenuous or unscientific it might be, or how clear the conflicts of interest.

Here’s another case in point: June 28, 2021, Bloomberg tweeted out a short video featuring Danielle Anderson, an Australian WIV virologist who left Wuhan shortly before the pandemic broke out. Anderson says she “does not believe” the virus is manmade. In response, Hotez tweeted:20

“And we’re in agreement: SARS-2 coronavirus has natural origins, was not produced through GOF [gain-of-function] research, and probably has nothing to do with the Wuhan Institute of Virology.”

Coincidentally, Anderson is also on The Lancet’s COVID-19 Commission,21 the same Commission that Daszak was on. Her Lancet Commission bio22 says nothing about her work at the WIV, only that she is a senior research fellow at the University of Melbourne, Australia. Why is that? Is Anderson’s link to the WIV yet another “random coincidence” that has no bearing on her message? Or is it part of a pattern?

I believe the engineering of viruses and other pathogens is one of the greatest threats to life on earth at this point. We lucked out with SARS-CoV-2, as it turned out to be far less lethal than initially predicted. The next time we might not be so lucky.

As reported in July 2020, China has plans to erect high-security biolabs in all of its 23 provinces, despite concerns about leakage risks.23 Worldwide, there are hundreds of laboratories where this kind of research is taking place on a daily basis. Considering the history of lab leaks, it’s only a matter of time before something truly nasty gets out.

This is why we must get to the bottom of where SARS-CoV-2 came from. We must know if it was manmade because, if so, we need to ban gain-of-function research aimed at making pathogens more dangerous to humans.

Yes, there are harmless gain-of-function experiments, and that’s not what we’re talking about here, although, harmless experiments can, of course, be steps in a process that ultimately results in a dangerous bioweapon. Overall, I think we need to seriously reconsider the need and value of genetic manipulation of viruses and the creation of synthetic ones.

reprinted with permission

Sources:

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Category:

Activism, research, vaccines, Viruses

Stomach Pain Can Be a Symptom of Lyme Disease

https://danielcameronmd.com/neurologic-lyme-disease-presenting-as-abdominal-pain-in-71-year-old-patient/

STOMACH PAIN CAN BE A SYMPTOM OF LYME DISEASE

woman with stomach pain from lyme disease

“Although abdominal pain is generally not considered a sign of LD [Lyme disease], in this case report we describe a patient with unexplained severe abdominal pain that eventually turned out to be LD due to radiculopathy,” explains Stolk from the Haga Teaching Hospital in the Netherlands. [1]

By 

The 71-year-old woman underwent an exhaustive evaluation to determine the cause of her abdominal pain. Tests included: CT scan of the chest and abdomen; whole body emission tomography-CT scan (PET-CT); colonoscopy; gastroscopy, and an MRI of the small intestines. Initially, doctors did not consider testing for Lyme disease as a cause of the patient’s stomach pain.

The woman was admitted to the hospital for pain management and other diagnostic workups.

READ MORE: Lyme disease manifests as abdominal pain in a young child

Approximately 8 weeks prior to her hospitalization, she experienced temporary lower back pain, myalgia, fever, burning sensations and tenderness on her head and upper legs and moderate stomach pain. Several weeks later, her abdominal pain worsened.

“Going over the history again, she emphasized that she had stayed in a high endemic area for ticks and had suffered a possible tick bite without any sign of erythema migrans,” writes Stolk and colleagues.

Lyme disease associated with stomach pain

Serologic testing and a spinal tap were consistent with Neurologic Lyme disease. The spinal tap revealed an elevated IgM antibody to Borrelia burgdorferi (Bb), a lymphocytic pleocytosis, markedly elevated IgM antibody index to Bb, and markedly elevated IgG antibody to Bb.

The authors point out that “Since the incidence of LD is rising it is important to realize that severe abdominal pain could be the first clinical manifestation of early neuroborreliosis.”

After a 2-week course of intravenous ceftriaxone to treat Lyme disease, the woman’s symptoms, including stomach pain, resolved completely.

This case demonstrates the importance of re-examining a patient’s history when symptoms cannot be explained, the authors point out.

“Instead of doing extensive diagnostic tests, it is important to scrutinize the patient’s medical history in the presence of unexplained clinical signs.”

The authors note: Abdominal pain in the presence of facial paralysis has been described in Europe as Bannwarth Syndrome.

Editor’s note: I often see Lyme disease patients in my practice who present with stomach pain severe enough to warrant extensive diagnostic testing before Lyme disease is suspected.

UPDATED: May 28, 2021

References:
  1. Stolk JM, van Nieuwkoop C, van der Voorn M, van Erp S, van Burgel ND. Ticking off diagnoses of abdominal pain: early neuroborreliosis with radiculopathy. Neth J Med. 2018;76(7):336-338.

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For more:

Category:

Lyme, Pain Management, research, Treatment

Research Consortium Aims to Develop New Drug For Bartonellosis

https://www.lymedisease.org/research-consortium-bartonellosis/

Research consortium aims to develop new drug for bartonellosis

July 15, 2021

Key infectious disease researchers at Tulane University, Duke University and North Carolina State University will collaborate on an initiative to develop a treatment for bartonelloses, a spectrum of vector-borne diseases that can cause debilitating symptoms.

The three-year, $4.8 million initiative funded by The Steven and Alexandra Cohen Foundation, will establish the Bartonella Research Consortium to develop a novel treatment for bartonelloses.

Bartonella are zoonotic, stealth bacterial pathogens that were not known to infect animals or humans prior to the HIV epidemic when immunocompromised patients began showing symptoms of bartonelloses.

Bartonelloses are often self-limiting diseases that can be cleared by the immune systems of healthy individuals. In immunocompromised individuals or as co-infections, they can cause severe neuropsychiatric, cardiovascular, and rheumatological symptoms. Cats and fleas often harbor the pathogen, which increases the likelihood of transmission to humans.

The principal investigators of the consortium support a collaborative approach to the study of complex, poorly understood infectious diseases. By working together to prevent and treat Bartonella infections, they will provide patient-relevant solutions that improve both animal and human health. Targeted antimicrobial strategies to eliminate long-standing Bartonella infections will dramatically improve patient outcomes.

Similarities between Bartonella and Lyme infections

Bartonella symptoms overlap with those of other vector borne organisms such as Borrelia burgdorferi, the bacteria that causes Lyme disease. In some instances, patients have been infected with both Bartonella and Borrelia burgdorferi infections, which can cause an exacerbation of symptoms. 

As often seen in Lyme disease patients, a subset of people with bartonelloses develop chronic symptoms despite prior antibiotic therapy. Treatment failures have been documented with both infections, thus the need for drugs that specifically target and eliminate these bacteria.

Associate Professor Monica Embers, a microbiologist and immunologist at the Tulane National Primate Research Center, focuses on the persistence of tick-borne infectious disease despite antibiotic therapy and will bring her expertise to the consortium.

“There are a lot of similarities between Bartonella and Borrelia infections, both of which are notoriously difficult to detect and treat. Developing targeted treatments has the potential to alleviate a lot of suffering, both in the human and pet populations,” said Embers.

There are over 40 known Bartonella species or subspecies and at least 17 have been associated with a spectrum of disease symptoms. Although Bartonella remain neglected in human and veterinary medicine, more recent evidence supports an important role for these bacteria in a variety of diseases.

Funding for this research initiative combines the strengths of research laboratories located at Duke University, North Carolina State University and Tulane University.

Principal investigators include Drs. Edward B. Breitschwerdt, Monica E. Embers, Timothy A Haystead and Ricardo G. Maggi. During the next three and a half years, these established investigators and their highly skilled research teams will develop a novel drug for the treatment of bartonelloses.

SOURCE OF PRESS RELEASE: Tulane University

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For more:

Category:

Activism, Bartonella, Psychological Aspects, research, Treatment

Pediatric Bipolar Disorders & Tick-borne Illnesses

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

Pediatric bipolar disorders and tick-borne illnesses

July 23, 2021

By Rosalie Greenberg, MD

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

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

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

Making a diagnosis

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

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

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

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

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

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

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

PANDAS/PANS

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

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

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

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

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

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

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

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

High strep titers

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

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

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

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

Bartonella

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

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

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

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

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

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

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

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

Tick-borne illnesses

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

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

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

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

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

24 out of 27 bipolar children had TBIs

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

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

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

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

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

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

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

“Bipolar-like” symptoms

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

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

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

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

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

Observations

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

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

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

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

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

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

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Babesia, Bartonella, Lyme, Psychological Aspects, research, Treatment