Archive for the ‘research’ Category

Lyme Disease Misdiagnosed as Shingles

https://danielcameronmd.com/lyme-disease-misdiagnosed-as-shingles-in-a-62-year-old-man/

LYME DISEASE MISDIAGNOSED AS SHINGLES IN A 62-YEAR-OLD MAN

man with lyme disease and shingles at doctor's office

A recent article, published in the journal Clinical Case Reports, describes the case of a 62-year-old man, from Norway, who was initially diagnosed with shingles, a viral infection which produces a painful skin rash with blisters in a localized area on the body. [1] Shingles, also known as herpes zoster, is common in older individuals who have had chickenpox.

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According to Hansen and colleagues, the patient was admitted to the emergency department complaining of epigastric pain that had been ongoing for 4 to 5 weeks. “He described a constant pain with episodic worsening,” writes Hansen. The pain began with a rash in the man’s right upper quadrant area.

Physicians considered several diagnoses. The man had a history of migraines, anxiety, colon polyps, and had been treated for gastroesophageal reflux disease (GERD). Small gallbladder stones were present but were not acute.

The man was diagnosed with shingles and prescribed acyclovir and pregabalin. Despite treatment, he remained ill. His pain increased and “he developed additional symptoms including nausea, lethargy, decreased appetite, constipation, decreased size and force of the urinary stream, and a 5–7 kg weight loss,” writes Hansen.

Imaging and lab tests were negative and the man was discharged. However, one week later, he was re-admitted to the hospital because “his general practitioner did not find it reasonable that his anxiety could explain his current symptoms,” says Hansen.

The man lived in an area endemic for Lyme disease. Although he did not recall a recent tick bite, he had been bitten previously, so serologic tests for Lyme disease were performed. Because his titers of B. burgdorferi IgG were so high and he had a history of tick bites and a rash, a lumbar puncture was ordered. Results were positive.

The 62-year-old man was diagnosed with Lyme disease. His symptoms, except for fatigue, resolved after a 3-week course of IV ceftriaxone. “His weight is now normalized and he has no problems with constipation,” explains Hansen. “The abdominal pain is almost gone. His main problem is fatigue but this is gradually improving.”

The authors point out that atypical clinical presentations of Lyme disease can occur, including gastrointestinal manifestations because of autonomous dysfunction, as was seen in this case.

Related Articles:

What happens to the brain during acute Lyme neuroborreliosis?

At least 50% of patients with Lyme neuroborreliosis remain ill years after treatment

When it looks like a brain tumor but it is Lyme disease

References:
  1. Hansen BA, Finjord T, Bruserud O. Autonomous dysfunction in Lyme neuroborreliosis. A case report. Clin Case Rep. 2018;6(5):901-903.

Category:

Lyme, research

Bartonella Found in Ticks, Biting Midges, and Moose

https://pubmed.ncbi.nlm.nih.gov/32757355/

. 2020 Aug 5.

doi: 10.1111/tbed.13762. Online ahead of print.

Bartonella spp. detection in ticks, Culicoides biting midges and wild cervids from Norway

Carlos Sacristán 1, Carlos G das Neves 1, Faisal Suhel 1, Irene Sacristán 2, Torstein Tengs 3, Inger S Hamnes 1, Knut Madslien 1
Affiliations expand

Abstract

Bartonella spp. are fastidious, gram-negative, aerobic, facultative intracellular bacteria that infect humans, and domestic and wild animals. In Norway, Bartonella spp. have been detected in cervids, mainly within the distribution area of the arthropod vector deer ked (Lipoptena cervi). We used PCR to survey the prevalence of Bartonella spp. in blood samples from 141 cervids living outside the deer ked distribution area (moose [Alces alces, n = 65], red deer [Cervus elaphus, n = 41] and reindeer [Rangifer tarandus, n = 35]), in 44 pool samples of sheep tick (Ixodes ricinus, 27 pools collected from 74 red deer and 17 from 45 moose) and in biting midges of the genus Culicoides (Diptera: Ceratopogonidae, 120 pools of 6,710 specimens). Bartonella DNA was amplified in moose (75.4%, 49/65) and in red deer (4.9%, 2/41) blood samples. All reindeer were negative. There were significant differences in Bartonella prevalence among the cervid species.

Additionally, Bartonella was amplified in two of 17 tick pools collected from moose and in 3 of 120 biting midge pool samples. The Bartonella sequences amplified in moose, red deer and ticks were highly similar to B. bovis, previously identified in cervids. The sequence obtained from biting midges was only 81.7% similar to the closest Bartonella spp.

We demonstrate that Bartonella is present in moose across Norway and present the first data on northern Norway specimens. The high prevalence of Bartonella infection suggests that moose could be the reservoir for this bacterium.

This is the first report of bacteria from the Bartonella genus in ticks from Fennoscandia and in Culicoides biting midges worldwide.

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**Comment**

Many Lyme patients also have Bartonella.  It is an under-appreciated pathogen:  https://madisonarealymesupportgroup.com/2019/04/24/human-bartonellosis-an-underappreciated-public-health-problem/

It can cause schizophrenia-like symptoms:  https://madisonarealymesupportgroup.com/2019/03/21/bartonella-sudden-onset-adolescent-schizophrenia-a-case-study/

Again, our ‘authorities’ have pigeon-holed Lyme into a singular illness when for many there are numerous pathogens at play, not to mention other important issues like MCAS and mold that need to be dealt with. Also, most doctors are taught that Bartonella is not a big deal and the immune system will just deal with it.  I’ve lost count of how many articles have crossed my desk showing just the opposite to be true.  Bartonella can kill.

Category:

Bartonella, research, Uncategorized

Can Lyme Disease Cause Dementia?

https://danielcameronmd.com/can-lyme-disease-cause-dementia/

CAN LYME DISEASE CAUSE DEMENTIA?

can lyme disease cause dementia

There have been reports of Borrelia burgdorferi (Bb), the bacterial agent of Lyme disease, triggering primary dementia, such as Alzheimer’s disease. Researchers who examined the records of 1,594 patients with dementia found that 1.25% had a positive intrathecal anti-Borrelia antibody index (AI), specific for neuroborreliosis. They concluded,

“Pure Lyme dementia exists and has a good outcome after antibiotics.” 1

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In a retrospective study, entitled “Secondary dementia due to Lyme neuroborreliosis,” Kristoferitsch and colleagues describe several case reports of patients diagnosed with dementia-like syndromes due to Lyme neuroborreliosis or Lyme disease.2

Rapid improvement with antibiotic treatment

The authors’ case report featuring a 76-year-old woman demonstrates how Lyme disease can cause dementia-like symptoms. The patient developed progressive cognitive decline, loss of weight, nausea, gait disturbance and tremor over a 12-month period. She was referred to a neurology clinic for evaluation.

Three months earlier, the woman had been diagnosed with tension headaches and a depressive disorder. Medications, however, did not improve her symptoms.

Further testing revealed bilateral white matter lesions and an old lacunar lesion located at the left striatum. Extensive neurocognitive testing found “a severe decline of attention, memory and executive functions corresponding to subcortical dementia,” the authors write.

“LNB [Lyme neuroborreliosis] was diagnosed when further CSF [cerebral spinal fluid] examinations disclosed a highly elevated Bb-specific-AI indicating local intrathecal Bb-specific antibody synthesis,” Kristoferitsch writes.

After a 3-week course of treatment with ceftriaxone, the woman “recovered rapidly,” the authors write.

“In a telephone call in February 2018 at the age of 82 years, the patient reported no gait problems or cognitive impairment and had just returned from a trip to Cuba,” the authors write.

Woman admitted to psychiatric ward with severe dementia

A 71-year-old woman with rapidly progressing dementia and short periods of altered consciousness was admitted to a psychiatric hospital. Six months earlier, she was having mild forgetfulness.

MRI results, which indicated slight mesiotemporal atrophy, along with neurocognitive testing supported an initial diagnosis of primary dementia.

“Later, the patient’s daughter reported a tick bite followed by a widespread rash,” the authors write. “Thus, LNB [Lyme neuroborreliosis] was suspected and confirmed by CSF investigations.”

After 2 weeks of antibiotic treatment with ceftriaxone, the woman’s symptoms subsided and her cognition improved.

READ MORE: 80-year-old man with Lyme encephalopathy instead of dementia

At her 5-year follow-up visit, the woman’s “cognition was stable” and memory tests indicated a score above the mean for females her age, “which strongly argued against any dementing process,” the authors write.

In reviewing the literature, Kristoferitsch et al. identified several signs and symptoms that may indicate that Lyme neuroborreliosis (or Lyme disease) is causing dementia in a patient.

Distinguishing features of Lyme-induced dementia

  • Most of the patients or family members did not recall previous tick bites, an EM rash or symptoms of Lyme disease. Therefore, when “EM or other characteristic symptoms of early LB 1–2 years before the onset of dementia may if untreated serve as an indicator for chronic LNB.”
  • Unlike most neurodegenerative dementias, dementia caused by Lyme disease appears to progress rapidly, the authors write.
  • “Weight loss is another symptom observed in LNB [Lyme neuroborreliosis],” the authors explain. “It is also compatible with the diagnosis of AD [Alzheimer’s disease] but when it occurs in chronic LNB, it can be more pronounced, reaching up to 20 kg/year.” Weight loss in patients with Alzheimer’s disease is less prominent, the authors explain.
  • Headache, nausea, malaise and vomiting are typically not symptoms of degenerative dementias, the authors explain. But, “might be associated with secondary dementia and thus also with chronic LNB [Lyme neuroborreliosis].”
  • Gait disturbances at the onset or early in the disease which was observed in all cases of this study, makes the diagnosis of a probable AD [Alzheimer’s disease] uncertain or unlikely.”

Additionally, “In most patients, improvement of symptoms was reported already within a few days of antibiotic treatment,” Kristoferitsch writes.

Early recognition and treatment is important

The authors stress the importance of recognizing Lyme-induced dementia-like syndromes.

“It is essential to be aware of this manifestation of Lyme neuroborreliosis, because early antibiotic treatment will prevent permanent sequelae that may occur throughout the further course of the untreated disease,” the authors conclude.

Related Articles:

Reversible causes of dementia and normal pressure hydrocephalus

POTS patients with brain fog have neurocognitive deficits

Tick-borne encephalitis can lead to chronic illness

References:
  1. Blanc F, Philippi N, Cretin B, et al. Lyme neuroborreliosis and dementia. J Alzheimers Dis. 2014;41(4):1087-1093. doi:10.3233/JAD-130446
  2. Kristoferitsch W, Aboulenein-Djamshidian F, Jecel J, et al. Secondary dementia due to Lyme neuroborreliosis. Wien Klin Wochenschr. 2018;130(15-16):468-478. doi:10.1007/s00508-018-1361-9

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**Comment**

The proof is in the pudding. These patients were given treatment and they immediately improved. This is noted again and again with chronic Lyme patients – yet according to mainstream medicine led by the CDC and IDSA, this is a figment of our imaginations – otherwise known as PTLDS, an acronym they give complicated cases so they don’t have to deal with persistent infection, and therefore lengthy treatment.

It also allows them to continue to attempt to peddle their lucrative vaccine they continue to pull out of the hat every couple of years.

For more:  https://madisonarealymesupportgroup.com/2020/05/16/lyme-disease-awareness-month-kris-kristofferson-was-misdiagnosed-with-alzheimers-memory-loss-was-due-to-ticks/

For more:  

 

 

Category:

Alzheimer's, Lyme, research, Treatment

Successful Treatment for Lyme Arthritis After Knee Surgery

https://danielcameronmd.com/treatment-for-lyme-arthritis/

SUCCESSFUL TREATMENT FOR LYME ARTHRITIS AFTER KNEE SURGERY

bandaged knee for treatment for lyme arthritis

This published case report by Wright and colleagues features what the authors believe is the “first patient with late Borrelia burgdorferi sensu stricto arthritis-related prosthetic joint infection. They suggest “the case highlights how early, prompt diagnosis and adequate antimicrobial therapy may obviate the need for additional aggressive orthopedic surgical intervention.”

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Doctors described a 67-year-old avid outdoorsman who received treatment for Lyme arthritis after having had knee surgery. Ten months earlier, the man had received a partial knee replacement for his left knee due to advanced single compartment degenerative arthritis.

Over a 3-month-period, the man developed progressive left knee pain and swelling.  He later presented with a moderate joint effusion but did not have an erythema migrans rash, warmth, instability, or significant pain with range of motion.

There was no history of a tick bite or trauma to the knee nor was there evidence of joint effusion, infection, or Baker’s cyst.

Aspiration of his knee revealed turbid purulent pleocytosis with 91.8% neutrophils, elevated C-reactive protein, and a positive Borrelia burgdorferi polymerase chain reaction (PCR).

Serologic tests were positive for an elevated erythrocyte sedimentation rate (ESR), C-reactive 0.7, and a positive B. burgdorferi antibody enzyme immunoassay (EIA) test and 10 of 10 immunoglobulin G (IgG) Western blot bands were reactive.

Lyme arthritis diagnosis

Based on the detection of B. burgdorferi sensu stricto DNA by PCR, clinicians diagnosed the man Lyme arthritis, a particular type of periprosthetic joint infection (PJI).

The diagnosis was based on criteria established by the Musculoskeletal Infection Society and the Infectious Disease Society of America (IDSA).

“Although there was no communicating sinus tract or direct result from traditional microbiological culture, our patient met these criterion for PJI based upon elevated synovial fluid leukocyte count (>3000 cell/µL), elevated synovial neutrophil count (>65%), purulence, and evidence of a microorganism with identification to the level of genus and species,” according to Wright and colleagues from the Division of Infectious Disease, Department of Medicine, Memorial Medical Center in York, Pennsylvania.

The authors summarized their concern over the seriousness of a PJI. “Periprosthetic joint infection is a devastating complication following joint arthroplasty that causes significant morbidity with an estimated cumulative incidence of 1% – 2% for both hips and knees,” the authors write.

IDSA treatment guidelines not applicable

Wright and colleagues concluded that the IDSA recommendations were not applicable to this patient. They cited two guidelines that would have limited the types of treatment to oral antibiotics and duration to no more than four weeks. These included:
  1. “Late Lyme arthritis can usually be treated successfully with antimicrobial agents administered orally (e.g., doxycycline, amoxicillin, or cefuroxime) for 28 days in adult patients without evidence of neurologic disease.”
  2. “Previous studies have also been published demonstrating the efficacy of once-daily ceftriaxone (2 gram dose) for 14 or 28 days in the treatment of late Lyme disease.”

Successful treatment with antibiotics

The 67-year-old man received treatment for Lyme arthritis which included antibiotics rather than undergoing surgical incision and drainage or excision arthroplasty. Twice daily, 100 mg of oral doxycycline was initiated empirically for a week until testing confirmed the diagnosis. The treatment was converted to a six-week course of daily intravenous 2 grams of ceftriaxone.

The antibiotic treatment for Lyme arthritis was successful.

“Clinically, the patient had cessation of his knee pain, resolution of joint effusion, normalization of synovial infection and inflammatory parameters, and negative end-of-therapy detection of B. burgdorferi DNA by PCR,” according to Wright.

However, the authors cautioned that their strategy of prolonged intravenous antibiotics might not be effective in other types of joint arthroplasties.

“Although this patient’s clinical outcome was achieved without the need for surgical incision and drainage or staged excision arthroplasty procedure, it is unclear whether this same strategy would produce similar results in patients with other types of joint arthroplasties,”

Are there any other cases of arthroplasties that might be prevented by antibiotic therapy? More than 82,660 patients underwent total knee arthroplasty (TKA) across the Medicare and United Health Care populations from 2009 to 2011 at a cost exceeding $10 billion per year. [2]

Authors’ Conclusion

“This case highlights how early prompt diagnosis and adequate antimicrobial therapy may obviate the need for additional aggressive orthopedic surgical intervention,” stressed Wright.

“This case also highlights the value of an aggressive need to further investigate and interpret unexpected findings in clinical practice.”

Related Articles:

5 cases of Lyme arthritis following an operation

Will steroid injections help children with Lyme arthritis of the knee?

Preventing unnecessary surgery for children with Lyme arthritis

References:
  1. Wright WF, Oliverio JA. First Case of Lyme Arthritis Involving a Prosthetic Knee Joint. Open Forum Infect Dis, 3(2), ofw096 (2016).
  2. Cohen JR, Bradley AT, Lieberman JR. Preoperative Interventions and Charges Before Total Knee Arthroplasty. J Arthroplasty, (2016).
  3. Fallon BA, Keilp JG, Corbera KM et al. A randomized, placebo-controlled trial of repeated IV antibiotic therapy for Lyme encephalopathy. Neurology, 70(13), 992-1003 (2008).
  4. Cameron DJ. Consequences of treatment delay in Lyme disease. J Eval Clin Pract, 13(3), 470-472 (2007)

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**Comment**

I wish there were more doctors questioning and overriding the extremely limited CDC Lyme “Guidelines” as they are inadequate for nearly everyone – unless it’s an acute case.

Speaking of IV ceftriaxone, IDSA founder Dr. Waisbren successfully used high doses (6-8gms) in his patients, despite the smear campaign against it:  https://madisonarealymesupportgroup.com/2017/07/09/idsa-founder-used-potent-iv-antibiotics-for-chronic-lyme/

https://madisonarealymesupportgroup.com/2017/06/23/no-bias-in-mmwr-for-any-other-infectious-disease-requiring-iv-antibiotics-except-for-lyme/

For more:  https://madisonarealymesupportgroup.com/2019/04/11/latent-lyme-disease-resulting-in-chronic-arthritis-early-career-termination-in-a-u-s-army-officer/

https://madisonarealymesupportgroup.com/2020/02/08/a-joint-effort-the-interplay-between-the-innate-and-the-adaptive-immune-system-in-lyme-arthritis/

 

Category:

Lyme, research, Testing, Treatment

New Case Report: Neuropsychiatric Symptoms and Bartonella-Associated Skin Lesions

https://www.galaxydx.com/bartonella-skin-lesions-and-neuro-symptoms-new-cases/

written on

New Case Report: Neuropsychiatric Symptoms and Bartonella-Associated Skin Lesions

A new case report co-authored by Galaxy Diagnostics scientists highlights the importance of bartonellosis being considered as a differential diagnosis when patients present with neuropsychiatric symptoms and skin lesions.

History

Bartonellosis is an emerging multi-system vector-borne disease caused by one or more bacteria belonging to the Bartonellagenus. Common Bartonella species infections such as cat scratch disease (CSD) or trench fever are often described as acute and, in the case of CSD, self-limiting in the medical literature. However, chronic symptoms and severe disease related to the heart, joints, and central nervous system (CNS) are increasingly described by researchers.

A 2019 publication by Dr. Breitschwerdt, chief scientific officer and co-founder of Galaxy Diagnostics, his team at NC State University, and a group of collaborating physicians described a boy diagnosed with PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) who was found to have Bartonella henselae in his bloodstream. The boy’s severe neuropsychiatric symptoms and skin lesions resolved in association with antibiotic treatment directed at B. henselae.

Bartonella species primarily occupy two niches in their host: the skin and the vascular endothelium (lining of the blood vessels). Vectors such as fleas, ticks, lice, and biting flies give Bartonella a vehicle to enter the skin and then the local blood and lymphatic vessels. The bacteria then travel through the bloodstream, in association with a relapsing bacteremia, to other areas of the body, potentially causing a wide variety of symptoms that can span months, years and possibly decades.

Newly Published Research

A new set of cases described by Dr. Breitschwerdt and a multi-institution collaborative team provide further evidence for neuropsychiatric and dermatological manifestations of bartonellosis in pediatric (< 18 years old) patients.

Dr. Breitschwerdt explained,

“Based upon the limited case reports and this case series, it is imperative to design studies that will determine if, or to what extent, Bartonella species might contribute to concurrent cutaneous [skin] lesions in patients with neuropsychiatric symptoms.”

At the same time as the team at NCSU has been advancing this symptom research, a team from Fujita Health University School of Medicine in Japan has been advancing the signaling work. They found a protein secreted by Bartonella species that activates the vascular endothelial growth factor (VEGF) pathway.

Where Do We Go From Here?

The pathophysiology of Bartonella species infections in people is complex. While the past 30 years of research has helped elucidate how persistent infections may occur, understanding why the host response differs and “atypical” symptoms develop in certain patient populations requires further research. Furthermore, research on these “atypical” manifestations may lead to the development of more accurate tools for Bartonella testing.

More research is needed to document both if Bartonella species might contribute to skin lesions in patients with neuropsychiatric symptoms and the mechanisms by which this might occur. We speculate that long-standing microvascular injury induced by these bacteria may result in chronic inflammation, local mast cell activation and collagen injury.

We encourage dermatologists and veterinarians to consider vector and animal exposures in patients with unusual or unexplained cutaneous lesions and consider testing these patients for Bartonella species infection.

We have found that advances in the understanding of skin lesions so far has been serendipitous, such as when a veterinarian’s own animal develops skin lesions and there are enhanced opportunities to collect samples. The more scientific inquiry is systemized across human and animal health (One Health), the faster our understanding of any potential association between Bartonella species infections and skin lesions will grow.

References

Breitschwerdt, E. B. et al. (2019). Bartonella henselae bloodstream infection in a boy with pediatric acute-onset neuropsychiatric syndrome. Journal of Central Nervous System Disease, 11. doi:10.1177/1179573519832014 https://journals.sagepub.com/doi/10.1177/1179573519832014

Maluki, A. et al. (2020). Imaging analysis of Bartonella species in the skin using single‐photon and multi‐photon (second harmonic generation) laser scanning microscopy. Clinical Case Reports, 2020, 1-7. doi:10.1002/ccr3.2939 https://onlinelibrary.wiley.com/doi/full/10.1002/ccr3.2939

Tsukamoto, K. et al. (2020). The Bartonella autotransporter BafA activates the host VEGF pathway to drive angiogenesis. Nature Communications, 11, 3571. doi:10.1038/s41467-020-17391-2 https://www.nature.com/articles/s41467-020-17391-2

Category:

Bartonella, research