Archive for the ‘research’ Category

Lyme Carditis Presenting As Sick Sinus Syndrome

https://www.ncbi.nlm.nih.gov/pubmed/32007907/

2020 Jan 25;59:65-67. doi: 10.1016/j.jelectrocard.2020.01.007. [Epub ahead of print]

Lyme carditis presenting as sick sinus syndrome.

Gazendam N1, Yeung C1, Baranchuk A2.

Abstract

Lyme disease, a tickborne infection caused by Borrelia burgdorferi, can affect cardiac tissue causing Lyme carditis. Patients with Lyme carditis most commonly present with varying degrees of atrioventricular block and rarely with sick sinus syndrome. A previously healthy 22 year-old male presented with syncope (fainting). His 2 week Holter monitor showed sinus pauses of 6.5 and 6.8 s. Lyme serology, including Western blot, was positive. A stress test, completed after 8 days of intravenous antibiotics for Lyme carditis, revealed no conduction abnormalities. He was discharged on 3 weeks of oral antibiotics and had no conduction abnormalities on subsequent follow-up.

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**Comment**

I hope someone is doing a lengthy follow-up on this young man.  Three weeks of antibiotics in someone with Lyme carditis isn’t enough.  This is a great example of patients not being followed throughout time which would pick up reoccurring/relapsing symptoms.

Sick sinus syndrome doesn’t have anything to do with the sinuses, but rather consists of a group of heart rhythm problems (arrhythmias) in which the heart’s natural pacemaker (sinus node) doesn’t work properly.

The sinus node is an area of specialized cells in the upper right chamber of the heart that controls the rhythm of your heart. Normally, the sinus node produces a steady pace of regular electrical impulses. In sick sinus syndrome, these signals are abnormally paced.

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The heart rhythms of a person with sick sinus syndrome can be too fast, too slow, punctuated by long pauses — or an alternating combination of these rhythm problems. The syndrome is relatively uncommon, but the risk of developing it increases with age.

Many people with sick sinus syndrome eventually need a pacemaker to keep the heart in a regular rhythm.

Symptoms

Most people with sick sinus syndrome initially have few or no symptoms. In some cases, symptoms come and go.

When they occur, sick sinus syndrome signs and symptoms might include:

  • Slower than normal pulse (bradycardia)
  • Fatigue
  • Dizziness or lightheadedness
  • Fainting or near fainting
  • Shortness of breath
  • Chest pains
  • Confusion
  • A sensation of rapid, fluttering heartbeats (palpitations)

https://www.mayoclinic.org/diseases-conditions/sick-sinus-syndrome/symptoms-causes/syc-20377554

Dr. Neil Spector writes about his heart troubles due to Lyme.  He required a heart transplant and pace-maker:  https://madisonarealymesupportgroup.com/2017/08/23/video-dr-neil-spector/

For more:  https://madisonarealymesupportgroup.com/2019/03/10/when-lyme-hurts-your-heart-warning-signs-solutions/

https://madisonarealymesupportgroup.com/2018/09/17/lyme-carditis-heart-block-other-complications-of-ld/

https://madisonarealymesupportgroup.com/2018/06/03/heart-problems-tick-borne-disease/

https://madisonarealymesupportgroup.com/2019/02/21/diagnosis-treatment-of-lyme-carditis/

https://madisonarealymesupportgroup.com/2018/02/22/new-lyme-cme-course-available-lyme-carditis-more-than-blocked-beats/  Course for doctors to become educated.

Category:

Lyme, research

Borrelia Prevalence & Species Distribution in Ticks Removed From Humans in Germany

https://www.ncbi.nlm.nih.gov/pubmed/31987819

2020 Mar;11(2):101363. doi: 10.1016/j.ttbdis.2019.101363. Epub 2019 Dec 23.

Borrelia prevalence and species distribution in ticks removed from humans in Germany, 2013-2017.

Springer A1, Raulf MK2, Fingerle V3, Strube C4.

Abstract

Lyme borreliosis caused by spirochaetes of the Borrelia burgdorferi sensu lato (s.l.) complex is the most common tick-borne disease in Europe. In addition, the relapsing-fever spirochaete Borrelia miyamotoi, which has been associated with febrile illness and meningoencephalitis in immunocompromised persons, is present in Europe. This study investigated Borrelia prevalence and species distribution in ticks removed from humans and sent as diagnostic material to the Institute for Parasitology, University of Veterinary Medicine Hannover, in 2013-2017. A probe-based real-time PCR was carried out and Borrelia-positive samples were subjected to species determination by reverse line blot (RLB), including a B. miyamotoi-specific probe.

  • The overall Borrelia-infection rate as determined by real-time PCR was 20.02% (510/2547, 95 % CI: 18.48-21.63 %), with annual prevalences ranging from 17.17 % (90/524, 95 % CI: 14.04-20.68 %) in 2014 to 24.12 % (96/398, 95 % CI: 19.99-28.63 %) in 2015.
  • In total, 271/475 (57.1 %) positive samples available for RLB were successfully differentiated
  • Borrelia afzelii was detected in 30.53 % of cases (145/475, 95 % CI: 26.41-34.89)
  • B. garinii/B. bavariensis (13.26 % [63/475], 95 % CI: 10.34-16.65)
  • Borrelia valaisiana  (5.89 % (28/475, 95 % CI: 3.95-8.41)
  • B. spielmanii (4.63 % (22/475, 95 % CI: 2.93-6.93),
  • B. burgdorferi sensu stricto (s.s.)/B. carolinensis (2.32 % (11/475, 95 % CI: 1.16-4.11)
  • B. lusitaniae (0.63 % (3/475, 95 % CI: 0.13-1.83)
  • B. bisettiae (0.42 % (2/475, 95 % CI: 0.05-1.51) of positive ticks
  • Borrelia kurtenbachii was not detected
  • B. miyamotoi (7.37 % (35/475, 95 % CI: 5.19-10.10) of real-time PCR-positive samples

Sanger sequencing of B. garinii/B. bavariensis-positive ticks revealed that the majority were B. garinii-infections (50/52 successfully amplified samples), while only 2 ticks were infected with B. bavariensis. Furthermore, 6/12 B. burgdorferi s.s./B. carolinensis-positive samples could be differentiated; all of them were identified as B. burgdorferi sensu stricto.

Thirty-nine ticks (8.21 %, 95 % CI: 5.90-11.05) were coinfected with two different species. Comparison of the species distribution between ticks removed from humans in 2015 and questing ticks collected in the same year and the same area revealed a significantly higher B. afzelii-prevalence in diagnostic tick samples than in questing ticks, confirming previous observations.

The obtained data indicate that Borrelia prevalence fluctuated in the same range as observed in a previous study, analysing the period from 2006 to 2012.

Detection of B. miyamotoi in 7.37 % of Borrelia-positive samples points to the fact that clinicians should be aware of this pathogen as a differential diagnosis in cases of febrile illness.

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**Comment*

Great example of how there are many more species of borrelia we need to be concerned about than Borrelia burgdorferi.  Remember, current 2-tiered testing only picks up only one borrelia species and is only picking up half of those limited cases showing the abysmal testing fix we are in.

For more on this: https://madisonarealymesupportgroup.com/2020/02/02/why-the-medical-communitys-perspective-on-lyme-disease-is-different-from-a-pathologists-perspective/

 

Category:

Lyme, research, Testing, Ticks

Conversion Disorder, Guillain-Barre Syndrome or Lyme Disease?

https://danielcameronmd.com/conversion-disorder-guillain-barre-syndrome-or-lyme-disease/

CONVERSION DISORDER, GUILLAIN-BARRÉ SYNDROME OR LYME DISEASE?

The authors of “Atypical Lyme Neuroborreliosis, Guillain-Barré Syndrome or Conversion Disorder: Differential Diagnosis of Unusual Neurological Presentations,” present a challenging diagnostic case involving a 62-year-old woman with symptoms consistent for multiple neurologic disorders.

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Teodoro and colleagues describe the case of a woman, who was initially suspected of having a conversion disorder but later diagnosed with Guillain-Barré syndrome, possibly triggered by an infection with Borrelia burgdorferi, the causative agent of  Lyme disease. ¹

(Conversion disorder is a mental condition in which a person has blindness, paralysis, or other nervous system (neurologic) symptoms that cannot be explained by medical evaluation.)

The woman reported to the emergency room with weakness in her left hand and both of her legs, which resulted in 2 consecutive falls with head trauma. Test results were normal, and she was discharged. But the following day her symptoms worsened, and she returned to the hospital with significant motor impairment (an inability to walk independently) and urinary incontinence.

“On admission, her neurological examination revealed asymmetric tetraparesis, hyporeflexia, doubtful hemihypesthesia, and left extensor plantar reflex,” writes Teodoro and colleagues in the journal Case Reports in Neurology.

(Tetraparesis means weakness in all extremities. Hemihypesthesia is a reduction in sensitivity on one side of the body.)

Conversion Disorder

The woman was initially treated for a conversion disorder since her findings suggested this diagnosis including “the absence of a typical pattern the reference to a positive Hoover sign in one of the early evaluations, inconsistent and fluctuating motor deficits, coinciding timeline with stressful life events, and a predominantly anxious basal affective state,” writes Teodoro.

The patient reported having a recent stressful event and symptoms of anxiety.  In turn, she was prescribed the antidepressant Sertraline (100mg) and Pregabalin (150mg), a nerve pain drug, also known as Lyrica.

But by day 5, the woman’s symptoms had worsened. Her upper and lower limbs were areflexic. And, needle electromyography revealed “a subacute motor axonal neuropathy pattern and a right median nerve mononeuropathy.”

Guillain-Barré syndrome

Guillain-Barré syndrome, an autoimmune disorder, was considered based on EMG findings and a spinal tap which revealed albuminocytologic dissociation, a hallmark finding of Guillain-Barré syndrome.

A 5-day course of 32 g/day of intravenous immunoglobulin (0.4 g/kg/day) was initiated and led to a partial improvement in motor function.

Lyme disease

She was subsequently diagnosed with Lyme disease based on a positive IgM titer and a repeat spinal tap, which showed an elevated mononuclear white blood cell count of 20/μL and positive IgM.

“None of the most common infectious agents associated with Guillain-Barré syndrome were identified.  Surprisingly serologies for Borrelia were revealed to be positive, with further finding of IgM Borrelia antibodies in CSF,” writes Teodoro.

“The possibility of a Guillain-Barré syndrome due to Borrelia infection should be considered,” the authors point out, “although this syndrome usually develops as a post-infectious syndrome.”

The woman was given a 14-day course of Ceftriaxone (2 g/day) and showed significant improvement in motor function. However, she was discharged requiring additional physical therapy and rehabilitation.

This is not the first case of a medical condition being diagnosed as a conversion disorder.  “There are case reports of Guillain-Barré syndrome misdiagnosed as a conversion disorder² highlighting the importance of considering the clinical heterogeneity of the possible presentations,” writes Teodoro.

Furthermore, although it is rare, there have been reports of Lyme disease mimicking Guillain-Barré syndrome.³

“This case highlights the importance of the differential diagnosis of atypical presentations of neurological disease, including the possibility of functional neurological symptoms,” the authors conclude.

Related Articles:

Lyme disease manifests as autoimmune disorder, Sjogrens Syndrome

Can Lyme disease trigger an autoimmune disease

Lyme disease mimics autoimmune disorder in elderly woman

References:
  1. Teodoro T, Oliveira R, Afonso P. Atypical Lyme Neuroborreliosis, Guillain-Barré Syndrome or Conversion Disorder: Differential Diagnosis of Unusual Neurological Presentations. Case Rep Neurol. 2019 Apr 30;11(1):142-147.
  2. Edelsohn G. Guillain-Barré misdiagnosed as conversion disorder. Hosp Community Psychiatry. 1982 Sep;33(9):766–7.
  3. Tyagi N, Maheswaran T, Wimalaratna S. Neuroborreliosis: the Guillain-Barré mimicker. BMJ Case Rep. 2015 Jun 25;2015.pii:bcr2014209080.

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For more:  https://madisonarealymesupportgroup.com/2019/01/09/transverse-myelitis-guillain-barre-associated-with-bartonella/

https://madisonarealymesupportgroup.com/2018/12/07/acute-flaccid-paralysis-is-most-often-guillain-barre-syndrome/

https://madisonarealymesupportgroup.com/2019/01/18/acute-transverse-myelitis-a-clinical-manifestation-of-lyme-that-nobody-has-a-clue-about-prevalence/

https://madisonarealymesupportgroup.com/2018/12/07/nevada-man-diagnosed-with-guillain-barre-syndrome-after-getting-flu-shot/

VARIOUS VACCINES ARE DEFINITELY CAUSING GBS.

https://madisonarealymesupportgroup.com/2018/10/19/rise-in-acute-flaccid-myelitis-cases-and-the-link-to-vaccinations/

https://madisonarealymesupportgroup.com/2016/11/07/connection-of-acute-flaccid-myelitis-and-vaccinations/ The connection between vaccination and paralysis has been known since the 40’s and 50’s and was written about in The Lancet by Stephen Mawdsley in an article titled, “Polio Provocation: Solving a Mystery With the Help of History.”

Mawdsley states:

“The application of epidemiological surveillance and statistical methods enabled researchers to trace the steady rise in polio incidence along with the expansion of immunization programs for diphtheria, pertussis, and tetanus. A report that emerged from Guy’s and Evelina Hospitals, London, in 1950, found that 17 cases of polio paralysis developed in the limb injected with pertussis or tetanus inoculations. Results published by Australian doctor Bertram McCloskey also showed a strong association between injections and polio paralysis. Meanwhile, in the USA, public health researchers in New York and Pennsylvania reached similar conclusions.Clinical evidence, derived from across three continents, had established a theory that required attention.”

Category:

Lyme, research

Complex Multisystemic Illnesses Lead to Psychiatric Diagnosis

https://danielcameronmd.com/complex-multisystemic-illnesses-lead-to-psychiatric-diagnosis/

COMPLEX MULTISYSTEMIC ILLNESSES LEAD TO PSYCHIATRIC DIAGNOSIS

All too frequently patients with complex, multisystem illnesses are dismissed by clinicians, their symptoms often attributed to a psychiatric illness simply as “a diagnosis of default,” writes Bransfield in “Differentiating Psychosomatic, Somatopsychic, Multisystem Illnesses and Medical Uncertainty.”¹ This attitude can lead to tragic delays in identifying a correct diagnosis and appropriate treatment.

By

In their article, Bransfield et al. describe two patients with complex, multisystemic illnesses, which included Lyme disease. Both patients suffered from debilitating symptoms over several years, which left them unable to walk and confined to a wheelchair. Doctors dismissed their complaints, which ranged from fatigue and weight loss to seizures and cognitive impairments. They were labeled as having “hysteria” and “wanting attention.”

From martial arts athlete to wheelchair-bound

The first case involved a healthy, athletic 18-year-old female who was skilled at Taekwondo. The girl developed a Bull’s-eye rash, followed by Bell’s palsy. Over a 4-year period, she became increasingly disabled and eventually required a wheelchair. She also suffered from seizures.

The girl’s symptoms included: cognitive impairments (attention, memory, processing speed, concentration/executive functioning), tactile hypersensitivity, sun sensitivity, orthostatic hypotension, weight loss, fatigue, non-restorative sleep, pelvic pain, difficulty urinating, headaches, peripheral neuropathy, muscle atrophy, cervical radiculopathy, hair loss, costochondritis, subluxation of multiple joints, and generalized pain.

Clinicians initially diagnosed her with fibromyalgia, “wanting attention,” chronic fatigue syndrome, hypoglycemia, and pseudoseizures, according to Bransfield.

However, she was eventually diagnosed with late-stage Lyme borreliosis with multisystem symptoms, along with porphyria, Ehlers-Danlos/ALPIM syndrome (anxiety-laxity-pain-immune-mood) with seizures caused by increased intracranial pressure from cranio-cervical instability, writes Bransfield.

Upon further evaluation, clinicians diagnosed the girl with complex partial seizures, rather than ‘pseudoseizures.’

“The patient was subsequently treated,” writes Bransfield, “and is now physically active, married, and leading a productive life.”

From ‘hysteria’ diagnosis to encephalitis

A 12-year-old girl from England suffers from leg pain and is diagnosed with reactive arthritis. She is admitted to the hospital complaining of “excruciating headaches, a complete loss of balance, and involuntary jerking movements,” explains Bransfield. The girl was discharged but her symptoms worsened.

One clinician’s assessment described the girl’s condition as “Hysteria, possible conversion disorder.” The patient “was left deteriorating and untreated, by which time she was having constant seizures and needed a wheelchair,” writes Bransfield.

Unfortunately, doctors ignored repeated requests by the mother to consider Lyme disease, as the family lived in an endemic region and other family members had been infected.

The girl was moved to another clinic where she was diagnosed with “encephalitis and possible encephalomyelitis (inflammation of the brain/brainstem/spinal cord), probably due to Lyme disease,” writes Bransfield.

She immediately began IV antibiotics and within 36 hours, the girl’s seizures had stopped and her headaches began to subside. Tests for Lyme disease came back positive.

After 2 months of IV treatment, the patient was able to walk again. But once antibiotics were stopped, the symptoms returned. The girl continued treatment in the United States but reported having persistent symptoms due to a delay in treatment.

Making the diagnosis can be difficult.

“Some healthcare providers have great difficulty understanding and making an accurate diagnosis when these symptoms are present and categorize them as being ‘vague’ or ‘subjective’ symptoms and, therefore, less valid,” writes Bransfield.

Individuals can be mislabeled as hypochondriacs.

“The number and the complexity of these symptoms can be overwhelming to the patient, and the patient may be labeled as being hypochondriacal, a psychosomatic illness, or having bodily distress disorder or somatic symptom disorder,” writes Bransfield.

“Historically, there has been a tendency to label physical symptoms that could not be explained as being of a psychiatric origin,” writes Bransfield.

“As a result, many patients with complex, confusing symptoms and poorly understood diseases who receive an inadequate assessment for their condition are often referred to psychiatrists until the time when the disease is better understood and defined.”

Related Articles:

Seizures and altered mental status after a tick bite

Dismissing chronic Lyme disease for somatic symptom disorder diagnosis

Yale doctor says children don’t have Lyme but medically unexplained symptoms

References:
  1. Bransfield RC, Friedman KJ. Differentiating Psychosomatic, Somatopsychic, Multisystem Illnesses and Medical Uncertainty. Healthcare 2019, 7, 114.

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**Comment**

Thank God for practitioners like Dr. Bransfield who continually show the devastation tick-borne illness can cause.

Please note the quick response and alleviation of symptoms when appropriate treatment is given.  The problem is that many are still misdiagnosed and untreated – yet suffering just like those mentioned in this article.

For more:  https://madisonarealymesupportgroup.com/2018/04/15/ld-the-brain-podcast-with-dr-bransfield/

https://madisonarealymesupportgroup.com/2019/11/22/differentiating-psychosomatic-somatopsychic-multisystem-illnesses-and-medical-uncertainty/

https://madisonarealymesupportgroup.com/2019/11/29/its-all-in-your-head-medicines-silent-epidemic/

https://madisonarealymesupportgroup.com/2019/05/27/have-you-been-told-its-all-in-your-head-the-new-biology-of-mental-illness/

https://madisonarealymesupportgroup.com/2017/06/20/suicide-lyme-and-associated-diseases/

https://madisonarealymesupportgroup.com/2015/10/18/psychiatric-lymemsids/

Category:

Lyme, Psychological Aspects, research, Treatment

5 Things to Know About Chronic Inflammatory Demyelinating Polyneuropathy (The 6th Thing is Lyme Can Cause It)

https://www.medscape.com/viewarticle/918480?

5 Things to Know About Chronic Inflammatory Demyelinating Polyneuropathy

By Ariel Harsinay

September 20, 2019

Chronic inflammatory demyelinating polyneuropathy (CIDP) may be a rare disease, but it is one of the most common forms of neuropathy and the most common form of chronic autoimmune neuropathy. Roughly 30,000 Americans are currently diagnosed with CIDP. Unlike many other neuropathies, CIDP is treatable, but its similarities with other nerve disorders often make it extremely difficult to diagnose. Here are five things to know about CIDP.

1. CIDP is an autoimmune disorder that attacks the peripheral nervous system.

CIDP is an autoimmune, neurologic condition in which the myelin sheath surrounding the axons of neurons is attacked by the immune system, causing demyelination. Myelin normally serves as axonal insulation, allowing neurons to rapidly transmit action potentials and communicate with neighboring neurons. The demyelination seen in CIDP impairs this process, resulting in motor impairment, numbness, difficulty walking, and general weakness and fatigue.

The immune response causing CIDP involves the activation of T cells as well as the expression of cytokines, tumor necrosis factor, interferons, and interleukins. Immunoglobulin and complement are also implicated in CIDP pathogenesis.

2. CIDP presentation can vary considerably.

Fifty to sixty percent of CIDP cases are so-called “typical,” presenting with symmetric symptoms of both proximal and distal limbs in which motor impairment is more prominent than sensory symptoms. A diagnosis requires that a patient’s symptoms have progressed gradually for at least 8 weeks, although some patients present with either acute or relapsing-remitting forms of the disease. While CIDP symptoms can usually be managed throughout life, long-term disability is not uncommon.

Some 20%-30% of CIDP cases are idiopathic, although it is frequently seen in conjunction with a variety of other illnesses, including HIV, diabetes, lupus, hepatitis, lymphatic cancer, and restless legs syndrome. It also may present as a comorbidity of infection or as a side effect of various cancer and HIV drugs.

CIDP can affect anyone but is most commonly diagnosed in individuals in their 50s and 60s and is twice as common in men. The global yearly incidence of the disorder is 1.5-3.6 million, with around 30,000 people affected in the United States at any given time. In patients with type 2 diabetes the incidence rises to over 26%.

3. A variety of tests can confirm a CIDP diagnosis.

Nerve conduction studies and electromyography are diagnostic standards in CIDP they; can reveal the demyelination and resulting slowed neuromuscular transmission characteristic of disease. Nerve biopsy can also be helpful, providing pathologic evidence of nerve damage and inflammation.

Often physicians will also order a lumbar puncture in suspected CIDP cases, looking for elevated spinal fluid protein without elevated white cells. In atypical cases, in which electrophysiologic tests may be inconclusive, MRI can help confirm a diagnosis. Blood tests may also be used to detect common comorbidities such as diabetes and lupus.

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**Comment**

And, Dr. Cameron has written how one woman with CIDP actually had Lyme disease:  https://danielcameronmd.com/chronic-inflammatory-demyelinating-polyneuropathy-cidp-case-resolved-antibiotics/

Excerpt:

Lyme disease has been ruled out in other conditions based on negative serologic tests only to seroconvert to positive serologies on follow-up. [1,2] This was demonstrated in the case of a 41-year-old woman with chronic inflammatory demyelinating polyneuropathy (CIDP), according to Perronne from the Infectious Diseases Unit, University Hospital Raymond Poincaré, APHP, Versailles Saint Quentin University, Garches, France.

The woman, who was then treated successfully with 6 weeks of doxycycline and hydroxychloroquine, showed “a dramatic clinical improvement” with a complete disappearance of neurologic signs, according to Perronne.

The authors advised against automatically ruling out Lyme disease based on negative serologic tests.

The woman presented with asthenia (loss of strength), weakness, and diffuse paresthesias (abnormal skin sensations). All of which are hallmark Lyme symptoms.

For more on CIDP:  https://30g7el1b4b1n28kgpr414nuu-wpengine.netdna-ssl.com/wp-content/uploads/2012/01/CIDP.pdf

A word of warning, however.  The pdf mentions the success of corticosteroids, but Lyme literate doctors have discovered this to be counter productive unless antimicrobials are used concurrently as catabolic steroids depress the immune system allowing the infection(s) to proliferate.  

Regarding treatment for CIDP, the pdf states that “up to eighty percent of CIDP patients respond to one or more therapies that modulate the immune system. Treatments shown to work in clinical trials include prescribing corticosteroids, blood plasma exchange or plasmapheresis, and intravenous immunoglobulin or IVIG. All three treatments are highly effective and lead to improved strength and function in CIDP patients. Each treatment has its advantages and disadvantages that should be discussed with the physician.”

If you’ve been diagnosed with CIDP but suspect tick borne illness, please share this with your medical practitioner.  Also, point out the initial seronegativity on Lyme tests by patients with CIDP who were found to seroconvert later.  

Category:

Lyme, research, Treatment