Archive for the ‘Treatment’ Category

The Gut-Lyme Connection (And How to Fix Both Naturally)

https://www.uprootinglyme.com/gut-lyme-connection/

The Gut-Lyme Connection (and how to fix both naturally)

By

Creating gut health is one of the two foundational pillars of holistic Lyme treatment.  It goes hand in hand with detoxification, the other pillar of successful holistic treatment.  Without these two systems working at the highest level possible, recovering from Lyme (or other complex chronic) disease will be slow-going to say the least.

Yet together, when functioning optimally, these two systems create the conditions inside the body that empower it to fight off infections and heal.

Once these aspects of treatment are fully in place, you are far better equipped to handle antimicrobial regimens and successfully implement other aspects of treatment that will propel your healing forward.

The Gut is the Center of Health & Healing Power

In many ways, the gut is central to the health of the entire being.  In Lyme and other multi-infection disease syndromes, it is also a crucial battleground where the struggle between the Lyme and our immune system is fought.

Chronic Lyme is intimately related to the following 4 issues:

  1. Weakened immunity
  2. Diminished cellular function
  3. Systemic infection
  4. Toxicity

Gut health impacts all of these.  The degree to which a person’s gut is functioning optimally impacts all of these conditions either positively or negatively.

Gut-Associated Lymphoid Tissue

The gut houses the GALT, or Gut-Associated Lymphoid tissue which comprises approximately 80% of the immune system and 70% of lymphocytes, including those all-important Natural Killer cells, so it is home to our primary line of defense against infection.

This fact really speaks to how much the GI tract functions to keep harmful elements from entering into the body, and why it’s so devastating when these tissues are compromised.

What makes the difference between a quiet daily co-existence with bacteria, fungi, viruses and rogue cells – versus the explosion of full-blown disease – is your immune system, and by association, gut health.

Nutrient Transformation & Absorption

The gut is responsible for nutrient transformation and absorption so  that the entire body may receive nourishment and building blocks for physical strength, energy, cellular fuel, and tissue repair.

In the face of Lyme-Borreliosis and other infections, the body needs the support of high-level nutrition.  It needs to be able to effectively make use of what is being ingested so that the cells have the resources to function properly, clean house and repair.  This requires a healthy functioning gut!

The Gut is our 2nd (or 3rd) Brain

Following the heart and the brain, the gut is highly innervated by the nervous system.  It is compromised by a tense or inflamed nervous system, and strengthened by a peaceful, flowing nervous system.  The gut-brain axis is a 2-way street, therefore psychological or other nervous system stress has a major impact on GI function and motility.

Meanwhile, the microbiota and gut function heavily impacts mood and cognition because, to give just 1 of many examples, 95% of serotonin is produced in the gut.

The gut microbiome has systemic effects and is involved in regulation of the heart, liver, brain, prostate, kidney, lung, pancreas, and inflammation.  Changes in the gut microbiome have been implicated in diseases from obesity to infections to cancer.

Restoration of a healthy gut microbiome is another aspect of whole body health.

The Gut & Emotions

From the traditional Chinese perspective, the gut is the center of our personal universe.  It is governed by the Spleen (an organ readily damaged by Babesia and Bartonella), and directly relates to our ability to think, absorb nutrients, discern what we should let in versus what we should keep out (on all levels of our being), and our ability to create energy, among other things.

The gut is the seat of all feeling. It is where many aspects of being are interwoven – the microbiome, the digestive system, immune function, the nervous system, the emotional body and the mental body.

Poor Gut Health + Lyme Disease = Downward Spiral

The GI system can become an ongoing source of inflammation, perpetual dysbiosis, and weakness that extends out to all other parts and systems of the body.

It is very common among modern people that the GI tract is a place of stagnation, fermentation, bacterial overgrowth, and becomes an enormous source of toxicity and inflammation.

Add a diet that contributes further to inflammation (high carb, high sugar and/or high in inflammatory fats), and it’s easy to see how the disease-causing bacteria quickly gain an upper hand within our bodies.

Ultimately we can see that the gut is both a major source of – and a foremost solution for – inflammation in tick-borne disease. 

Furthermore, the gut is a dynamic organ – it can be damaged and it can be healed!

5-Part Plan to Heal GI Weakness & Heal Chronic Lyme

  •  Utilize supplements to restore gut functionality & ease symptoms. 

Digestive symptoms are uncomfortable and potentially embarrassing at best, and completely debilitating at worst.  Bloating, gas or constipation, can make one’s entire being feel blocked and sluggish. Chronic diarrhea can inhibit a person’s ability to leave home or attend meetings without concern that they will have an accident if they can’t get to the bathroom in a hurry.  Nausea, vomiting, and stomach pains can make eating a good diet virtually impossible.

There are some good natural stop-gap measures for GI symptoms such as betaine HCl, pancreatic enzymes, bile salts, and soothing herbs that serve to both support proper functioning and alleviate symptoms until the deeper causes of dysfunction are fully dealth with.

  • Move stagnant food and waste matter.  

Stagnation of food, waste, mucus and gas inside the GI tract is very common, and it is what creates an ideal breeding ground for pathogenic bacteria.  Food and waste stagnation leads to lots of uncomfortable symptoms and the progression of GI diseases.

Clearing stagnation also allows gut healing treatments to work better, so you don’t want to skip this step.  Examples of ways to do this include regular colonics or enemas, the use of herbal laxatives, laxative foods, supplements such as magnesium, and consuming less solid food overall.

  • Address malabsorption and nutrient deficiencies.

When your digestive system is weak, you don’t digest and break down your food well.  This leads to mal-absorption of nutrients, which in turn leads to a weakening of the entire body, including the vital and sense organs, the muscles and joints, immune system, hormones, and all the tissues and cells. The body can’t operate properly without the enzymes, nutrients, and building blocks that it has to acquire from food.

Addressing know nutrient deficiencies with supplementation is important, as is juicing and utilizing superfoods in your diet in easy to absorb forms (think liquid food!) to help replace what is lacking.

  • Eliminate all food allergens and sensitivities.

When your food is not fully digested and broken down in the small intestine or if it is triggering an immune response,  proteins from undigested food can pass into the colon and cause irritation and inflammation. This irritation and inflammation can cause pain, spasm, mucus in the stool, and diarrhea.  Over time this compromises the delicate lining of the small and large intestine, which is only 1 cell thick.

As the gut membrane is compromised and breaks open in places, toxic waste and other inflammatory particles can seep into the bloodstream and massively increase the level of inflammation in the body. This is why the gut can be a major source of inflammation that accelerates degeneration and disease processes including Lyme, and also increases pain levels throughout the body.

In order to heal gut problems + Lyme disease, it is very important to eliminate all allergenic foods, at least until the final stages of healing when some foods can be re-introduced and improved tolerance and digestibility is likely.

  •  Eliminate infections and correct dysbiosis.  

This is about both getting the microbiome back into a healthy proportion where the health-promoting and neutral bacteria are dominant over the potentially pathogenic microbes.

We start with treating active infections that are wreaking havoc in the gut and system as a whole, such as yeast, parasites, Lyme, CMV and more.

These protocols need to be targeted to the specific organisms that are known or suspected to be plaguing the body.  We utilize a multi-pronged anti-microbial approach that includes herbs such as Chinese scutellaria, olive leaf and black walnut hull; liposomal essential oils such as oregano, clove and fennel, and biofilm-busters to eradicate these infections.

For more:  https://madisonarealymesupportgroup.com/2019/12/16/the-root-of-autoimmune-disease-can-be-found-in-the-gut/

https://madisonarealymesupportgroup.com/2019/12/28/what-are-the-pros-of-probiotics/

https://madisonarealymesupportgroup.com/2019/12/26/settle-your-stomach-with-digestive-health-supplements/

https://madisonarealymesupportgroup.com/2019/04/04/the-importance-of-gut-health-to-healing-from-chronic-illnesses-podcast-dr-jill-carnahan/

Category:

diet and nutrition, Gut Health, Herbs, Lyme, Supplements, Treatment

Which Treatment Guidelines Should You Follow For Lyme Carditis?

https://danielcameronmd.com/treatment-guidelines-lyme-carditis/

WHICH TREATMENT GUIDELINES SHOULD YOU FOLLOW FOR LYME CARDITIS?

Lyme carditis occurs when Borrelia burgdorferi spirochete penetrate the pericardium (a membrane that encloses the heart) or myocardium (muscular tissue of the heart). The infection triggers an inflammatory response, typically causing atrioventricular (AV) conduction abnormalities, such as a first, second or third-degree heart block.

By

In their article Lyme Carditis: A Rare Presentation of Sinus Bradycardia Without Any Conduction Defects, Grella and colleagues present “a unique case of Lyme carditis, without the classical findings of Lyme disease [such as a rash] or common EKG findings of AV conduction abnormalities.”¹

A 56–year-old man was admitted to the emergency department with lightheadedness and chest pain. An EKG revealed sinus bradycardias. Western blot test results for Lyme disease were positive and included IgG bands 18, 28, 39, 41, 45, 58, 66, 93 and negative for IgM (band 23 was positive). The patient was given a 7-day course of IV ceftriaxone.

However, “he continued to have persistent bradycardia with his heart rate dropping to 20 to 30 beats per minute throughout the night,” writes Grella. “Additionally, he had several sinus pauses while sleeping, with the longest lasting for 6.1 seconds.”

The man required further treatment with a pacemaker and a 3-week course of IV ceftriaxone.

At his one-month follow-up appointment, he was symptom-free.

The authors note that Lyme disease patients’ presentations may differ. “A gray zone exists in regards to the treatment of Lyme disease because every patient does not present with the characteristic rash and symptoms of Lyme disease.”

Furthermore, as Grella points out, there are different treatment guidelines for Lyme disease.

“The Infectious Diseases Society of America (IDSA) recommends that patients be started on a short course of antibiotics as the persistent infection is infrequent or non-existent.”

“The International Lyme and Associated Diseases Society (ILADS) recommends the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. This system emphasizes that a prolonged course of antibiotics be required, keeping in mind the high failure rates from a short course of antibiotics and the high prevalence of disseminated disease in a large number of cases.”

Meanwhile, Lyme carditis treatment varies between patients, as well.

“Patients with Lyme carditis who do not have high-grade heart block are managed conservatively with oral antibiotics.”

“Patients with a high-grade heart block should be hospitalized, closely monitored, and treated with IV ceftriaxone 2 grams or IV penicillins for second/third-degree AV block or prolonged for PR interval > 300 ms.”

Other institutions offer different approaches. “The European Federation of Neurological Societies (EFNS) recommends ceftriaxone or cefotaxime for 2 weeks as the standard of care in acute Lyme carditis.”

The authors conclude: “A high clinical suspicion of Lyme carditis is required when someone from a Lyme endemic region presents with unexplained cardiac symptoms and has EKG findings suggestive of carditis.”

Editor’s note: The length of treatment for this patient was consistent with the ILADS guidelines, as the man had failed the initial treatment.

Editor’s disclosure: I am co-author of the ILADS treatment guidelines.

Related Articles:

17-year-old young man dies from Lyme carditis

Broad range of presentations for Lyme carditis

Lyme carditis causes complete heart block in 26-year-old man

References:
  1. Grella BA, Patel M, Tadepalli S, Bader CW, Kronhaus K. Lyme Carditis: A Rare Presentation of Sinus Bradycardia Without Any Conduction Defects. Cureus. 2019 Sep 2;11(9):e5554

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For more:  

https://madisonarealymesupportgroup.com/2020/01/12/broad-range-of-presentations-for-lyme-carditis-cases/

https://madisonarealymesupportgroup.com/2019/11/29/increasing-burden-of-lyme-carditis-in-united-states-childrens-hospitals/

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

https://madisonarealymesupportgroup.com/2019/11/04/suspect-lyme-carditis-start-empiric-antibiotics-case-report-suggest-and-lyme-carditis-is-not-rare/

https://madisonarealymesupportgroup.com/2018/07/09/with-unexpected-death-autopsies-should-look-for-lyme-carditis/

https://madisonarealymesupportgroup.com/2019/05/15/lyme-carditis-presenting-as-atrial-fibrillation/

https://madisonarealymesupportgroup.com/2020/02/17/lyme-carditis-presenting-as-sick-sinus-syndrome/

https://madisonarealymesupportgroup.com/2019/12/21/patients-can-die-when-lyme-carditis-is-not-treated/

Category:

Heart Issues, research, Treatment

Using Light Therapy to Treat Multiple Sclerosis

https://uwm.edu/healthsciences/news/using-light-therapy-to-treat-multiple-sclerosis/

Using light therapy to treat multiple sclerosis

Posted on April 3, 2018

Jeri-Anne Lyons in the multiple sclerosis laboratory.

Jeri-Anne Lyons in the multiple sclerosis laboratory.

Through a study funded through the National Multiple Sclerosis Society, Associate Dean and Professor in the College of Health Sciences Jeri-Anne Lyons, PhD (pictured above), hopes to demonstrate the positive impact of light therapy in treating muscle fatigue in patients with multiple sclerosis (MS).

Photobiomodulation therapy (PBMT) uses red and near infrared light to decrease inflammation and neurodegeneration. Given the recent evidence supporting the clinical benefit of PBMT on muscle function in healthy individuals, Lyons and her co-researchers believe PBMT may also help people with MS.

What is MS?

MS is a destructive disease in which the body’s immune response attacks the nerves in the brain and spinal cord and prevents proper nerve function. The signs and symptoms of MS are unpredictable and highly variable, but many experience blindness, muscle weakness, decreased mental function, tingling in the hands and feet, and limited mobility or paralysis. As of 2015, the Multiple Sclerosis Foundation estimated that more than 400,000 people in the US and roughly 2.5 million people worldwide have MS.

During an attack, or a relapse, the patient’s immune response brings about other mechanisms in the body that play a role in disease progression and permanent disability. The added stress on cells from repeated relapses makes it more difficult for the body to heal itself after an attack. Over time, cellular damage becomes permanent and escalating, which affects systems throughout the body.

Why light therapy?

Current treatments are expensive, only partially effective and can lead to a variety of side effects. These therapies also lose their potency as the disease progresses to permanent disability because they only target the immune response and do not stop the other mechanisms that progress the disease.

Photobiomodulation therapy with far red or near infrared light can be a helpful therapeutic approach because such wavelengths increase energy production by cells and protective anti-inflammatory responses, while decreasing damaging inflammation.

Lyons explained the potential of PBMT as a therapeutic approach to MS.

“We’ve already seen success with this treatment in mice. Our experiments showed that mice treated with PBMT experienced less severe clinical disease and experienced fewer relapses than mice not receiving PBMT. As we prepare to move toward clinical studies, we are trying to ascertain whether similar effects are noted on human immune cells.”

Combining scientific approaches

Lyons is working with Alexander V. Ng, PhD, FACSM, associate professor in the Exercise Science program at Marquette University in Milwaukee, Wisconsin. An exercise physiologist, Ng brings his extensive expertise with muscle fatigue to the project.

“Alex’s protocol for measuring muscle function will help us figure out if the light treatment is merely improving circulation or if PBMT can actually improve nerve function in MS patients,” Lyons said.

Lyons and Ng will treat a muscle in the shin with PBMT and assess the participant before and after light treatment to measure muscle function. Because PBMT is known to elicit localized and systemic effects, they will also measure markers in the blood to assess whether or not inflammation decreases following PBMT.

“Light therapy holds a great deal of potential, but it is by no means a ‘magic bullet’,” said Lyons. “Dosage and frequency of treatment is key in this kind of therapy – too little, and patients may not see results. Too much, and there may be adverse outcomes. Our study aims to capture that fine line and reveal what steps may come next for developing PBMT as a viable treatment option for people with MS.”

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**Comment**

If you’ve never heard of red-light therapy:  https://redlightclinic.com/red-light-therapyfrequently-asked-questions/

The current research:  https://redlightclinic.com/red-light-therapy-researchproven-clinical-studies/   Everything from skin improvement to help with Rheumatoid arthritis and wound healing.  The best statement:

Although there is still more research needed, LLLT has shown significant potential in improving our overall health and well-being in a number of ways.

Category:

Treatment

Pathogenic Mycoplasma Infections in Chronic Illnesses: General Considerations in Selecting Conventional and Integrative Treatments

https://www.scirp.org/journal/paperinformation.aspx?paperid=95720

Pathogenic Mycoplasma Infections in Chronic Illnesses: General Considerations in Selecting Conventional and Integrative Treatments

Author(s)  Garth L. Nicolson
Department of Molecular Pathology, The Institute for Molecular Medicine, Huntington Beach, California, USA.

ABSTRACT

The presence of pathogenic mycoplasmas in various chronic illnesses and their successful suppression using conventional and integrative medicine approaches are reviewed. Evidence gathered over the last three decades has demonstrated the presence of pathogenic mycoplasma species in the blood, body fluids and tissues from patients with a variety of chronic clinical conditions: atypical pneumonia, asthma and other respiratory conditions; oral cavity infections; urogenital conditions; neurodegenerative and neurobehavioral diseases; autoimmune diseases; immunosuppressive diseases; inflammatory diseases; and illnesses and syndromes of unknown origin, such as fatiguing illnesses.
Only recently have these small intracellular bacteria received attention as possible causative agents, cofactors or opportunistic infections or co-infections in these and other conditions. Their clinical management is often inadequate, primarily because of missed diagnosis, under- and inadequate treatment and the presence of persister or dormant microorganisms due to biofilm, resistence and other mechanisms.
Pathogenic Mycoplasma species infections have been suppressed slowly by anti-microbial and integrative treatments, resulting in gradual reductions in morbidity, but not in every patient. Even if mycoplasmas are not a cause or an initial trigger for many chronic illnesses, they appear to play important roles in the inception, progression, morbidity and relapse of chronic illnesses in rather large patient subsets. Ignoring such infections can result in failure to achieve eventual patient recovery, even with application of potentially curative treatments.
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**Comment**
As Dr. Breitshwerdt is the Bart Guru, Dr. Nicolson is the Mycoplasma King.  Both are involved intimately with pathogens that have changed their lives.  We owe these men a great debt as without their expertise and fortitude, we would be completely in the dark.  To read about Dr. Nicolson’s experience with bioweaponized Mycoplasma read the provocative book, “Project Daylily.”  I notice that he dedicated this article to his deceased wife who survived a lethal mycoplasma infection.
Please refer to the full-length article in the link at the top of the story but I’ve highlighted a few things below on how Mycoplasma evades the immune system as well as effective treatment.  There’s much, much more in the full-length article you should understand.
According to Dr. Nicolson, 80% of Lyme/MSIDS patients also have Mycoplasma.
CFS/ME patients according to PCR have various mycoplasmas.
Excerpt from section 2 on Host Response Systems:
Pathogenic mycoplasmas can evade immune recognition and destruction by undergoing rapid surface antigenic variations [7] [27]. Even with their slow intracellular growth rates, by rapidly altering their cell surface antigenic structures as well as modulating host immune responses, pathogenic mycoplasmas can evade host surveillance mechanisms [7] [27]. This helps explain the chronic nature of mycoplasmal infections and the inability of hosts to completely suppress pathogenic mycoplasmal infections via host responses that are effective against other more rapidly growing bacteria [27].
Excerpt from 4.12 Fatiguing Illnesses:
The most common fatiguing illness is chronic fatigue syndrome (CFS) or myalgic encephalomyelitis. This is an unexplained, long-term, persistent illness characterized by disabling fatigue plus additional signs and symptoms [98] [99]. Most if not all patients with CFS show evidence of chronic viral and bacterial infections (reviewed in [45] [47] ). In fact, the odds ratio for the presence of chronic infections was calculated to be 18.0 (p < 0.001), suggesting that CFS patients have a very high probability of multiple chronic infections [100]. The most commonly found infections (by PCR of blood monocytes) were various pathogenic species of mycoplasmas [100] [101].  M. pneumoniae was the most common mycoplasma species found, followed by M. fermentans, M. hominis, and M. penetrans [101].
Excerpt from Section 5 Treatment of Pathogenic Mycoplasmal Infections:
In many cases mycoplasmal infections are not the definitive infection that defines the condition. An example of this is chronic Lyme disease, a complex clinical condition with Borrelia species as the prominent infectious agent but with other bacterial, parasite, and viral components as co-infections [47] [119] [120] [121]. Pathogenic mycoplasmal co-infections are important in such multiple infection diseases, being present in up to 80% of chronic Lyme diseases cases [120] [122].
Excerpt from Section 5.1 Antimicrobial Treatments:

The conventional antimicrobial treatments of pathogenic mycoplasmal infections usually involve systemic therapy with oral antibiotics, but the choice of antibiotic(s) depends to a certain degree on the mycoplasma species being treated. Since mycoplasmas do not have a cell wall, antibiotics that act on cell wall synthesis are ineffective [2] [3] [7] [40] [50] [59] [124] [125]. Instead, mycoplasmas are treated with anti-microbials that attack their metabolism, replication, synthetic machinery or other specific bacterial targets. Since most mycoplasmas and ureaplasmas are generally sensitive to tetracyclines (doxycycline, minocycline, among others), with some notable exceptions, these should be considered for frontline treatment, and quinolones (ciprofloxacin, sparfloxacin, levofloxacin, ofloxacin, among others) [125] [126] [127] [128] , as alternative treatment. However, M. pneumoniae and M. genitalium strains are especially sensitive to macrolides (azithromycin, clarithromycin, erythromycin, among others), whereas M. hominis strains are usually resistant [126] [127] [128]. Ureaplasmas are moderately susceptible to macrolides [127] [128]. M. hominis and Ureaplasma urealyticum are generally more resistant to tetracyclines than other species [129] [130] , and M. hominis strains have been observed to be resistant to quinolones [131]. Some discussion of these antimicrobials and their uses in treating pathogenic mycoplasmal infections in chronic illnesses can be found in [132] [133] [134].

Treatment of pathogenic mycoplasma infections with oral antibiotics generally involves daily or pulsed treatment, such as every-other-day administration, at the maximum dose recommended for a particular antibiotic [132] [133] [134] [135]. Due to the cyclic nature of mycoplasmal proliferation some organizations recommend every-other-day antibiotic regimens [135].

Another important consideration is antibiotic resistance, which can occur during treatment [132] [138]. A major problem has been the shifting minimum inhibitory dose concentrations required to treat mycoplasmal infections with antibiotics, such as treatment of M. genitalium infections with oral tetracyclines [139]. This requires increasing dose levels or shifting to a different antibiotic regimen [132].

In most chronic illness patients pathogenic mycoplasma infections do not respond quickly to anti-microbial therapy, so long-term therapy must be considered [123] [132] [133] [135].

When antibiotics are used to treat pathogenic mycoplasmal infections, Jarisch-Herxheimer reactions (J-H reactions) usually occur [132] [141]. These are observed as temporary increases in the severity of signs and symptoms, and J-H reactions generally involve fevers, chills, muscle aches, fatigue, skin rashes, pain and other signs and symptoms related to cytokine release [141].

In most patients this has required prolonged treatments that have resulted in very slow recoveries, often requiring a year or more of treatment [48] [121] [123] [132] [133].

There are some alternative procedures that can increase the in vivo effectiveness of antimicrobial therapies. One method that has been used to increase the effectiveness of antibiotics has been the use of agents that increase the penetrability or the intracellular activities or effectiveness of antibiotics or other drugs. For example, the anti-malarial drug Plaquenil (hydroxychloroquine) has been used to alkalize intracellular compartments and improve antimicrobial entry and cytotoxic effects [121] [132] [145].

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For more:  https://madisonarealymesupportgroup.com/2015/08/12/connecting-dots-mycoplasma/

https://madisonarealymesupportgroup.com/2016/02/07/mycoplasma-treatment/

https://madisonarealymesupportgroup.com/2017/07/14/clinical-association-lyme-disease-and-guillain-barre/Epstein-Barr, also known as Mono, is an infection that triggers Guillain-Barre as well as mycoplasma and cytomegalovirus.  http://www.webmd.com/brain/tc/guillain-barre-syndrome-topic-overview#1

https://madisonarealymesupportgroup.com/2017/07/16/mycoplasma-and-other-intracellular-bacterial-infections-in-rheumatic-diseases-comorbid-condition-or-cause/

Category:

Mycoplasma, research, Treatment

5-Week Old Girl With Lyme Disease Podcast

LYME PODCAST: 5-WEEK-OLD GIRL WITH LYME DISEASE

Lyme Disease Podcast: 5-week-old girl with Lyme disease

Welcome to an Inside Lyme case study. I find that the best way to get to know Lyme disease is through reviewing actual cases. In this case study, I will be discussing a 5-week old baby girl with Lyme disease. This case series will be discussed on my Facebook and made available on podcast and YouTube.

By

In this episode, I will be discussing a 5-week old baby girl with Lyme disease.

This case was described in the journal Pediatrics, written by Handel and colleagues in 2019.

This paper reminds parents of the need to look for a tick bite and Lyme disease even in babies. The authors described a healthy 5-week-old girl who was diagnosed with Lyme disease. The baby girl lived in Long Island, New York, an area endemic for Lyme disease.  The baby was rarely outdoors, but the family dog was allowed outdoors. The dog could have brought the baby in contact with the tick.  Other researchers have reported a higher risk of Lyme disease in pet owners.

The parents did not report seeing a tick. Instead, the parents removed “an engorged, black “bug” from behind her left ear six days before symptoms started.” writes Handel. This highlights the difficulties parents can face in recognizing a tick.

The fact that the presumed tick was engorged was also important. The risk of Lyme disease from an engorged tick is much higher.  The number of spirochetes rises as the tick takes a blood meal. The spirochetes in a tick have more time to multiply and migrate from the midgut of the tick to the salivary glands.  The higher numbers of spirochetes in the salivary gland, the more likely the bite will lead to a tick-borne disease.

The baby girl was diagnosed with early disseminated Lyme disease.  The rashes were typical with “multiple flat rings with peripheral blanching erythema, a central clearing, and outward expansion without tenderness or peripheral scaling” writes Handel.  He added, there was also a rash near the bite.  Early disseminated Lyme disease often occurs without the initial erythema migrans rash when the bacteria have already spread throughout the body.

The doctors hospitalized the baby.  The baby had a fever 101.1 and was irritable.  The tick-borne tests were negative, which is common in early Lyme disease. The western blot Lyme disease test was not performed, as the ELISA screen was negative.

The doctors were concerned that the baby might suffer from Lyme meningitis.  This is an uncommon but important concern for the doctor treating Lyme disease.  The spinal tap was not successful. The doctors treated for Lyme meningitis with intravenous antibiotics since they were still concerned the baby might have Lyme meningitis. The baby girl was discharged from the hospital after two weeks of intravenous ceftriaxone.

There were no complications on follow-up, according to the doctor.

The authors noted that there are few cases of babies being treated for tick-borne illnesses in the published literature. That does not mean that young children aren’t contracting tick-borne diseases in practice.  Children under the age of 5 years-of-age are the most likely to be infected with Lyme disease according to the CDC.

What can we learn from this case?

  1. Babies can be infected with a tick-borne infection even with little outdoor exposure.
  2. The family pet can bring a baby into contact with ticks.
  3. It can be difficult to determine if a baby has Lyme meningitis. The spinal tap in this 5-week-old baby girl was unsuccessful.  Even if the spinal tap had been successful, the spinal tap may be negative in neurologic Lyme disease.

What questions does this case raise?

  1. Would it have been helpful if the parents had recognized the “bug” as a tick?
  2. Would the parents or the doctor have recognized Lyme disease if the rash were single or atypicial?  The most common rash is a flat red rash in one study.
  3. Would the baby have been successfully treated with oral antibiotics rather than intravenous antibiotics?
  4. What if the baby did not have a rash? Would the doctor have been willing to use clinical judgment to diagnose Lyme disease in a baby?
  5. Would the IgM western blot test for Lyme disease have been positive if the doctor had ordered a western blot test?  The IgM western blot test is often positive in early Lyme disease.
  6. Would antibiotic treatment at the time of the engorged tick bite have prevented the need for a 24 days hospitalization, a spinal tap, and intravenous antibiotics in the baby girl?
  7. When is it important to perform a spinal tap?
  8. Will the baby girl develop a co-infection like Ehrlichia, Anaplasmosis, and Babesia? This is particularly important as the intravenous ceftriaxone prescribed for the baby would not be effective for these tick-borne infections.
  9. Will two weeks of intravenous antibiotics prevent chronic manifestations of Lyme disease?

TREATING TICK-BORNE DISEASE IN MY PRACTICE

In my practice, each individual requires a careful assessment. That is why I order tests a broad range of tests, including blood counts, liver and kidney function, thyroid disease, lupus, and rheumatoid arthritis in addition to tests for tick-borne infections. I also arrange consultations such as neurologists, rheumatologists, and ophthalmologists.

Many patients are complex, as highlighted in this Inside Lyme Podcast series.

We need more doctors with skills diagnosing and treating Lyme disease in children. We could use a reliable test to determine who has Lyme disease and a test to be sure Lyme disease has resolved. We need to determine the best course of treatment for babies.  In this case, were there oral antibiotics that would have been effective? We hope that if a professional sees a baby that they can use this case to remind them to look for Lyme disease and treat accordingly.

We also need to give doctors the freedom to treat these difficult cases without undue interference by colleagues, insurance companies, medical societies, and medical boards.

Inside Lyme Podcast Series

This Inside Lyme case series will be discussed on my Facebook and made available on podcast and YouTube.  As always, it is your likes, comments, and shares that help spread the word about this series and our work. If you can, please leave a review on iTunes or wherever else you get your podcasts.

Sign up for our newsletter to keep up with our cases.

References:
  1.  Two Neonates With Postnatally Acquired Tickborne Infections Andrew S. Handel, Harriet Hellman and Saul R. Hymes Pediatrics 2019;144;

Category:

Lyme, research, Testing, Treatment