Archive for the ‘Treatment’ Category

Two Cases of Babesia

Severe Babesia microti infection presenting as multiorgan failure in an immunocompetent host.

Ripoll JG, Rizvi MS, King RL, Daniels CE.
BMJ Case Reports, online first 2018 May 30.

https://doi.org/10.1136/bcr-2018-224647https://doi.org/10.1136/bcr-2018-224647

Abstract

A previously healthy 67-year-old farmer presented to an outside hospital after a 2-week history of non-specific respiratory symptoms. A certain diagnosis was not initially apparent, and the patient was discharged home on a regimen for presumed chronic obstructive pulmonary disease exacerbation.

He re-presented to the emergency department with shock and hypoxaemic respiratory failure requiring prompt intubation and fluid resuscitation. He was then transferred to our institution due to multiorgan failure.

On arrival, the patient demonstrated refractory shock and worsening acute kidney injury, severe anaemia and thrombocytopaenia. The peripheral smear revealed absence of microangiopathic haemolytic anaemia. A closer review of the smear displayed red blood cell inclusion bodies consistent with babesiosis.

The patient was started on clindamycin and loaded with intravenous quinidine, and subsequently transitioned to oral quinine. A red cell exchange transfusion was pursued with improvement of the parasite load.

The patient was discharged home on clindamycin/quinine and scheduled for outpatient intermittent haemodialysis.

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A Walk in the Park: A Case of Babesiosis in the South Bronx

Hajicharalambous C, Rattu M, Leuchten S.
Clinical Practice and Cases in Emergency Medicine. 2018 Jan 11;2(1):61-63. eCollection 2018 Feb.

https://doi.org/10.5811/cpcem.2017.8.35924

Abstract

Babesiosis, mainly endemic within the Northeastern and upper Midwestern regions of the United States, is a zoonotic disease that invades and lyses red blood cells, which can result in hemolytic anemia. Its decreased incidence in comparison to Lyme disease is often attributed to the greater asymptomatic infection proportion and insufficient physician awareness or suspicion of this disease. Here we describe a case of undifferentiated febrile illness with hemolytic anemia that yielded the diagnosis of babesiosis.

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**Comment**

What mainstream medicine as YET to acknowledge and learn is that Lyme patients are typically coinfected with a plethora of pathogens that all demand attention and treatment.  I find the statement in the second abstract telling:  “Its decreased incidence in comparison to Lyme disease is often attributed to the greater asymptomatic infection proportion and insufficient physician awareness or suspicion of the disease.”

What happens in treatment is symptoms disappear one by one only to be replaced by new ones that the patient never noticed before.  My husband and I both had Babesia but didn’t really know it until some of the Lyme symptoms began to abate with treatment.  I was told, and it certainly is true, that treating for tick borne illness is like peeling an onion layer by layer.  This was our exact experience.

Physicians desperately need education on all things TBI as throwing all the doxy in the world at this isn’t going to help many people.  Babesia is a cousin to malaria and requires anti-malarial drugs.  Babesia is also extremely persistent and Dr. Horowitz recommends 9 months to a year of solid treatment.  We treated with Mepron, Arthemisinin (Allergy Research Brand), and an intracellular for a year.  All Babesia symptoms are gone.

http://www.wildcondor.com/dr-horowitz-on-babesiosis.html Dr. Krause published in the New England Journal of Medicine that when a patient has Lyme and Babesia, Lyme is found three-times more frequently in the blood, proving Babesia suppresses the immune system. https://madisonarealymesupportgroup.com/2017/06/28/concurrent-babesiosis-and-lyme-in-patient/.  It also means you are sicker than a dog.

For more:  https://madisonarealymesupportgroup.com/2016/01/16/babesia-treatment/

https://madisonarealymesupportgroup.com/2018/05/31/widespread-babesiosis-in-canada/

https://madisonarealymesupportgroup.com/2018/02/20/babesia-and-heart-issues/

 

Lyme Education for Healthcare Professionals

https://globallymealliance.org/education-awareness/physicians-training-program/

LYME EDUCATION FOR HEALTHCARE PROFESSIONALS

There is an increasing risk for Lyme and other tick-borne diseases across the country. GLA recognizes the importance of patients having access to physicians who are trained to properly diagnose and treat Lyme and other tick-borne diseases. We are committed to educating the medical community by providing educational programming and training opportunities focused on diagnosing and managing Lyme disease, other tick-borne co-infections, and Lyme comorbidities.

CME-Accredited Education

GLA provides CME-accredited educational programs for healthcare professionals to learn more about diagnosing and treating Lyme and other tick-borne diseases.

On Demand CME
Pediatric Tick-Borne Disease: Diagnosis and Management
Patricia DeLaMora, MD, FAAP discusses the proper diagnosis and management of Lyme and other tick-borne diseases in children.This educational activity was developed to teach pediatricians and other healthcare professionals who want to learn:

-Limitations of current Lyme disease testing
-Recognition of some co-infections
-Antibiotic management of tick-borne diseases

Earn your CME credits now. Global Lyme Alliance developed this educational activity in partnership with Global Education Group. Global Education Group designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™

Physician Training Grants

Each year, GLA provides grant support to physicians and other healthcare professionals to attend the International Lyme and Associated Diseases (ILADS) Annual Conference. GLA has funded hundreds of clinicians to attend this major conference to learn about the latest clinical updates. These clinicians gain important Lyme disease knowledge and information to treat patients in their communities.

Physician Training Program

Over the years, the GLA Physician Training Program has provided grants to hundreds of clinicians to study alongside physicians experienced in treating Lyme and other tick-borne diseases. This peer-to-peer training program provided clinicians an opportunity to learn how to properly diagnose and treat Lyme and other co-infections from experts in the field. This program helped equip clinicians with the necessary skills to effectively treat and care for Lyme patients in their community.

ON DEMAND CME PEDIATRIC TICK-BORNE DISEASE: DIAGNOSIS AND MANAGEMENT
  • Our ImpactOUR IMPACTGLA has awarded over $9 million for research, and our GLA-funded projects have led to unprecedented advances in prevention, diagnosis and treatment of tick-borne illnesses.

    LEARN MORE

  • Published ResearchPUBLISHED RESEARCHGLA funds innovative research projects. View research articles published in peer-reviewed journals.

    LEARN MORE

  • scientific advisory boardSCIENTIFIC ADVISORY BOARDThe Scientific Advisory Board (SAB) plays a key role in directing GLA’s grant funds into programs judged to have exceptional prospects of delivering measurable advances.

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**Comment**

For more on how to become educated on Lyme/MSIDS:  

https://madisonarealymesupportgroup.com/2018/02/19/calling-all-doctors-please-become-educated-regarding-tick-borne-illness-heres-how/

https://madisonarealymesupportgroup.com/2018/02/22/new-lyme-cme-course-available-lyme-carditis-more-than-blocked-beats/

There are also annual conferences in which practitioners can obtain CME’s.  For info:

http://www.ilads.org

Friday-Saturday, June 15-16, 2018
Warsaw, Poland
The ILADS 2018 European Conference will be held June 15-16, 2018 at the Sheraton Warsaw Hotel. The theme is Chronic Borreliosis – Infection, Inflammation, Immunity.

and

Thursday-Sunday, November 1-4, 2018
Chicago, IL
ILADS’ 2018 fall meeting venue will be held in Chicago, IL at the Sheraton Grand Chicago

https://www.lymediseaseassociation.org

LDA/Columbia University – 19th Annual
Lyme/TBD CME Scientific Conference
October 27 & 28, 2018
Marriott Providence Downtown
Providence, RI

 

 

 

 

 

 

Heart Problems & Tick Borne Disease

Recently some articles have come out on Heart issues with Tick Borne Disease (TBD).  Most talk about Lyme; however, as you will see – there are many other players.

http://davidjernigan.blogspot.com/2015/05/functional-heart-problems-and-lyme.html  The Hansa Center in their blog states that a common symptom of chronic Lyme is Postural Orthostatic Tachycardia Syndrome or POTS.  POTS can cause headaches, lightheadedness, heart palpitations, fatigue, shaking, fainting, cold or pain in extremities, chest pain, shortness of breath, and even nausea.  Evidently, POTS can be caused by Lyme Endocarditis.

For an excellent read on Lyme Carditis, please see:  https://www.bayarealyme.org/blog/lyme-carditis-why-early-diagnosis-is-critical/  In a nutshell, it’s inflammation caused by an infection such as Lyme, viruses, and other pathogens.  This inflammation messes up electrical signal conduction and can cause AV block, a serious oxygen depriving condition, hence all the symptoms listed above.  Lyme Carditis is the more general term but it can be in any part of the heart: myocardium, pericardium, endocardium, cardiac muscle, valves, and aorta.  The good news is it can usually be reversed with appropriate treatment.  Sometimes a pacemaker is also needed.  The article states about 4-10% of people with TBD develop this.

CDC Expert Commentary by Joseph D Forrester, MD, MSc

Forrester states Lyme Carditis is “rare,” but even 4-10% of patients is a chunk of people.  PEOPLE HAVE DIED FROM THIS and even the CDC reported 3 cases of sudden cardiac death between Nov 2012 & July 2013 among patients with unrecognized Lyme carditis.  If one person died from Zika there would be a media blitz.  

https://www.ctvnews.ca/health/rare-but-serious-complication-of-lyme-disease-can-attack-the-heart-doctor-1.3952476  Recently a heart specialist in Ontario is warning doctors to be on the look out for Lyme carditis.  Dr. Baranchuk points out that numerous people with heart symptoms were admitted to the ER two to three times before anyone considered Lyme carditis.  He also states many don’t get the bullseye rash or notice vague symptoms of fever and muscle aches.

https://www.ctvnews.ca/mobile/video?clipId=1406334  CTV News Video

Baranchuk wrote a paper http://www.cmaj.ca/content/190/20/E622 advising doctors to treat young patients with strange heart problems with antibiotics while waiting for results of Lyme blood tests.

He states: “These patients may not require pacemakers to be implanted. They can be treated with IV antibiotics for 10 to 12 days and the electricity of the heart will recover completely forever,” he said.

Interestingly the title of the article by CTV News states, “Rare but serious complication of LD….” and yet they even quote Baranchuk saying,

“We have the suspicion that there are way more cases than are reported, because doctors are failing to report it,” he said.

That’s kind of a big deal.

QUIT SAYING THE WORD RARE IN YOUR REPORTING ON TBD.

Then there’s the story of Dr. Neil Spector, an oncologist who rubbed shoulders with experts and the best that medical care can offer and yet, due to doctors with heads in the sand suffered for years with bizarre and frustrating heart symptoms until he nearly crossed over to the other side. (He was told it couldn’t be Lyme as he lived in Florida.  The doctors were happy to diagnose him over the phone but ALL stated unequivocally he did NOT have Lyme!) After a heart transplant, Spector is speaking out about Lyme Disease and has even written the book, Gone in a heartbeat – A Physician’s Search for True Healing.  For a great review of the book:  https://www.lymedisease.org/when-lyme-disease-affects-the-heart/

Lyme and carditis:

https://madisonarealymesupportgroup.com/2017/06/10/lyme-carditis-with-complete-heart-block/

https://madisonarealymesupportgroup.com/2017/06/07/early-onset-lyme-carditis-concurrent-disseminated-erythema-migrans/

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

But Lyme (Bb) isn’t the only culprit.

Similar to inflammation caused by Borrelia burgdorferi (Bb), inflammation can be caused by many bacteria and viruses:  https://www.myocarditisfoundation.org/research-and-grants/faqs/causes-of-myocarditis/

Most common viruses causing carditis:

  • Parvovirus B19
  • Human Herpes Virus 6
  • Enterovirus (Coxsackie Virus)
  • (Research needed.  Tons of viruses involved with TBD)

Most common bacteria causing carditis:

  • Corynebacterium diptheriae
  • Staphylococcus aureus
  • (Research needed.  Tons of bacteria involved with TBD)

Most common parasites causing carditis:

  • Borrelia burgdorferi
  • Ehrlichia species
  • Babesia species
  • Trypanosoma cruzi (Chagas Disease)
  • Bartonella (My addition due to the following…..)
  • (Research needed.  Tons of parasites involved with TBD)

I added Bartonella to the list due to the following (add it up, it isn’t rare):

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6010976/  Five cases of infective endocarditis associated with Bartonella henselae.

https://www.ncbi.nlm.nih.gov/pubmed/9196420  Two cases of Bartonella Carditis.

https://www.ncbi.nlm.nih.gov/pubmed/11496560 One case.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5942242/ Four cases.

https://www.ncbi.nlm.nih.gov/pubmed/8849149 22 cases – 13 that had undetermined Bartonella species.

https://www.ncbi.nlm.nih.gov/pubmed/16762254  A total of 6 cases reported in Spain.  Conclusion states it is likely to be underestimated and to suspect it with negative blood cultures, history of chronic alcoholism, the homeless, and those in contact with cats or bitten by fleas or lice, as well as patients with endocarditis and positive serology against Chlamydia spp.  This abstract, written in 2006 wouldn’t have considered that ticks carry a Chlamydia-like organisms (CLO):  https://madisonarealymesupportgroup.com/2016/10/07/chlamydia-like-organisms-found-in-ticks/  These results suggest that CLO DNA is present in human skin; ticks carry CLOs and could potentially transmit CLOs to humans.  Two other studies have come to the same conclusion: that there exists a high prevalence and diversity of Chlamydiales DNA in ticks and the very real possibility of human infection. https://www.ncbi.nlm.nih.gov/pubmed/24698831 and https://www.ncbi.nlm.nih.gov/pubmed/26386066
All of this continues to demonstrate why Lyme Disease isn’t typically just Lyme Disease but MSIDS, multi systemic infectious disease syndrome, a literal menagerie of pathogens invading the human host making our cases extremely complex and difficult.

Bartonella and carditis:

https://madisonarealymesupportgroup.com/2017/01/04/endocarditis-consider-bartonella/

https://madisonarealymesupportgroup.com/2017/05/11/bartonella-henselae-in-children-with-congenital-heart-disease/

https://madisonarealymesupportgroup.com/2018/02/07/finally-rt-pcr-detected-bartonella-henselae-dna-on-tissue-valve/

https://madisonarealymesupportgroup.com/2017/05/20/bartonella-endocarditis-opportunistic-infection-in-cancer-patients-and-eye-inflammation/

Babesia and carditis:

https://madisonarealymesupportgroup.com/2018/02/20/babesia-and-heart-issues/

Mycoplasma, Chlamydia, Bb and carditis:

https://madisonarealymesupportgroup.com/2018/04/04/correlation-of-natural-autoantibodies-heart-disease-related-antibacterial-antibodies-in-pericardial-fluid-mycoplasma-bb-chlamydia/  Mycoplasma pneumoniae antibody positive patients had significantly higher anti-CS IgM levels. In CABG patients we found a correlation between anti-CS IgG levels and Mycoplasma pneumoniae, Chlamydia pneumoniae and Borrelia burgdorferi antibody titers. Our results provide the first evidence that natural autoantibodies are present in the PF and they show significant correlation with certain antibacterial antibody titers in a disease specific manner.

Hopefully by now it’s clear that carditis caused by TBD’s is not even close to rare.  It should also be painfully clear that we are truly in the dark ages on this and that much work needs to be done – and quickly.

Ending on a personal note, I had these bizarre heart symptoms early in my journey.  To say they were frightening would be an understatement.  I would wake in the middle of the night with my heart flopping like a fish out of water.  It felt like an elephant was sitting on my chest and my biceps were often numb.  I gasped for air as well.

Upon my first dose of Mepron, Artemisinin, and an intracellular antibiotic, I felt as if I was having a heart attack.  Thankfully we pulsed the artemisinin as that allowed the frightening herxes to dissipate some.  Due to my response to these drugs my guess is Babesia was the culprit.  https://madisonarealymesupportgroup.com/2016/01/16/babesia-treatment/  We treated Babesia for an entire year as it’s a notoriously persistent pathogen.  It’s important to hit it hard and long as it’s been known to build resistance to drugs.

There has been debate among some as to the effectiveness of Artemisinin and I do feel quality matters.  I’m a huge fan of this kind:  https://www.allergyresearchgroup.com/quality-artemisinin.  And no, I’m not affiliated with them in any way.  BTW:  We used 500mg morning and night MWF.  It makes your mouth taste metallic.

Do not mess around with heart symptoms.  Be a clanging gong until someone takes you seriously and feel free to copy this article and take it to your doctors.  They need to be educated and We the People are up to bat.

Lastly, please remember all the testing for ALL TBD is horrible.  You need a doctor who will diagnose and treat you clinically.  Your reaction to the medication is important to track as it will alert your doctor to what you are dealing with based on symptoms:  https://madisonarealymesupportgroup.com/2015/08/15/herxheimer-die-off-reaction-explained/

https://madisonarealymesupportgroup.com/2017/06/28/jarisch-herxheimer-a-review/

https://madisonarealymesupportgroup.com/2017/11/03/first-report-of-bartonella-quintana-immune-reconstitution-inflammatory-syndrome-complicated-by-jarisch-herxheimer-reaction/

Let’s suffice it to say, heart problems with tick borne illness is NOT rare.

 

 

Ocular Manifestations of Rickettsia in Children: Common but Frequently Overlooked

https://www.ncbi.nlm.nih.gov/pubmed/29776935

Ocular manifestations of rickettsia in children: common but frequently overlooked.

Marques SHM1,2, Guerra MG2, Almeida C2, Ribeiro M2.

Abstract
We review two cases of ocular manifestations of Rickettsia conorii infection in children. A girl who presented unilateral visual loss with focal retinitis and macular oedema and a boy with unilateral central scotoma and bilateral anterior uveitis. Progressive functional and anatomic recovery was observed after oral antibiotics and steroids were initiated.

 

Update on TBD’s in Travelers

https://www.ncbi.nlm.nih.gov/m/pubmed/29789953/

Update on Tick-Borne Bacterial Diseases in Travelers.

Review article

Eldin C, et al. Curr Infect Dis Rep. 2018.

Abstract

PURPOSE OF REVIEW: Ticks are the second most important vectors of infectious diseases after mosquitoes worldwide. The growth of international tourism including in rural and remote places increasingly exposes travelers to tick bite. Our aim was to review the main tick-borne infectious diseases reported in travelers in the past 5 years.

RECENT FINDINGS: In recent years, tick-borne bacterial diseases have emerged in travelers including spotted fever group (SFG) rickettsioses, borrelioses, and diseases caused by bacteria of the Anaplasmataceae family. African tick-bite fever, due to Rickettsia africae, is the most frequent agent reported in travelers returned from Sub-Saharan areas. Other SFG agents are increasingly reported in travelers, and clinicians should be aware of them. Lyme disease can be misdiagnosed in Southern countries. Organisms causing tick-borne relapsing fever are neglected pathogens worldwide, and reports in travelers have allowed the description of new species. Infections due to Anaplasmataceae bacteria are more rarely described in travelers, but a new species of Neoehrlichia has recently been detected in a traveler. The treatment of these infections relies on doxycycline, and travelers should be informed before the trip about prevention measures against tick bites.

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**Comment**

This review clearly shows how much work still needs to be done.  To boil down this complex illness to a round of doxycycline shows a simplistic understanding of these pathogens on steroids.  Mainstream researchers still haven’t gotten the memo that Eva Sapi reported about doxy throwing the spirochete into the non-cell wall form or the information that both pathologist Alan McDonald and microbiologist Tom Greer are finding spirochetes hiding in worms in the brains of folks with dementia and Alzheimer’s.

To announce doxy as the “one side fits all” treatment is truly uninformed.

While doxy is a great front-line drug, patients need to be monitored closely for symptoms.  Since testing is so poor, doctors should also be educated on:  https://madisonarealymesupportgroup.com/2017/09/05/empirical-validation-of-the-horowitz-questionnaire-for-suspected-lyme-disease/  Print out and complete the symptom check lists and take them with you to your appointment.

Remember, Lyme is the rock star we all know by name.  There are many wanna-be’s just as powerful often at play:  https://madisonarealymesupportgroup.com/2017/07/01/one-tick-bite-could-put-you-at-risk-for-at-least-6-different-diseases/  The number is actually 18 and counting.

Please encourage doctors to become educated.  It’s our only hope.

https://madisonarealymesupportgroup.com/2018/02/19/calling-all-doctors-please-become-educated-regarding-tick-borne-illness-heres-how/

Here is an example of good Lyme treatment:  https://madisonarealymesupportgroup.com/2016/02/13/lyme-disease-treatment/

Type other pathogens into the search bar to get other treatment suggestions.  Feel free to copy these off and share with your practitioner.