November 8, 2013
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Bacterial infection caused by Borrelia Burgdorferi, a spiral shaped spirochete Transmitted through the bite of an infected tick Ticks carry multiple infections – natures “dirty needle” Lyme disease must include borrelia and co-infections Lyme disease is clearly transmitted maternal – fetal in-utero and breast milk Black legged tick Ixodes scapularis (NE)- Ixodes pacificus (West Coast) carry
Borrelia Burgdorferi Other Borrelia species
B. garinii - Eurasia B. Afzelii – Eurasia B. miyamoto I – Japan & NE B. lonestar I – TX & SE
Over 100 strains of Bb in the US. Bb genetically one of the most sophisticated ever studied (syphilis has 22 genes, Lyme has 132)
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Conc. in NE Upper mid-west / mid-Atlantic but in all 50 states Confirmed cases in MA DPH
2009: 4,045 2005: 2,461
DPH Est 5-10X under reporting Can occur any time of year Young ticks most active May-July Adult ticks active spring ,fall and winter temperatures above
freezing Transmission
Length of attachment time Can be within 4 hours (location, thin skin) Longer attachment = > transmission but no safe time
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Avoid tick habitats Cut grass low Clear 10’ space before trees Cut underbrush increase sunlight Spray yard with permethrin Body checks Wear protective clothing – permethrin on clothes
only – deet not on infants, on children – oil of lemon & oil of eucalyptus
Tick tubes Damminix permethrin can decrease larvae, nymphs, ticks
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Deer tick nymphs poppy seed size Deer tick adult female sesame seed Dog tick larger If bit pull tick straight out with tweezers put in plastic
bag label – send to www.tickdiseases.org for ID 30% or more are Bb infected Ticks also carry Anaplasma, Ehrlichea, Babesia,
Bartonella, mycoplasma, viruses Varying # of incidence Bart 5-10% cult Babesia 12%
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LD is a clinical diagnosis Early DX- tick bite and symptoms EM rash is definitive with or without the tick being
seen or symptoms 50% don’t see tick bite 50% don’t see EM rash
Likelihood of exposure & symptoms LD is great imitator of our times like syphilis in the past On-set abrupt or slow All organs can be affected Symptoms often vague and change day to day
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Flu-like illness Fatigue not relieved by rest Headaches Low grade fever Dizziness Pain or stiffness Migratory arthralgia, myalgia Sleep disturbance Abdominal pain Neurological: ◦ Poor balance, coordination ◦ Hypersensitive to touch, sound, light ◦ Mood disturbances , depression/anxiety ◦ New onset phobias ◦ Oppositional behavior ◦ OCD ◦ Motor/vocal tics ◦ Bells palsy, optic neuritis ◦ Peripheral neuropathies
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Difficulty with concentration/attention
Word finding common
Short term memory difficulties
Social withdrawal, less participation
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CDC 2 tiered testing 1. Elisa screening test (50% negative) 2. W Blot IgM 3 bands/IgG 10 bands
◦ Antibody response to specific bands – reflect exposure to Borrelia
◦ 18 23 31 34 39 83-93 Lyme specific bands ◦ 41 = spirochetes in general ◦ CDC def 2 IgM bands / 5 IgG bands ◦ IgM increases by 7-10 days – cont to increase over 1-2
months/decrease over 6 months ◦ IgG increase after 30 days; can last years
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Most commercial tests 1 strain Igenex 2 strains, all bands IgM/G – including 31 & 34 Even 1 specific band can indicate exposure; more
bands = stronger test PCR – DNA material Bb is in tissue not blood – only 30%+ PCR May require multiple samples looking at serum, whole
blood, urine, CSF (only 10% +) Testing: CD57 NK cells by Lab Corp or Igenex New blood culture for Lyme – Advanced Lab At 16 week – 94% accurate 1 peer review article
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Early easy 4 week amoxicillian, ceftin, doxycycline >8 years
Sicker patients less likely to be antibody pos. 30% can have neg. western blot 36% convert to pos. WB after treatment Co-infections = sicker person Immune factors Genetic makeup Biofilms Klinghart emf virulence of Bb
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Bb spirochete exists in 3 forms: ◦ Spirochete ◦ L form no cell wall ◦ Cystic form
Early disease ◦ Amoxicillin, doxycycline, cefuroxime ◦ Length of treatment at least 4 weeks ◦ All signs and symptoms cleared ◦ If ill > few months ◦ Treat at least 2 months after no symptoms – no cyclic recurrence ◦ Sickest children often need months to years of treatment ◦ All co-infections must be treated often must rely on clinical diagnosis only
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Antibiotic Categories: Cell wall agents: ◦ Amoxicillin ◦ Augmentin ◦ Cefuroxime ◦ Cefdinir ◦ Bicillin IM ◦ Ceftriaxone IV
Intracellular agents: Doxycycline Minocycline Clarithromycin Azithromycin Rifampin
Cyst & biofilm agents: Metronidazole Tinidazole
Also for biofilm: Samento/banderal Nattokinase, umbrokinase,
serrapeptase
Grapefruit seed extract
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Co-infection testing even less accurate Antibody testing ◦ Anaplasma ◦ Ehrlichea chaffensis ◦ Bartonella Henselae/Quintana ◦ Babesia microti/duncani Blood smear early in infection
• Igenex Fish testing for Bart/Babesia • Fry biofilm – hemobartenella-like organisms Galaxy
Lab - PCR and culture for Bartonella species
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Symptoms of Bartonella: Gradual onset, occasional light night sweats More CNS symptoms than skeletal GI upset, pain Sore soles feet Can have VEGF Rashes Rapid relapse if treatment incomplete Responds to: ◦ Azithromycin ◦ Sulfa ◦ Rifampin ◦ Fluoroquinolones
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Symptoms of Babesia: Abrupt onset, marked night sweats Cycles every few days Fatigue, global headache, chills, chest pain Cough, palpitations Responds to antimalarials: ◦ Mepron/Malarone ◦ Azithromycin ◦ Clindamycin ◦ Sulfa ◦ Artemesinin
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Rapid onset can be high fever
Headache knife like, behind eyes, sore muscles
Can have (low) WBC, LFT elevated
Responds to Doxycycline, Minocycline, Fluoroquinolones, Rifampin
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Gradual onset, light sweats
Major fatigue, neurologic symptoms
Sickest and poorest responding patients CFIDS
Difficult to treat
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Must treat all 3 forms of Lyme spirochete, L form, cyst Consider coinfections, viruses, mycoplasma Support detox, immune system Low sugar diet Check for heavy metals – especially Hg Pb Attention to gut health Endocrine disorders (Low thyroid adrenal) Sleep issues Pain Autonomic dysregulation
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Maternal Lyme 50% chance infected child 1 Antibiotic = 25% less risk 2 antibiotics throughout pregnancy – lowers risk to 1% Amoxicillin/Cefdinir, Cefuroxime, Azithromycin, Mepron Breast feeding risk
Dr. Jones 160+ women with Lyme treatment before and during pregnancy – all healthy children 8 tested positive for Borrelia or Bartonella PCR of placenta/umbilical cord or foreskin & were treated
for 6 months oral antibiotics and are symptom free
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