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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