Tips about Ticks:
A 6-Part Overview of Lyme Disease, Co-infections, Diagnosis, Conventional and Alternative Treatments, Complications and Prevention Strategies
By Dr. Deanna Walker, ND and Dr. Rahima Hirji, ND
PART 2: Co-Infections
Lyme disease is caused by B. Burgderfori however, often ticks carry more than one infection. There are several co-infections that can be carried and transmitted by ticks making the diagnosis and treatment of these diseases very difficult.
Babesia
One of the most common co-infections is Babesia. It is transmitted via Ixodes scapularis ticks (also called blacklegged ticks or deer ticks)
It presents with malaria like symptoms including fever, chills, sweating, muscle pain, fatigue and enlargement of the spleen as well as air hunger, shortness of breath, rib pain, sharp, shooting pains, bone pain and headaches. Neurological symptoms like brain fog and numbness and tingling might also be present with concurrent psychological illnesses including depression, anxiety and insomnia. Gastrointestinal symptoms may also occur.
In some cases, hemolytic anemia, liver problems, very low blood pressure and kidney failure can occur and may result in death.
Babesia can be diagnosed by a blood smear where the parasite can be seen on microscopic examination. However, this method is only reliable in the first two weeks following infection. After these two weeks, antibody titers may raise during the first few weeks of infection and can be measured or a PCR test can be used. More information on testing will be available in the upcoming blog posts.
Babesia can be difficult to treat but the most common treatment includes Atovaquone and Erythromycin or Clindamycin and Quinone. Combination drugs should be considered due to the high probability of resistance when using only one drug.
For chronic infection, treatments may be prescribed for several months.
In the case of infection with both Lyme and Babesia, there may be increased severity and prolonged duration of illness.
Bartonella
Bartonella is transmitted by fleas, lice and ticks. There are three main types of Bartonella:
- Bartonella henselae, or cat scratch disease
- Bartonella quintana, caused by human lice and are responsible for trench fever
- Bartonelal bacilliformis which is transmitted by sand fleas and causes Carion’s disease.
Ticks in Europe, Asia and North America have been shown to carry B. Burgderfori and B. henselae. Symptoms include muscle and joint pain, headaches, fatigue, decreased stamina, tremors, migratory peripheral neuropathy, foot/heel pain and alcohol intolerance. Neurologic symptoms may include cognitive impairment, impaired executive functioning, memory deficits, delayed processing speed, moodiness, transverse myelitis or encephalopathy. Mental emotional symptoms include rage, OCD type behaviour, anxiety/depression, acute changes in personality and PANDA (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection) or PANS (Pediatric Acute-onset Neuropsychiatric Syndrome. Of unique significance is the appearance of striae on the skin (stretch marks) that seem to disappear when the bartonella is treated.
In pregnancy, symptoms of fatigue, headaches and urinary pain that are unresponsive to traditional treatments can be a sign of infection. Babies born to infected mothers have been shown to acquire the illness and can present with colic, frequent waking, night sweats, hyperactivitiy, dark circles under the eyes, frequent eye blinking and ear infections.
Blood tests, PCR tests and tissue biopsies can be used to diagnosis Bartonella, however, there are often false negatives.
Treatment usually includes azithromycin however clarithromycin, rifampin, trimethoprim-sulfamethoxazole and ciprofloxacin may also be used. In more serious cases, it is important to use more than one agent for longer periods of time. Relapses and the need to retreat are very common.
Borrelia Miyamotoi
- miyamotoihas been detected in two species of North American ticks, the black-legged or “deer” tick (Ixodes scapularis) and the western black-legged tick (Ixodes pacificus). Symptoms of B. miyamotoi include recurrent high fevers, drenching sweats and chills, headaches and neck stiffness, fatigue, muscle pain, confusion, hearing loss and loss of control of body movements (ataxia). It presents similar to other tick borne illnesses and can be difficult to distinguish.
Testing for B. miyamotoi is not very reliable. Antibody tests and PCR tests can be used but are not always accurate and can result in false negatives.
Doxycycline is commonly used but a combination of treatments may be required if the infection is serious or if there is central nervous system involvement.
Ehrlichia/Anaplasma
Ehrlichia or Anaplasma are one of the most common tick borne co-illnesses. It is transmitted by the lone star tick (Amblyomma americanum). The most common symptoms for ehrlichiosis are a high fever, severe headaches, flulike symptoms, muscle pain, rash, nausea, vomiting and fatigue. In the immunocompromised, ehrlichia can be fatal so it is important to suspect and treat if symptoms present.
When diagnosed and treated, ehrlichia does not seem to have the same chronic effects of illness as Bartonella, Babesia and Mycoplasma.
Ehrlichia or Anaplasma should be diagnosed based on clinical symptoms and history and can be later confirmed through blood tests and through microscopic examination of white blood cells, bone marrow and cerebral spinal fluid.
Doxycycline is the treatment of choice and should be continued for 7 – 14 days or at least 3 days after the fever subsides and clinical symptoms start to improve. Longer treatment may be required in chronic cases.
Other Co-Infections
Many other co—infections have been identified and present depending on geographical locations. These include the following:
- Colorado Tick Fever
- Q Fever
- Powassan
- Rocky Mountain Spotted Fever
- Tularemia
- Mycoplasma
The presence of co-infections makes diagnosis and treatment very difficult. It is important to get the appropriate testing done in a timely manner and to address all underlying possible causes of illness.
Stay tuned for our next post outlining testing options for Lyme disease and co-infections.