A CAROUSEL OF MICROBES IN THE TICK-BORNE MENAGERIE

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PRESENTED AT THE 2002 LDF INTERNATIONAL SCIENTIFIC MEETING.ON TBDsA CAROUSEL OF MICROBES IN THE TICK-BORNE MENAGERIE-- PATHOGEN MICROBES MAY ROTATE IN TURN AS THEIR CO-INFECTORS WAX AND WANEAbstract by Virginia T. Sherr, M.D.It is generally assumed that if a prominent tick-borne microbe istreated aggressively, any hidden co-infections will stay at a steadylevel unless they, too, have been actively addressed whereupon they areexpected to maintain a permanent back seat. When this assumption istested in the clinical setting, it is discovered that surpriseexacerbations of previously unknown or treated co-infections are likelyto occur and, if not suspected and tested for, they likely will confoundthe success of the physician's treatment plan. For example, in 1998 apatient who previously had tested negative for ehrlichiosis, Mrs. P, wasnearing completion of 8 months of IV antibiotic treatment for herchronic neuroborreliosis (chronic Lyme disease of the nervous system).Her symptoms, which had been subsiding, returned at nearly full force.At first, the increase of her symptoms was blamed on the idea that theIV cefotaxime (Claforin) had lost its power to eradicate spirochetes. Asthe syndrome progressed, her symptoms coalesced into clusters, then intowaves of sweats, chills, itching, burning, hot and cold spells, blurredvision, irritability and neurological changes such as clumsiness. Theperiodicity of the mostly afternoon waves made it reasonable to test forbabesiosis, which is a malaria-like tick-borne disease (TBD) caused byan intra-red blood cell protozoa. Testing showed an IFA titer of>1:512-a significantly positive test for active babesiosis. Atovaquone (Mepron) immediately was used to treat this parasite and once again the symptoms subsided. The course of treatment included several oral antimicrobials combining to destroy the menagerie within Mrs. P. Then, in 1999, after a period of improvement, a serious flare of symptoms recurred. The cornucopia of tick-borne organisms was tested for once more and a previously quiescent ehrlichiosis--called by some "Spotless Rocky Mountain Fever" and by others, "the Rodney Dangerfield of TBDs for it gets no respect" was revealed as now virulent in this patient. There was a positive HGE (Human Granulocytic Ehrlichiosis) antibody titer of 1:160 that helped to explain why the patient was weak and otherwise symptomatic. This recurrent, rickettsial, intra-white cell bacteria had been tested for early on when the Lyme and then the babesiosis were flaring and had been thought to be absent. Mrs. P's condition has required on-going treatment with antibiotics and this familiar pattern is noted to be circular. In recent years, attempts to eliminate any cystic spirochetal forms by using metronidazole combined with appropriate antibiotics, led to rounds of symptom flares that, in turn, led to further testing including that for the likely-to-be-lurking ehrlichiosis. Once again, this patient who had avoided the out-of-doors, who has no pets, and has not been re-exposed to tick-bites, has a titer of 1:160 but now for antibodies to HME (Human Monocytic Ehrlichiosis). She has experienced the spinning manifestations of a variety of microbes in the carnival that has become her health. Seemingly, the animals on the "carousel" take turns at becoming the dominant player, dependent upon which of the associates are resilient enough to take charge when the latest dominant alpha microbe is diminished and is beaten into submission.