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Compliments of & Kate's Lyme doctor, thanks for scanning and sharing.

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Marta

More Handout

Just in from my " scanner " person...

Babesiosis

Babesiosis is an infection that may be spread by the same tick that carries

Borreliosis (Lyme disease). It is caused by Babesia microti, which is a

protozoa, not a bacteria, virus, fungus, or yeast.

Other examples of protozoal infections are Malaria and Giardia. Water

contaminated with Giardia will cause diarrhea. Because a protozoa is a different

type of germ, it may require antibiotics that are not normally used for

Borreliosis.

In the past, it was known that some Borreliosis patients had co-infections.

Ticks carry many infections, such as Ehrlichia, Tularemia, and Rocky Mountain

spotted fever.

At the 1999 Borreliosis and tick-borne infection conference in New York City, it

was stated that most Borreliosis patients have a co-infection, especially

Babesiosis. Indeed, since I returned from that conference and started testing

more for Babesiosis in my Borreliosis patients, I have been getting more

positive than negative test results for Babesia.

Prior to that conference, I was just ordering IFA (Immuno-fluorescent antibody)

tests in an effort to keep costs down for patients. At the conference, I learned

I was missing a lot of Babesiosis cases by not doing the full Babesia panel from

IgX labs. Like I was told, several patients for which I ordered the full panel,

had negative IFA's but a positive PCR-DNA probe and or a positive blood smear

test (FISH: fluorescent-in-situ-hybridization).

Obviously, the question arises about whether the Babesia test results are

falsely positive. Uniformly, almost all patients with a positive Babesia test

respond to Mepron and Zithromax. So, false positives have not been a problem.

At the 1999 conference in New York, Joe Burrascano, M.D. said in his lecture

that many of his Borreliosis patients with a negative Babesia test still respond

to Mepron and Zithromax. I have seen the same thing in my patients with negative

Babesia tests.

The question then is whether false negative Babesia tests occur, or if Mepron

and Zithromax are killing Borrelia burgdorferi (one of the Borrelia that may

cause Lyme Borreliosis). Like a lot of things in life, maybe some of both factor

into the result.

Regardless, since I have been more aggressive in testing for Babesiosis, and

treating with Mepron and Zithromax, my success rate in helping Lyme Borreliosis

patients has escalated dramatically. It has been such an exciting addition to

treatment options.

In New York City at the conference, it was stated that the symptoms of

Babesiosis are the same as Borreliosis. Except Babesiosis causes even more

sweats and fever than Borreliosis. In other words, Babesiosis is just as

important an infection as Borreliosis, if not more so. Borreliosis patients with

sweats and fever are a red flag to go after Babesiosis.

Some patients have positive Babesia tests and negative or equivocal (almost

positive) Borreliosis tests. This has been an interesting twist. Since most

Borreliosis patients have Babesiosis, the opposite applies. Babesiosis patients

eventually get a positive Borreliosis test in most cases.

Ehrlichiosis was also stated to be a chronic persistent infection at the New

York conference. This tick-borne infection used to be thought to be an acute

fulminant life-threatening infection, which it may be. Patients die from acute

Ehrlichiosis. But it may also be a chronic persistent infection like Borreliosis

and Babesiosis. Ehrlichiosis should be covered by tetracycline, Doxycycline, or

Minocycline.

For Lyme Borreliosis, Joe Burrascano, M.D. in New York prefers Doxycycline. Ken

Liegner, M.D. in New York prefers Minocycline. Sam Donta, M.D. in Boston likes

Tetracycline. In my practice, Tetracycline works the best.

Tetracycline is less bound to protein in your blood (serum). So it gets better

penetration into your tissues where the germs are. Doxycycline may be taken

twice a day. Minocycline gets into the brain better. So each has its advantages.

All may predispose patients to sunburn. Pants, long-sleeved shirts, wide-brimmed

hats, and a 30 spf sunblock should be used if sun exposure is going to occur.

Mepron and Zithromax are usually all that is needed to get Babesiosis patients

better. Jarisch-Herxheimer reactions may occur with Mepron and Zithromax. These

reactions occur when antibiotics kill germs and when the germs die, they release

their toxins. Since toxins are the cause of symptoms, a Jarisch-Herxheimer

reaction results in a worsening of the symptoms.

The better an antibiotic works, the more germs will die and release their

toxins. So, the worse the Jarisch-Herxheimer reaction the better the antibiotic

is working.

Mepron and Zithromax have markedly improved Babesiosis patients symptoms. As you

might conclude, Mepron and Zithromax may thus cause terrible Jarisch-Herxheimer

reactions. This is a two-edged sword. Greater success is desirable but patients

get better quicker with milder Jarisch-Herxheimer reactions.

Therefore, the first time Mepron and Zithromax are tried, low doses are

increased until the patient feels better, or gets up to 1 teaspoon of Mepron

twice a day with food in adults.

Start with 1/4th of a teaspoon, taken with food, twice a day for 3 days. Then

use 1/2 teaspoon twice a day for 3 days, then 3/4 teaspoon with breakfast and

supper for three days, and finally 1 teaspoon twice a day. A bottle of Mepron

has 210 ml (42 teaspoons), so it will take about 5 weeks to get through the

first bottle, unless there are any Jarisch-Herxheimer reactions. If these

reactions occur, go off both Mepron and Zithromax until your worsened symptoms

get better. It is best to go completely off antibiotics during these reactions.

With the low initial dose approach, and going off during Jarisch-Herxheimer

reactions, it may take longer than 5 weeks to get through the first bottle of

Mepron. Do not worry about that. Just try to get through the bottle, however

long it takes.

Symptom improvement at doses of Mepron lower than 1 teaspoon twice a day is a

signal to stop increasing the dose. In the past, I had patients push the dose up

to 1 teaspoon twice a day. But pushing doses often leads to severe

Jarisch-Herxheimer reactions. So now I tell patients to stop at the dose where

they start feeling better.

If the symptom improvement levels off, that plateau is indicative that you need

to bump up your dose of Mepron if you are on less than 1 teaspoon twice a day.

Overall, the trend should be that you are getting better, not staying the same.

Use just one 250 mg Zithromax tablet once a day while you are finding your top

dose of Mepron. If you start improving, keep your doses of both Mepron and

Zithromax the same.

If you get to a full teaspoon of Mepron twice a day and do not feel any better,

then go up to two Zithromax tablets a day. Wait 3 days, and if no response, add

a third Zithromax at a different time. After another 3 days, your Zithromax dose

may be increased to two tablets twice a day. Be sure your pharmacist gives you

tablets that you may take with food (not capsules, which require an empty

stomach). Most of my patients get better with lower doses of Mepron and

Zithromax. Very few people take two Zithromax twice a day.

While on Mepron and Zithromax, or any antibiotic, be sure and take your

Nystatin. The yeast protocol applies anytime you are on antibiotics.

After you finish your bottle of Mepron, stop the Zithromax also. Wait 3 days

before you start Flagyl (Metronidazole). Take Flagyl for 5 weeks, then go off it

3 days before your next round of Mepron and Zithromax.

With the second bottle of Mepron, you may start directly with the top dose of

Mepron that you used with the first bottle. You do not have to slowly taper up

the dose like you did in the first round. Start with the same top dose of

Zithromax also.

Every time you go through a bottle of Mepron, stop the Zithromax at the same

time and wait 3 days before starting your 5 weeks of Flagyl. Using these

alternating cycles of Mepron and Zithromax and Flagyl is really working

fantastically in most patients.

Many patients that I have treated for years and have tried on them just about

everything on planet Earth, are doing much better with this approach. Lately, my

need for intravenous antibiotics for patients has plummeted because of the

patient responses to these oral antibiotics.

Getting rid of all symptoms could occur in about 3 months. But more

realistically, 6-12 months or longer is usually needed. But almost everybody

gets better. I do not guarantee anything to anyone, but you should focus on most

patients greatly improving.

If Mepron and Zithromax do not help, then Sulfa, Quinine, or Clindamycin may

need to be added to the protocol. It is nice to have other aces up our sleeve,

just in case.

Flagyl (Metronidazole) was also presented at the 1999 conference in New York

City. It is an old antibiotic that has been around for about 40-50 years. But is

new for Borreliosis treatment, and has proven to be very effective.

Tinidazole is a similar antibiotic to Metronidazole. Tinidazole is a drug that

is made by Pfizer, but because there was no obvious market for it, not much was

done. So you have to get Tinidazole from a compounding pharmacist that orders

the Tinidazole powder from Pfizer and puts the powder into capsules.

The price of Tinidazole is about three times higher, but it causes less

gastrointestinal upset and passes the Ames test for cancer. It is nice to have

another option to Metronidazole.

Flagyl often gives great results so the Jarisch-Herxheimer reaction may thus be

severe. Three of my patients have had to be hospitalized because of these

reactions.

Usually, just going off Flagyl is all that is needed for the worsened symptoms

to get better. But a bad reaction may require a short burst of steroids, such as

Prednisone 20 mg, 3 times a day in the middle of meals, usually for 3 days.

Patients may have to refill the Prednisone several times, however.

With most antibiotics, after 3-6 days off, the Jarisch-Herxheimer reaction is

better. But with Flagyl or Mepron with Zithromax, some patients have taken a

month for the symptoms to get better! You need to respect Flagyl, and go off if

there is any question about your symptoms getting worse.

Start with very low doses of Flagyl initially, even if you are a 300 pound

football player. On the first day, take 1/4th of a 250 mg Flagyl tablet once a

day, and see how you do. Slowly increase your dose until you feel better, or

until you get up to a full 250 mg 3 times a day, with food. If you get to 250 mg

three times a day, wait 6-8 weeks before considering the 500 mg pills of Flagyl.

Very few of my patients tolerate the 500 mg dose, and they are usually big

muscular men.

Far more of my patients are on the lower doses of Flagyl. Some patients have to

take a " sliver " of a 250 mg pill every 4 days to keep their Jarisch-Herxheimer

reactions bearable. But at these incredibly low doses, they are still getting

better.

The message I am hearing from patients over and over is " low dose and slow " wins

the race. You want to be a turtle, not a rabbit! If you start to feel better,

stay at that dose unless you plateau. If you feel better but push your dose of

Flagyl, watch out for a bad Jarisch-Herxheimer reaction.

The correct dose is when you are slowly getting better, and if you have a

JarischHerxheimer reaction that it is a mild one. Aggressive personalities

invite prolonged recovery times from these reactions. Since you have to go off

Flagyl during the reaction, in the long run, you get better slower. It is better

to hit a dip in the road to recovery than a deep, wide valley.

As mentioned, Giardia is a protozoa. One of the drugs used for Giardia is

Flagyl. So if Flagyl will kill the Giardia protozoa, maybe it will kill the

Babesia protozoa. I do not have any scientific proof of that. But I have lots of

patients with positive Babesiosis and Borreliosis tests who are getting better

with just Flagyl. So in the clinical trenches, it looks very promising.

In the past, I recommended 3 weeks of Mepron and Zithromax and 3 weeks off -

repeating this cycle. But most patients need more than 3 weeks to get through a

bottle of Mepron.

The reason I changed to 5 weeks of Flagyl is based upon some research done in

Norway. Brorson and Brorson discovered that the spirochete (spiral-shaped

bacteria) Borrelia burgdorferi has the ability to turn into a cyst form. Think

of it as a ball shape. But it is a microscopic cyst, not a visible cyst like in

the skin.

The only antibiotic that kills the cyst form of Borrelia burgdorferi is Flagyl.

Other antibiotics actually cause the spirochete to turn into the cyst form!

This explains why a lot of Borreliosis patients may get better for a while on

antibiotics before hitting a plateau or getting worse. Some spirochetes were

being killed so patients felt better. But some spirochetes changed into the cyst

form, due to the antibiotics.

The cyst form of Borrelia burgdorferi may produce tumor necrosis factor, for

example, which may make you feel lousy. So, the cyst form may be a significant

source of symptoms.

In my opinion, this research from Norway is the most important discovery for

Borreliosis in over a decade. It partly explains why we have struggled over the

years in helping patients. Part of the " brick wall " that patients run into is

the Jarisch-Herxheimer reaction. And part of it is the co-infection with

Babesiosis. Who knows what that " brick wall " may be discovered to contain in 10

years? But the cyst form is absolutely huge, as I see it.

The Norwegians also discovered that if a patient goes off antibiotics for a

week, a one day old cyst form of Borrelia burgdorferi will convert to a

spirochete form.

If the cyst is 5 weeks old or older, after a month off antibiotics the cyst will

transform into a spirochete.

In the test tube, Flagyl kills the cyst form, but not the spirochete form. But

the problem I have with that, is that a lot of my patients are getting better

with just Flagyl. The human body is not a test tube. Maybe Flagyl kills the

spirochete form in the body, or by killing the cyst form your immune system may

do a better job killing spirochetes.

It would appear that an anti-spirochetal antibiotic would need to be added to

Flagyl. But other antibiotics cause the spirochete to turn into a cyst form.

This may be shooting ourselves in the foot.

But some of my patients have required adding a second antibiotic to their

Flagyl. One of my jobs is to figure out what to put with Flagyl, if anything.

Think of the cyst form and spirochete form like a caterpillar and a butterfly.

They are the same organism but in different forms. Except cysts and spirochetes

may change back and forth.

The reason I changed to 5 weeks of Flagyl, in between cycles of Mepron and

Zithromax for Babesiosis, is due to the conversion time for a cyst form to turn

into a spirochete. If it takes a month for a cyst that is 5 weeks old or older

to convert, then theoretically, 5 weeks of Flagyl should result in conversion of

more cysts back into spirochetes.

In general, cysts are harder to kill than other forms of germs. So converting

cysts to spirochetes may help.

Since Flagyl may cause a terrible Jarisch-Herxheimer reaction, just like Mepron

and Zithromax, do not take all 3 of these at the same time. A " double "

Jarisch-Herxheimer reaction could theoretically be deadly. One patient took all

3, and his reaction was so severe he thought he had had a stroke. Interestingly,

he was tremendously better prior to his reaction. Maybe very, very low doses of

these 3 would work, but cause mild reactions.

After patients are normal and have no symptoms, I give them one more month of

Flagyl, then go off for 5 weeks. They then take 2000 mg of Flagyl all at one

time, and wait a few days to see if they have a Jarisch-Herxheimer reaction.

Next they take a high dose of an anti-spirochetal antibiotic.

Again, they go off 5 weeks, and repeat the 2000 mg of Flagyl, followed by an

anti-spirochetal drug. Wait 5 weeks again, and repeat these drugs a third time.

Theoretically, 5 weeks off will convert some residual cysts to spirochetes.

Many Borreliosis patients get rid of their symptoms. But later when they are

traumatized physically or emotionally (car wreck, divorce, bankruptcy, death of

a loved one, moving, job change, falling off a horse, etc.) their Borreliosis

symptoms may return.

Trauma stresses and weakens the immune system. Since all of the Borrelia

burgdorferi are not eradicated with antibiotics, a weakened immune system

invites bacterial growth and symptom reappearance.

So, if high doses of Flagyl and an antispirochetal antibiotic are used every 6th

week for 3 cycles, hopefully some of the residual cysts and spirochetes will be

killed. Then future traumas and immune suppression may possibly not result in or

flare of symptoms.