Dr. Mrs. Laurence Meer-Scherrer
Two years ago I spoke about Lyme Disease, the diagnostic and therapeutic aspects. Today I will tell you about the co-infections. Today I wish to show you how important research and treatment for co-infections is. Scientifically illness should be referred to as Tick-borne disease not Lyme Disease, because Tick-borne disease is more correct.
Co-Infections are all micro-organisms which also can be transmitted by tick bites together with Borrelia bacteria. The bacterial co-infections are Bartonella henselae, Rickettsia, Erlichia gran, Erlichia mono and Mycoplasma fermentans. Dr, Mordechai will us more about Mycoplasma and Bartonella later and in my second talk this afternoon, I will tell you about a case report of a patient with Bartonella henselae.
Another class of co-infection is the Protozoa – and here we have the example of Babesia microti as a co-infection. There are several – Babesia microti, Babesia divergens, Babesia wai, Babesia bovis, Babesia bigemina canis, Theleiria. There is not yet a definite list of all Babesia species, - also the list may change in the future because they may find little differences in the strains and make another division of classification.
Protozoa are animals with one cell - they can cause long illnesses, e.g. Malaria or toxoplasmosis are also protozoal illnesses but not transmitted by ticks.
We must also consider the Viruses. There is classic FSME and West Nile virus. This West Nile virus is not in Europe but I try to look in my patients and be aware about WNV because there are ticks in birds and birds fly long distances, so it is not excluded that we can get this also in Europe.
Co-infections are more and more important and they occur more often than several years ago. I find there is more Erythema migrans chronicum (Emc)( a skin rash symptom) that doesn’t heal and it is more and more of a problem to treat than 2 – 5 years ago. The patient may have Doxycycline for 3 - 6 weeks and it is not treated by this, the patient is still sick and increasingly I find co-infections in these cases.
Why is this so? In the whole of Europe we have a warmer climate and some ticks don’t die in the winter. These can accumulate more micro-organisms and I don’t know if you know this but young ticks feed on the adult ticks so they can pick up the micro-organisms of the adult ticks. So there can be an exchange of micro-organisms from adult forms from last year and the young ticks of the new year.
I think birds are very important because of this exchange of micro-organisms. If you ever see a dead bird and open it (with gloves) - you will see so many ticks, many more ticks than on dogs or other little animals in the woods. That is my theory.
When ticks feed on human beings, not only does the human receive the micro-organisms of the tick, but also ticks can take micro-organisms from the human. However, there is nothing in the literature about this. (Is this possible Dr. Mordechai? - He answers but inaudible). Which micro-organisms can be pathogenic for the human beings? In normal conditions we have lots of micro-organisms which are normally not pathogenic for humans. However, having Borreliosis can lead to a type of immune deficiency, and then other micro-organisms that are present can get more pathogenic for humans.
Also there is information about emerging vector-borne and zoonotic diseases by veterinary doctors – they are saying there are more of these in the last few years.
Here is a list - Leishmaniasis in N. Africa but recorded as spreading, cytauxzoonosis (a protozoan infection), Erlichia, Lyme Disease, Babesia microti, Bartonella henselae, Larva migrans, Ascarides, Leptospirosis and Rabies. Malaria could come to Europe too.
In the Protozoa, cytauxoonosis is an infection that is also in the erythrocytes of cats, it is a feline pathogen. Ehrlichia, Borrelia, Babesia and Bartonella, we know. Larva migrans – is a human pathogen, other worms are found in Europe, also Ascarides.
Leptospirosis and Rabies:
Veterinary scientists say they are coming back more and more.
We think we have evicted these diseases but it is not so – they’re all coming back.
The first description of this was in 1999. ( See the ILADS website.)
This was in the Swiss health system bulletin B.A.G. bulletin 52/99 from December 1999. Also, in 2000 Babesia (positive to PCR) was found in Swiss ticks and reported at the conference Surtick 2000. In 2002,
there was confirmation of my publication. The tick results were published by the CDC, USA, in the CDC Journal of Emerging Infectious Diseases. The same results done also in Switzerland by another team.
In 2001, this infection was reported in Czekia in ticks and published.
In 2002, the
disease was also found in ticks from Poland.
Positive serologies have been found in Switzerland in 2002, and in Germany in 2000.
Recently a little girl in the US became ill and then the whole family became ill and they were found to have Monkey Pox (a Variola virus). The Monkey Pox came a long way north because normally the disease only occurs in Africa. How did this happen?
The way was the following: Giant hamsters (which were living in Africa) were exported as a novelty pet. The US has imported the giant hamsters and four of them carried the Monkey Pox which they passed to ‘Prairie Dogs’. Prairie dogs are normally wild in North America. However, now they are becoming a domestic animal or pet. The giant hamster transmitted the pox to the prairie dogs and then the prairie dogs were bought and bit the girl. The girl became very sick with typical pox symptoms. The prairie dogs were also sold to others and at least 60 people were infected. Fortunately no-one died. The Health system of Chicago gave pox vaccines to many people to protect the population. The human is not intelligent and helps to transmit disease sometimes! This illness is dangerous and it never occurred in the US before.
In immune competent persons the symptoms are mild. But symptoms can be life-threatening in immune deficient patients especially in those with splenectomy and transplanted patients, eg people with heart transplants. There are cases of blood received by blood transfusion passing life-threatening Babesia infections to these patients. There are a lot of publications in the US about this. A recent publication gives an example of a healthy human who gave his blood four times and four transplant patients had life threatening Babesiosis because of this. Also HIV and tumor patients can also have a life-threatening illness.
Symptoms of Babesiosis are relatively non-specific. However, I have a lot of Lyme patients and in my Lyme patients – in a lot, I can differentiate whether there is Babesia or not. Those with Babesia have many more sweats and really enormous sweats that come quickly, also chills,
fever, muscle pain, headache and a mood lability. This seems to be a special mood lability in which the mood can change from one minute to the other, wheras I notice that in those with Lyme alone, the mood tends towards depression. The moods are absolutely inexplicable – and one or two hours
later they are gone. Also a fatigue and anaemia but not in all cases.
Also raised leucocytes, raised liver enzymes and splenomegaly (More the exception, most patients have none of these laboratory findings.)
What about the diagnostic possibility of Babesia?
The Babesia divergens is known by vets and also human physicians when patients are splenectomised. Serology of Babesia when the bloodstream is examined can show severe hemolysis with free haemoglobin in the urine and the serum. There can be ARDS (re lung) and kidney failure. That’s a life threatening form of Babesia divergens in Europe. There are seven publications I think.
Babesia microti as a co-infection:
Blood examinations can be serum IgM, IgG and western blot.
I have been doing these tests in the Igenex Laboratories, the MDL Laboratories and also at the University Hospital in Switzerland.
Blood stream examination has less than one percent of
the erythrocytes that have the parasite. It affects the thrombocytes and makes a difference to the artefacts and the colouration of the microscopical appearance. It is difficult and it takes a lot of time to look at the bloodstream, maybe 2 – 3 hours per sample, the signs are so subtle and
no-one has the time( to do tests like this).
You have to repeat the ‘bloodstream negative’ and the next one will be positive. Need to take the blood when there is a fever, so it is a big limitation.
Fortunately, we now have the PCR tests at MDL and this is helping with the diagnosis and I could confirm all my results by PCR in two different laboratories.
And there is another fluorescing test (FISH) also, but it is not accepted so I won’t speak about it.
(A slide of a
bloodstream from a patient in Flammatt, Switzerland, and we can here see a red blood cell with a Babesia – that is the more dark area - Babesia in bloodstream.
Several drugs can be used.
Firstly, Clindamycin and Chinin in combination but this is toxic. (so we can’t do it too long) (Krause et al).
Secondly, also an Atavaquone and Azithromycin treatment (Krause et al.)
The other four treatments here are Empiric treatments:
Mefloquine, Artemisia, highest doses of doxycycline and metronidazole.
These are Empiric treatments and I say this to patients. They are not in the textbooks.
Eradication is not possible (this can also happen in Malaria).
Extracellular forms. It is published that these can happen.
The form of the Maltese cross – can evade the immune system
Stored in liver, spleen and bone marrow.
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