Diagnosis and therapy of chronic systemic co-infections in Lyme disease and other tick-borne infectious diseases

Townsend Letter for Doctors and Patients, April, 2007 by Garth L. Nicolson

Another co-infection found in some LD patients is a rickettsial infection caused by Ehrlichia species. (2,3) These small, gram-negative, pleomorphic, obligate, intracellular infections are similar to mycoplasmas in their structures, intracellular locations, and resulting signs/symptoms. Commonly found species are E. chaffeensis and E. phagocytophila, and these microorganisms can cause signs/symptoms within one to three weeks of exposure, such as fever, shaking chills, headache, muscle pain, and tenderness, and, less commonly, nausea, vomiting, abdominal pain, diarrhea, cough, and confusion. (3) Laboratory features include mild to moderate transient hemolytic anemia, decreases in white blood cell count (leucopenia, thrombocytopenia), elevated erythrocyte sedimentation rate and, sometimes, increases in liver enzymes and, less often, increases in blood urea nitrogen and creatinine. Serology is usually only positive after one to two weeks with the limitations discussed above. Since culturing the microorganism is not practical, antibody and PCR testing have been used for confirmation of the infection. (3)

LD patients are at risk for a variety of other opportunistic infections, including other bacterial infections as well as viral and fungal infections. These can complicate diagnosis and treatment, but they may be a problem principally in the late, chronic phase of the disease. Late-stage patients with neurological manifestations, meningitis, encephalitis, peripheral neuropathy, and other signs/symptoms may have complicated co-infections that are not recognized or treated by their physicians.

Treatment of LD Borrelia and Co-Infections

Most LD patients do well on combinations of antibiotics plus nutritional and nutraceutical support. Experts agree that LD is much easier to treat in the earlier phases, but some of the co-infections can be difficult to treat, especially if the disease is in the late chronic stage. The most common recommendations for the treatment of LD Borrelia and co-infections involve antibiotics that can effectively suppress early localized or early disseminated LD Borrelia. (2-4) A variety of antibiotics in two-week regimens show good activity against early-stage Borrelia infections, such as combinations of doxycycline plus amoxicillin, doxycycline plus penicillin V and amoxicillin or penicillin V plus cefuroxime axetil, in that order, in terms of effectiveness and expense, (2,13) although some reports indicate that the latter antibiotics are just as effective as the doxycycline combinations. (14,15) Also, doxycycline also shows good activity against most species of Mycoplasma and Ehrlichia, and it also shows good penetration into the central nervous system (CNS). Doxycycline should not be used in children under the age of eight years, but some have suggested that short-duration treatments (two weeks) at pediatric doses are very useful. (13) Alternatives include the use of erythromycin, but most experts do not consider this a first-line treatment for LD Borrelia. (2,13)