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What Is Post Treatment Lyme Disease Syndrome?
Question: Hello, my question is regarding Post Treatment Lyme Disease Syndrome (PTLDS) & co-infections with Lyme Disease.
Some background information: I was diagnosed with Lyme disease about 4-5 years ago. There is a marked decline in my functioning after the treatment for the Lyme disease (CDC recommended 30 days on doxycycline) - And, it still effects my ability to go to work, school, and be social. I'm constantly tired (fatigue) & I suspect the condition is also worsening my other psychiatric conditions (anxiety, depression, executive functioning).
When my doctor tested for Lyme 5 years ago the IgG was negative but the IgM was positive. (This was a bit concerning & made us suspect not Lyme but an autoimmune disorder). But then the Western Blot for Lyme was positive. My research told me that the negative IgG probably means I had the Lyme for a long time (https://labtestsonline.org/understanding/analytes/lyme/tab/test/).
I continue to do research to eliminate other possible reasons for my condition. So far my doctors ruled out any thyroid problems, diabetes, and rheumatoid arthritis. A recent blood test showed that my hemoglobin(?) count was on the low side of normal/high side of low (<12 g/dL) which got me thinking about Lyme disease co-infections.
It seems most co-infections (bartonella, erlichia, Q fever) would have been treated with the doxycycline with a couple of exceptions. One that caught my eye was babesiosis - in addition to being related to Lyme, some of the symptoms for the disease that fit are headaches, muscle & joint pains, emotional lability, depression, and retinopathy (2 years ago my eye exam was normal, early this year - January 2016 - I had laser surgery for macular holes), and so on.
My question is 2 fold:
(1) When I asked my PCP about the possibility of babesiosis, she said that 3 years ago - so about 2 to 3 after the Lyme disease treatment - the *follow up* Lyme Western Blot came back negative, so there is no need for an additional test for co-infections. Does the Lyme Western Blot also test for co-infections like babesiosis, or does the Western Blot need to be specific tagged to each disease? Or, would late stage (mostly asymptomatic) babesiosis need another kind of test/specialized test all together (http://www.aafp.org/afp/2001/0515/p1969.html)?
(2) What is the probability that the lower hemoglobin count could be (hemolytic?) anemia if the rest of the counts in that serologic test were normal?
Thank you!
Some background information: I was diagnosed with Lyme disease about 4-5 years ago. There is a marked decline in my functioning after the treatment for the Lyme disease (CDC recommended 30 days on doxycycline) - And, it still effects my ability to go to work, school, and be social. I'm constantly tired (fatigue) & I suspect the condition is also worsening my other psychiatric conditions (anxiety, depression, executive functioning).
When my doctor tested for Lyme 5 years ago the IgG was negative but the IgM was positive. (This was a bit concerning & made us suspect not Lyme but an autoimmune disorder). But then the Western Blot for Lyme was positive. My research told me that the negative IgG probably means I had the Lyme for a long time (https://labtestsonline.org/understanding/analytes/lyme/tab/test/).
I continue to do research to eliminate other possible reasons for my condition. So far my doctors ruled out any thyroid problems, diabetes, and rheumatoid arthritis. A recent blood test showed that my hemoglobin(?) count was on the low side of normal/high side of low (<12 g/dL) which got me thinking about Lyme disease co-infections.
It seems most co-infections (bartonella, erlichia, Q fever) would have been treated with the doxycycline with a couple of exceptions. One that caught my eye was babesiosis - in addition to being related to Lyme, some of the symptoms for the disease that fit are headaches, muscle & joint pains, emotional lability, depression, and retinopathy (2 years ago my eye exam was normal, early this year - January 2016 - I had laser surgery for macular holes), and so on.
My question is 2 fold:
(1) When I asked my PCP about the possibility of babesiosis, she said that 3 years ago - so about 2 to 3 after the Lyme disease treatment - the *follow up* Lyme Western Blot came back negative, so there is no need for an additional test for co-infections. Does the Lyme Western Blot also test for co-infections like babesiosis, or does the Western Blot need to be specific tagged to each disease? Or, would late stage (mostly asymptomatic) babesiosis need another kind of test/specialized test all together (http://www.aafp.org/afp/2001/0515/p1969.html)?
(2) What is the probability that the lower hemoglobin count could be (hemolytic?) anemia if the rest of the counts in that serologic test were normal?
Thank you!
Brief Answer:
Lyme disease with co-infection
Detailed Answer:
Hi,
Thank you for your query. I can understand your concerns.
Lyme Western Blot is specific for Lyme disease . However misuse or misinterpretation of IgM blots has been a factor in the incorrect diagnosis of Lyme disease in patients with other illnesses.Hence an IgM western blot is considered positive if two of the following three bands are present:23, 39, and 41 kDa. However, the combination of two such bands may still represent a false-positive result. An IgG blot is considered positive if 5 of the following 10 bands are present: 18, 23, 28, 30, 39, 41, 45, 58, 66, and 93 kDa.
You have not mentioned about the details of the results undergone before 30 days doxycycline therapy.
Although babesiosis is most often asymptomatic, infection with
this agent may cause nonspecific systemic symptoms, particularly in the young and co-infected patients may have more severe or persistent symptoms .
Babesiosis may cause hemolytic anemia.Low hematocrit, hemoglobin, and haptoglobin levels and elevated reticulocyte counts and lactate dehydrogenase levels are consistent with hemolytic anemia.Please go for these additional test to confirm hemolytic anemia.
Serological test for babesiosis is different.
An indirect immunofluorescent antibody test for B. microti is most
commonly used. IgM titers of ≥1:64 and IgG titers of ≥1:1024 suggest
active or recent infection.Lyme Western Blot does not test for co-infections like babesiosis.
Though Doxycycline is not the drug of choice in babesiosis but it can be used as an alternative drug therapy.
Hence Doxycycline may partially cure co-infection like babesiosis
Regards
Dr. T.K. Biswas M.D. XXXXXXX
Lyme disease with co-infection
Detailed Answer:
Hi,
Thank you for your query. I can understand your concerns.
Lyme Western Blot is specific for Lyme disease . However misuse or misinterpretation of IgM blots has been a factor in the incorrect diagnosis of Lyme disease in patients with other illnesses.Hence an IgM western blot is considered positive if two of the following three bands are present:23, 39, and 41 kDa. However, the combination of two such bands may still represent a false-positive result. An IgG blot is considered positive if 5 of the following 10 bands are present: 18, 23, 28, 30, 39, 41, 45, 58, 66, and 93 kDa.
You have not mentioned about the details of the results undergone before 30 days doxycycline therapy.
Although babesiosis is most often asymptomatic, infection with
this agent may cause nonspecific systemic symptoms, particularly in the young and co-infected patients may have more severe or persistent symptoms .
Babesiosis may cause hemolytic anemia.Low hematocrit, hemoglobin, and haptoglobin levels and elevated reticulocyte counts and lactate dehydrogenase levels are consistent with hemolytic anemia.Please go for these additional test to confirm hemolytic anemia.
Serological test for babesiosis is different.
An indirect immunofluorescent antibody test for B. microti is most
commonly used. IgM titers of ≥1:64 and IgG titers of ≥1:1024 suggest
active or recent infection.Lyme Western Blot does not test for co-infections like babesiosis.
Though Doxycycline is not the drug of choice in babesiosis but it can be used as an alternative drug therapy.
Hence Doxycycline may partially cure co-infection like babesiosis
Regards
Dr. T.K. Biswas M.D. XXXXXXX
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Above answer was peer-reviewed by :
Dr. Remy Koshy
Answered by
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