December 19, 2018
How Lyme and Hidden Infections Sabotage Our Clinical Outcomes
by Jason Bachewich, ND
Jason Bachewich, ND, is a naturopathic doctor practicing in Winnipeg, Manitoba, Canada. He is the owner and clinical director of Nature Doctors and has a keen interest in infectious disease and cancer. He graduated from the Canadian College of Naturopathic Medicine and has consulted for many of the large professional nutraceutical manufacturers. He has lectured internationally on a number of topics and has been a presenter on many local television stations. For more information, please see http://www.lymedoc.net or http://www.thenaturedoctors.ca.
What if I told you that as a clinician, you were potentially misdiagnosing a large percentage of your autoimmune patients? What if the arthritis, Alzheimer's, cancer, or Grave's disease was actually caused by an infection? The research is starting to show that perhaps our bodies are not flawed or simply have bad luck but rather sabotaged by chronic and hidden infections. Our treatment plans would be different, and our outcomes more positive. This is the beginning of a whole new understanding of chronic disease, and the potential is hugely exciting.
Environmental Toxin Lyme disease has been gaining a lot of attention in the media lately. Doctors are becoming more aware of the symptoms, but why just look at Lyme disease? There are multiple bacterial, viral, and other parasitic infections that can sabotage our clinical outcomes and have been ignored or assumed to be benign. This article is going to help you to identify those key symptoms to look for, how to test for the infections, and familiarize you with the most common hidden infections that we are not taught about in medical school.
Lyme is the ultimate mimicker. Sometimes it looks like arthritis, sometimes like MS or rheumatoid arthritis, and other times like chronic fatigue.1-3 A patient may present with adrenal fatigue or weird facial or muscle tics, unusual skin sensations, and periods of feeling okay and other times struggling to get out of bed. On top of this, all diagnostic testing comes back mostly normal: no indication of autoimmunity, normal organ function testing, and no nutritional deficiencies.
My experience over the last few years has taught me to throw out the "facts" that I have been taught about chronic infections: The bullseye lesion is rare, incredibly rare, and often can look like a bruise or present as a rash on a different part of the body than the bite location.
There is no season to Lyme disease or co-infections. Ticks have two main peaks in their life cycle; and when you take into account global warming, increased songbird migration range, and the international travel of our clients, never rule out an infection based on time of year.
It was thought that the tick needs to be attached for 24 hours, that bites need to be seen; but this is not the case.4 In fact, many of my patients rarely remember a tick being on them. Many of these infections can also be transmitted by fleas and mites and intimate contact with someone already infected.
Definitive diagnosis based on lab work is not always possible. Lab tests can be accurate and flawed. Does the lab you use test for one of the more than 52 strains identified? It is believed that four to six of the strains are the disease causative ones, but a few years ago we believed it was only one or two. Did the lab test occur before the one-month mark or after the three month mark? Was the lab test performed after antibiotics had been initiated? Did the lab also test for co-infections? Many tests are performed improperly, at the wrong time, or are inherently flawed.
Autoimmune disease doesn't usually "just happen." Sometimes, we do have a fluke in nature, and the body short circuits; but it is becoming more and more apparent that the body does not intend to start destroying itself. Often the immune system is hunting something inside the cells of the tissue itself and destroys healthy cells in the friendly fire. A great example of this is the link between Epstein-Barr virus (EBV) and thyroiditis/Graves' disease.5,6
I find it shocking to think that the medical profession believes that something as simple as herpes virus 1 or 2 can come out as a lesion on our skin yet not create a lesion inside the body and produce symptoms that are hard to understand, while diagnostic imaging would be negative and blood tests all show normal.
BDNF Essentials The World Health Organization in 1997 estimated that some cancers are 84% attributable to viruses, bacteria, and parasites and estimate that 15% of all cancer cases could be prevented by preventing the infection in the first place. They also went on to state that treating the bacterial, viral, or parasitic infection could result in the remission of cancer.7
One of my first patients was a gentleman with chronic debilitating testicular pain. He had every test in the book done on him, and everything was fine; yet he was in excruciating pain. I questioned him extensively and discovered that despite having no obvious trauma to the testicles, his pain started shortly after a couple weeks of extreme stress, sleep deprivation, and poor diet. My mind immediately thinks "immune suppression," and what occurs when the immune system is weak is these hibernating viruses come out to play. I asked his doctor to test him for chickenpox and herpes, and sure enough, it was internal shingles. We were not taught about these abnormal and internal presentations of the disease in school, but if you look in the literature, it exists. Antiviral therapy, B12 injections, nutraceuticals supporting the immune system and suddenly the pain subsided.
Anytime a patient presents with abnormal symptoms and no obvious event or cause, you need to think infection. I have had patients with chronic migraines, sudden onset, no history and nothing abnormal in conventional medical investigation; yet their labs come back as positive for a secondary occurrence of Cytomegalovirus.
We have to add in the fact that patients might have acquired an infection, but Lyme is not the only possibility.
Ehrlichia/Anaplasma often presents with symptoms similar to Lyme, but there are a few distinguishing differences. Often patients will have sharp, knife-like headaches, muscle pain (not joint), sudden onset of psychiatric symptoms, and possibly a diffuse rash over large parts of their body. The treatment is often the same as Lyme, but this infection is often missed by simply not testing for it. In the area where I live, rate of co-infection with Lyme and Ehrlichia is 50%, meaning if you get Lyme, there is a 50% chance you also contracted Ehrlichia/Anaplasma. The published data shows much less with rates closer to 10% in Manitoba,8 but infectious disease doctors have confided that their experience shows that it is much higher.
DesBioBartonella has some very unique and confusing symptoms. Being that all of these infections can theoretically infect the brain and spinal cord, we need to look for mood disorders and psychiatric changes of sudden onset. Patients may experience morning fevers, muscle twitching/seizures, striae across their backs that look like stretch marks, and extreme fatigue. In addition, Bartonella can lead to endocarditis, retinitis, epilepsy, aseptic meningitis, and liver and spleen enlargement. Patients that are hospitalized with these conditions would not be typically tested for infection. There are even associations with pediatric and blood borne cancers.9,10
Babesia is similar to malaria in many ways, which perhaps is the reason why it responds so well to artesunate IV's or oral artemisia medications. Patients will often have issues with sweating, temperature control, stiff neck, air hunger, stomach pains, rapid onset of fever, and feel mentally dull and tired. This infection can often be confused with menopausal symptoms, adrenal fatigue, and simply being stressed out and run down. Malarone, Plaquenil, or quinine are the drugs of choice; but it does respond well to natural medications and often requires multiple supports and medications.
Rickettsia has a similar presentation to Babesia with fevers, headaches, swollen lymph nodes, and nausea/vomiting; but it can also simply present as a rash.
Chlamydia pneumoniae is not the STD that most patients assume it is. It is usually contracted through human contact and results in an upper respiratory infection. However, in those with a compromised immune system, it can develop into arthritis, brain fog, ear/nose/throat chronic concerns, and tendovaginitis. There have even been papers published showing a connection to multiple sclerosis, rheumatoid arthritis, depression, Alzheimer's, autism, and other neurological pathologies.11-13
Mycoplasma pneumonia is also an acute, usually self-limiting, upper respiratory infection. However, it can set up shop in a run-down individual and create symptoms that mimic so many other diseases. Fatigue, joint pain, swelling, headache, insomnia, anxiety, memory loss are all symptoms I have seen in patients with this infection. The literature also shows an association with ALS, Gulf War syndrome, esophageal cancer, and encephalitis.14
NDNR Award Yersinia is associated with short-term but acute bowel symptoms, but it can be much more complicated. In my practice, I had a gentleman presented with acute bowel pain, just above the umbilicus, no precipitating event. Eating relieves it for five minutes but increases the pain after. Pain killers have little effect, and lab work/scopes all show normal. My first thoughts were to try an elimination diet and do a complete digestive stool analysis to see what was reacting and what was growing in him. He displayed some food sensitivities, and the stool analysis showed some overgrowth but no parasites. I decided to run an infection panel through a German lab, and we discovered his immune system was fighting Yersinia. Upon further investigation, I learned that Yersinia usually is self-limiting but, on rare occasions, can burrow into the muscular tissue of the bowel and create chronic symptoms.15 In the end, we ended up treating with antibiotics and natural supportive agents. This was another perfect example of a hidden infection.
Viral infections add a whole other bag of complications to our patients. More often than not, a Lyme patient will be treated, and their symptoms get 50% better; but they wax and wane. Many practitioners will say "biofilm" or "cysts" and augment the treatment protocol. Sometimes it works but often it doesn't. I have found that in many of my chronic patients, their latent viruses come back to life—Epstein-Barr virus (EBV), Herpes 1-8, Coxsackie, Cytomegalovirus (CMV) amongst others. Never mind other infections such as Powassan virus that very few labs test for.
EBV is a tricky beast. Acutely known as "mono," few doctors realize that it can become chronic. How many doctors have had patients that we treat that have said that they have never been well since having mono as a teenager? Or how many patients have all the pain symptoms resolve after treatment for Lyme but have persistent fatigue issues now being called "post Lyme syndrome"? My clinical experience has shown that if a person still feels sick for a long period of time, they are still fighting something. It is normal to have a medication hangover from long-term antibiotics and inflammation, but anything past a couple months should raise alarm bells. EBV has also been associated with non-Hodgkin's lymphoma.16
Herpesvirus 6, 7, and 8 are usually acquired during childhood and can re-emerge later. The symptoms for herpes-virus 6 mimic MS, Hashimoto's, and fibromyalgia. Bone marrow suppression seems the main characteristic, so abnormal white blood cell counts should get you thinking. Herpesvirus 7 (roseola) is acute but also chronic. The key mechanism to think about is myelin degradation. Signs include memory issues, twitches, headaches, unusual sensations, and muscle spasms or knots that don't relate to tension or overuse. Herpesvirus 8 is usually associated with the immune compromised (such as HIV/AIDS). Patients will often present with fatigue, arthralgia, and fevers. In HIV/AIDS patients, this virus is associated with the onset of Karposi's sarcoma.
Cytomegalovirus does not stand out in terms of unusual symptoms. They are typically fatigue, fever, and swollen lymph glands. However, there are some papers to show that there is an association between this virus and coli-tis, atherosclerosis, esophagitis, hepa-titis, pneumonitis, and non-Hodgkin's lymphoma.17,18
Parvovirus (slapped cheek disease) can reinvigorate during adulthood and clinically present as polyarthritis and chronic fatigue. The arthritis would typically be symmetric and chronic, showing a similar pattern to rheumatoid arthritis.
Coxsackie (hand, foot & mouth disease) in children presents with the classic sore throat, cough, fatigue, headache, night sweats, and conjunctivitis. Complications that can arise include diabetes, aseptic meningitis, and central nervous system paralysis. However, I have noticed that many of my chronic fatigue syndrome patients have tested positive for active Coxsackie and responded quite well to anti-viral therapies. Coxsackie has been associated with chronic fatigue syndrome many times in the literature.19
This is the developing part of the story. Many labs still rely on the standard IgG and IgM antibody testing. While this may be useful in the acute onset of the disease, these tests can be useless in the second coming of a latent virus. Some labs have started to develop new tests such as the Elispot test that looks at the activity of the immune cells over the last 72 hours. There are a few labs in the world using this test now but call it by different names. This has been extremely useful as antibody testing can be flawed. Western and Southern blot and DNA PCR testing can be helpful but are often plagued with false positives from cross reactivity or false negatives from lack of genetic strain diversity. Cystic forms of the disease such as in Lyme disease can now be tested for using antibody testing. While no test exhibits 100% accuracy, my experience has taught me that we are better to check off more boxes on the test requisition form than less. Many infections present as chronic fatigue, so how do you pick which one? Some useful tips for using lab tests include the following:
Test for more than less. It is easier to convince a patient to spend a bit more than to see a negative test come back and convince them to send another kit back in.
Call the lab and talk to the physician or lab director in charge of testing to interpret results that are not clear. I have learned a ton doing this.
Most labs use great technique and science. If one lab says they are the best and tells you not to use another lab, be wary. Profit should not trump care.
Don't test too often or too early. You will drive yourself crazy as these diseases wax and wane. A good pattern is 12-week protocol with retesting.If we test the CD57+/CD 56, do antibody testing, DNA PCR, and Elispot testing, we can get pretty darn close to 99% specificity and 99% sensitivity. This usually will come to $2000 - $3000 to put together a full panel. I currently use three different labs – two situated in the United States and one in Germany (see the Resources section). As a clinician, there is nothing worse than sending away for testing after convincing the patient to drop a fair chunk of money and have it come back negative for everything.
Transfer Factor Some naysayers will preach that if you check off enough boxes, you will eventually find something. This could be true, but that is the meaning of the word medical "practice." Experience will show you trends that lead you to the diagnosis. There are always going to be false positives; but if you combine that with knowledge and clinical experience, the true diagnosis will reveal itself. At the end of the day, we need to park the ego and realize that we have to continue to learn and grow as a clinician. So, the next time a patient does not respond to treatment, perhaps you will start to think about the possibility of a hidden infection.
Now the fun part begins as you will notice that there are very few proven medical treatments for these chronic infections, but there are many natural interventions with historical use and success. But that is another article.
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- Rashid T, Ebringer A. (2011, September 2). Autoimmunity in Rheumatic Diseases Is Induced by Microbial Infections via Crossreactivity or Molecular Mimicry. Autoimmune Dis. September 2, 2011; or Hsieh Y-F, et al. Serum Reactivity against Borrelia burgdorferi OspA in Patients with Rheumatoid Arthritis. Am Soc Microbiol. September 19, 2007.
- Saberi A, Akhondzadeh S, Kazemi S. Infectious agents and different course of multiple sclerosis: a systematic review. Acta Neurologica Belgica. July 13, 2018.
- Sertour N, et al. Infection Kinetics and Tropism of Borrelia burgdorferi sensu lato in Mouse After Natural (via Ticks) or Artificial (Needle) Infection Depends on the Bacterial Strain. Front. Microbiol. 2018;9:1722.
- How to Handle a Tick Bite. https//iladef.org
- Janegova A, et al. The role of Epstein-Barr virus infection in the development of autoimmune thyroid diseases. Endokrynologia Polska. May 1, 2015.
- Dittfeld A, et al. A possible link between the Epstein-Barr virus infection and autoimmune thyroid disorders. Cent J Eur Immunol. October 25, 2016.
- Cassell GH. Infectious Causes of Chronic Inflammatory Diseases and Cancer. Emerging Infectious Diseases. July-September 1998.
- Manitoba Annual Tick-Borne Disease Report – 2017. https://www.gov.mb.ca/health/p.....rt2017.pdf
- Messinger CJ, et al. (2017 March 22). Seroprevalence of Bartonella species, Coxiella burnetii and Toxoplasma gondii among patients with hematological malignancies: A pilot study in Romania. Zoonoses Public Health. September 2017.
- Mazur-Melewska, K, et al. The significance of Bartonella henselae bacterias for oncological diagnosis in children. Inf Agent Cancer. 2015.
- Marrodan M, et al. The role of infections in multiple sclerosis. Mult Scler. 2019 Jan 14 : 1352458518823940.
- Saberi A, Akhondzadeh S. Kazemi S. Infectious agents and different course of multiple sclerosis: a systematic review. Acta Neurol Belg. September 2018.
- Contini C, et al. Chlamydophila pneumoniae Infection and Its Role in Neurological Disorders. Interdiscip Perspect Infect Dis. 2010:273573.
- Huang S, et al. (2001, April 15). Mycoplasma infections and different human carcinomas. World J Gastroenterol. April 15, 2001.
- Saebø A, Lassen J. Acute and chronic gastrointestinal manifestations associated with Yersinia enterocolitica infection. A Norwegian 10-year follow-up study on 458 hospitalized patients. Ann Surg. 1992 Mar;215(3):250-5.
- Jha HC, Banerjee S, Robertson ES. The Role of Gammaherpesviruses in Cancer Pathogenesis. Pathogens. 2016;5(1):18.
- Mehravaran H, et al. Association of Human Cytomegalovirus with Hodgkin's Disease and Non-Hodgkin's lymphomas. Asian Pac J Cancer Prev. 2017;18(3):593–597.
- Weng MT, et al. Cytomegalovirus colitis in hospitalized inflammatory bowel disease patients in Taiwan: a referral center study. BMC Gastroenterol. 2017;17(1):28.
- Rasa S, et al. Chronic viral infections in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). J Transl Med. 2018;16(1):268.
Arminlabs (Germany): http://www.arminlabs.com
Can test for bacteria, viruses, parasites, and mold as well as many others.
Turn-around time is usually 1-2 weeks sometimes even less.
Do not need a centrifuge; simply draw and ship Monday or Tuesdays.
Price is relatively lower than other labs for complete viral and bacterial panel, about $1000 - $1500 US
Gives you the option of testing for cyst or round body form of Lyme disease, which is pretty unique.
Elispot testing shows recent cellular activity so it is a way of tracking.
Have to draw and send by UPS early in the week to ensure it gets there quick enough, which can be hard for some people's schedules.
IgeneX (US): http://www.Igenx.com
Similar testing options to Arminlabs now; their version is called the Immunoblot (vs. Elispot).
May be easier shipping option for doctors in the US.
Need to centrifuge the samples prior to shipping.
Similiar comprehensive panel could cost about $1500 -$3000 US.
Less viral options for testing.
DNA Connexions (US): http://www.dnaconnexions.com
Easy urine sample – great for pediatric, young kids, or people with terrible veins.
Cheap: about $500 US
Tests Lyme and co-infections but no viruses.
DNA PCR testing; it is possible that the absence of DNA in the urine does not mean you are free and clear of infection.
W. O. Belfield, Jr.