Melissa Bell - Reporting Live from ILADS Conference Dr. Mozayeni – Baronella Science & Clinical Considerations (with Galaxy Labs) Common when there are neurological and neuro-psychiatric symptoms Common with Lyme treatment failure Small vessel inflammatory Disease – diverse symptoms depending on which organ is impacted; Test for SVID – subcortical neurological exam (potentially partner with neurologist) Gram negative bacteria Slow replication Transmission – via animals (especially cats), ticks, fleas Papules, lymphadenopathy are common Atypical presentation includes endocarditis, granulomatous hepatitis Pathogenesis - inflammation and coagulation; fibrin deposits and biofilms lead to symptoms Symptoms Mild cognitive impairment White matter subcortical disconnect Executive dysfunction impaired (not a dementia) Working memory Processing speed Mood labile Peripheral migratory neuropathy Dysautonomia/POTS Tremors Muscle pain – myalgia Joint pain - arthralgia Headaches Fatigue Decreased stamina Low BP liver cysts (tend to resolve in Bartonella concentration in cats 1 million times higher than dogs or humans; single blood culture probably insufficient due to fluctuating levels in blood (triple screen recommended) Testing at Galaxy – PCR (with sequence confirmation) plus enrichment culture x3 to increase sensitivity (80-90%); repeat testing every 3-6 months to determine effectiveness of treatment Antibody – often negative due to immune suppression (especially before treatment); antibodies develop and disappear during treatment Case study – aspirated cyst in breast tested positive for Bartonella 2012 paper – study where most patients had failed Lyme treatment; small vessel disease clinical selection. Culture positive Bartonella in 41%. Variety of strains (sequenced); serology 62% were positive; 75% had one or the other. Veterinarians higher occupational risk. Perinatal – no evidence of transmission in his practice; umbilical cord blood negative and children are healthy; there is a published case on perinatal transmission (confirmed in newborn) but he feels this is the exception Treatment: Pitfall endocrine – Rifampin treatment interferes with endocrine funciton; this is often a cause of treatment failure (including adrenal fatigue and thyroid; hypothyroidism is often subclinical and with treatment, symptoms improve with T3) Long duration (ramp up time plus 6 months) Conventional protocols don’t seem work PO antibiotics fine in moth Intracellular and extracellular permeation Resistance vs. persistence Common patient profile: Typical IgM positive for Lyme that normalizes with Rx; IgG negative (no seroconversion) Mild WBC decrease (transient neutropenia; watch patients weekly) Elevated C4a
Posted on: Fri, 10 Oct 2014 12:58:57 +0000