Co-Infections

There are a number of co-infections to consider treating Lyme Disease. It is currently believed these enter the body with the tick bite. The first two are the ones we commonly see here in Australia. These two are frequently found on PCR testing after negative serology in Lyme disease.

Mycoplasma including fermentans

Chlamydia Pneumoniae 
(recently re-classified chlamydophila but this terminolgy is not being widely used yet. It is distinct from STD's)

Bartonella Henselae 

An emerging bacterial infection in domestic and farm animals in Australia but now also humans. Serology may detect this in the meantime. Treatment is azithromycin, rifampicin or Doxycycline. PCR testing is only available in the US

In Australia we have another genotype of bartonella causing human disease - more on this imminently

Babesiosis - Human - Usually B. Microti or B. Duncanii can be found. It is suspected we have a further genotype causing human infection in Australia.

A good description of this disorder is given at http://emedicine.medscape.com/article/996610-overview
and from The American Family Physician http://www.aafp.org/afp/2001/0515/p1969.html
It is a very serious disease in people who have had a splenectomy. Treatment is Atavaquone 750mg and Azithromycin 500mg for 6 to 8 months. There is another treatment regime with quinine and clindamycin but the serious side effect profile runs at 72%.

Anaplasmosis 

An emerging infectious disease. http://www.cdc.gov/ncidod/eid/vol11no12/05-0898.htm
and a bovine form in Australia http://www.dpi.qld.gov.au/4790_5839.htm
more US info and data http://www.health.state.mn.us/divs/idepc/diseases/anaplasmosis/hcp.html
The acute infection is called tick fever. Treatment is doxycycline 200mg daily until fever has subsided for 3 days

The practice case load (serologically proven) has all the above infections including a recently found anaplasmosis in a woman who had not left Australia!

XMRV possible role of a retro virus - some snippets from current research

In the US they are now finding protomyxzoa rheumatica, another problematic bacterial infection. We will be keeping a close eye on developments with this over 2012-2013.