Tick-borne relapsing fever (TBRF) is a spirochetal infection caused by Borrelia hermseii, Borrelia miyamotoi, and several other less well-known bacterial species. Tick-borne relapsing fever is found in Africa, Spain, Saudi Arabia, Asia, Canada, and the western United States. Rodents are the primary reservoir and ticks are the likely vector for this disease. Tick-borne Relapsing Fever is best diagnosed by PCR testing.

Symptoms of TBRF include:

• Fever
• Malaise
• Cognitive Dysfunction
• Fatigue
• Body Aches
• Other transient and nebulous symptoms vary from patient to patient

Fungal Infections As Co-infections or Secondary Infections in Lyme Disease Patients Who Are Immunocompromised

As of 2018, recent research by Fry Laboratories in Scottsdale, Arizona, suggests that, at least in some patients with chronic fatigue syndrome and arthritis, the fungus may be the actual problem. This should come as no surprise because fungi, bacteria, and viruses have been coevolving on Earth and in hosts for millions and millions of years. Fungi are found throughout the environment and especially in soil, air, water, and in normal healthy people, they may not pose a problem. However, in patients who are immunocompromised, fungal infections can be VERY problematic.

Candida is a well-known yeast in the intestines that feeds on sugar and can become symptom-causing in patients who have a poor diet of carbohydrates and sugar. BUT…this is not the only fungus that immunocompromised patients are susceptible to. There are many other fungi that are disease-causing but diagnostic testing was severely lacking. Things have changed now. Fry Labs has a urine, blood, or stool DNA sequencing test that most insurance companies cover. Disease-causing fungi such as:

Entomophthoromycota – contains pathogens of insects

Ascomycota – parasitize mammals and cause systemic infection

Basidiomycota – airborne cells that can cause pneumonia

Aspergillus – causes pneumonia, sinusitis, and brain abscesses

Fusarium – spreads through the bloodstream and can cause skin infections

Mucorales – airborne and dangerous to patients with diabetes and uncontrolled blood sugar

These are simply a few of the fungal organisms that can be problematic to human health and fully recovering from Lyme Disease. But there is a test for these now and we can specifically identify them and treat them so that the total pathogen load on the immune system is reduced.

Without question, fungal infections can be treated by both herbs and/or anti-fungal medications, but you MUST know which infection(s) you have so that you can get on the right medication. Some natural antifungals include:

• Caprylic Acid
• Garlic
• Oregano Oil
• Neem
• Cloves
• Black Walnut
• Cinnamon
• Coconut Oil
• Ginger

Some medications that treat fungal infections include:

• Nystatin
• Diflucan
• Ketoconazole
• Sporanox
• Itraconazole

However, anti-fungal medications are typically hard on the liver and routine monthly blood tests to check for liver enzymes is a MUST. Pulsing anti-fungal medication is also a good idea.

Talk with Dr. Marra if you would like to be tested for fungus other than Candida through Fry Labs. You won’t be sorry that you did this test.

Ehrlichia chafeensis (HME), Ehrlichia ewengii and Anaplasma phagocytophilum(HGE), are emerging zoonotic diseases, especially in areas where human urban living encroaches on endemic tick areas.  These bacteria are largely found in mammals residing in the southeastern, south-central, and mid-Atlantic areas of the United States, and according to the CDC, most cases are reported in the states of Maryland, Arkansas, Missouri, Oklahoma, and Tennessee.  Ehrlichia and Anaplasma bacteria have also been noted in Brazil, the United Kingdom, France, Slovenia, Switzerland, Germany, the Netherlands, Spain, Russia, and Japan. However, similar to other tick-borne diseases, migratory birds probably play a significant role in disease spread around the globe, and these bacteria (HGE and HME) are likely found in other areas of the world not yet identifying and reporting the disease.  Of note, Ehrlichia in particular is known to be a veterinary disease largely seen in horses and dogs.

Ehrlichia and Anaplasma are intracellular obligate bacteria that require a host for replication and a vector for transmission (i.e., ticks).  Human signs and symptoms of these diseases are often not accompanied by a “Bullseye rash”, however, there may be redness and heat at the site of the tick bite.  HME or HGE illness can occur quickly (depending on the number of bacteria delivered to the host at the bite site), or it can develop more slowly over time as the bacteria replicate and proliferate in the host.  Generally, clinically presenting symptoms can include fever, stiff neck, joint pain, muscle aches, headache, chills, malaise, nausea, and diarrhea.  Elevated serum liver enzymes including ALT and AST may also occur, lending clues to the underlying bacterial infection in question.

HGE and HME are serologically diagnosed using antibody titer tests or by using PCR (polymerase chain reaction) which demonstrates the presence of bacterial DNA in the blood and therefore exposure to the bacteria that cause Ehrlichiosis.  Careful determination of these bacterial infections is important because the presence of Rocky Mountain Spotted Fever, Brucella, Typhus, and Q fever (also zoonotic diseases) can cause false-positive serology for Ehrlichia.

Occasionally, these infections can require hospitalization, especially for pain management which results from the activation of acute and prolonged pro-inflammatory cytokine release and tissue damage due to the host’s immune system activation.

An integrated medicine treatment approach to Ehrlichia and Anaplasma infections, where a combination of immune-supportive herbs, anti-inflammatories, and antibiotics in rotation, are recommended and generally yield favorable outcomes.   However, not unlike other tick-borne infections, when the infection(s) are diagnosed early (less than 12 months from the time of the tick bite) prior to dissemination throughout the body, a return to health is maximized.

In the next decade, cutting-edge research on genomics, proteomics, and the cellular microbiology of these bacterial infections is likely to reveal additional therapeutic agents (i.e., herbal, nutritional, and pharmacological). Future therapeutic interventions may focus on disengaging adhesin molecules that bind to white blood cells, which interfere with the replication and proliferation of these bacteria in the host.  Around the world, more and more researchers are becoming interested in developing effective new therapeutics for eradicating these diseases.

Brucellosis is a zoonotic and tick-borne disease caused by the bacteria Brucella melitensis, and is an ancient disease, dating back to the 5th plague of Egypt around 1600 BC.  Archeological excavation of Egyptian human bones dating around 750 BC demonstrated evidence of osteoarticular abnormalities that are often symptom complications from a Brucellosis infection.  Brucella is found all over the world, especially in countries that rely heavily on agriculture, livestock, and dairy products such as Australia, Canada, Denmark, Finland, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom, the Middle East, and central Asia.

David Bruce was the first scientist to identify the bacteria Brucella melitensis in British soldiers stationed on Malta (an island in Italy) who developed severe fever leading to the name “Malta Fever” for this disease complex.  In 1897, a Danish veterinarian, L.F. Bernhard Bang, discovered a bacillus bacteria in cattle and termed it “Bang’s Disease.”  However, an American scientist, Alice Evans, famous for her work on pathogenic bacteria in dairy products, confirmed that Malta Fever and Bang’s Disease were caused by the same bacteria now known as Brucella melitensis.  Alice Evans was largely responsible for instituting the pasteurization process of dairy products to prevent human disease in the United States.

To date, there are 9 species of Brucella, (5 are pathogenic to humans), and in 1990 it was discovered that Brucella was also found in marine mammals.  Brucella species are facultative, intracellular, Gram-negative, coccobacilli, and nonmotile due to the lack of flagella.  Sheep or goat’s milk consumption is a significant source of Brucellosis infection, so minimizing the natural animal reservoirs for this disease is important for curbing disease outbreaks.

Symptoms of Brucellosis include fever, night sweats with a strange odor, chills, weakness, malaise, insomnia, anorexia, headache, joint pain, constipation, nervousness, depression, and impotence.  Many organ systems can be affected by Brucella infection including the: brain (encephalitis), heart (endocarditis), joints (arthritis), testes (orchitis), and prostate gland (prostatitis).

Mothers who are breastfeeding may transmit the infection to their infants and sexual transmission has also been reported in the scientific literature.

Diagnosis of Brucellosis is confirmed using antibody titer tests, IgM, and IgG which demonstrates exposure to the Brucella bacteria.

Integrated medicine treatment for Brucellosis including herbal and nutrient immune support coupled with antimicrobial herbs and antibiotics generally yields very positive outcomes. However, Brucella can have varied effects on individuals so the length of treatment time is variable.

If you have additional questions or concerns please contact our office.

Vector-borne bacterial infections such as Lyme disease can be a serious infection caused by Borrelia species, also known as a spirochete, which is transmitted via a tick bite (perhaps also flea and mosquito bites). Many strains of Borrelia exist, and some do not cause disease. Nonetheless, there are likely greater than 100 strains of pathogenic Borrelia and probably more as yet unidentified. Certainly, geographic strain differences exist, especially with regard to continents, as the disease-causing bacteria have also been documented in Europe, Australia, China, South America, and Africa. Lyme disease and co-infections are most probably ubiquitous and found on every continent in the world.

Below is a map showing the average risk of encountering Lyme disease-carrying ticks in central and Eastern Canada from the year 2000 compared to the year 2015:

Lyme disease and other tick-borne illnesses can present as acute or chronic infection(s) depending on the length of exposure to the bacteria and the pathogen load at the time of infection. Often the infection(s) is treated with appropriate antibiotics, but at other times when persistent long-term infection ensues, treatment becomes more difficult. To complicate matters further, ticks carry other infectious bacteria in addition to Borrelia. They include Babesia, Ehrlichia, Anaplasma, Bartonella, and Mycoplasma for certain, but there may be other bacteria, viruses, and fungi not yet identified that are problematic and disease-causing as well. Additionally, a tick bite may also transmit the newly identified HGRV retrovirus. However, to date, the latter infection has not yet been scientifically documented as a vector-borne disease.

More likely, the presence of Borrelia sets the stage for the invasion of opportunistic secondary infections (i.e., HHV6, EBV, Cytomegalovirus, Parvovirus B19, Chlamydia pneumonia, Candida) by lowering the overall host’s immune system function. This allows the proliferation of other infections that in effect overwhelm the body’s inherent immune defense mechanisms. Intestinal parasites such as hookworm, tapeworm, flukes, etc., may also contribute to intestinal illness seen in the tick-borne disease.  Further discussion of this matter as it directly pertains to you will occur at your initial office visit.

Lyme disease is well known for variable symptom presentation which is one of the reasons it is so difficult to diagnose. Arthritis, Lupus, Multiple Sclerosis, ALS, Parkinson’s Disease, Crohn’s Disease, Irritable Bowel Disease, autoimmune diseases, a myriad of psychiatric disorders, and Autism are simply a few of the diagnoses where Lyme disease should be considered in the differential diagnosis. This is precisely why Lyme disease is known as the “Great Imitator” because the constellation of symptoms observed in a patient is likely to be confused with other diagnoses. Additionally, the incidence of Lyme disease and co-infections in the United States alone has been steadily escalating since the mid-1980s. Although Borrelia was first identified in 1975 by Dr. Willie Burgdorfer in Lyme, Connecticut, global recognition of the bacteria’s presence and severity remains elusive.

Rocky Mountain Spotted Fever (RMSF) is considered the most serious tick-borne illness and is caused by the bacteria, Rickettsia rickettsii.  It can be deadly if not treated with the proper combination of antibiotics and supplements. It was identified in the Rocky Mountains in the 1800s but is also found in Western Canada and parts of Central and South America.

It is primarily carried by the American dog tick, Rocky Mountain wood tick, and the brown dog ticks. Symptoms of Rocky Mountain Spotted Fever include lacy rash, headaches, high fever, nausea, muscle pain, poor appetite, abdominal pain, joint pain, and conjunctivitis. Typically, the rash starts at the extremities and moves to the trunk as small, flat, pink non-itchy macules.  The rash can involve the palms and soles of the feet.

Complications from the infection can occur, including cognitive deficits, ataxia, hemiparesis, blindness, deafness, or amputation.

Treatment for RMSF can include doxycycline, tetracycline, rifampin, and possibly fluoroquinolones. The treatment may last many months to avoid complications.

Louse-borne relapsing fever (LBRF) is caused by the spirochete, Borrelia recurrentis, and is largely transmitted from person to person by lice. This bacteria is unique because it can alter the proteins expressed on its surface which causes the “relapsing” characteristic symptoms. It initially infects the mucus membranes and then moves into the bloodstream.

Symptoms can include:

1) Fever
2) Malaise
3) Fatigue
4) Cognitive Dysfunction
5) Prolonged QT interval on EKG
6) Jaundice

Generally, this is a more severe infection than tick-borne relapsing fever and is often found in poor, underdeveloped countries such as Ethiopia.

Q Fever is a vector-borne disease caused by the bacteria, Coxiella burnetii, and is found in cattle, sheep, goats, cats, and dogs.  Humans can get infected by inhaling endospores, ingesting the milk, urine, or feces of an infected animal, or from a tick bite.

Patients with Q Fever generally develop fever, chills, fatigue, and muscle pain.  If not treated properly, the infection can become chronic and require long-term antibiotic treatment, including doxycycline and Plaquenil.

It is thought to have been used as a biological weapon at one time. It is highly infectious, with as little as one organism needed to cause clinical infection, making it an attractive organism for use in biowarfare.

What is Bartonella?

Prevalence

There are over 20 known species of pathogenic Bartonella including B. henselae, B. quintana, etc. Four of them have been isolated in cats, which is why it is called “Cat Scratch Fever.” Reliable Bartonella serum antibody tests are limited to the species B. henselae and B. quintana.  However, newly developed fluorescent in situ hybridization (FISH) testing is now able to detect Bartonella at the species level.

Bartonellosis was first isolated in the early 1920s, and the prevalence of the infection varies geographically.  Northern climates reportedly have less prevalence of the disease, although this trend is changing in conjunction with global climate change.

Effect on Immune System Function

Bartonella infection is characterized by regional lymphadenopathy, low-grade fever, malaise, muscle aches, joint pain, and chronic fatigue.  There have also been reported cases of the enlarged spleen, endocarditis, and encephalitis due to infection.

The infection in immunocompromised patients with low natural killer cells, low T helper cells, and low T suppressor cells present with “red streaks” resembling cat scratches, and this condition is known as bacillary angiomatosis or peliosis.

Studies of patients infected with Bartonella reveal that this bacteria has a particular affinity for the vascular endothelium where organisms are observed in clumps along the vessel wall.  This is an advantageous residence for bacteria that utilize nutrients in the host’s blood for their benefit.

Clustering of Bartonella cases within families has been observed especially when they have adopted feral cats.  Ocular, neurologic, dermatologic, hematologic, orthopedic, cardiac, renal, and pulmonary presentations are typical for Bartonella infections. Symptom presentation may vary among family members.

Treatment

A combination of herbs, antibiotics, immune support, alkalized diet, and exercise are the recommended treatment.

Metabolic Syndrome

Metabolic Syndrome is a collage of risk factors that are associated with an increased risk of stroke, type 2 diabetes, coronary artery disease, and peripheral artery disease. About 30 million Americans suffer from the following symptoms:

• Central abdominal obesity
• Fasting glucose of greater than 100mg/dL
• BP greater than 130/85
• Low HDL
• Fasting triglycerides greater than 150mg/dL

Risk factors for developing Metabolic Syndrome include:

• Increased abdominal girth
• Insulin resistance
• Hypertension
• Hyperlipidemia
• Genetics
• Infections

Scleroderma and Bartonella… Is there a connection?

Dr. Marra has been treating patients with tick borne illness since 1999 in both Westport Connecticut and Seattle Washington. She has had two patients with severe Raynaud’s Syndrome, a Scleroderma diagnosis, and a positive Bartonella henselae serology test, one from each coast.

Dr. Marra does not think that this is a coincidence as Bartonella is known to reside in the vascular system along the inside of the vessel endothelium. She strongly suspects that Raynaud’s Syndrome and Scleroderma could have an infectious etiology that has been overlooked by the medical community because Bartonella is just now considered an emerging zoonotic infection. There is sparse scientific literature on Bartonella infection implications, and she would like to see more research done in this area.

To date, there is no literature indicating an infectious etiology for either Raynaud’s Syndrome or for Scleroderma. There is also very few treatment options offered to patients with these diagnoses. Typically they are left to suffer with these diseases, and Scleroderma can be extremely painful.

Dr. Marra suggests to any patients that have Raynaud’s Syndrome or Scleroderma to be tested for Bartonella henselae through Igenex laboratory. It’s important that the test be done accurately so that tests document the presence of an infection. If an infection is present, prompt use of antimicrobial herbs or antibiotics is extremely important. It is also beneficial that herbs or antibiotics are taken just prior to a very hot shower so that the medicine can reach the peripheral tissue.

In both patients who were found to have a Bartonella infection, subsequent antibiotic therapy was initiated with substantial symptom relief. Better blood flow occurred and the pain and swelling in the fingers receded. Of course this is simply anecdotal evidence, but in the face of having no scientific articles to turn to, this may be a valuable clinical observation for patients with either Raynaud’s Syndrome or Scleroderma.