When Lyme disease causes a positive test for mononucleosis

False positive serologies for Lyme disease have been previously reported in patients with acute infectious mononucleosis. However, a recent paper describes two cases in which Lyme disease was misdiagnosed as mono based on false positive serologies for the Epstein-Barr virus (EBV).

 

by Daniel J. Cameron, MD MPH

In the article, published in the journal Clinical Infectious Diseases, Pavletic, from the National Institute of Mental Health, reports “two cases of false positive Epstein-Barr virus (EBV) serologies in early-disseminated Lyme disease.”

In the first case, a 16-year-old male from Virginia developed fatigue, myalgias and three brief episodes of fevers over an 18-day period. He was diagnosed with acute infectious mononucleosis based on a positive viral capsid antigen (VCA) IgM and negative VCA IgG.

It was not until 17 days later with the onset of multiple erythematous rashes and right-sided peripheral facial nerve palsy that doctors diagnosed the young man with Lyme disease. Laboratory evaluation revealed a positive C6 peptide ELISA index of 6.02 and a positive IgM immunoblot. He was prescribed a 4-week course of doxycycline and recovered.

“Repeat VCA IgG, VCA IgM and EBNA were negative, indicating that the initial VCA IgM was falsely positive,” according to Pavletic.

In the second case, an avid biker from Maryland presented with a six-day history of fatigue, fever, myalgias and headache. Lyme disease was diagnosed the next day based on multiple erythematous rashes. Lyme serologies were positive by ELISA, IgG and IgM immunoblots.

Twelve days into her illness she tested positive for mononucleosis with a positive VCA IgM, VCA IgG, EBV early antigen, EBNA IgG, and positive monospot.

The fever resolved and the rashes faded with a 21-day prescription of doxycycline. The recovery was complicated by a right upper trunk brachial plexopathy. “The pain resolved and the weakness improved over the next six months,” according to Pavletic.

“Three and a half years later, repeat VCA IgG and EBNA were positive, and VCA IgM was negative.”

According to the authors, both cases were initially misdiagnosed. “Here we present two cases where early manifestations of Lyme disease were initially misdiagnosed as acute EBV infection due to positive VCA IgM results.”

The authors touched on the difficulties interpreting acute mononucleosis testing. “While isolated VCA IgM may indicate early acute mononucleosis, the test can be nonspecific, especially when the likelihood of acute EBV infection is low.” Pavletic adds, “Immune activation with other pathogens can also result in a false positive VCA IgM.”

The second case was difficult to interpret given the positive monspot, heterophile and VCA IgM tests. “In this case, we cannot exclude that the positive VCA IgM could be due to subclinical EBV reactivation, which has little clinical relevance in immunocompetent individuals,” states Pavletic, adding, “Heterophile antibody tests are known to have false positives due to acute infections, autoimmune diseases and cancer.”

In practice, Lyme disease and mononucleosis are common conditions that share similar symptoms. The authors’ two cases remind the reader of the need to consider Lyme disease even if initial serologies suggest mono.

 

References:

  1. Pavletic AJ, Marques AR. Clin Infect Dis. 2017 Apr 4. doi: 10.1093/cid/cix298.


69 Replies to "When Lyme disease causes a positive test for mononucleosis"

  • Elysa
    05/09/2017 (4:12 pm)
    Reply

    3 weeks after a tick bite, I went to the doctor with fever, aches, chills, joint pain and exhaustion. ELISA came back negative but the MonoSpot lit up like a christmas tree. For the next 5 years I was told I had Post Mononucleosis Syndrome, Fibromyalgia, MS, Cancer, Depression… I was able to find an LLMD through ILADS.org who ran a Western Blot among other tests. They came back postive for Lyme and Babesia. I’m now going on my 9th month of treatment but I’ll be living with the damage for the rest of my life.

  • Julie
    05/09/2017 (5:51 pm)
    Reply

    I always wondered if my EBV diagnosis when I was 16 could have been Lyme’s, since, it was so severe I was sick for years and my fatigue, neurological problems continued up to and have continued thru & after I diagnosed w Lyme’s and co-infections at age 35.

    • Destiney
      07/19/2017 (11:55 pm)
      Reply

      That sounds exactly like me I was finally diagnosed yesterday with Lyme…as well as Babesia, Mono, Candida and numerous other things…i missed the last month of 7th grade due to mono???? And my physical and mental health continued to decrease…i wonder if it was Lyme the entire time…We were ALWAYS outside…sports camping playing…..i feel so overwhelmed

      • Dr. Daniel Cameron
        07/20/2017 (5:46 am)
        Reply

        I am sorry to her you are overwhelmed. It can be hard to sort out when Lyme disease starts when other common illnesses are present.

  • Becca
    06/16/2017 (1:13 am)
    Reply

    So interesting! My daughter is 9 and had tests run through IGenex. Showed ++ on 41 band of IgG and IgM but gave a negative overall result. Doctor tested her for EBV and it came back positive. She has severe joint pain, tummy aches, fatigue, weight loss, and random fevers on occasion. When I asked him what to do with the EBV result, he said “Lots of rest.” He assured me she did not have Lyme and that she has had EBV for “quite some time.” Her symptoms have been going on for 18 months. No known tick bite but she did have lice right before symptoms started.

    • Dr. Daniel Cameron
      06/16/2017 (6:16 am)
      Reply

      It would be reasonable to revisit the cause of symptoms beyond 6 weeks even if the EBV were well documented. It is also possible someone can have EBV and a tick borne illness since they are common in children.

    • Anna
      07/06/2017 (6:42 am)
      Reply

      Not all doctors are correct and when it comes to our children we know what is right and a lot of us go by our gut feeling because we know our children better then a 5 minute exam and a test or two. I pray you don’t accept the doctor’s answer and demand she be retested by another facility or by a doctor specializing in Lyme’s Disease. 18 months of symptoms is way too long for your little girl! Do not stop testing or seeing doctor after doctor until she is diagnosed. I wish you and your family the best and I will keep your daughter in my prayer’s. Anna

    • Carolyn
      02/24/2018 (3:56 pm)
      Reply

      My daughter’s Ilad said the sicker or more chronic the Lyme disease the harder it is to test positive. Her IGenex test came back inconclusive for Lyme but positive for Babesio and other coinfections . Her blood was also sent to a lab in Germany where the Lyme was positive along with the coinfections. She also tested positive for EBV. She now has Chest port and receiving Iv antibiotics but improving.

      • Dr. Daniel Cameron
        02/25/2018 (8:53 pm)
        Reply

        Thanks for sharing. Don’t forget Babesia as it differs from Lyme disease treatment.

    • Joyce Dahlberg
      02/26/2018 (9:49 pm)
      Reply

      Did the test show #31 or even # 34. If #31 that is staph aureus USA strain 300, potentially USA strain 252. # 34 is a deeper infection. These two go together and favor lung and brain. #34 has elastic type protein that goes to brain an lung as it prefers higher oxygen levels.

      • Dr. Daniel Cameron
        02/27/2018 (12:33 am)
        Reply

        There can be more than once cause for each band.

    • Joyce Dahlberg
      02/26/2018 (10:26 pm)
      Reply

      find out the other numbers. # 31 is staph aureus bacteria which is opsA and is USA 300 strain. Possibly even USA strain 252. # 34 (opsB)is also a deeper infection that goes together with the #31. #41 is the flagella and not necessarily a tick spirochete. Staph aureus is a spirochete too. Get the Igenex numbers. The mentioned #31 and #34 were like eliminated or manipulated by the CDC after the 2 bacteria (mycoplasma and chlamydophila C pneumonia) were accidently found to be bacteria. The smallest known bacteria to this day. The CDC does not want people to know that water contamination is the root of all inflammatory diseases. Yes it activates a lot of viruses. The lyme testing was changed after finding those viruses were found to be bacteria. It is easy to find info on the meaning of the numbers. Although the staph # 31 is not talked about nor made public. We all know why. SO to summarize. it is E coli and also being injected through vaccinations.

  • Lynne
    06/20/2017 (4:41 pm)
    Reply

    Interesting indeed. I have an Igenex IgM result with 31+, 41++ and 45+ And have been told I am negative for Lyme disease. Of course that is CDC negative. I still have unbelievable fatigue and joint pain that is nearly unbearable 24 hours a day. The fact that I live in NY makes it that much more difficult. No one seems to want to treat this and all I want is to feel better.

    • Joyce Dahlberg
      02/26/2018 (9:58 pm)
      Reply

      #31 is staph aureus bacteria. More or less contaminated water. # 41 is the spirochete (not necessarily Lyme). # 45 I believe is osteomyelitis as I have that # as a previous infection/together with # 30 as a European strain. Yes I got osteomyelitis as a child after getting the BCG vaccine in France. Current infection is for me #31, #34 and # 41. This is chlamydophila C pneumonia from staph aureus infection. #34 is a deeper infection of lung and yes the infection affected my brain. This staph bacteria favors higher oxygen level. The #34 is a deeper fungal infection with elastic type protein production. It is possible you have bone infection as osteopenia which I have too. If I was you I would get tested for all mycoplasma and chlamydiaphila C pneumonia ( under chlamydia tests). Do not freak out this one is not a sexually transmitted disease although your kids will have the disease too because it is also contagious and transmitted to offsprings.

  • Kathleen
    07/03/2017 (1:34 pm)
    Reply

    Mono at age 18. Lyme and Mono at age 55 and early onset Alzheimer’s symptoms at age 55. Lyme test was positive and I have been recovering my health since 2012. There are no more symptoms of early onset Alzheimer’s and I am grateful that my family doctor, at the time, was able to prescribe the right antibiotics for the necessary time to get me healed. I have also changed my diet, exercise and lifestyle around to be healthier, because thanks to Lyme and Mono, I can no longer take a break from staying on top of my health, or it all might come back

    • Debbie
      02/06/2018 (2:03 am)
      Reply

      What antibiotic and how long were you on it?

      • Dr. Daniel Cameron
        02/07/2018 (12:30 am)
        Reply

        Each case is different. The treatment depends in part on the response.

  • Helen
    07/06/2017 (8:29 pm)
    Reply

    38 years ago while working as a RN I became so totally exhausted to the point that I could barely get out of bed and had to sleep. I was a very healthy active woman at 26 years old. The lab called me and first told me I had mono then, that I was pregnant. I was very happy since we were planning to have a baby, our first of two daughters 13 months apart. I was also happy that there were two “reasons” why I was completely exhausted yet I still felt I was TOO exhausted. Not until 11 years later after I had a huge bulls eye rash summer of 1987 at age 37 did I begin to feel even more anxious and irritable and depressed. I remembered I began having anxiety out of the blue when I had “mono”. Unfortunately back then I didn’t know about Lyme disease etc. Same year our younger daughter at 9 years old began to get very ill. Nightmare time truly began. We took her to countless Dr’s. Despite her constant painful pressure headaches, knees being so painful it made it almost impossible for her to walk and only wanting to sleep we were told there was nothing wrong physically with our bright happy daughter who loved school. Finally we found the life saving neurologist who diagnosed our daughter with Lyme disease. A few days before we had our first appointment with this angel Dr our daughter complained that her vision was getting “fuzzy”. She was hospitalized immediately, IV antibiotics began and our local pediatrician agreed that our daughter have a lumbar puncture and that she’d work with our LLMD/neurologist who saved our daughter’s life. Our daughter had pseudo-tumor cerebri and papilledema. She was treated aggressively for a year, IV then orals. Our daughter got better. Fast forward, I began to have more symptoms and 7 years after my bulls eye rash and deathly ill I was diagnosed with Lyme disease. Our other daughter got very sick at 17, Lyme again and another Picc line etc. My husband also got sick in his early 40’s. Picc line #3 and long term treatment as well.
    My family seemed to feel much better and were able to resume their lives. I was so grateful. But I didn’t. After initially feeling much better with treatment I totally crashed when treatment ended. I got my first Picc line. Not until another several years was I diagnosed with WA-1 babesiosis, erlichiosis, mycoplasma HHV 6/8 by a well known LLMD. I’ve been extremely sick (intractable cranial nerve pain, had vegetations aortic valve, SPECT severe hypoperfusion both cortical hemispheres, severe monoparesis left side and have been treatment resistant but am doing better. Our grandson now 6 got sick when he was 2. Lyme disease again. I’ve heard about having a positive mono test but it’s Lyme disease. Thinking back to my positive mono lab when also told I was pregnant 38 years ago and the anxiety depression and irritability that came out of the blue then makes me wonder if I had Lyme then before my bulls eye rash 11 years later.

    • Stacey
      08/06/2017 (6:52 am)
      Reply

      Thanks for sharing everyone. I gave birth 17 months ago and kept thinking I felt so tired from the new house, new baby and work. Never once did i think I was sick. Just always tired. Then I got dizzy spells but I had suffered with migraines for three-four years before my daughter so I assumed this was my body reacting to migraines (even though I got those in check now). I went back to my naturopathic doctor who helped with the Migraines and she did a full work up. Same as she had done in 2015 before I got pregnant and when I went off the migraine drugs. Somewhere between then and now I had mono and I have Lyme disease. I’ve been seeing a cardiologist because my body feels like it will explode at times (literal heart palpitations) and so far everything is looking good. Yet now I have an irregular heartbeat that I didn’t have before. Do to the mono? Because the Lyme was just diagnosed and I’m told I’m in the early stage (thankfully) and have been put on meds for it. Dizzy spells? If not from the Lyme than what? This is all so crazy to me. I was a perfectly healthy 35 year old before I got pregnant. Yes I had migraines but nothing else bothered me. I worked full time and ran a side business. I had so much energy. And I’ve been chalking this up to motherhood prior but I don’t think that’s it. What scares me most is now I fall asleep randomly. I don’t even realize im falling asleep until I wake up scared because I do not know when it occurred. Between the dizzy spells, the heartbeat and the crazy sleeping I’ve been so scared. I just want to know how to fix it all so I can be around for my daughter. I waited to have her until I was ready and now that I am I feel like my health is controlling my life.

      • Dr. Daniel Cameron
        08/06/2017 (10:49 pm)
        Reply

        Thanks for sharing your story. It is worth looking past mono.

      • Joyce Dahlberg
        02/26/2018 (10:16 pm)
        Reply

        So many of the stories could be mine. I got sick in 1977 or 1978 but did not understand what the 1st symptoms meant. SO 37 years later I am able to recall as my mind has returned due to being treated for Lyme starting in 2016. 2015 was a hell of a year with heart palpitations, pains, pins and needles and so much more. As getting better (at times feeling worse) symptoms emerged. The saying is that the first symptom you had is the last one to go away. Well I started to have shortness of breath, sneezing and others. Asked to get tested for mycoplasma and I tested pos for chlamydophila C pneumonia. Although identified as Lyme this one is NOT A TICK based disease but spread from person to person. My mind returned for a 25 year absence. 1977 or 78 I had an ear infection (only have had one in my entire life/felt like a funnel, then a sore lung that eventually went away. SO decades of cysts, skin issues (job syndrome) and mental health issues I was able to identify that staph aureus from water contamination is the root. Husband (prior to marriage), all his family members with lots of issues/deaths. Area the same lots of lyme/cancers/pneumonia (including many family members). A dr in that Midwest are (MN) even stated to another family member you do not need a tick bite to get Lyme. That is true because all insects can pass it and also people are infecting each others. The chlamydophila C pneumonia that I have is caused by staph aureus bacteria (#31 which is opsA). #34 is the deeper infection (opsB) that favors the lung and brain. Believe me I had my share of that in the past. # 41 is the spirochete (not necessarily Lyme). Now you know all these brain diseases origin. Yes MS is #2 on this too and so is Alzheimer, lupus, and so many others. SO I have a systemic infection (even validated by Garth Nicholson) and totally no tick involved. I do not think I knew tick existed in 1977. The USA 300 strain is the staph aureus #31. Mine is possibly USA 252 and goes with #34. Yes methicillin resistant bacteria and yes # 31 has biofilm.

  • Mary K Hull
    08/18/2017 (3:37 pm)
    Reply

    Two weeks ago my arm, chest, and hands started to hurt and I noticed clusters of puss pimple like rashes on the same right arm and palm. In a few days the pain was so awful I ended up in the then emergency room. I am a 54-year-old mother of 4 and I have never known such pain. My right knee started to hurt. I used a cane most days. I have been tested for everything including STDs and parvo. I have also developed vertigo. The only thing that has come back positive is mono. What do I do? This is no way to live considering I was hiking up to 14 miles a day just 1 year ago. I had tick tests and they were also neg. Please help

    • Dr. Daniel Cameron
      08/19/2017 (9:01 am)
      Reply

      I am sorry to hear you are ill. It sounds as if the doctors have been working on finding an answer. The All Things Lyme Blog reminds based on a review of the literature reminds us as doctors that sometimes a tick borne illness may end up a factor.

    • K Murray Leisure MD
      09/27/2018 (1:09 am)
      Reply

      Consider also right-sided body shingles, VZV. Interesting that some cases of Lyme have been followed by Varicella zoster virus (shingles, reactivated chicken pox virus) blocks of rash within the same nerve distribution, the same dermatome, as the tick bite. Perhaps the arachnid / tick bite activated VZV usually latent in the spinal column to erupt in the limbs peripherally?

      • Dr. Daniel Cameron
        09/27/2018 (3:32 pm)
        Reply

        Good question. We have a lot to learn.

      • Jackie
        10/12/2018 (9:34 pm)
        Reply

        I got lyme from a spider bite and so did the NP who’s treating me. (She came from a rheumatology practice and left because she didn’t agree with their diagnosis and treatment protocols.)

  • Laura
    08/28/2017 (5:48 am)
    Reply

    Wow, this is an informative article and I appreciate the responses from your readers as well. Based on my incapacitating fatigue, my Nurse Practioner had me tested for EBV when I was getting labs to check my thyroid levels. Upon receiving the news that I was having a severe EBV reactivation episode, I asked to be tested for CMV and for Lyme. CMV was negative, but I was confirmed to have Lyme (this was on 7/5/2017). I had been so ill that I had to resign from my job in mid-June and have not been able to work. I was referred to a LLMD and had to wait several weeks to get in to see him. Within the week, I began IV treatments to start my fight to regain my strength and health. This is an exhausting journey – physically, spiritually, emotionally and financially. Just in the last 3 days, I have begun to see little improvements in how I feel. This gives me hope. Hope that I will get my joy, my energy and my life back from my complexities of conditions.

  • Susan
    09/15/2017 (12:25 am)
    Reply

    So my son had mono in early 2015. He had a very bad case that was undiagnosed because he didn’t have sore throat or swollen lymph nodes, just crazy fever, drenching sweats for 9 days and fatigue, which doctors ignored. He got sort of better, played basketball and wound up in the hospital where they finally diagnosed him with mono after a positive monospot, atypical lymphocytes =31, and a very enlarged spleen (19cm). He was very sick with fevers for another two weeks did get the awful sore throat and lost 20 pounds. He’s never been well since and seems to always have something wrong going on… In the fall of his freshman year (2016), he suffered a concussion, from which he recovered by Christmas break. Since then, he has had lymphangitis in his arm, eustachian tub dysfunction, a sinus infection, two very severe febrile episodes that I could have sworn was mono all over again. Sometime in February when he had the sinus infection and eustachian tube dysfunction he became dizzy, unable to focus, foggy, couldn’t read with overall clogged feeling in the head and tired. We found out recently that he has a vision/vestibular saccades issue. We have been going down the road that he has post concussion syndrome causing the dizziness and have been to ENT to check for peripheral vestibular problem, MRI, PT, Chiro, and vestibular rehab. It’s never-ending. To rule everything out, he has also been tested for lyme and are awaiting the results. In the meantime we got back EBV tests that showed EBV EA at 6x the norm and VCA IGg 10x the norm. We’ve been told he has reactivated mono. Can lyme cause both of those tests to be elevated and can lyme cause problems with saccades and make him unable to focus? Has mono been reactivating over and over again or is it possibly been lyme all this time? Can a concussion bring out lyme or EBV? At my wits end with this…

    • Dr. Daniel Cameron
      09/15/2017 (5:00 am)
      Reply

      I am sorry to hear your son remains ill. EBV titer can be hard to interpret if they are elevated. It is difficult to tell the difference between chronic fatigue, Lyme and a concussion. I have seen Lyme disease cases that have been difficult to identify since they started with mono, an elevated EBV or concussion. I would prefer a tick borne illness evaluation be included even if the tests are negative.

  • Kelly Kutrufis-Lee
    10/25/2017 (9:54 pm)
    Reply

    Good Afternoon,

    I was recently diagnosed with mono- EBV Ab VCA, IgG = 559.0 on 9-21-17 and tested negative for Lyme total An test/Reflex-lyme IgG/IgM Ab= <.91 on 8-9-17. I am still having problems and I'm very frustrated and worried that my diagnosis is wrong. I would like to know where everyone was finally diagnosed with Lyme's? Or what steps I should take next? Currently I'm seeing my general practitioner.
    Thank you for your help!!

    • Dr. Daniel Cameron
      10/26/2017 (6:32 pm)
      Reply

      Both EBV and tick borne illnesses are common. It is reasonable in practice look a second time at a tick borne infection if the illness is atypical or persists beyond the 4 6o 6 weeks typical of mono.

  • Rita Shaw
    12/30/2017 (5:04 am)
    Reply

    I dont understand I was tested in 2009 2 different times and my Elisa-Lyme reactive was high positive both times…but western Igg and Igm were negative..with comment
    Antibodies to less than 2 of 3 significant B.burgdorfebe. proteins detected additional specimen should be submitted in 2-4 weeks..
    Rheumatoid factor was
    20.0 normal 0.0-20.0
    I had all lyme symptoms for 2 yrs after camping tripin 2007…in 2012 high ebv tilters? Also get flu like symptoms, though I was diagnosed fibromyalgia and chronic fatigue after lyme was negative. I have also been diagnosed Anterior Pituitary disorder..migraines, and now no false tb skin test..in 2007 , myalgia and Myostitis, Joint pain, and hearing loss due to chronic ear infection…Perineurophy.
    its all the cormorbid illnesses, symptoms,that drive me crazy.
    I don’t know if I should be tested a 3rd time? Is it to late to treat? Been 10 years?
    Why would elisa/reflex be high positive both times and western be negative?
    I wish I could find some answers..

    • Dr. Daniel Cameron
      01/10/2018 (1:45 pm)
      Reply

      The tick borne tests leave something to be desired. Your doctor may have to use clinical judgment rather than a test if you remain ill without another answer.

    • Joyce Dahlberg
      02/26/2018 (10:47 pm)
      Reply

      Never too late. for me 37 years untreated. Do not go by the regular offered testing. Too many numbers were purposefully eliminated as too many people would test pos. This occurred in 1994 after 2 viruses were determined to be bacteria. Get the IGENEX test that gives the numbers that you can evaluate and research yourself too. CDC and many others do not want people to get diagnosed to start out with. You have to be your own advocate. DO NOT RELY ON TRADITIONAL MEDECINE.

  • ilene
    01/25/2018 (5:22 pm)
    Reply

    My daughter, 13 years old now, was recently diagnosed with mono after high fever and swollen glands for weeks at a time. 3 summers ago she was diagnosed with lyme after coming home from summer camp with muscle and joint aches, severe weakness and a bulls eye rash. After a day of docyclone, she threw up and it threw her into a long term panic attacks for the fear of throwing up again. After therapy. After the recent diagnosis of mono, I insisted the Dr to run the lyme test while they were running the other levels after coming across Dr. Cameron’s website. It is positive as well. I am so torn if we should treat her for lyme again since her past experience was so tramatic or if it could be a false positive.

    • Dr. Daniel Cameron
      01/26/2018 (8:16 pm)
      Reply

      Doxycycline can be hard on the stomach even if she takes it with food. It also may have been a Herxheimer reaction where the symptoms get worse before they get better. There are other antibiotics that she may tolerate. It would be reasonable to include a tick borne illness in her evaluation if she remains ill.

  • James
    02/24/2018 (1:56 am)
    Reply

    When I finally tested positive for lyme in 2010 I also tested positive for EBV

  • Dawn
    02/24/2018 (2:48 am)
    Reply

    I read mixed rewiews regarding the use of antibiotics for chronic lyme. Any one have experience using long-term antibitotics?

    • Joyce Dahlberg
      02/26/2018 (10:42 pm)
      Reply

      Yes I am. I personally do not believe you can get better without some. The biofilm is key in killing this smart and stubborn bacteria. Must also use supplements, healthy eating and so much more. There is no one simple cure it is a combination of lots including detoxing like crazy. I know too many that are on herbs only and they so not seem to get better. I do know one that did but I think it is before she caught it right away. How long before starting treatment is the key. I knew mine needed to include antibiotics as it has been decades.

      • Dr. Daniel Cameron
        02/27/2018 (12:37 am)
        Reply

        The biofilm research in tick borne illness is still understood. Most of the research on biofilms are from other infections e.g. staph and strep

  • Dacia
    02/24/2018 (9:42 am)
    Reply

    Interesting blog– I’ve never made that link, although like others posting here, I’ve had both mono and Lyme/Babesia. When I was a first-year student in college, my roommate and her boyfriend both came down with mono. I wasn’t surprised when a couple of weeks later I came down with something awful: 10 days of drenching night sweats, 103-104 fever, extreme muscle weakness. But I tested negative for mono. A few months later, a circular rash appeared on the back of my thigh: this time the doctor told me it was ringworm, and sent me home with a fungicide cream. The circular rash continued to grow until it stretched from knee to top of my thigh, and took 7 months to go away. The following year I began having painful heart palpitations, I had extreme difficulty breathing, debilitating panic attacks, and was suffering from ‘tendinitis’ in my elbows, my knees, my shoulders. No testing done, no explanations given. Fast forward to 1997: between 1997 and 2000 we had three children. The first had and still has difficulty breathing, with unexplained seizures and temporary paralysis on one side of his body at 8 years; the second had and still has difficulty breathing, Asperger’s as well as intense social phobia and at the age of 12 became increasingly violent with bipolar tendencies; he was forcibly ejected from the school system and was on his way into the judicial system when in 2014 he was diagnosed with Lyme, Babesia, mono and strep (positive blood tests). Our youngest became ill at about the same time, tested positive for mono, but negative for Lyme and Babesia. I was also tested as I was very ill at this point: now I was positive for mono, as well as for Babesia and clinically for Lyme. It’s now been six years and all I can say is that these diseases and their after-effects have destroyed my two youngest children’s lives.

    • Dr. Daniel Cameron
      02/25/2018 (8:50 pm)
      Reply

      My All Things Lyme Blog series, book, and live #LymeHangout should encourage a dialogue. Thanks for sharing your challenges.

  • Colonyresidents
    02/25/2018 (5:17 am)
    Reply

    How does this work, since we all know that the OspA that is released by the spirochetes damages the immune system and allows all kinds of other pathogens to reactivate?

    • Dr. Daniel Cameron
      02/25/2018 (8:54 pm)
      Reply

      The affects on the immune system are still uncertain.

  • Carl Tuttle
    02/25/2018 (7:58 pm)
    Reply

    The Marques paper talks about false positive Epstein Barr serology but many believe outer surface protein A of the Borrelia spirochete causes immunosuppression for the following reasons…

    “Spirochetes disseminate to the lymph nodes, bone marrow, spleen and brain within a week of infection [1]. Lymph node germinal centers, where B cells are supposed to mature and be assigned an immune system function, are rendered incompetent [2] “B-cell AIDS”
    1.
    http://JOURNALS.PLOS.ORG/PLOSPATHOGENS/ARTICLE?ID=10.1371/JOURNAL.PPAT.1002066

    2. http://JOURNALS.PLOS.ORG/PLOSPATHOGENS/ARTICLE?ID=10.1371/JOURNAL.PPAT.1002066
    CARL TUTTLE
    LYME ENDEMIC HUDSON, NH

  • Carl Tuttle
    02/26/2018 (8:06 pm)
    Reply

    The Marques paper talks about false positive Epstein Barr serology but many believe outer surface protein A of the Borrelia spirochete causes immunosuppression for the following reasons…

    “Spirochetes disseminate to the lymph nodes, bone marrow, spleen and brain within a week of infection [1]. Lymph node germinal centers, where B cells are supposed to mature and be assigned an immune system function, are rendered incompetent [2] “B-cell AIDS”

    (1) http://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1002066

    (2) http://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1004976

    I truly believe that Lyme disease is immunosuppressive allowing latent viruses to rear their ugly heads and the positive EBV tests in the Marques case studies were reactivated infection as 90% of all Americans have been exposed to this virus but as you know, a healthy immune system keeps Epstein–Barr in check.

    It is well established that chronic Epstein–Barr virus can cause lymphoma and there is no disagreement within the medical community. I often tested positive for chronic EBV during the eight years treating chronic Lyme. Four years ago I had another tick bite (deer tick) in the right upper thigh area. Shortly thereafter the lymph node adjacent to that bite began to swell. All nodes swelled on the right side of the body followed by the left side and the swelling continued. A year later I was diagnosed with follicular lymphoma.

    Search Pubmed for: “Borrelia lymphoma”

    Carl Tuttle
    Lyme Endemic Hudson, NH

  • Beth
    05/24/2018 (10:39 pm)
    Reply

    is it possible to have mono and Lyme disease? my daughter is 14 and was told by her dr. She has Lyme disease, mono, and her gallbladder isn’t working if anyone can give me info please let me know

    • Dr. Daniel Cameron
      05/27/2018 (1:08 pm)
      Reply

      Some of my patients have had both. In some cases, Lyme disease was discovered when the symptoms of mono resolved.

  • Rita Shaw
    06/16/2018 (4:28 pm)
    Reply

    Hi everyone, it’s Rita Shaw again, I’m really confused. Like I said 3 not 2 Elisa came back high positive, 1.11, 1.25, 1.43
    But all western blot negative-Dr’s were shocked because I had all the symptom of Lyme, later test show high postive, ebna-Igg& vca-Igg 2006 , EBV, though clearly symptomatic, blood lab thought to be a passed on maternal infection?
    At 14, I was hospitalized for severely high fever, enlarged spleen, and liver?( And always had history since baby of tonsillitis (removed at 2)strep, bronchitis, pneumonia, laryngitis, swollen lymph nodes, etc, every years once or more.ever since) in 2006- I caught
    severe mrsa infection from work, also along with this, I didn’t know ..until this yr when asked for copies medical records, also 2006- 3 weeks after I had caught mrsa, and still fighting it, they protein in urine several times, went for sonogram of kidneys. Small white kidneys with unknown pathological lesion in right kidney? Cat scan recommended, not done) ( I knew I had something because dark bubbly, foamy urine alot over years) but drs never said nothing, also diagnosed same time
    Chronic glomerulonephritis kidney disease.? I was shocked because my egfr-=60. But I’ve been dehydrating since 2006, at least once a year, now my vision is horrible, I’m low on electrolytes and vitamins, Periherial neuropathy. Emg showed slowing of muscles, anterior pituitary disorder/ hypopituitism which I assumes was car accident tbi in 2005
    But on NibH Site” It says Periherial neuropathy, Ckd, hypopituitism, many more can all be connected.. kidneys are not able to fight off infections? Or my immune system. So this last year I started sweating exclusively, espiceally my face, head, embarrassing so…dehydrated urgent care again .
    Another bladder possible, kidney infection. I drink close to a 2 liter bottle of water a day because of thirst, but don’t urinate much? Constantly choke when swallowing fluid and food too at times.. Urgent care also, said ‘Anemic low iron, ferritin, very low transferritin?
    I’ve seen over 15 Dr’s since this started after car accident 2005, they gave up after Lyme was neg and called it fibromyalgia and fatigue, reiters disease, myalgia, myotis, migraines with aura, but with the other issues I dont think so.
    In 2007 tested postive for latent lyme, but turns out it was pneumonia, also had both feet operated on in 2007 cavus deformed foot structure ,and deformed upside down wine bottle look calves, surgeon said CMT inhertied, I told my dr and he said whats that?
    Now I’m looking for a new provider, n RI whose educated in the latest diseases, I’d like to go to Boston for free genetic testing and other tests but don’t drive, and no support system. I’m just curious, be honest…should I be right to keep searching as to whats happening in my body? Any resources if you agree?

    • Dr. Daniel Cameron
      06/17/2018 (11:08 pm)
      Reply

      Keep searching for an answer. It is also possible that there is more than one answer that has been overlooked.

  • Rita
    06/16/2018 (10:32 pm)
    Reply

    How does CMV virus compare to Ebv? Could they be mistaken? Also I had shingles, HPV virus, what’s the best way to go about testing for all these issues, my mris ,show pineal cyst ,5.5mmx6.5mmx7.5mm,
    1-along with felt to be in normal limits-signal in mass cell, mild right side mastoiditis, , yet..2 yrs later MRI has expanded compared to original mri-maistoidtis right side,
    2- prominence in surrounding area soft tissue nasopharyngitis, and mild prominence of cystic adrenoid of lymphoid tissue? I know these aren’t Lyme, but with constant sinus issues, and trouble swallowing without choking often lately, I wonder if you think it warrants following up?

    • Dr. Daniel Cameron
      06/17/2018 (11:12 pm)
      Reply

      It is common to find evidence of a range of virus on testing. It can be difficult to sort out ENT issues. Don’t forget to look a second time at the bacteria and Babesia that are in a tick.

  • Shelly Willis
    07/27/2018 (7:19 pm)
    Reply

    My 2 yr granddaughter had an engorged tick removed ,followed by rash near bite, high fever ,vomiting diarrhea and swollen lymph nodes in her neck. Started amoxicillin ,4 days after removal of tick and then amox-clav a few days after finishing the amoxicillin.high fever stopped but started complaining of sore hands knees elbows neck and back also complained of tummy pain would wake up in the middle of the night crying due to the neck /back pain and her hands and fingers were hurting.wrnt back to Dr. Asked to be tested for Lyme disease and any other illness that could be causing this. Out now anit 5 weeks at this point Lyme test came back negative ,but positive Rocky Mountain spotted fever numbers very low. Sent to our infectious disease who said the test was iffy reordered a better test at a better Laboratory and said it could also be tularemia. tularemia came back negative Rocky Mountain Spotted Fever positive once again
    One week doxycycline. She is better than she was but symptoms are slowly starting to reoccur went to another specialist who said there’s no way she had Rocky Mountain Spotted Fever do to the timeline she would have died did blood test for what all I’m not sure but now is saying she is positive for mono and still waiting on the rest of the test results to come back. My question is could this be Lyme disease instead of rmsf or mono? No one has actually told us what the numbers were for any of the test so far but I’m just worried with her only being too that we’re not going to get the right course of treatment and what the long lasting effects could be… please any advice on what to do next would be greatly. appreciated

    • Dr. Daniel Cameron
      07/28/2018 (6:36 pm)
      Reply

      Your granddaughter’s illness reflects the difficulties knowing what the cause or causes are when a tick borne illness is part of the concern. The CDC includes up to a 2 week of doxycycline in young children for RMSF without dental problems. RMSF is a serious illness that can be deadly. The fact that your daughter is alive does not rule out RMSF. It is always good to look at other illnesses including Epstein Barr and Cytomegalovirus illness (causes of Mono). Our practice does not work with children your grandaughter’s age. Keep working on it.

  • Vivian Verrier
    08/30/2018 (9:21 pm)
    Reply

    I got a bullseye rash 3 times in 2005. Same spot. Drs. Said noone can get a bugbite on the bra line. 13 years later I FINALLY may get treatment for Lyme. Lots of positive tests. Not ALL . Was told about EBV. Recently. Lyme ruined my life. Destroyed my body and spirit..wonder if 4 weeks of doxycycline will work. So many years later.

    • Dr. Daniel Cameron
      08/31/2018 (6:14 am)
      Reply

      A single antibiotic course of 4 weeks does not always work even when treated earlier. You should include a doctor experienced in treating Lyme disease along with your other doctors.

  • Mike
    08/31/2018 (8:44 pm)
    Reply

    I was bitten by a tick in April 2018 and developed fatigue, night sweats and joint pain in knees, hands and feet 3 weeks later. I was prescribed 3 weeks of Doxycycline. The night sweats stopped but the fatigue and joint pain have remained. I had bloodwork 2 weeks ago and was told I have acute active EBV. My IgM for 39 and 23 were positive for Lyme, Lyme IgG/IgM is .94 ISR, quant IgM is 2.01 index. I was told I don’t have Lyme, just EBV. Is it possible I have Lyme, could the Epstein-Barr cause the joint pain or is something else going on?

    • Dr. Daniel Cameron
      09/02/2018 (1:17 am)
      Reply

      Lyme and EBV are common Acute active EBV is defined differently by differing doctors. Sometimes the EBV is old. You should included a doctor with experience working with Lyme disease.

  • Lon Honzell
    10/09/2018 (8:25 pm)
    Reply

    Years ago I was diagnosed with Mono, severe case. Was hospitalized for three days, getting well? 18-20 Years later was diagnosed with MS, Which I still have. was tested for Lyme disease, not found. Through out this process I kept telling doctors I thought it was something else. No it’s MS, MRI’s shows it? Still having my doubts, what was I to do. Except keep taking that non working MS Medication.
    Until much later, Now. I have been doing some personnel research, coming to the conclusion it is Lyme Disease. ?

    • Dr. Daniel Cameron
      10/10/2018 (1:57 pm)
      Reply

      It can be so difficult to make a diagnosis. In some cases, my patients have more than one condition. It would be reasonable to include a doctor familiar with tick borne illnesses in your evaluation.

  • Sara Moulton
    10/20/2018 (1:20 am)
    Reply

    I had a tick bite then 10 days later developed very swollen glands. Two weeks later, still swollen glands, IGG and IGM neg for Lyme, but began 100 mg doxy. Two weeks later, no change in swollen glands. Mono test positive. Doctor says no Lyme, stop doxy, mono only. I am concerned that I have both, and that the mono is caused by Lyme reactivating or allowing its development. Is this a likely scenario?

    • Dr. Daniel Cameron
      10/21/2018 (12:55 pm)
      Reply

      Both conditions are common. I would have thought it reasonable to treat for both conditions with followup.

  • Anne ROBERTSON
    10/31/2018 (12:25 am)
    Reply

    Hello Dr. My daughter is pos for cronic bartonella. She is currently in Denver for school and is very sick. swollen glands, face, super cogested, major leg pain, eyes are crusty and goopy. She went to the ER and they said it was either Mono ( which there is no test for) or its viral. My kiddo can eat nor has the energy to do anything. we have tested her for Mono before she was diagnosed with Bart and she was pos for being esposed to it but not currently having it. She never had any signs of mono before till now. I have no idea if she really has mono or a virus. She has been exposed to a close friend at school who just went home with mono. Can the mono test showing she was exposed be wrong? or her bart coudl have casued it to be pos for exposure? and now she currently has it? what test do you suggest we do to figure out if its mono? Are you available to see her? Thanks for this article. Anne

    • Dr. Daniel Cameron
      10/31/2018 (7:26 am)
      Reply

      It is important to look at more than one factor. My latest Lyme disease Science Blog reviews to cases where the child had both conditions. It is not always clear that a positive test e.g. Bartonella is a factor. There are IgG and IgM tests for Epstein Barr and for Cytomegalovirus hat may offer insight into the viral question. I am available. Call my office at 914 666 4665 in New York if you need a tick borne evaluation.

  • Carolyn Johnson
    11/23/2018 (10:15 pm)
    Reply

    My husband (52) came down with a fever of 38 AND 39. I took him to emergency and they supposed it was the flu. Told him to take Tylenol for the fever. The high fever went away but returned a week later. We went back to emerg. same diagnosis and this time Tylenol and Advil again. The fever was less for 3 days ant then back to 39, nite sweats and chills..We went to a different hospital and they took many tests. I noticed a red blotch on his back and then a few more but not the bulls eye and they seem to come and go. His tests showed a swollen spleen, a bit of a fatty liver and very low white platelets- down to 60. They took tests for Lyme and other diseases and we had to wait 5 days for the results. They sent him home with Doxicycline and the next day his fever was down to normal and stayed there during the 2 week course. The tests came back and showed Lyme. WE saw him today re the results and positive for Lyme but also for mono. He said not to take more Doxi and requested lab tests in 2 weeks. He did not have swollen glands or soreness in joints. I think he should take two more weeks of the Doxi as it worked the very next day to take away his fever. The doctor thinks the Doxi has already done its job. Would 2 more weeks hurt along with boosting his immune system with vitamin C in case it is EBV ? How can we cover both bases ? I do not want him to go through what he initially did again. What is the likelihood EPV or LYME or both ? Thank you in advance. I am totally confused on this issue. His platelets are back up to almost normal now after the 2 weeks on Doxi

    • Dr. Daniel Cameron
      11/24/2018 (9:07 am)
      Reply

      I have patients where more than mono and a tick borne illness are both possible. Rocky Mountain Spotted Fever, Ehrlichia and Anaplasmosis should be considered. Both are common conditions. I would have your doctor followed for both conditions. I do not like to cut off treatment for a tick borne illness too early in my patients.

  • Brian Johnson
    11/24/2018 (2:07 am)
    Reply

    This site was an amazing find. Starting October 19th, I ran a fever of 103F (39.5C) for 5 days straight with severe chills, constipation and tiredness. On the 2nd day, I went to the ER and was told by the doctor it was the flu and to treat the fever with acetaminophen and ibuprofen, and also that my platelets were slightly low (140). After the fever broke I started feeling better but was still tired, which I assumed was normal after what I went through. On November 3rd, the fever came back at the same temps as did other symptoms. Again I went to the ER on the 2nd day and again was told it was the flu. But on the 4th day, I went to the ER of a different hospital and that doctor decided since it was my 2nd presentation of the same thing to run a battery of tests from everything from Hepatitis A, B and C to West Nile to Lyme to bacterial infections etc. My platelet count was only 60 then. She asked me to come back the next day to get an ultrasound of my organs (liver, kidney, spleen etc) and then to return again in a few hours when an internist was available. The ultrasound showed an enlarged spleen and fatty liver. On that next ER visit, my platelet count was 49 and my wife noticed a rash that seemed to disappear and reappear elsewhere (not a bulls-eye rash). The ER doctor and the internist discussed my case and decided to start me on a 2 week course of doxycycline 100mg. Amazingly, my fever finally broke the next day (6 days into this 2nd stretch), which was now 2 weeks ago, and has not returned. However, I still get tired in the afternoon and sometimes nap (which is not normal).

    About 5 days later, I was called by the ER doctor who told me I tested positive for Lyme.

    Today I just had a follow up with my regular doctor who reviewed ALL the tests, and he told me that though I tested positive for Lyme, I also tested positive for EBV, and that my symptoms were more accurately descriptive of Mono than of Lyme. I had hoped to extend my course of doxycycline but he believes 2 weeks was sufficient and that now my immune system is working on putting the EBV in check. After reading this, I am worried that 2 weeks was not sufficient and that I still need to focus on battling Lyme. Perhaps it is true that my symptoms were from EBV/Mono but after reading all this, this only happened because Lyme compromised my immunity which allowed existing EBV I contracted free reign.

    In your opinion, is 2 weeks of doxycycline 100mg sufficient in my case?

    I will be tested again after Dec 3rd, and I am hoping for a negative result of both Lyme and EBV as well as normal levels for liver function, platelets, etc. In the meantime, I will focus on boosting my immunity with high doses of Vitamin C and other natural methods and hope that can fight off both.

  • Carolyn Johnson
    11/29/2018 (8:26 pm)
    Reply

    Dr Cameron
    Thank you ever so much for the work you are doing online. You are a Godsend. Your replies to us re Lyme and mono made perfect sense. We continued with Doxi even though the Dr said 2 weeks was enough. It made no sense to us at first but since we live in an area that is rampant with ticks, have 4 shelties that have all been treated for Lyme I am surprised my doctor would not see the possibility of that being the main cause. I also put my husband on a regime that I have had great results with many cancer patients. High Vitamin C the most important ingredient in the drink. His white platelets went from 40 to 221 in less than 2 weeks at next testing. His spleen went back to normal. He says he feels better than he has in months. I am not sure how to approach
    this with our Dr as he is a first year practicing Dr. and we continued the Doxi when he said it was enough at 2 weeks. It was given to my husband at emerg not by him. We have both learned so much from your posts.
    Thank you again for putting this issue out there . We so appreciate it.


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