Dr. Daniel Cameron: Inside Lyme Podcast

Anaplasmosis in the brain

 

Welcome to another Inside Lyme Podcast with your host Dr. Daniel Cameron. In this episode, Dr. Cameron will be discussing the case of a 64-year-old woman with central nervous system involvement of the brain.

The case was first described by Mullholand and colleagues in the British Medical Journal in a paper entitled “Central nervous system involvement of anaplasmosis.” 1

A 64-year-old woman was hospitalized with a 24-hour history of confusion and lethargy. The following morning, her lethargy had worsened and she developed subjective fever, mild headache, nausea, vomiting and increased confusion, according to the authors.

The physical exam showed “aphasia and memory lapse of the past 24 hours and an engorged tick behind the knee.”

Her tests revealed leptomeningeal enhancement and bilateral frontal lobe subarachnoid hemorrhage (SAH).

Note: Leptomeninges are the two innermost layers of tissue that cover the brain and spinal cord. The causes of leptomeningeal enhancement can include infectious meningitis of bacterial, fungal, and viral etiology; autoimmune and inflammatory diseases such as encephalitis, vasculitis, and sarcoidosis; trauma; and metastatic disease.1

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The Anaplasmosis PCR test of the serum was positive. A spinal tap was not performed.

The authors point out that the time from transmission to symptom onset in anaplasmosis can be within 24 hours. And typically, neurologic involvement is seen more often in Lyme disease and Ehrlichia.

Tests for Lyme disease or other co-infections were negative. However, the authors acknowledged that these tests might not be positive in early disease.

Treatment for Anaplasmosis

The woman was treated with doxycycline and discharged home.

“However, the patient was again hospitalised 6 weeks later due to persistent headache, word finding difficulties, memory loss and generalised fatigue,” wrote the authors.

“Repeat MRI and MRA of the brain showed significant increase in the FLAIR hyperintensity and hypointensity involving bilateral frontal, parietal occipital lobes, consistent with SAH with persistent left MCA anterior division vasospasm.”

She was discharged without retreatment and speech therapy was arranged.

“The patient has had marked improvement and returned to her cognitive baseline 3 months later,” wrote the authors.

The following questions are addressed in this Podcast episode:

  1. What is Anaplasmosis?
  2. What is leptomeningeal enhancement?
  3. What is subarachnoid haemorrhage (SAH)?
  4. How quickly can tick-borne infections be transmitted?
  5. How long does it take for Anaplasmosis symptoms to appear?
  6. What other treatments are there for Anaplasmosis?

Thanks for listening to another Inside Lyme Podcast. Please remember that the advice given is general and not intended as specific advice to any particular patient. If you require specific advice, please seek that advice from an experienced professional.

Inside Lyme Podcast Series

This Inside Lyme case series will be discussed on my Facebook page and made available on podcast and YouTube.  As always, it is your likes, comments, and shares that help spread the word about this series and our work. If you can, please leave a review on iTunes or wherever else you get your podcasts.

References:
  1. Mullholand JB, Tolman N, De Obaldia A, et al. Central nervous system involvement of anaplasmosis. BMJ Case Reports CP 2021;14:e243665.


6 Replies to "Anaplasmosis in the brain"

  • G
    05/09/2022 (8:23 am)
    Reply

    My mother showed signs of rapid deterioration (confusion, disorientation) after she notice a tick attachment on the back of her neck 4 years ago. I got no help locally so I took her to a larger hospital and in the testing an abnormal result in spinal fluid and one Dr. had a suspicion that Lyme disease was the culprit. She was treated with Rocephin For 60 days. She responded immediately to the antibiotics and in 60 days was nearly back to normal. Now, years later I am seeing some confusion and dizziness set in. How can I find out if this is a Lyme relapse or true dementia starting?

    • Dr. Daniel Cameron
      05/09/2022 (10:45 am)
      Reply

      I advise my patients to work with a neurologist and a doctor experienced in treating Lyme disease. Keep fighting for your mother.

  • catherine shaw
    01/26/2022 (9:31 am)
    Reply

    Hi Dr Cameron,how do you treat anaplasmosis,and other lyme infections,im in the UK, they are in complete denial of lyme over here.Do you use anti biotics only or a combination of things.thanks

    • Dr. Daniel Cameron
      01/27/2022 (8:15 am)
      Reply

      I typically use oral doxycycline. I use Rifampin as a backup. I use other treatments if I suspect other tick borne infections. I have needed to use IV antibiotics on some occasions for tick borne illnesses.

  • Nancy Taylor
    01/25/2022 (8:01 pm)
    Reply

    Is there any indication of how long the woman had been on doxy?

    • Dr. Daniel Cameron
      01/25/2022 (8:35 pm)
      Reply

      The authors did not indicate how long she was treated. They did state that Anaplasmosis is typically treated for 10 days.


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