Lyme Disease and Autism: Could Infections Worsen Neuropsychiatric Symptoms?
Neuropsychiatric symptoms may have multiple contributing factors
Infections can complicate neurologic and behavioral presentations
More research is needed to understand these relationships
“Case report: Substantial improvement of autism spectrum disorder in a child with learning disabilities in conjunction with treatment for poly-microbial vector borne infections,” by Drs. Offutt and Breitschwerdt describes the case of an adolescent diagnosed with autism spectrum disorder whose cognitive and neuropsychiatric symptoms improved following treatment for Lyme disease and Bartonella.
Patients and families often ask whether infections can worsen neuropsychiatric symptoms in autism. This case report raises questions about whether infectious triggers may contribute to symptom severity in selected individuals, though causation remains uncertain.
The 14-year-old boy had been sick for years with neurologic and psychiatric issues and had visited several physicians seeking an explanation for the fluctuating nature of these symptoms.
Neuropsychiatric Symptoms in Lyme Disease and Autism
His severe symptoms included:
- ADD/ADHD
- Tics (neck roll)
- Anxiety
- Baby talk
- Immaturity
- Dysgraphia
- Oppositional behavior
- Low reading comprehension
- Stammering
- Depression
- Anger
- Picky eating
- Bed wetting
On multiple occasions, the young man had behavioral outbursts, which led to his running away from home. He had received several diagnoses, including:
- Cerebellar hypoplasia (in utero)
- ADHD (onset at age 5)
- PANS – pediatric acute-onset neuropsychiatric syndrome (onset during elementary school; officially diagnosed at age 10)
- Autism (onset during elementary school; diagnosed at age 14)
- Autoimmune encephalopathy (diagnosed at age 14)
These overlapping neurologic and behavioral symptoms complicated diagnosis and management. Learn more about neurologic Lyme disease.
Evidence of Infectious Triggers
At age 10, the Cunningham Panel™ revealed anti-neuronal antibodies with a borderline anti-Tubulin assay. At age 14, he was diagnosed with autoimmune encephalitis and began treatment with intravenous immunoglobulin (IVIG), which temporarily improved symptoms.
Further testing revealed exposure to several tick-borne infections with serologic evidence of Bartonella and Lyme disease.
“This case report provides further support to the growing body of literature indicating that infectious triggers may contribute to neuropsychiatric disorders…” the authors wrote.
Neuroinflammation and infectious triggers have also been discussed in related pediatric conditions such as PANDAS and Lyme disease.
Treatment Response Following Lyme Disease and Bartonella Therapy
The patient was prescribed various treatments including amantadine, doxycycline, minocycline, amoxicillin, amoxicillin/clavulanate, clindamycin, IV ozone, a gluten-free diet, and a dairy-free diet.
“Following the introduction of a drug, most therapeutics, particularly antibiotics, were quickly discontinued due to intolerable side effects and flaring of behavioral symptoms,” wrote the authors.
A transition to new regimens included combinations of antimicrobials including disulfiram, rifampin, minocycline, rifabutin, clarithromycin, and methylene blue.
Other therapies included probiotics, antioxidants, and anti-inflammatories.
Antibiotic treatments reportedly resulted in substantial improvement in cognitive and neurobehavioral symptoms, including oppositional behavior, mood dysregulation, tics, and academic performance.
The patient transitioned to regular classrooms, improved social functioning, took college entrance examinations, and was accepted into a 4-year university.
Unfortunately, he was unable to discontinue antibiotics without symptom flares.
Authors’ Perspective
The authors acknowledged that the patient had a well-defined embryonic abnormality diagnosed in utero. Yet they pursued treatment targeting potential infectious contributors and secondary autoimmune mechanisms.
The authors encouraged further research to define the extent to which occult infections contribute to neuropsychiatric illness and symptoms associated with autism spectrum disorder.
- “We propose that a risk/benefit analysis in most patients diagnosed with autism spectrum disorder would warrant evaluation and treatment for potential chronic infectious triggers.”
- “This case report provides further support to the growing body of literature indicating that infectious triggers may contribute to neuropsychiatric disorders, including those in children who phenotypically present as academically challenged, or meet the criteria for autism spectrum disorder.”
Frequently Asked Questions
Can infections worsen neuropsychiatric symptoms in autism?
This case report suggests infectious triggers may contribute to symptom severity in selected individuals, though more research is needed and causation remains uncertain.
Can Lyme disease cause autism?
This article does not suggest Lyme disease causes autism. The case report explores whether infections may worsen symptoms or contribute to neuropsychiatric complexity in selected cases.
Why was Bartonella discussed alongside Lyme disease?
The patient had serologic evidence of multiple tick-borne infections, making coinfections part of the authors’ clinical considerations.
What is PANS and why is it relevant?
PANS involves abrupt neuropsychiatric symptom changes and is sometimes discussed in relation to infectious or immune triggers.
Why is more research needed?
This publication was a single case report. Larger studies are necessary before broader conclusions can be drawn.
Clinical Takeaway
This case report raises questions regarding whether infections may worsen neuropsychiatric symptoms in selected patients with autism spectrum disorder.
More research is needed to determine when infectious, inflammatory, or immune contributors should be considered in complex neuropsychiatric presentations.
Related Articles
These related articles explore pediatric Lyme disease, diagnostic delays, neuropsychiatric presentations, and tick-borne contributors to neurologic symptoms.
Delayed Lyme disease diagnosis
Lyme disease or dementia?
Powassan virus in children
Pediatric Lyme disease
Lyme coinfections
References
- Offutt A, Breitschwerdt EB. Case report: Substantial improvement of autism spectrum disorder in a child with learning disabilities in conjunction with treatment for poly-microbial vector borne infections. Front Psychiatry. 2023;14:1205545.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
