Dr. Daniel Cameron: Inside Lyme Podcast

Tick bite leads to Guillain-Barré Syndrome

 

Welcome to another Inside Lyme Podcast with your host Dr. Daniel Cameron. In this episode, Dr. Cameron will be discussing the case of a 71-year-old woman who was initially diagnosed with Ehrlichia, a tick-borne illness but later developed Guillain-Barré Syndrome.

The study, entitled “Case of ehrlichiosis induced Guillain-Barre Syndrome in a 71-year-old female,” was published by Malhis and colleagues in the journal IDcases

The woman’s initial symptoms occurred over a 3-week period and included: generalized weakness, dizziness, visual changes, chills, a fever, neck and abdominal pain.

After presenting to the hospital, she was diagnosed with Ehrlichia, a tick-borne illness, based on a low platelet count, elevated liver function tests, an insect bite, a positive Ehrlichia test by PCR, and absence of another illness.

The woman was treated with doxycycline and her symptoms improved.

Click below to watch a video discussing Ehrlichia-induced Guillain-Barre Syndrome 

CLICK BELOW TO LISTEN TO PODCAST

However, approximately one week later, she returned to the hospital with worsening symptoms and “numbness and areflexia in her lower extremities which progressed since her first encounter,” the authors write.

She developed an unsteady gait, which required a walker and had tingling in her feet and difficulty urinating. She required a straight foley catheterization.

“Although ehrlichiosis is not a common cause for GBS, the pathogenesis is like Lyme disease or Campylobacter jejuni,” the authors write.

“This patient had clinical symptoms that were like tick-borne illness yet as her disease progressed, it illustrated the need for an expanded differential diagnosis.”

The woman was diagnosed with an acute inflammatory demyelinating polyneuropathy, often referred to as Guillain-Barré Syndrome.

There was no evidence of another tick-borne illness including Lyme disease, Babesia, Heartland or Bourbon Virus.

The patient improved significantly with IVIG and was discharged to a rehabilitation center.

“Although ehrlichiosis is not pathognomonic for Guillain-Barre, it is important to not rule out as a cause,” the authors point out. “With the COVID-19 outbreak, there have been reported cases of GBS induced by COVID. It too can cause an immune response to the nervous system.”

Bourbon virus

“There have been reported cases of tick-borne illness that have not recovered despite tetracycline treatment,” reports Kosoy et al.2

They cite the case of a 50-year-old male from Eastern Kentucky who was found to have several tick bites, enlarged Lymph nodes, a macular papular rash, low platelets, low white count, and complaints of nausea, vomiting and diarrhea, followed by fever, myalgias, headaches and arthralgias.

The patient’s labs were negative for known tick-borne pathogens and he failed tetracycline treatment.

“Multiorgan failure developed, and he died 11 days after illness onset from cardiopulmonary arrest,” the authors write.

The man was later diagnosed with the Bourbon virus, a newly recognized tick-borne illness.3

Guillain-Barré Syndrome

 Guillain-Barré Syndrome (GBS) is an acute autoimmune demyelinating polyradiculoneuropathy that induces rapid and progressive flaccid weakness, according to Malhis.1 GBS can be life threatening if it progresses to involving the diaphragm.

 There are a number of causes of GBS. Respiratory and gastrointestinal infections can lead to GBS.  Lyme disease, tick-paralysis, HIV, and West Nile Virus can also lead to GBS.  There is also a very slim chance (1 in a million) that a flu vaccine can lead to GBS.

Treatment for GBS includes intravenous immunoglobulin (IVIG) therapy or plasma exchange. Steroids have not been helpful in treating the condition. An estimated 85% of patients recover their independent ambulation.

The authors conclude: “It is important to keep a broad differential as sometimes common syndromes do not always come from common pathogens and with the COVID-19 pandemic having similar results, we are learning new things that may potentially be new standards in medical education.”

The following questions are addressed in this Podcast episode:

  1. What is the Guillain-Barré Syndrome?
  2. What is the treatment for Guillain-Barré Syndrome?
  3. What is the Bourbon and Heartland virus?
  4. Why are there concerns for individuals with COVID-19?

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. Malhis JR, Mahmoud A, Belote A, Ebers A. Case of ehrlichiosis induced Guillain-Barre Syndrome in a 71 year-old female. IDCases. 2021;26:e01301. doi:10.1016/j.idcr.2021.e01301
  2. Kosoy OI, Lambert AJ, Hawkinson DJ, et al. Novel thogotovirus associated with febrile illness and death, United States, 2014. Emerg Infect Dis. May 2015;21(5):760-4. doi:10.3201/eid2105.150150
  3. Hearland and Bourbon Virus Disease. CDC. https://www.cdc.gov/ticks/tickbornediseases/heartland-virus.html Last accessed 12/12/21.


5 Replies to "Tick bite leads to Guillain-Barré Syndrome"

  • Neil Martin
    01/17/2022 (5:38 am)
    Reply

    BTDT. Tick exposure in New York, Vermont in 1995. Lyme and associated TBDs followed, misdiagnosed GBS, CIDP.
    My insurer’s PCP, ID and Neuro gatekeepers followed IDSA Lyme Dx and TMT guidelines. I almost died. Had to self pay for IGENIX tests, IV antibiotics. Much improved now but still disabled, and battling multiple NHL cancers, jaw pain. I asked two insurers to reimburse my out of pocket costs. Won two court cases, lost 2 — the last in 9th Circ Appeals court. Some hate light and love darkness.

  • Yvonne
    01/12/2022 (7:50 pm)
    Reply

    Ik hoop dat dit vertaald kan worden. Ik vertelde het eerder. In 2016 had ik GBS, alle ledematen verlamd, inclusief nek en de ademhaling. Grove tremor/uitschieters aan armen en fijne over het hele lichaam. De volgende dag had ik een klauwhand en een slappe arm, 2 klapvoeten, heel zwakke benen, romp, armen, nek en slikstoornissen. Ademhaling was nog steeds slecht en daarbij witte tenen en vingers. Die avond ervoor, acuut verlamming, waren mijn vingers halfblauw en kon bijna niet meer praten. Dr. Daniël heeft gelijk, het is een gevolg van diverse oorzaken en geen auto immuunziekte. Het kan net als bij Covid, auto immuun reageren, net als bij long Covid. Ik ben na 4 maanden langzaam hersteld.

    I told you before. In 2016 I had GBS, paralyzed all limbs, including neck and breathing. Coarse tremor/outliers on arms and fine all over body. The next day I had a claw hand and a limp arm, 2 foot drop, very weak legs, trunk, arms, neck and swallowing difficulties. Breathing was still bad with white toes and fingers. That night before, acutely paralyzed, my fingers were half blue and could barely speak. dr. Daniel is right, it is a result of various causes and not an autoimmune disease. It can react autoimmune, just like with Covid, just like with lung Covid. I have slowly recovered after 4 months. [translated with google]

  • James Pritsky
    01/11/2022 (5:18 pm)
    Reply

    I was Lymes- sick in June of 2020 while in Maine for the summer. I developed big circular rashes all over my body not bull-eyes. I had a fever as high as 103 up and down. This lasted about a week, my head ached, I vomited when my fever was the highest. I had body violently shaking with chills. When the rash hadn’t gone away after 2 weeks I went to a walk-in. Covid was new then and we tried to stay away from places like that. I’d had a test while I was sick which was negative for Cobid. The PA at the clinic took a look at my rashes asked me where I hurt that was new, I told her my knees, my neck. She diagnosed me with Lymes sickness and prescribed 3 weeks of Doxycycline. By late July early August I was still feeling fatigued more than my normal and just ached all over. We found a NP who was very LL because she’d had it herself. She became our most caring practitioner. Without all the details in between, I was getting worse we had headed back to Florida for the winter. I’m getting more fatigued and had very little energy to walk and it was becoming more difficult. I had some very bad falls. I saw a quack in Florida stating he was LL but to a Lymie it doesn’t take long to realize when someone doesn’t understand Lymes and co-infection. My practioner in Maine had ordered Igenix Lymes testing in August and my results were: Positive for Borreliosis, Burgdorferi, Babesiosis and Mycoplasma. I gradually lost feeling in my hands and feet and my arms and legs. By January 2021 I was in bed. In April I made contact with the practitioner in Maine and begged her to please help me long distance. Seeing the lyme specialist in Florida had been a total waste of time . With her help and the supplements and tinctures made by an herbalist in Maine and a Compounding Pharmacy here in Florida for LDN, I had neck surgery on September 29th to fuse C-5 & 6, with a basket and screws around it. I have been in-patient re-hab following my surgery for 6weeks. Now I’m home I’ve regained feeling in my limbs and walking with help for short distances. I’m actually going to walk again.

  • Janice Schmidt
    01/11/2022 (1:40 pm)
    Reply

    In the mid-70s, I had a neighbor contract GBS associated with a viral infection. In the early 80s, as my undiagnosed condition spread throughout my body, I noted how similar it was to her description of the GBS onset…moving from extremities towards the trunk. It took 37 years to diagnose Lyme/Bartonella with multi-viral reactivation. I still remember how each new flare-up would introduce “whatever it was” to a new muscle/joint complex, then die down to embers until new stress or source of fatigue would start the process in a new area. It took 8 years to fully envelop the musculoskeletal system, then was present but subdued until 2017 when multi stressors led to an immune collapse. Multiantibiotic treatment plus several herbals are showing progress, but this latest flare damaged brain function more noticeably. Someday someone will find the common links.

  • John
    01/10/2022 (10:09 am)
    Reply

    I have personally seen this in someone post-vaccine.
    It seems as though many are experiencing extremely similar symptoms after having Lyme, Covid and post vaccine. Long Covid, Chronic Lyme and Post vaccine injury are almost symptomatically identical.

    What is the common denominator here?


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