Updated August 2016
The gastrointestinal infection – psychiatric connection …
Spirochetes in the intestine
Incs quotes from the following papers..
- Relief of psychiatric symptoms in a patient with Crohn’s disease after metronidazole therapy (14 year old boy)
- Spirochetal dysentery: a case report and review of literature.
- Invasive intestinal spirochetosis: a report of three cases.
- Gastrointestinal pathology in children with Lyme disease
- The Spectrum of Gastrointestinal Manifestations in Children and Adolescents with Lyme Disease
These findings indicate that the patient had active, systemic Borrelia burgdorferi infection and consequent Lyme hepatitis, despite antibiotic therapy.
“Palsy Of The Gut” And Other GI Manifestations Of Lyme And Associated Diseases
Snippets from article below..
“The vagi (10th Cranial Nerves) are major suppliers of the gut’s external nervous system and being very long and complex, are vulnerable to neuropathies such as Lyme disease or diabetes which can cause them serious damage.” (Personal communication from Neurologist, Richard Rhee, M.D., F.A.A.N., Neptune, NJ)
“Vagus nerve paralyses are more commonly diagnosed when caused by Herpes (varicilla) zoster or Herpes simplex viruses wherein most patients I have seen are nauseated and have no appetite. I have not observed paralytic ileus in these cases. Should vagal paralysis occur in a Lyme patient, I think the patient would complain of hoarseness and dysphagia.” (Personal communication from Dr. Hidecki Nakagawa, Japan) Indeed, both of these problems are common symptoms of neuro-Lyme.
“The autonomic nervous system supplies the gut . . . sympathetic fibers inhibiting peristalsis and secretion and parasympathetic fibers increasing them . . . Functions of the sympathetic nerves include vasomotor, motor to the sphincters, inhibition of peristalsis, and transport of sensory fibers from all of the abdominal viscera. . . . Functions of the parasympathetic nerves comprise motor and secretomotor to the gut and glands” (8).
Borreliosis-caused, gastrointestinal tract paralysis and related abnormalities can occur anywhere along the entire length of the tract (9,10)—involving, for example, functionality of taste buds (11,12), muscular strength of the tongue, gag reflex, ability to swallow, gastroparesis, peristaltic retardation (or excitation) related to small bowel competency, dysbiosis, total arrest of peristalsis (“ileus”), pseudo-obstruction (sometimes associated with Bell’s palsy) (13), colon dysfunctions, encopresis, proctalgia fugax and the final act of defecation. “In 5%–23% of patients with early Lyme borreliosis, there can be gastrointestinal symptoms such as anorexia, nausea, vomiting, severe abdominal pain, hepatitis, hepatomegaly and splenomegaly. Diarrhea occurs but is seen in only 2% of cases” (14). Regardless of the site, spirochetes’ disturbing symptoms may come and go spontaneously, often temporarily resolving in a matter of hours to days, although resolution does not imply cure. As with Bell’s palsy of the face, these gastrointestinal conditions may endure or only partially remit (15).
Similarities between Bb-caused paralyses of muscles supplied by the Facial Nerve and Lyme-caused GI neurogenic paralyses suggested a pseudonym to this writer—Bell’s palsy of the gut—despite the fact that the two manifestations of the infection may not be synchronous. Yet, they are etiologically related, which suggests need for a high index of suspicion regarding presence of borrelial disease in all perplexing gastrointestinal syndromes.
For full article go to: http://www.publichealthalert.org/palsy-of-the-gut-and-other-gi-manifestations-of-lyme-and-associated-diseases.html
Liver function in early Lyme disease.
Hepatology. 1996 Jun;23(6):1412-7.
Horowitz HW, Dworkin B, Forseter G, Nadelman RB, Connolly C, Luciano BB, Nowakowski J, O’Brien TA, Calmann M, Wormser GP.
Department of Medicine, Westchester County Medical Center, Valhalla, NY 10595, USA.
To evaluate the frequency, pattern, and severity of liver function test abnormalities in patients with Lyme disease associated with erythema migrans (EM), 115 individuals with no other identifiable cause for liver function test abnormalities who presented with EM between July 1990 and September 1993 were prospectively evaluated. For individuals with abnormal liver function tests, common causes of hepatitis, including hepatitis A, B, and C, were excluded. A local control group was used for comparison. Forty-six (40%) patients had at least one liver test abnormality, and 31 (27%) had more than 1 abnormality compared with 19 (19%) and 4 (4%) of controls, respectively (P < .01 for each comparison). gamma-Glutamyl transpeptidase (28%) and alanine transaminase (ALT) (27%) were the most frequently elevated liver function tests among Lyme disease patients. Anorexia, nausea, or vomiting was reported by 30% of patients, but did not occur more frequently in patients with elevated liver function tests compared with those with normal values. Patients with early disseminated Lyme disease were more likely to have elevated liver function studies (66%) compared with patients with localized disease (34%) (P = .002). After antibiotic treatment, elevated liver function tests improved or resolved in most patients. Liver function test abnormalities are common in patients with EM but were mild, most often not associated with symptoms, and improved or resolved by 3 weeks after the onset of antibiotic therapy in most patients.
PMID: 8675158 [PubMed – indexed for MEDLINE]
The Spectrum of Gastrointestinal Manifestations in Lyme Disease
Journal of Pediatric Gastroenterology & Nutrition:
October 1999 – Volume 29 – Issue 4 – p 495
Purpose: To describe the GI manifestations of Lyme
Methods: Twenty two consecutive patients between the ages of 8 and 20 years presented with a history of chronic gastrointestinal symptoms coupled with multiple organ system complaints. A clinical diagnosis of Lyme disease was made. Endoscopic evaluation was performed to assess the gastrointestinal mucosa and to obtain biopsies for polymerase chain reaction (PCR) to the outer surface protein A (Osp A) of Borrelia burgdorferi. As controls, ten patients with biopsy proven Crohn’s disease were also tested by PCR. The laboratory performing the PCR analysis was blinded to the diagnosis of all specimens they received.
Results: The presence of Lyme disease in the gastrointestinal tract was confirmed by PCR for B. burgdorferi DNA in 14 of 20 patients with the diagnosis of Lyme and in two of the control subjects with Crohn’s disease. Biopsy evidence of gastritis, duodenitis and colitis was found in Lyme patients and associated with the detection of B. burgdorferi in the GI tract.
Conclusion: In patients living in an endemic area for Lyme disease who present with abdominal pain, acid reflux, chronic diarrhea or blood in the stool, Lyme should be considered as part of the differential diagnosis. In the absence of an erythema migrans rash or blood test confirmation of Lyme, diagnosis can be provided by PCR analysis of gastrointestinal biopsies.
Muscle, reticuloendothelial, and late skin manifestations of Lyme disease
1995: Ilowite N T
The American journal of medicine 1995;98(4A):63S-68S.
In addition to classic organ system involvement, Lyme disease may be characterized by myositis, liver and spleen involvement, and atypical cutaneous manifestations. Myositis is characteristically localized near an involved joint or localized neuropathy. Nuclear imaging with gallium-67 may be useful for detection. Myositis responds to treatment with intravenous or oral antibiotics.
Patients with erythema migrans have been observed to have liver function test abnormalities in the absence of symptomatic hepatitis.
Splenomegaly has been noted infrequently in patients with Lyme disease.
Chronic cutaneous manifestations of Lyme disease–including erythema migrans, acrodermatitis chronica atrophicans, and lymphadenosis benigna cutis–have been observed more frequently in Europe than in the United States. It appears that they are caused primarily by the Borrelia afzelii genomic group of Borrelia burgdorferi, which has been found exclusively in Europe.
Hepatitis Due to Recurrent Lyme Disease
1. MARK H. GOELLNER, M.D.;
2. WILLIAM A. AGGER, M.D.;
3. JOHN H. BURGESS, M.D.; and
4. PAUL H. DURAY, M.D.
La Crosse, Wisconsin
; Fox Chase Cancer Center;
Lyme Disease, a multisystem disorder caused by the tick-borne spirochete, Borrelia burgdorferi (1), is characterized by malaise, fever, headache, arthralgia, myalgia, stiff neck, lymphadenopathy, paresthesia, and a distinctive rash, erythema chronicum migrans, in its early phase (2). Neurologic, cardiac, and joint abnormalities may follow within weeks to months (3-5). We report the case of a patient with fever, hepatitis, and a maculopapular rash due to recurrent Lyme disease.
Gastrointestinal and hepatic manifestations of tickborne diseases in the United States.
Clin Infect Dis. 2002 May 1;34(9):1206-12. Epub 2002 Apr 2.
Zaidi SA, Singer C.
Division of Infectious Diseases, Long Island Jewish Medical Center, Long Island Campus for the Albert Einstein College of Medicine, New Hyde Park, NY, 11040, USA.
* Clin Infect Dis. 2003 Nov 15;37(10):1397-8.
Signs and symptoms related to the gastrointestinal tract and liver may provide important clues for the diagnosis of various tickborne diseases prevalent in different geographic areas of the United States. We review clinical and laboratory features that may be helpful in detecting a tickborne infection. Physicians evaluating patients who live in or travel to areas where tickborne diseases are endemic and who present with an acute febrile illness and gastrointestinal manifestations should maintain a high index of suspicion for one of these disease entities, particularly if the patient has received a tick bite. If detected early, many of these potentially serious illnesses can be easily and effectively treated, thereby avoiding serious morbidity and even death.
PMID: 11941547 [PubMed – indexed for MEDLINE]
Spleen Symptoms of Lyme Disease
Lyme disease is caused by the parasite Borrelia burgdorferi, which is carried by ticks. Humans develop Lyme disease after receiving a bite from an infected tick. Early diagnosis and treatment with antibiotics usually cures the disease and removes all symptoms. However, if the disease is not treated, it can spread to other parts of the body, including the spleen, and cause additional symptoms.
If the parasite that causes Lyme disease is not treated, if can spread to other parts of the body. Some patients with untreated Lyme disease may develop an enlarged spleen, according to the North Caroline Lyme Disease Foundation. The spleen is a small, fist-sized organ that is found underneath the ribcage, on the left side of the body. The spleen filters blood and produces white blood cells used by the immune system to fight disease. Certain types of infection, such as Lyme disease, can cause the spleen to swell.
If the spleen becomes enlarged, it can cause several additional symptoms. The most common is pain or tenderness in the area of the spleen, on the left side of the back just under the rib cage. The pain may sometimes spread to the left shoulder. If the spleen presses on the stomach, it can causes feelings of fullness after eating only a small amount of food, or without eating anything, explains the Mayo Clinic. Doctors can usually diagnose an enlarged spleen through a physical examination.
Because the spleen filters blood and regulates the blood supply, an enlarged spleen can cause anemia, or low levels of red blood cells in the blood. An enlarged spleen tends to hold onto more red blood cells than it needs to, instead of releasing them into the bloodstream. If red blood cells levels drop too low, additional symptoms may result, such as easy bleeding and trouble clotting, according to the Merck Manuals. People with an enlarged spleen may also suffer from fatigue and feelings of weakness and tiredness.
The Effects of Lyme Disease on the Liver
1. Lyme Disease
o Lyme disease is caused by a bacteria called Borrelia burgdorferi (Bb) that ticks carry. Called deer ticks (or “seed ticks”), the arachnids that carry the bacteria are very small and can often escape notice. When the ticks bite mice that have Lyme disease and then bite a human, the disease is transmitted. According to the Centers for Disease Control and Prevention (CDC), someone who has been bitten by a tick may not notice for a week or two that he has symptoms, which can include a flu-like feeling, a “bulls-eye rash” at the site of the tick bite and widespread joint pain. The disease is named for its 1975 discovery in children living in and around Lyme, Connecticut.
Abnormal Liver Function
o In an article published in 2003 in Hepatology Journal (hepatology is the study of liver diseases), 115 people were studied who presented with the tell-tale rash from a tick bite. More than 40 percent of the patients exhibited at least one liver abnormality, and 27 percent of patients had tests that returned more than one liver abnormality. Of those patients who contracted the secondary stage of Lyme disease (early dissemination), 66 percent had elevated liver function results. When the disease moves from the first stage to the second, the spirochetes (the bacteria that causes Lyme disease) that were restricted to the blood pass into the tissues, and the disease becomes chronic.
o “Lyme hepatitis occurs in 15 to 20 percent of patients,” says Dr. John Bleiweiss, a specialist in Lyme disease. Hepatitis is a condition wherein the liver is inflamed. The function of the liver is to screen toxins from the blood. When the liver is unable to handle the toxin load, you can develop liver diseases. Lyme disease causes the liver to slow its function, which can cause jaundice (yellowing of skin and eyes), severe itching and nausea.
o Because there is more anecdotal than scientific evidence for liver involvement with Lyme disease, the treatments tend to be management of the symptoms rather than an actual cure. There is usually no treatment prescribed for hepatitis A, as the condition tends to resolve on its own. Treatment for hepatitis B and C is interferon, which is made from proteins that signal the cells to immunize when an infection threat is realized. Generally recognized treatments for Lyme disease are varied courses of antibiotics (including regular IV treatments) over the course of four to six weeks. Science is slowly coming to realize that this may not “cure” Lyme disease, and that it can be a life-long, chronic condition. Over-the-counter remedies include milk thistle, which is efficacious for detoxifying your liver.