With Lyme disease visibility on the rise, there is much higher awareness of the real dangers this disease presents than there was ten years ago. Reported Lyme cases are going up every year, although this could potentially be attributed to the disease becoming more widely known. Lyme disease is quite easy to prevent, as we know exactly where it comes from and how to stop it; the causative bacteria (Borrelia) is transmitted to humans via tick bite, and in the early stages, the disease is easily treatable via antibiotics. If the acute Lyme window is missed, however, the chronic stage will inevitably develop some time after. Chronic Lyme is much more complicated to diagnose and treat, not least because the symptoms present differently for every patient.
Although Lyme disease is becoming more prominent, very few people know about the occurrence of co-infections, which can be transmitted simultaneously with the Borrelia bacteria. One of those co-infections is called ehrlichia. So what is ehrlichia? And what is the connection between ehrlichia and Lyme disease?
Cases of ehrlichia infection in dogs have been long documented, but the first human case was reported in 1986. Like Lyme, which was christened in 1975, ehrlichiosis in humans is a relatively new disease, so medical professionals are still coming to grips with it. It is spread through the bite of an infected tick, and can easily be transmitted to a host at the same time as Lyme (and possibly a number of other co-infections). It is, on the surface at least, not a particularly prominent disease (the CDC, Centers for Disease Control and Prevention, estimates there are about 500 cases per year), but when mixed with Lyme disease, it can create a particularly debilitating cocktail. However, it is worth noting that the number of reported cases is generally assumed to be passive, and the true incidences of ehrlichia infection are thought to be much higher.
The two primary agents of ehrlichiosis in humans are known as E. chaffeensis and E. ewingii. The latter is quite similar to another prominent co-infection, anaplasmosis, and the two are sometimes grouped together as one. The two strains invade separate host cells, with E. chaffeensis targeting monocytes, and E. ewingii seeking out neutrophil granulocytes. So exactly what are the symptoms of ehrlichiosis? Despite the two strains going after different cells, the clinical paths they subsequently take, and the symptoms they manifest in humans, are quite similar. Patients can expect symptoms to develop a week or two after the initial tick bite, with around 70% reporting flu-like symptoms such as headaches, muscle aches, fever, and chills. A distinctive rash, known as a maculopapular rash, can also develop. This rash is distinctively different from the telltale bullseye rash of Lyme; it presents as a flat, red area covered with small, confluent bumps. The symptoms in the early stages of the disease are often unspecific, which of course confounds diagnosis.
Many cases of ehrlichiosis are unproblematic, and patients often experience a complete recovery. However, if the infection is compounded by an underlying immunosuppression disorder, then the complications can be potentially devastating. Unfortunately, Lyme disease is one such disorder. Chronic Lyme can wreak havoc with the patient’s immune response, making them susceptible to all sorts of conditions and issues. The most prominent complications of ehrlichia infection involve the central nervous system, a prolonged, severe fever, coagulopathy, seizures, coma, and a septic-shock like syndrome.
Early diagnosis of the disease is critical, as it is with Lyme disease. Minnesota-based specialists Infectolab know all about the importance of co-infections, and how crucial it is to catch them simultaneously with Lyme. Traditionally, an ELISpot test (a blood test with a wide range of applications) has been used to test for Lyme disease. Unfortunately, this test is not specific enough for the subtleties of chronic Lyme, and all too often returned a false negative. Realizing the limitations of this test, Infectolab and the German-based BCA-clinic aided the development of a new ELISpot test, designed to catch Lyme and its co-infections the first time around. This new ELISpot test is unique in that it tests the patient’s sample for two types of T-cells (key cells utilized by our immune system), both killer and memory. Lyme is a disease of inflammation as much as it is infection, and both spectrums of symptoms need to be addressed at the same time. The presence of killer T-cells indicates an active infection, while the presence of memory T-cells indicates a dormant, more chronic stage of the disease.
The new ELISpot test for ehrlichia can also potentially diagnose a number of Lyme co-infections, by specifically searching for antigens produced by the disease in question. Ehrlichiosis is one of these diseases, along with numerous others like bartonellosis and babesiosis. Because Lyme is such a vague disorder which gives doctors little to no concrete information to act on, specific tests like the new ELISpot are drastically needed to level the playing field. Initiatives like this are a great step forward for Lyme disease treatments across the world. Hopefully other institutions follow suit, and work towards giving their patients a better understanding of the challenges they face when it comes to Lyme disease and its co-infections.