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colleenrn

NEW lab results- please help interpret!

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My 5 year old son has been treated for Lyme since end of Feb. after deer tick embedded, probable erythema migrans rash, and IgG western blot bands 23, 30, 41 positive. Just got more labs back and I need help interpreting please.

 

The results read:

 

Rickettsial Fever Abs

RMSF, IgG, EIA POSITIVE

RMSF, IgG, IFA <1:64 <1:64 negative 1:64 positive recent/active >1:64

 

Q Fever Phase I negative

Q Fever Phase II negative

 

Lyme PCR, Bb negative

 

Note says this negative PCR does NOT rule out possibility of infection or Lyme borreliosis.

 

His bartonella and babesia duncani (WA1), and erlichia were negative. His MTHFR negative.

 

His WBC are low at 3.5. They were also low when we did initial labs on Feb. 28, then were back in normal range with labs done March 16, now labs done April 25 back down to 3.5. His other out of range labs are HIGH Eos 6.0 normal(0-4), and LOW neutrophils(absolute)1.1 normal(1.2-5.2)

 

His western blot (again done at lab corp) is different then it was in February. It was positive for IgG bands 23,30, 41 in Feb. Now it is only positive for IgG band 41.

Serum creatinine HIGH at 0.60 normal(0.3-0.59)

Both IgG and IgM mycoplasma pneumo negative

 

Rocky mountain spotted fever IgM 0.07 negative negative <0.90

 

Thank you so much for any help!

Colleen

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Colleen- When we had our initial LLMD appt. our daughter also came back positive for RMSF IgG (super elevated- 1:256). Her doctor said it was just more evidence of tick borne infections, causing symptoms. I'm not sure he even treated for it - or, the abx he put her on for the lyme/bart treated it as well. She still test positive, over a year later, but only slightly elevated. Hope that helps some.

 

edit- daughter's RMSF IgM was negative.

Edited by philamom

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Thanks for the replies. When you say she was exposed, did it show up in bloodwork? My son was on three weeks of doxycycline and I wonder if that is why his IgG is positive and not his IgM. I also don't know if three weeks of doxy is enough.

Colleen

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I noticed you live in Virginia. My son also tested IGG positive for RMSF almost two years after having two tick bites and an EM rash and being diagnosed with Lyme. In southeastern Virginia, many ticks carry rickettsia parkeri which has been identified as the cause of Tidewater Spotted Fever. It is part of the spotted fever group of bacteria, but is not exactly the same as the bacteria that causes RMSF. The symptoms are not as severe as RMSF. I suspect it causes a positive result on the RMSF test. I'm fairly certain it is what caused my son's positive test result.

 

Here's an article on it. 83% of ticks in the study were found to be infected at the beginning of 'tick season' in May which is when my son was bit.

 

http://wwwnc.cdc.gov/eid/article/17/5/10-1836_article.htm

 

My son's doctor did treat him with doxy briefly just to be sure the infection was addressed, even though it was two years after the tick bites. He was only 6 at the time, so we couldn't do doxy for very long... only about a week.

Edited by JT's Mom

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JTsmom-

 

That makes complete sense b/c he had multiple, different extreme rashes, but not the typical one you get with RMSF (on palms and soles of feet). This is what it probably was or is, the rickettsia parkeri. Thank goodness my LLMD put him on doxycycline despite of his age. I only kept him on the doxycycline for 3 weeks b/c I was nervous about the possibility of teeth staining although my LLMD said at a recent conference, the Institute of Medicine said teeth staining with doxy was an "urban myth", that it only occurs with tetracycline. I have searched high and low for confirmation of this and here it is, straight from the CDC themselves. It is the treatment for rickettsia in any age person, endorsed by the AAP. The bolded and underlined is mine.

 

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5504a1.htm

 

 

 

Doxycycline is the drug of choice for treatment of all TBRD in children and adults. This drug is bacteriostatic in its activity against rickettsial organisms. The recommended dose is 100 mg per dose administered twice daily (orally or intravenously) for adults or 2.2 mg/kg body weight per dose administered twice daily (orally or intravenously) for children weighing <100 lbs. (45.4 kg). Intravenous therapy is frequently indicated for hospitalized patients, and oral therapy is acceptable for patients considered to be early in the disease and who can be managed as outpatients. Oral therapy also can be used for inpatients who are not vomiting or obtunded. The optimal duration of therapy has not been established, but current recommendations for RMSF and HME are for treatment for at least 3 days after the fever subsides and until evidence of clinical improvement is noted, which is typically for a minimum total course of 5--7 days. Severe or complicated disease might require longer treatment courses. Patients with HGA should be treated with doxycycline for 10--14 days to provide appropriate length of therapy for possible incubating coinfection with Lyme disease (45).

 

The use of tetracyclines to treat children with TBRD is no longer a subject of controversy (56--58). Concerns regarding dental staining after tetracycline therapy have been based primarily on studies conducted during the 1960s that involved children receiving multiple courses of the drug for recurrent otitis media (59,60). The propensity of tetracyclines to bind calcium can lead to darkening of the teeth if the antibiotic is ingested during the period of tooth crown formation. More recent studies in 1971 and 1998, however, have demonstrated that although multiple exposures to tetracycline increase the risk for tooth staining, limited use of this drug in children during the first 6--7 years of life has a negligible effect on the color of permanent incisors (56,57). Beyond ages 6--7 years, the risk for tetracycline staining is of minimal consequence because visible tooth formation is complete. Moreover, a prospective study of children treated with doxycycline for RMSF demonstrated that these children did not have substantial discoloration of permanent teeth compared with those who had never received the drug (56). Because TBRD can be life-threatening and limited courses of therapy with tetracycline-class antibiotics do not pose a substantial risk for tooth staining, the American Academy of Pediatrics Committee on Infectious Diseases revised its recommendations in 1997 and has identified doxycycline as the drug of choice for treating presumed or confirmed RMSF and ehrlichial infections in children of any age (61,62).

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