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Newark Star Ledger:
Lesser-known cousins to Lyme grab attention


By Carol Ann Campbell
STAFF WRITER


Section 1, Page 1
June 20, 2000


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Doctors diagnosed Robyn Greco's Lyme disease a decade ago, yet treatment failed to end her debilitating aches, fatigue and dizziness. She found herself using a wheelchair and unable to work.

Recently, Greco was tested for two lesser-known tick-borne illnesses, ehrlichiosis and babesiosis. She tested positive for both.

"I've been walking around all these years with three illnesses," said the 30-year-old Greco, who lives in Carlstadt. "It's scary. But I'm also ecstatic. At least somebody was able to validate what was wrong with me."

While Lyme disease remains the predominate tick-borne illness in New Jersey, the two other diseases -- often overlooked by patients and doctors -- are emerging as public health concerns.

In its first comprehensive study of these two diseases, the state Department of Health and Senior Services is now testing 400 ticks collected from throughout the state. Results should be available by the end of the year.

"We're trying to get a handle on what's happening here," said Eddy Bresnitz, an assistant state health commissioner. "When you have these emerging diseases, you want to know where they are going, and whether it's a real problem."

Like Lyme disease, ehrlichiosis and babesiosis cause chills, high fever, headache and fatigue. Ehrlichiosis will kill 2 to 5 percent of patients who don't get treatment, according to medical experts.

They can also complicate the diagnosis and treatment of Lyme disease. Some Lyme patients have contracted one or both of the other diseases. They can be infected by multiple tick bites or pick up more than one infection from the same tick. Bresnitz said the newer tick-borne illnesses are difficult to diagnosis and may be missed entirely by physicians.

"Part of the reason is that physicians may not necessarily be thinking about them," he said.

One Hunterdon County study examined 100 ticks collected from different parts of the county. The study, published in the Emerging Infectious Diseases journal in 1998, found 43 of the ticks carried Lyme, while 17 carried ehrlichiosis and five had babesiosis. Ten ticks carried two of the three diseases.

"There's a significant possibility for patients who suffer tick bites to pick up more than one infectious agent," said John Beckley, director of the Hunterdon County Department of Health. The department conducted the study with New York Medical College in Valhalla, N.Y.

Experts in New Jersey say the actual number of babesiosis and ehrlichiosis cases is higher here than the number reported to state officials. Just a handful of cases are reported each year. Laboratories are supposed to alert state health officials when a patient tests positive, yet out-of-state laboratories aren't obligated to notify New Jersey. Some doctors can diagnose a patient without a laboratory test.

Last year, just three cases of babesiosis were reported to the state. Seven cases were reported in 1998, and three in 1997. State health department figures say six ehrlichiosis cases were reported in 1999, four in 1998 and eight in 1997. Lyme still far outpaces these newer illnesses: 1,719 cases of Lyme were reported last year in New Jersey.

Physicians who are current on tick-borne illnesses find a percentage of their Lyme patients are co-infected. Andrea Gaito, a rheumatologist from Basking Ridge and president of the International Lyme Society, said 13 percent of her Lyme patients are also infected with babesiosis or ehrlichiosis.

She described one patient she saw recently: "This patient's Lyme test came back positive. She was being treated by a physical therapist who said to her, 'Something's wrong. You should be getting better.' She came to me and I tested her. It turns out her Ehrlichia levels were off the wall."

All three diseases are carried predominately by the deer tick and have similar symptoms, but they attack the body in different ways and require different treatments.

Lyme is caused by a corkscrew-shaped bacteria called spirochetes. The Centers for Disease Control and Prevention says long-term complications can include arthritis, numbness and pain. It is distinguished by the characteristic bull's-eye rash and treated with antibiotics.

Babesiosis is actually a parasitic organism. Infected blood can be mistaken for malaria. Patients may suffer from an enlarged spleen, said Philip Paparone, an infectious disease physician and Lyme expert in Atlantic County. Babesiosis patients may also be anemic, and can experience severe night sweats. Anti-parasitic drugs, such as quinine, are used to treat the disease.

Debate exists over whether the disease carries long-term symptoms, such as muscle aches and fatigue. Some doctors say blood smears examined under a microscope do not always detect babesiosis, and so more sophisticated tests are necessary. The disease can also be transmitted through blood transfusions.

Ehrlichiosis patients may have a low white blood cell count and low platelet count, as well as elevated liver enzymes. Some patients may get better on their own.

Antibiotics that work for Lyme do not work against ehrlichiosis. Instead, doctors use drugs in the tetracycline family. Tetracycline drugs can be used against Lyme, so some doctors cover both bases by prescribing tetracycline when the diagnosis is unclear.

"The tests take 10 to 14 days to come back," said Gaito. "If patients are ill, you have to start the medicine."



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