Dr. med. Uwe Auf der Strasse

Case 3

Toxoplasmosefallbericht 3: Silke H., 54 Jahre

Mrs. Silke H., 54 y.

 

In 2007 Ms. H. developed a Lyme disease from a tick bite. With a delay of about 3 months, she was treated with doxycycline for 6 weeks. In 2009 an inflammation of the thyroid gland (Hashimoto's thyroiditis) was diagnosed in connection with weight gain, and has since been treated accordingly with L-thyroxine. At the same time, there were also unclear joint pain, severe pains in the stomach, the tendon attachments and the Achilles tendon of the left foot.

 

In addition,  concentration and anxiety disorder developed, accompanied by extreme stage fright (unusual for an experienced professional musician) and other fears, which hadn't been present before. Rheumatological examinations did not reveal any tangible cause of the disease. In 2011 an arthroscopy of the right knee was performed due to unclear pain and swelling. There was pronounced inflammation of the synovial membrane, a rheumatic disease was ruled out again.

From around 2013 there was severe pain in the tendons and carpal tunnel syndromes on both hands, at least 5 operations on the hands followed without any improvement, Ms. H had almost completely to stop her activity as an orchestral musician. Towards the end of 2014 the pain increased more and more, after all, Ms. H even had to be prescribed morphine preparations to reduce the pain to a tolerable level; she was unable to work for many months. The pain was accompanied by constant leaden tiredness and exhaustion.

In the following years, the pain spread to more and more joints, and Ms. H had  difficulties in sitting, standing or walking. In 2018, an LTT test for Borrelia was carried out, it was again positive and it was again treated with doxycycline for 4 weeks - but without any effect, the symptoms did not improve. 9/2020, Ms. H summarized her symptoms as follows:

 

"Sleep disturbances, extreme heat sensation especially strong at night, burning eyes, blurred vision and deterioration of eyesight in a relatively short time, severe morning stiffness and stiffness always after remaining in one position, severe fatigue without real recovery, unsteady gait and fear of falling due to the severe pain, Shortness of breath even after minor exertion, swelling of the lymph nodes at the back of the neck, frequent headaches, difficulty concentrating, difficulty finding words (..) "

 

At this point  Chlamydia trachomatis and Pneumophilae, Bartonella, Anaplasma, Ehrlichia and Rikettsia had already been excluded as causes of the disease. The Toxoplasma IgG antibodies were positive with a titer of 1: 320, the IgM and IgA antibodies were negative. In 10/2020 the Toxoplasma LTT was clearly positive at 9.4 SI, the Checklist Toxoplasmosis showed a high risk for chronic active Toxoplasmosis while the  Borrelia LTT delivered a negative result. Due to scheduling difficulties, we were only able to start a rotating toxoplasmosis therapy in 11/2020, we used the same revolving combination as in Case 1:  Pyrimethamine 25 mg 2 x 1 and Calcium-folinate 6,35 mg 1x1 were taken daily and continuously. 

An antiobiotic was added,  at   first Cotrimoxazole 960 mg  2 x 1,   after 5 days this was changed to Clarithromycine 500 mg 2 x 1, after 5 days this was changed to Clindamycine 300 mg 3 x 1, after 5 days this was switched back to Cotrimoxazole 960 mg 2 x 1 again, and the whole system was repeated.  This revolving therapy resulted in a continuous improvement of all symptoms. 

              Checklist 

              Toxoplasmosis       Mr / Mrs.       Silke H. 

                                                                                                                  Fluctuation of

              Age: …54...Years              Duration:  11 years            symptoms yes / No

                    

                   Toxoplasma                        IgG                      1:320              IgM  negative

    

                    LTT   9,4 SI                         Date......…...26.11.2020              Date..............19.1.2021  

                   Treatment:                         Revolving  Therapy              Revolving  Therapy 

                    

                   Tiredness                            0 1 2 3 4 5 6  7  X 9 10              X 1 2 3 4 5 6 7 8 9 10

                   Muscular pain                    0 1 2 3 4 5  6 7 8 9  X               X 1 2 3 4 5 6 7 8 9 10

               

                   Concentration -                  0 1 2 3 4 5  6 7 X 9 10              X 1 2 3 4 5 6 7 8 9 10

                   disorder

                 

                   Profuse sweating              0 1 2 3 4 5 6 X 8  9  10              X 1 2 3 4 5 6 7 8 9 10

                 

                   Shortness of breath          0 1 2 3 4 5 6 7  X 9 10              X 1 2 3 4 5 6 7 8 9 10

                   Listlessness /                    0 1 2 3 4 5 6 7  X 9 10              X 1 2 3 4 5 6 7 8 9 10

                   Exhaustion...............................................................................................................................

 

                   Irritability                            0 1 2 3 4 5 6 7  8 X 10              X 1 2 3 4 5 6 7 8 9 10

               

                   Visual disturbancy             0 1 2 3 4 5 6 7  8 X 10              0 X 2 3 4 5 6 7 8 9 10

               

                   Dizzyness                           0 1 2 3 4 5 6 7  X 9 10              X 1 2 3 4 5 6 7 8 9 10

               

                   Depressive moods             0 1 2 3 X 5 6 7  8 9 10             X 1 2 3 4 5 6 7 8 9 10

                   Anxieties                             0 1 2 X 4 5 6 7 8 9 10              X 1 2 3 4 5 6 7 8 9 10

                   Morning stiffnness             0 1 2 3 4 5  6 7 8 9  X               X 1 2 3 4 5 6 7 8 9 10

                   Oedema                               0 1 2 3 4 5 6 X 8  9 10              X 1 2 3 4 5 6 7 8 9 10

                   Sleeping disorder               0 1 2 3 4 5 6 7 X 9 10              0 1 X 3 4 5 6 7 8 9 10

                   Insecure gait                       0 1 2 3 4 5 6 X 8  9 10              X 1 2 3 4 5 6 7 8 9 10

                   impaired coordination..........................................................................................................

                   Pressure in upper              0 1 X 3 4 5 6 7 8 9 10             X 1 2 3 4 5 6 7 8 9 10

                   abdomen

                 

                   Headache                            0 1 2 3 4 5 X 7  8  9 10              0 1 X 3 4 5 6 7 8 9 10

                  Joint pains                          0 1 2 3 4 5  6 7 8 9  X              1 2 3 4 5 6 7 8 9 10

                  Swollen lymphnodes         0 1 2 3  4 6 7 8 9 10              1 2 3 4 5 6 7 8 9 10

                 

                  SCORE                          137                                    5

 

 

Comment: It can be assumed, that a persistent Lyme disease had been the dominant reason for the disease for years and that it weakened the patient so much that a reactivation of toxoplasmosis occurred. This is by no means a rare risk: Since the contamination rate with Toxoplasma Gondii in Germany is around 50%, statistically every second person with Lyme disease is also a carrier of toxoplasmosis, which can potentially become active. Please check for contamination rate of Toxoplasma and Borrelia in your country.  

The negative Borrelia LTT of 11/2020 shows that the 2nd Borreliosis therapy in 2018 has been effective, the lack of improvement is best explained by a reactivated toxoplasmosis. This case shows particularly impressively how a reactivation of toxoplasmosis can follow Lyme disease, aggravate the disease and make healing considerably more difficult. So far I know 4 patients whose disease showed this  combination as well. They could be treated successfully.