GASTROINTESTINAL TIC BORNE  INFECTIONS Martin D. Fried, MD, FAAP Pediatric Gastroenterology Physician Nutrition Specialist...
Gastrointestinal Complaints abdominal pain vomiting blood in stool  constipation heartburn chest pain  soiling diarrhea mo...
Apthous Ulcers
Canker Sore
Erythema Nodosum
Psoriasis
Ulcers
Colitis
Rectal Fissure
Skin Tag  vs Granuloma
Psoriasis with Granuloma
 
 
Bartonella Borrelia burgdorferi H  pylori Mycoplasma  Salmonella, EBV Clostridium difficile
SINGLE INFECTIONS  30
COINFECTIONS =  20
TRIPLE INFECTIONS  = 6
80 PATIENTS,  88 INFECTIONS
Heartburn, Abdominal Pain, Skin Rash,  Gastritis, and Duodenitis Bartonella henselae
<ul><li>Cat Scratch Fever </li></ul><ul><li>Lymphandenopathy </li></ul><ul><li>hepatitis-elevated liver enzymes </li></ul>...
Gastrointestinal Bartonella <ul><li>Hepatosplenic Abscess </li></ul><ul><li>Abdominal Pain-burning </li></ul><ul><li>Mesen...
GI Presentation <ul><li>Heartburn </li></ul><ul><li>Abdominal Pain </li></ul><ul><li>Skin Rash-striae –stretch marks </li>...
VIOLACEOUS RASH
NEW BLOOD VESSELS
 
GI Infections <ul><li>tic bite </li></ul><ul><li>No prior GI complaints </li></ul><ul><li>No steroid use </li></ul><ul><li...
Infection and or Diet <ul><li>Pain not resolved by antacids, Histamine blockers, PPI </li></ul>
Skin Rash <ul><li>Violaceous- deep reddish purple </li></ul><ul><li>Serpinginous- “snake like” </li></ul><ul><li>Breast or...
 
 
Mesenteric Adenitis <ul><li>CT Abdomen </li></ul><ul><li>Lymph Nodes > 1cm in diameter </li></ul><ul><li>May mimic appendi...
Endoscopy and Biopsy <ul><li>Assess the GI mucosa </li></ul><ul><ul><li>H. pylori </li></ul></ul><ul><ul><li>Bartonella by...
Bartonella Pathology <ul><li>Chronic Gastritis and or duodenitis </li></ul><ul><li>No Ulcer </li></ul><ul><li>No  evidence...
Bartonella Rashes <ul><li>Maculopapular </li></ul><ul><li>Urticarial </li></ul><ul><li>Erythema Nodosum (crohns also) </li...
 
 
Striae <ul><li>Endothelial Proliferation </li></ul><ul><li>Differentiate from stretch marks  </li></ul><ul><li>in obese or...
Bartonella  GI Inflammation <ul><li>An Association Shown </li></ul><ul><li>IL-2, IL-6, IL-10, Elicited </li></ul>
Interleuken 6 <ul><li>Multipotent cytokine </li></ul><ul><li>Elicited by Infections </li></ul><ul><li>Induces inflammation...
NEOVASCULARIZATION NEW BLOOD VESSELS
 
STEROID EFFECT
STEROID EFFECT
SERPINGINOUS RASH  =  INFECTION
SNAKE  LIKE  = INFECTION
Bacteria Infects humans only Transmitted - human to human Helicobacter pylori
H.  pylori <ul><li>Irritant to stomach lining </li></ul><ul><li>Cause of gastric, duodenal ulcers </li></ul><ul><li>Lifelo...
 
H pylori  breath test
Helicobacter pylori <ul><li>Nodularity Gastritis </li></ul>
Eradication of  H. pylori Two antibiotics for two weeks Clarithromycin Amoxacillin Proton pump inhibitor for a month intra...
Mycoplasma <ul><li>Intracellular infection </li></ul><ul><li>Rarely in the blood </li></ul><ul><li>Worsens Lyme, Bartonell...
Mycoplasma  protein <ul><li>Stimulates immune cells </li></ul><ul><li>Proinflammatory cytokines </li></ul><ul><li>TNFalpha...
Chronicity of Mycoplasma   <ul><li>Surface antigenic variation  </li></ul><ul><li>Supress host immune responses </li></ul>...
Celiac vs Food Intolerance <ul><li>Celiac is Autoimmune to wheat, rye, barley </li></ul><ul><li>Gluten, Genetics and Envir...
Inflammation causes  permeable gut Foreign proteins to immune system  Crohn’s, Colitis, Celiac
 
Treatment  complications
Candida Albicans
Candida Albicans <ul><li>Normal Flora  Yeast </li></ul><ul><li>Antibiotics kills Normal Flora </li></ul><ul><li>Yeast over...
Clostridium difficile <ul><li>C. difficile is normal bacterial flora </li></ul><ul><li>Antibiotics kill lactobacilli, bifi...
Pseudomembranous  Colitis
 
Foods with  sc FOS <ul><li>Banana  onions  </li></ul><ul><li>garlic  asparagus </li></ul><ul><li>Barley  wheat  </li></ul>...
 
Conclusions <ul><li>Lyme, Bartonella, Mycoplasma occur in the GI tract of children 5-21 yrs </li></ul><ul><li>PCR  biopsie...
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Lyme gi talk for md

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a talk given in July 2011 on the gastrointestinal manifestations of Lyme, Bartonella, Mycoplasma and other tic borne diseases.

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Lyme gi talk for md

  1. 1. GASTROINTESTINAL TIC BORNE INFECTIONS Martin D. Fried, MD, FAAP Pediatric Gastroenterology Physician Nutrition Specialist 3200 Sunset Ave Suite 100 Ocean, NJ 07712
  2. 2. Gastrointestinal Complaints abdominal pain vomiting blood in stool constipation heartburn chest pain soiling diarrhea mouth sores MULTISYSTEM difficult swallow Skin rashes
  3. 3. Apthous Ulcers
  4. 4. Canker Sore
  5. 5. Erythema Nodosum
  6. 6. Psoriasis
  7. 7. Ulcers
  8. 8. Colitis
  9. 9. Rectal Fissure
  10. 10. Skin Tag vs Granuloma
  11. 11. Psoriasis with Granuloma
  12. 14. Bartonella Borrelia burgdorferi H pylori Mycoplasma Salmonella, EBV Clostridium difficile
  13. 15. SINGLE INFECTIONS 30
  14. 16. COINFECTIONS = 20
  15. 17. TRIPLE INFECTIONS = 6
  16. 18. 80 PATIENTS, 88 INFECTIONS
  17. 19. Heartburn, Abdominal Pain, Skin Rash, Gastritis, and Duodenitis Bartonella henselae
  18. 20. <ul><li>Cat Scratch Fever </li></ul><ul><li>Lymphandenopathy </li></ul><ul><li>hepatitis-elevated liver enzymes </li></ul><ul><li>Splenitis </li></ul><ul><li>Pneumonitis </li></ul><ul><li>Fever Unknown Origin </li></ul>
  19. 21. Gastrointestinal Bartonella <ul><li>Hepatosplenic Abscess </li></ul><ul><li>Abdominal Pain-burning </li></ul><ul><li>Mesenteric Adenitis-mimic Appendix </li></ul>
  20. 22. GI Presentation <ul><li>Heartburn </li></ul><ul><li>Abdominal Pain </li></ul><ul><li>Skin Rash-striae –stretch marks </li></ul><ul><li>Enlarged Lymph nodes </li></ul>
  21. 23. VIOLACEOUS RASH
  22. 24. NEW BLOOD VESSELS
  23. 26. GI Infections <ul><li>tic bite </li></ul><ul><li>No prior GI complaints </li></ul><ul><li>No steroid use </li></ul><ul><li>No abrupt weight gain </li></ul>
  24. 27. Infection and or Diet <ul><li>Pain not resolved by antacids, Histamine blockers, PPI </li></ul>
  25. 28. Skin Rash <ul><li>Violaceous- deep reddish purple </li></ul><ul><li>Serpinginous- “snake like” </li></ul><ul><li>Breast or lower back </li></ul><ul><li>Groin or back knee </li></ul><ul><li>Periumbilical (belly button) </li></ul><ul><li>Inner thigh </li></ul><ul><li>stretch marks are different </li></ul>
  26. 31. Mesenteric Adenitis <ul><li>CT Abdomen </li></ul><ul><li>Lymph Nodes > 1cm in diameter </li></ul><ul><li>May mimic appendicitis </li></ul>
  27. 32. Endoscopy and Biopsy <ul><li>Assess the GI mucosa </li></ul><ul><ul><li>H. pylori </li></ul></ul><ul><ul><li>Bartonella by PCR </li></ul></ul><ul><ul><li>Borellia burgdorferi PCR </li></ul></ul><ul><ul><li>Mycoplasma PCR </li></ul></ul><ul><ul><li>Ehrlichia and Babesia PCR </li></ul></ul>
  28. 33. Bartonella Pathology <ul><li>Chronic Gastritis and or duodenitis </li></ul><ul><li>No Ulcer </li></ul><ul><li>No evidence of allergy (eos) </li></ul><ul><li>No Acute Inflammation (polys) </li></ul>
  29. 34. Bartonella Rashes <ul><li>Maculopapular </li></ul><ul><li>Urticarial </li></ul><ul><li>Erythema Nodosum (crohns also) </li></ul><ul><li>Granuloma Annulaire (ringworm) </li></ul><ul><li>Thrombocytopenic Purpura </li></ul><ul><li>Leukoclastic Vasculitis </li></ul>
  30. 37. Striae <ul><li>Endothelial Proliferation </li></ul><ul><li>Differentiate from stretch marks </li></ul><ul><li>in obese or steroid using patients </li></ul>
  31. 38. Bartonella GI Inflammation <ul><li>An Association Shown </li></ul><ul><li>IL-2, IL-6, IL-10, Elicited </li></ul>
  32. 39. Interleuken 6 <ul><li>Multipotent cytokine </li></ul><ul><li>Elicited by Infections </li></ul><ul><li>Induces inflammation </li></ul>NEOVASCULARIZATION
  33. 40. NEOVASCULARIZATION NEW BLOOD VESSELS
  34. 42. STEROID EFFECT
  35. 43. STEROID EFFECT
  36. 44. SERPINGINOUS RASH = INFECTION
  37. 45. SNAKE LIKE = INFECTION
  38. 46. Bacteria Infects humans only Transmitted - human to human Helicobacter pylori
  39. 47. H. pylori <ul><li>Irritant to stomach lining </li></ul><ul><li>Cause of gastric, duodenal ulcers </li></ul><ul><li>Lifelong infection unless treated </li></ul><ul><li>Predispose to stomach cancer </li></ul><ul><li>due to chronic irritation </li></ul>
  40. 49. H pylori breath test
  41. 50. Helicobacter pylori <ul><li>Nodularity Gastritis </li></ul>
  42. 51. Eradication of H. pylori Two antibiotics for two weeks Clarithromycin Amoxacillin Proton pump inhibitor for a month intracellular death of infection
  43. 52. Mycoplasma <ul><li>Intracellular infection </li></ul><ul><li>Rarely in the blood </li></ul><ul><li>Worsens Lyme, Bartonella symptoms </li></ul><ul><li>Fibromyalgia, CFS, RA, and Gulf War </li></ul>
  44. 53. Mycoplasma protein <ul><li>Stimulates immune cells </li></ul><ul><li>Proinflammatory cytokines </li></ul><ul><li>TNFalpha, IL-1, IL-6 </li></ul><ul><li>GI may resemble Crohn’s </li></ul>
  45. 54. Chronicity of Mycoplasma <ul><li>Surface antigenic variation </li></ul><ul><li>Supress host immune responses </li></ul><ul><li>Slow growth rates </li></ul><ul><li>Intracellular locations </li></ul><ul><li>Can take 3 years to eradicate </li></ul><ul><li>Can follow IgM and IgG titers </li></ul>
  46. 55. Celiac vs Food Intolerance <ul><li>Celiac is Autoimmune to wheat, rye, barley </li></ul><ul><li>Gluten, Genetics and Environment </li></ul><ul><li>Intolerance is IgE or non IgE mediated </li></ul>
  47. 56. Inflammation causes permeable gut Foreign proteins to immune system Crohn’s, Colitis, Celiac
  48. 58. Treatment complications
  49. 59. Candida Albicans
  50. 60. Candida Albicans <ul><li>Normal Flora Yeast </li></ul><ul><li>Antibiotics kills Normal Flora </li></ul><ul><li>Yeast overgrowth occurs </li></ul><ul><li>Diet to produce lactobacillus, bifidobacteria </li></ul><ul><li>Short chained fructooligosaccharides (FOS) </li></ul><ul><li>Not a casein or gluten related problem </li></ul>
  51. 61. Clostridium difficile <ul><li>C. difficile is normal bacterial flora </li></ul><ul><li>Antibiotics kill lactobacilli, bifidobacter </li></ul><ul><li>C. difficile overgrowth occurs </li></ul><ul><li>C. difficile elicits – Toxin A and Toxin B </li></ul><ul><li>Pseudomembranous colits </li></ul><ul><li>Treat with Metronidazole and probiotics </li></ul><ul><li>However, prebiotics help L and B multiply </li></ul>
  52. 62. Pseudomembranous Colitis
  53. 64. Foods with sc FOS <ul><li>Banana onions </li></ul><ul><li>garlic asparagus </li></ul><ul><li>Barley wheat </li></ul><ul><li>Tomatoes leeks </li></ul>
  54. 66. Conclusions <ul><li>Lyme, Bartonella, Mycoplasma occur in the GI tract of children 5-21 yrs </li></ul><ul><li>PCR biopsies to document infection </li></ul><ul><li>Consider Coinfections </li></ul><ul><li>Prevent yeast, c. difficile overgrowth with prebiotics and probiotics </li></ul>
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