Welcome to the Townsend Letter's new section to be featured every other month, bringing you tips and treasures regarding integrative care for our little ones. Sections will be focused on a case report with selected relevant references for your review. The recognition is that many of you are not pedi-people, so explanations will be given, which might be more routine for pedi-practitioners. Treatment focus is generally homeopathic combined with herbal remedies when needed. The foundation of care is based on an organic diet without exception. Nutraceuticals and supplements are added when necessary with the understanding that administering to little ones may be challenging if they are dealing with sensory defensiveness or are "picky eaters." Therefore, treatment regimens and choices should be carefully selected. This section will be clinically focused with a "how-to" orientation.
Our launch feature is related to this month's highlighted topic, Lyme disease and co-infections, referred to as "Lyme disease," an overlooked and mishandled issue in pediatric care. An emphasis will be placed on clinical management with real cases complete with on-the-frontline dilemmas.
Management of Congenital Lyme Disease Infection
Mom R is a 32 year old under my care for chronic Lyme disease, with positive antibodies to Borrelia burgdoferi and Bartonella henselae via Igenex®. While in the office, I noted her three year old to have linear red lines on her extremities, and we began treatment for bartonella infection for the three year old. However, the mom was insistent on getting pregnant although she was cautioned against it until we had a better response to her Lyme disease. The family was lost to follow up, and they returned with an eight-month-old baby girl one year later, who was also exhibiting linear red lines appearing intermittently on her body. Mom R recognized that this "rash" was not "the baby scratching herself" as she was told by her doctor, but a manifestation of bartonellosis.
The pregnancy was remarkable for poor weight gain. Baby A was born via NSVD (normal spontaneous vaginal delivery) without any complications. Her birth weight was 5 lbs, borderline SGA (small for gestational age). Her history was remarkable for prolonged fevers after her first immunization with DTaP, and she hadn't received any further immunizations since. She was presently being nursed while mom was on herbal antibiotics for bartonella treatment. Baby A's physical exam was notable for height and weight, which were below the 3rd percentile, a slightly enlarged spleen to palpation, and linear red lines on her trunk and extremities.
The family was unable to pay for any labs tests outside of regular insurance coverage. Her labs were remarkable for a low vitamin D level and borderline low platelets. Her borrelia and bartonella antibody tests were negative via Quest Diagnostics.
Congenital Lyme Infection
Congenital infections are recognized in the Western literature for Lyme disease and co-infections, such as bartonella.1-4 The challenges that present include the fact that they are not routinely looked for due to often absent or misdiagnosis in the mother. Additionally, routinely ordered labs via conventional testing miss many Lyme infections and are of limited reliability. Looking at the case of Mom R, she was self-treating after her initial visits with me and also didn't report to her midwife what she was doing. (Real life scenarios!) Whether the baby also had a mixed infection was unclear, but presumably likely. The rate of infection transmitted to the newborn goes down significantly when mom is treated with antibiotics. Dr. Jones reported at a 2011 ILADS conference that the rate of Lyme transmission is 50% in women that are untreated, dropping down to 25% when women are treated with one antibiotic and to 5% when treated with two antibiotics. I could not find statistics as to whether the same effect is noted with herbal antibiotics.
When treating Lyme disease in children, particularly in babies, there are several factors to first consider:
1. What is the nutritional status/immune status of the infant and mother?
2. Is the infant nursing, and is the baby pooping adequately?
3. What is the detoxification capacity of the infant?
4. What can the parents handle and afford?
5. Which lab tests would be most useful?
Because this infant was not in any distress at the time of the visit and for the most part thriving except for the notable growth issue, we had the luxury of looking at the above factors before launching into any type of therapeutics. Which labs to draw to assist in the management of this baby can be tricky. The blood volume of an infant is approximately 100 ml/kg. This infant weighed 6 kg at the first visit, so her entire blood volume is only about 600 ml. Additionally, finding a qualified pediatric phlebotomist can be challenging! A baseline CBC,Vitamin D level, and an urinalysis are helpful to begin with, which will offer a window to immune function, iron and B12 status, and kidney function. I try to obtain labs that are covered by insurance when possible and to use urine and stool instead of venipuncture, which the parents (and the child) will appreciate as well.
The first step was to ensure an organic/nutritious diet of mom. Mom R also had been diagnosed with Hashimoto's thyroiditis previously and was off dairy and gluten. This baby was only nursed, and I did introduce solids into her diet to increase her protein intake and baseline weight. Baby A was able to poop without issue. This topic must be addressed in every child since constipation may be affecting nearly one-third of children, often unknown by the parents since once kids are potty-trained, parents are often unaware what is going on behind the bathroom door. I usually ask for pics of the poop (which the siblings will think is very funny) since it can be diagnostic and will spare the need for a stool test. Mom was MTHFR homozygous, so presumptively the baby was likely at least heterozygous for the MTHFR snp methylation issue, which I took into consideration.
Prior to treatment, I began the mom on a detoxification program using German Biological Medicine (Bioresource®), also known as bioregulatory medicine (https://www.chelseagreen.com/product/bioregulatory-medicine/) for liver, kidney, and lymph with the thinking it would get into the breast milk. Breastfeeding can be an effective way to treat babies gently. I did this for one month and brought the baby back for reassessment. She still was doing well and gained a small amount of weight. During the detox, the mom noted more frequent rashes in the infant, which could represent a flare of her infection from a possibly clearing. Mom tolerated the detox without any issues.
I then started the infant on Vitamin C 500 mg/day and silver (Argentyn 23®) two drops daily for two weeks which she tolerated well. The thinking was to give her antioxidant support and antimicrobial support prior to addressing the core infection.
The challenge at this juncture was whether to treat her with herbal antibiotics or homeopathics. Because I had experience with this family, I knew the other family members had responded well to homeopathic treatments in the past. If you note that a certain treatment works well in parents or siblings, this data can be extrapolated for the patient. I began the baby on a homeopathic series kit for bartonella from Desbio®, the most prominent infection noted in this infant clinically. I reduced the dosing to one-half of what I would normally use in an adult, and this treatment continued for two months. (https://desbio.com/featured/series-therapy/)
At the follow-up visit, Mom R reported that the baby had gained weight (now on the 5th percentile; weight gain is a very positive sign!) and noted fewer red linear lines that we had presumed were due to bartonella (which we used as a marker to monitor her progress), although still present. Not convinced we were done, I began a course of herbal antibiotics with MC-bar 1 (Beyond Balance®), starting low and slow at one drop twice a day, slowly increasing to five drops twice a day. Epsom salt baths were utilized to offset possible Herx reactions, which this baby did not seem to exhibit. Another herbal preparation I would have used is Tox-Ease from Beyond Balance® to off-set potential Herx reactions since these herbs are well-tolerated in children and are gentle and effective.
Ideally, to maximize excretion of organisms on testing, I usually like to test approximately three weeks into treatment, now preferring urine PCR testing in children (https://dnaconnexions.com/lyme-panel-temp/, for example). A negative test does not rule out infection, and I base treatment on clinical parameters using laboratory data as an adjunct to care of the child.
After six months of treatment and bringing in MC-bar 2 after we completed the MC-bar 1, the infant was thriving, and the weight and height growth leveled off at the 10th percentile. No further rashes were noted, and Baby A is being monitored at this point. She is being maintained on probiotics (sauerkraut juice), methyl B12/methyl folate at 400 mcg each, and Vitamin C 500 mg. daily. If I were to bring in probiotic treatment, I've now been evaluating sporebiotics from Microbiome Labs®, presently introducing a new pediatric spore preparation; a topic for future kiddie korners!
1. Breitschwerdt EB, et al. Molecular evidence of perinatal transmission of Bartonella vinsonii subsp. berkhoffii and Bartonella henselae to a child. J Clin Microbiol. 2010 Jun;48(6):2289-93.
2. Mylonas I. Borreliosis During Pregnancy: A Risk for the Unborn Child? Vector Borne Zoonotic Dis. 2011;11:891-8.
3. Hussein H, Showler A, Tan DHS. Tick -borne relapsing fever in pregnancy. CMAJ. 2014 February 4; 186(2): 131–134.
4. Lakos A, Solymosi N. Maternal Lyme borreliosis and pregnancy outcome. International Journal of Infectious Diseases. 2010; 14.6: e494-e498.
Michelle Perro, MD, is a veteran pediatrician with nearly four decades of experience in acute and integrative medicine. More than fifteen years ago, Dr. Perro transformed her clinical practice to include pesticide and health advocacy. She has both directed and worked as attending physician from New York's Metropolitan Hospital to UCSF Benioff Children's Hospital Oakland. Dr. Perro has managed her own business, Down to Earth Pediatrics. She is currently lecturing and consulting as well as working with Gordon Medical Associates, an integrative health center in Northern California. She has co-authored What's Making Our Children Sick? with Vincanne Adams, PhD, and is executive director for the prominent science and health-based website, www.gmoscience.org.