Sorry I didn't post the final results sooner, but I seem to have some kind of infection...folks, it’s getting weird over here. Over the weekend I developed the exact same symptoms I described in Lakeith (fever, aches and pains, chills, headache). I had a tick bite 2 weeks ago, though no bulls eye rash. I just got tested for Covid-19 this morning at an urgent care clinic, and I’m waiting to hear back from my primary care provider (apparently, they don’t call you back the same day anymore!) I’ll keep you posted on my case, but in the meantime:
Lakeith’s Lab values:
ALT 150 (normal is 7-55 U/L)
AST 105 (normal is 8-48 U/L)
Bilirubin 3.5 (normal 0.1 to 1.2 mg/dL)
All other blood work was normal
Elevated liver enzymes are common in both Covid-19 and Lyme disease, so this isn’t a good differential. A study I read showed 76.3% of 417 patients had abnormal LFTs and 21.5% had liver injury with Covid-19 (April 13, 2020, https://www.journal-of-hepatology.eu/article/S0168-8278(20)30218-X/fulltext). They had ALT, AST, total bilirubin and gamma-glutamyl transferase levels elevated to more than 3× the upper limit. Patients with abnormal liver tests of hepatocellular type or mixed type at admission had higher odds of progressing to severe disease
For practical and efficient screening of large populations for a viral infection like Covid-19, reports from China recommend including white blood cells (WBC) and C-reactive protein (CRP) in laboratory examinations for early monitoring of infection (Lu, L. Interpretation of 7th edition of COVID-19 diagnostic and treatment guidelines. Lifotronic webinar: Diagnosis Guidelines for COVID-19, March 19, 2020 https://onlinelibrary.wiley.com/doi/10.1002/ajh.25774)
Their analysis revealed that on admission (so this would be for patients much sicker than Lakeith), most patients had a normal CBC (normal Hb, WBC and platelet count) and lactate dehydrogenase (LDH). And, no patient presented with moderate or severe thrombocytopenia that is frequently observed in other viral illnesses such as dengue fever.
However, reports from China are showing high levels of lymphopenia (Absolute Lymphocyte Count < 1 × 109/L). Those requiring ICU care had a lower ALC and higher LDH. Lymphopenia (ALC) and lactate dehydrogenase (LDH) have both been significantly elevated in hospitalized COVID-19 patients in a small study of 96 confirmed COVID-19 cases in Singapore.
Lyme Disease
In the U.S., Lyme disease is caused by Borrelia burgdorferi and Borrelia mayonii. The most common tick-borne illness, Lyme disease is transmitted by the bite of an infected deer tick.
Lakeith’s nurse practitioner ordered an ELISA test for Lyme, though an ELISA test might not be positive during the early stage of Lyme disease. The rash is distinctive enough to make the diagnosis without further testing in people who live in areas infested with ticks that transmit Lyme disease (New York State is a hot spot for Lyme disease). In addition, the ELISA test can sometimes provide false-positive results, so it’s not the sole basis for diagnosis. Lakeith’s ELISA and subsequent Western blot both came back positive.
Signs and Symptoms of Lyme
A small, red bump, similar to the bump of a mosquito bite, may appear at the site of a tick bite or tick removal, but this may occur with or without Lyme disease. Erythema migrans (bullseye rash) is one of the hallmarks of Lyme disease, although not everyone with Lyme disease develops the rash. Other symptoms include Fever, chills, fatigue, body aches, headache, neck stiffness and swollen lymph nodes. If untreated, new signs and symptoms of Lyme infection might appear in the following weeks to months (https://www.CDC.gov/lyme/signs_symptoms/index.html). These include bouts of severe joint pain and swelling, especially likely to affect the knees, but the pain can shift from one joint to another. Weeks, months or even years after infection, meningitis can cause Bell's palsy, numbness or weakness in limbs, impaired muscle movement and problems with mentation and memory, so it is important to diagnose Lyme early. Delayed diagnosis increases the risk of Post Treatment Lyme Disease Syndrome (https://www.cureus.com/articles/24863-lyme-disease-with-erythema-migrans-and-seventh-nerve-palsy-in-an-african-american-man) and other long-term complications from Lyme disease.
Antibiotics are used to treat Lyme disease. In general, recovery will be quicker and more complete the sooner treatment begins. Many signs and symptoms of Lyme disease are often found in other conditions, so diagnosis can be difficult.
Covid-19 False Negatives
Researchers at Johns Hopkins have found that the chance of a false negative result -- when a virus is not detected in a person who actually is, or recently has been, infected -- is greater than 1 in 5 and, at times, far higher. The researchers caution that the predictive value of these tests may not always yield accurate results, and timing of the test seems to matter greatly in the accuracy. https://www.sciencedaily.com/releases/2020/05/200526173832.htm.
Lakeith requested a second Covid-19 test, which was also negative. He is currently taking a two-week course of oral Doxycycline.
Health disparities and Lyme
A recent study finds that African Americans who contract Lyme disease are 10% more likely than Caucasians to exhibit symptoms such as neurological or heart problems, and they are 30% more likely to suffer from arthritis as a result of the disease. Whites were nearly six times more likely than African Americans to have detected a bull’s-eye rash, according to the study, which may be due to darker skin color that hides the bull’s-eye rash. Because skin tone may hide this key indicator, African Americans may remain untreated longer and therefore suffer more complications from Lyme disease. This highlights the need for increased health care education on Lyme disease in African-American communities. https://minoritynurse.com/darker-skin-tones-slow-detection-of-lyme-disease/
Health disparities and Covid-19
Twenty-two percent of U.S. counties that are disproportionately black account for 52 percent of the nation’s COVID-19 cases and 58 percent of COVID-19 deaths (https://directorsblog.nih.gov/2020/05/14/covid-19-brings-health-disparities-research-to-the-forefront/)
In another study, 33% of hospitalized patients were black, compared to 18% in the community, and 8% were Hispanic, compared to 14% in the community. These data suggest an overrepresentation of blacks among hospitalized patients. Death rates among black/African American persons (92.3 deaths per 100,000 population) and Hispanic/Latino persons (74.3) that were substantially higher than that of white (45.2) or Asian (34.5) persons. (https://www.CDC.gov/coronavirus/2019-ncov/need-extra-precautions/racial-ethnic-minorities.html)
Racial disparities are a major issue with Covid-19. Evidence has emerged that doctors are less likely to refer African Americans for testing for covid-19 when they exhibit symptoms (https://www.washingtonpost.com/outlook/2020/05/18/most-medical-professionals-arent-racist-but-our-medical-system-is/). U.S. Senator Elizabeth Warren (D-MA) and Representative Ayanna Pressley (D-MA) have called for more thorough collection of racial data, faulting the government for “currently failing to collect and publicly report on the racial and ethnic demographic information of patients tested for and affected by Covid-19.” (https://www.nejm.org/doi/full/10.1056/NEJMp2012910)
Thanks for commenting and liking - I so appreciate it. I'm going to take some acetaminophen and go back to sleep. Ugh.
I thought it would make for an interesting and informative discussion. Thanks for reading and commenting.
