Infections and Childhood Psychiatric Disorders: Tick-Borne Illness and Bipolar Disorder in Youth

Abstract

Objective: To explore possible links between tick-borne illness (TBI) and pediatric bipolar disorder (PBD) in a retrospective series of youth from a Northeast U.S. psychiatric private practice.Methods: PBD diagnosis in 27 youth (15 Bipolar I and 12 Bipolar II) was based on DSM-IV TR criteria following interviews with parents and children, questionnaires and school reports. Testing for Borrelia burgdorferi (Lyme disease), Babesia, Bartonella, Mycoplasma pneumoniae, Anaplasma and Ehrlichia occurred between February 2013 and July 2015. Lyme testing included an ELISA and Western Blot IgM/IgG and cultures; Babesia and Bartonella were ascertained by IgM/IgG antibody titers and fluorescent in-situ hybridization (FISH) tests. Other pathogen exposure was determined by IgM/IgG antibody titers. Testing was performed at LabCorp, Mayo Medical, IgeneX, Advanced Labs and/or Galaxy Diagnostics Laboratories. Clinical diagnoses were confirmed by physicians familiar with TBI. Data was summarized using descriptive statistics.Results: Eighty-one percent of the sample was male and 19% was female. Mean age at PBD diagnosis was 7.3 years. Exposure to one or more pathogens was found in 24/27 (89%) of the patients. Frequency of positive serology included: Babesia (n=16), Mycoplasma pneumoniae (n=11), Bartonella (N=8), and Lyme (n=6). Twenty-two of these 24 agreed to clinical evaluation and 92% (20/22) were diagnosed with TBI. Conclusion:The high rate of TBI in PBD patients presented here is provocative. If confirmed, this association may suggest gene-environment interactions and has implications for the prevention and treatment of PBD. Research evaluating TBI in bipolar cases vs. matched controls with other psychopathology and without psychiatric disease using standardized serological testing is needed.

Imaging analysis of Bartonella species in the skin using single‐photon and multi‐photon (second harmonic generation) laser scanning microscopy

“…infection may play a role in some cases of pediatric mood disorders. 19 Consistent with these observations, all three patients in this study initially saw mental health professionals due to the psychiatric/ psychological nature of the presenting symptoms. Mood disturbances, heightened anxiety, difficulty with school attendance and academic performance were the overwhelming clinical manifestations in each case.…”

“…These include resistance to complement activation, antigenic variation of surface proteins, and inhibition of host cell apoptosis. 19 There are no gold-standard diagnostic tests to confirm Bartonella spp. infection.…”

Neuropsychiatric Lyme Borreliosis: An Overview with a Focus on a Specialty Psychiatrist’s Clinical Practice

“…An outpatient retrospective chart review without a control group demonstrated 80% of children with psychiatric illness referred to a child psychiatrist, 49 of the 69 without a known history of LB or other TBD, demonstrated evidence of exposure to one or more of the pathogens B. burgdorferi , Bartonella, Babesia , Ehrlichia and Anaplasma on serologic testing performed by multiple laboratories and 22% of children with an onset of bipolar disorder referred to a child psychiatrist tested CDC surveillance criteria positive for LB. In addition, 74% of these children tested positive to exposure to one or more of the pathogens B. burgdorferi , Bartonella, Babesia , Ehrlichia and Anaplasma on serologic testing performed by multiple laboratories [ 45 , 46 , 47 ].…”

“…Bipolar disorder has been associated with a number of infections including LB [ 46 , 73 , 80 , 81 , 82 ]. When bipolar disorder is seen in LB patients, it is invariably rapid cycling [ 12 ].…”

Neuropsychiatric Borreliosis/Tick-Borne Disease: An Overview

“…When bipolar disorder is seen, it is invariably rapid cycling [12]. The prevalence of bipolar illness in LB/TBD is 74% (in children) [75], 47% (mood swings) [76], 28% (homicidal) and 10% [12]. Depression Depression from LB/TBD can frequently be prevented with early diagnosis and effective treatment [77].…”