3 More Weeks (part 9)

Revision. Appointment at 12:40. We were there 2 hours before. Normally you are attended to sooner, but today is very busy. First a look with just the doctor headgear. Eye widening drop, and another hour waiting for the drop to work. 

“Jansen”

Another man stood up and entered the room. Huh?

Engineer Jansen followed him and expressed surprise.

“Sanchez, not Jansen”

Ah. Sorry.

Patience.

Time passes.

More time passes.

“Jansen”

“Not Sanchez?”

“No”

More looking into the eyes. Up, down, left, right, etc etc

“Disc is much paler, inflammation is down.”

“We will stop treatment, as we see no more activity”

3 More Weeks

Engineer Jansen expected that attitude, and came prepared. His big goal for today was: obtaining the extra 3 weeks of antibiotics, as with the article patient. The article “Unusual presentation” has a quite similar patient, who gets 6 weeks of doxycycline in total, sees some improvement after 3 weeks, and more improvement after 6 weeks. Yet another article has a patient with 12 weeks. 

Standard protocol in Spain is 2 weeks when Lyme is detected early, 4 weeks if later and the blood test detects Lyme.  The Lyme blood tests however, are very insensitive. Literature describes so many cases with negative tests, also with lumbar punctions (“spinal taps”).

The engineer now has had 3 weeks of doxycycline, and after that sneaked in the remaining 8 days of Cefuroxime that he got the very first day in Urgencias, so he was under treatment every day since, with just one day of that Cefuroxime remaining. So, 4 weeks in total, though without visual improvement. 

“I really think it’s not necessary”

“I understand that completely, but borrelia/Lyme really is a nasty bacteria, it can hide and come back..”

“I lost one eye, that is quite a disaster, losing another eye would be a catastrophy.”

“3 more weeks of antibiotics probably will not kill me, but losing another eye would be, a catastrophy”

“We could do vitamins..”

The engineer looked really unhappy.

“This article…, they do 6 weeks, the other article 28 days IV Ceftraxione”

She gave in, even though she disgreed.

3 more weeks.

I wonder if they see many patients that interfere with their treatment like this.

(Sorry!)

Tomorrow Centro Salud in home village for extracting blood for the serologia tests. 

Together with engineer De Waal, for his followup blood tests.

Yes, toxoplasmosis IgG and IgM are both listed. Jolly!

Status

4 weeks in, the bad news is that there currently is substantial vision loss in one eye, the good news is that the inflammation has stopped.  Now hoping that vision improves in weeks or months to come, as with the article patients. 

Toxoplasmosis or no? (part 8)

Reading up on the appointments in the Andalucia Salud app the engineer encountered the report of a serologia analysis. Interested as he is the engineer studied it. 

Attentive readers will remember that extracting blood from the engineer went rather chaotically, not the engineer's fault, of course. Saturday 16/8 a vial was taken to detect Lyme/borrelia, Monday 18/8 the engineer was called back to the hospital in the evening because "they did not have enough", no one knew how or what, and two vials were extracted at the request of the engineer, and to determine later what to do with them. Tuesday 19/8 was a revision appointment at oftalmologia, that evening they called that the engineer was to present himself at the Sala de Extracciones, without breakfast. 6 vials were taken. Bloody vampires!

Informe serologia, AST, IGG, IGM

Anyway, the Salud Andalucia App has a report on serologia above,  "Fecha de toma de muestre" is "18/08/2025 21:25", so this must be those two vials that they were to see what to do with.

The last lines discuss "toxoplasmosis", or "cat scratch disease".  It has an IgG of 32,8, which means: positive.  

And "IgM: Muestra insufficiente". Hm.

Also, there is quite  high value for "Alanina Transaminasa" (AST).  An article on toxoplasmosis in dogs says 

"The biochemistry profile usually reveals abnormally high levels liver enzymes ALT (alanine aminotransferase) and AST (aspartate amionotransferase)"

The engineer combined the 3:

- high AST

- high IgG

- missing IgM

and investigated.

IgG, IgM

"IgG" tells if you were exposed to toxoplasmosis in the past. That in itself is no cause for alarm, as the majority of people has been in contact with toxoplasmosis. At the age of 70 the vast majority of people is positive for IgG.

If you have a current and active toxoplasmosis infection your "IgM" is elevated. But not: missing.

Damn! Blast!

Ocular Toxoplasmosis

Yes, toxoplasmosis can affect the eyes, and the symptoms can be quite what the engineer has. 

Toxoplasmosis is not a bacteria, it's a one celled critter that is difficult to eradicate, not sensitive to antibiotics, and can go in hiding in cysts, also in the eye, and resurface after many many years. 10-20 or more years. Not good news.

You get toxoplasmosis from cat scratches, especially from kittens, cat poop, eating raw meat that is contaminated with the cysts, eating (raw) vegetables that are contaminated in the field, or by contacting contaminated soil.

The engineer is not a cat lover, due to allergies, and avoids cats. Nor is he an avid raw-meat eater.  Raw vegetables: well.. yes! Lettuce comes washed, radishes, too. 

                       AAAAARGHHH!

Jensen Test

For Lyme/borrelia there is a test called the Jansen Test (see The engineer researches optical nerve inflammation and optical discs, and finds Lyme (part 3).

Hilariously for toxoplasmosis there is the Jensen Test, according to dr. Google (Ad Interim):

Urgencias (again)

As vision has deteriorated, another visit to Urgencias. Passed on to Oftalmologia again, as they cannot access the serologia report of the other two blood extractions at Urgencias.

Not the eye doctor who ordered the serologia:

"You don't have toxoplasmosis"

"But the symptoms..."

"You don't have toxoplasmosis, you have optic neuritis"

"But the IgM is missing"

"hm. Go to your Centro Salud for a new serologia with this request (paper)"

Could make the appointment in theApp straight away, for 13:28 the same day at the "Enfermeria".

Enfermeria

Ah, no, blood extraction is only Wednesday and Friday, and you need to talk to the doctor first. So, that is an appointment next week, Tuesday 16 Sep.

Rationale

The engineer well believes the oftalmologist that he does not think toxoplasmosis is the cause. It has quite specific lesions in the eye. On the other hand, if those lesions are not yet there you may still have toxoplasmosis. The engineer does not trust missing numbers due to "not enough sample blood available". It's bad enough as it is, and no time can be wasted.

The engineer wonders if they have ever had a patient challenging them on IgG and IgM numbers.

And that Nobel prize committee still has not called. Maybe this afternoon?

PS

No immunodeficiency virus. Good.