In Ehrlichiosis, test for both the monocytic and granulocytic forms. Many presently uncharacterized Ehrlichia-like organisms can be found in ticks and may not be picked up by currently available assays, so in this illness too, serologies are only an adjunct in making the diagnosis. Babesia are parasites, and I suggest that if a coinfection is found involving this organism, treat this first, so that subsequent therapy for Borrelia and Ehrlichia will be more effective. Experience has shown that collateral conditions exist in those who have been ill a long time. 100mg each of B1 and B6 and 1000 mcg of B12 IM at least weekly in the more ill patient.
Magnesium deficiency is very often present and quite severe.
Magnesium is predominantly an intracellular ion, so blood level testing is of little value. Because the Lyme syndrome has been associated with faulty activation of T4, measure free T3 levels by RIA and basal A.M. body temperatures. If hypothyroidism is found, treat with T3 preparations. This not only helps with the differential diagnosis, but if done before and after acetazolamide, it will guide in the use of vasodilators, which may clear some cognitive symptoms. Therapy can also include serotonin agonists, pentoxiphylline and even Ginko biloba.