Lyme-Like Illness in Brazil: Similar Challenges in Diagnosis and Recognition
Lyme-like illness in Brazil—often referred to as Baggio-Yoshinari Syndrome (BYS)—has been described with features similar to Lyme disease, including multisystem involvement and diagnostic challenges. :contentReference[oaicite:0]{index=0}
Researchers note that, despite increasing reports of suspected cases, the condition remains under-recognized in parts of Brazil.
Clinical Features Overlap with Lyme Disease
BYS has been reported to include symptoms seen in Lyme disease, such as:
- Erythema migrans–like rashes
- Arthritis
- Neurologic symptoms
- Cardiac involvement
Like Lyme disease, the condition may be difficult to diagnose—particularly in later stages when patients may not recall earlier exposures.
Multisystem and Recurrent Illness
Reports suggest that BYS can involve multiple organ systems, including neurologic, cardiac, ophthalmic, muscular, and joint manifestations.
Some patients experience recurrent symptoms, particularly when treatment is delayed.
These patterns have raised questions about disease persistence and immune-related responses.
Diagnostic Limitations
Laboratory testing presents challenges.
Standard Lyme disease tests, developed using Northern Hemisphere strains, may have limited sensitivity when applied to Brazilian cases.
This may contribute to underdiagnosis or diagnostic uncertainty.
Possible Role of Coinfections
Investigators have identified additional microorganisms in some patients, including structures resembling Mycoplasma and Chlamydia species.
These findings raise the possibility that coinfections or mixed microbial processes may contribute to the clinical picture.
Animal Reservoirs and Transmission
Wild and domestic animals may serve as reservoirs for tick-borne pathogens.
In Brazil, capybaras and other animals have been associated with tick exposure and may play a role in maintaining transmission cycles.
Similar patterns have been observed in other regions where animal hosts contribute to the spread of tick-borne disease.
Ongoing Debate and Uncertainty
The nature of Lyme-like illness in Brazil remains an area of active discussion.
Some investigators have described a syndrome resembling Lyme disease, while others have not found consistent serologic evidence supporting its presence.
This difference in interpretation highlights the broader challenges of diagnosing and defining tick-borne illness across geographic regions.
Clinical Perspective
Reports from Brazil illustrate that the challenges seen in Lyme disease—diagnostic uncertainty, variability in presentation, and evolving understanding—are not unique to one country.
Clinicians may encounter similar patterns of multisystem illness and diagnostic complexity in different settings.
Patients may benefit from understanding Lyme disease symptoms, reviewing testing limitations, and considering coinfections when symptoms remain unexplained.
References
- Basile RC et al. Brazilian borreliosis with special emphasis on humans and horses. Braz J Microbiol. 2016.
- de Oliveira SV et al. Lack of serological evidence for Lyme-like borreliosis in Brazil. Travel Med Infect Dis. 2018.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
Dr Cameron good morning, I am an ID specialist and had the opportunity to listen from Dr Steere about the LD epidemy surrounding the Pennsylvania state.
I would like to share some news from the Brazilian Borreliosis, as we have molecular evidence of Borrelia burgdorferi in Ixodes and in patients.
Lopes FA et al, Rev Bras Reumatol Engl Ed, 2017
Dall’Agnol B et al, Ticks and Tick-borne Dis, 2017
Regards,
Thanks for sharing your findings. Let me know the details.
Demographics are changing. There is a vastly growing Brazilian population in the Is that often go back to Brazil. My son is in Brazil. Before he left to visit I had him tested. He tested positive for Borrelia burgdorferi Borrelia myonii anaplasma babesia and TBRF. Are there any Dr.s in Brazil qualifies to deal with this SP- now imagine multiply all the people transiting back and forth. Vector borne diseases are going to spread.
Unfortunately Steere is very narrow in his take on Lyme disease. I was misdiagnosed by an ID Dr in 2007 because he couldn’t think outside the box and he was too caught up in labs rather than clinical diagnosis. He never even thought of looking at the differential diagnosis for my symptoms. Took me 9yrs and thousands of dollars before I got bit again by a tick and had an ILADS Dr look at my notes and labs from 2007 to tell me I had bartonella. IDSA guidelines are developed by a panel of Dr.s of which multiple members are conflicted with insurance companies.
Hi, I got Lyme disease in a rural part of Rio De Janeiro state. I would be happy to share with you about it. No way I believe there have only been three credible cases. I know exactly where I was when exposed to ticks and found them burroughed in my hip a week later; the symptoms appeared exactly three weeks after that. I could not get a doctor to prescribe antibiotics here in Bethesda MD, because I did not test positive for any tick-transmitted illness and was told “its probably just a virus.”
Doctors are divided over the risk of tick borne diseases in South America. You should include a doctor familiar with tick borne illnesses if you remain ill.
Capybaras are not ” a popular Brazilian house pet”. Totally misconception.
I live un a rural région of São Paulo were ticks are simply a part of the environment and are present at a certain time of the year, in forrests and pastures. Some are big and easy to spot and others really small but bitting and itching hard! You learn to live with them. Animals and humans are getting regularly bitten and to some extend this cannot be avoided. There are domestic and wild animals, horses, wild capivaras, dogs… it is a farm like so many others. Ticks are as normal as other insects and part of this ecosystem. However it does not mean that they necessarily transmit LD. The symptoms are so subtle that it seems to me you can likely convince yourself you have LD even if you don’t. My question would be : what percentage of ticks might be infected by Lyme? How can we know this? Can some people be infected and then cure themselves from their own body immune system? Is there a reliable way to test for LM? Thank you doctor Cameron.
These question are difficult to answer even in countries that invest more resources into tick-born illnesses.
Neuropathy Mimicking Dental Pain in a Patient Diagnosed with Lyme Disease, Mello I, Peters J, Lee C, J Endod 46[9]: p1337-1339; 20-06-17:
DOI: 10.1016/j.joen.2020.06.011
Why dental professionals should know about the signs and symptoms of Lyme disease, Bell C, Dal News 21-02-19: https://www.dal.ca/news/2021/02/19/-why-dental-professionals-should-know-about-the-signs-and-sympto.html
Dr. Mello is an endodontist from Brazil and wasn’t aware of Lyme disease and couldn’t believe how much it was disrespected.
I also thought the article was helpful. You can read my Lyme Disease Science Blog at https://danielcameronmd.com/dental-surgery-triggers-full-body-pain-patient-severe-post-treatment-lyme-disease-symdrome/