Relapsing Fever vs Lyme Disease: Borrelia miyamotoi Symptoms
Relapsing fever symptoms can overlap with Lyme disease
Borrelia miyamotoi may not cause classic recurrent fevers
Testing limitations can complicate diagnosis
Relapsing fever vs Lyme disease can be difficult to distinguish because patients with Borrelia miyamotoi often present with symptoms that overlap with Lyme disease and other tick-borne infections. Fever, headaches, fatigue, muscle pain, and abnormal laboratory findings may appear without the classic recurrent fever pattern many clinicians expect.
Because Borrelia miyamotoi is transmitted by Ixodes ticks, the infection frequently enters the differential diagnosis alongside coinfections, Lyme disease, and other tick-borne illnesses.
Why Borrelia miyamotoi may not follow a relapsing fever pattern
Despite having the genetic apparatus, B. miyamotoi typically does not manifest with a relapsing fever. “Although evidence of antigenic variation, which drives the relapsing course of other relapsing fevers due to borrelia has not been demonstrated clinically or in an animal system thus far for B. miyamotoi, it has been shown that this species does have the genetic apparatus for this variation,” according to Sudhindra from the Division of Infectious Diseases, New York Medical College. [3]
All but one of the 51 individuals in the case series presented with fever. They did not, however, suffer from recurrent fevers.
According to Sudhindra, “The low percentage of cases with a relapse of fever may be due to the frequent use of empiric antibiotic therapy early in the course of febrile illnesses in patients with tick exposures.” [3]
What is the relapsing fever pattern in Borrelia miyamotoi?
Patients searching for a relapsing fever pattern may expect repeated cycles of fever separated by symptom-free periods. However, many patients with Borrelia miyamotoi never develop classic recurrent fever episodes, making diagnosis more challenging.
What are Borrelia miyamotoi symptoms?
The individuals exhibited symptoms similar to those found in other tick-borne illnesses. The majority presented with headaches, myalgias, arthralgias, and malaise/fatigue.
“More than 50% were suspected of having sepsis, and 24% required hospitalization,” states Molloy. [1]
Elevated liver enzyme levels, neutropenia, and thrombocytopenia were common in 75%, 60%, and 51%, respectively. “Borrelia miyamotoi disease may be clinically similar to or be confused with human anaplasmosis,” according to Molloy.
These findings may overlap with other tick-borne illnesses and coinfections.
Relapsing fever vs Lyme disease: key differences
Patients searching for relapsing fever vs Lyme disease are often trying to understand why symptoms do not fit a classic pattern.
- Lyme disease may present with erythema migrans; B. miyamotoi generally does not.
- Laboratory abnormalities such as thrombocytopenia and neutropenia may be more common with B. miyamotoi.
- Classic relapsing fever episodes may be absent despite classification among relapsing fever borreliae.
- Both infections can overlap clinically with multiple Ixodes-transmitted infections.
Why Borrelia miyamotoi testing may miss early disease
The B. miyamotoi organisms were identified as part of an active detection protocol among acutely ill patients in Massachusetts, Rhode Island, New Jersey, and New York.
Researchers initially identified cases by whole-blood PCR testing for common tick-borne infections. B. miyamotoi was confirmed based on immune response to recombinant glycerophosphodiester phosphodiesterase (rGlpQ) protein. [1]
The rGlpQ test was negative for most cases when initially treated.
“Serologic testing using the rGlpQ EIA seems insensitive in diagnosing acute BMD infection given that it was positive for IgG or IgM in only 16% of the case patient samples at the time of clinical presentation,” states Molloy.
The rGlpQ was positive after the fact in 86% of patients during convalescence. [1]
Testing limitations may contribute to delayed diagnosis, particularly when symptoms overlap with other infections.
Is Borrelia miyamotoi Lyme disease?
Borrelia miyamotoi is not Lyme disease, but it is transmitted by the same Ixodes ticks.
According to Molloy, “Infection with B. miyamotoi is the fifth recognized Ixodes-transmitted infection in the northeastern United States and should be part of the differential diagnosis of febrile patients from areas where deer tick–transmitted infections are endemic.”
Read more about Borrelia miyamotoi.
Frequently Asked Questions
Does Borrelia miyamotoi always cause relapsing fever?
No. Many patients present with fever but never develop recurrent fever episodes.
Is Borrelia miyamotoi Lyme disease?
No. It is a separate infection transmitted by the same tick vector as Lyme disease.
What are common Borrelia miyamotoi symptoms?
Symptoms may include fever, headaches, fatigue, myalgias, arthralgias, and laboratory abnormalities.
Why is early testing difficult?
Early serologic testing may have limited sensitivity, making PCR and clinical context important.
Clinical Takeaway
Classic recurrent fevers may be absent in many patients with Borrelia miyamotoi infection despite its classification among relapsing fever borreliae.
The absence of a classic relapsing fever pattern should not exclude Borrelia miyamotoi disease in patients with compatible symptoms and tick exposure.
Related Articles
Coinfections in Lyme disease
Lyme test accuracy
Persistent Lyme disease overview
Delayed Lyme disease diagnosis
References
- Molloy PJ, Telford III SR, Chowdri HR, Lepore TJ, Gugliotta JL, Weeks KE, Hewins ME, Goethert HK, Berardi VP. Borrelia miyamotoi Disease in the Northeastern United States: A Case Series. Ann Intern Med. 2015.
- Telford SR III, Goethert HK, Molloy PJ, Berardi VP, Chowdri HR, Gugliotta JL, Lepore TJ. Borrelia miyamotoi Disease: Neither Lyme Disease Nor Relapsing Fever. Clin Lab Med. 2015;35(4):867-882.
- Sudhindra P, Wang G, Schriefer ME, McKenna D, Zhuge J, Krause PJ, Marques AR, Wormser GP. Insights into Borrelia miyamotoi infection from an untreated case demonstrating relapsing fever, monocytosis and a positive C6 Lyme serology. Diagn Microbiol Infect Dis. 2016;86(1):93-96.
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
I have been having some issues since November. I feel as if I may have Lyme disease. I have had several bites last year. Do you take GHI. ppo Emblemed health insurance? If not how much out of pocket does visit cost. Thanks
Kevin Mitchell
Sorry to hear you are ill. Call the office at 914 666 4665 with any questions.
What is the best treatment for Borrelia Miyamotoi?
The evidence is weak. Doxycycline and Zithromax are common recommendations but the data in people is not in.
I was positive on igenex immunoblot TBRF. one of the types they test for is miyamotoi. but there are others. is there a test available to determine which of the other “borrelias” i have ? not alot of info on proper protocols. i have also tested pos for borrelia burgdorf that was a few years ago. i think that i have irradicated that with abx treatment.
There are a growing number of test by a wide range of labs that are in production. I find it can be difficult to difficult to determine which tick-borne infections are present or resolved.
I was just diagnosed with miyamotio. I am on doxy(twice a day) 100mg pills. Should I modify my diet or take any herbal supplements?
I focus of probiotics as well as avoidance of sugar and alcohol at my first step. You may have to look at a second antibiotic if doxycycline does not work as we don’t fully know what works for Borrelia miyamotoi or if another tick borne illness is present.
Help – my 20 year old tested positive for Miyamotoi. He is allergic to Sulfa antibiotics and cephalosporins. He did a short course of azythromicin and then did 2 weeks of Biaxin 2x per day. During the 2 week period he felt better. (ONLY SYMPTOMS ARE BAD LEG PAIN THAT STARTED AND FEW MONTHS AGO). After he stopped the Biaxin (began to taper off) the leg pains came back. Was never on Doxycycline. Thoughts ??? Go back on Biaxin? For how long? Need Doxy? Mix of antibiotics? IV antibiotics?
There might be another co-infection. I would look at treatment with doxycycline. I would also consider an evaluation for Babesia. I also would look for illnesses not related to ticks.