Malaria and Lyme Disease Co-Infection: Case Report Findings
Co-infections can complicate diagnosis and treatment in infectious diseases. A case report describes a patient with both malaria and Lyme disease, highlighting the importance of considering multiple infections when symptoms evolve or do not respond as expected.
“As far as we are aware, we are writing the first report of Plasmodium spp. and Borrelia burgdorferi co-infection,” explains Neves from the Infectious Diseases Department, Centro Hospitalar São João, Portugal.
The patient had returned to Portugal from Angola, where he worked as a welder. Four months earlier, he had been diagnosed with malaria and treated as an outpatient. After returning, he developed fever, constitutional symptoms, headaches, and blurred vision.
Malaria was suspected based on thin blood smears and rapid diagnostic testing. Treatment was initiated with intravenous quinine and doxycycline.
Neurologic Symptoms Prompted Evaluation for Lyme Disease
On the second day of hospitalization, the patient developed altered mental status with increasing lethargy. Neurologic evaluation revealed confusion, disorientation, cognitive slowing, and a slight left central facial palsy.
“Atypical malaria has a broad differential diagnosis, of which co-infections represent a cornerstone,” the authors note.
The diagnosis of Lyme disease was based on clinical findings and positive serology for Borrelia burgdorferi. Polymerase chain reaction (PCR) testing of cerebrospinal fluid confirmed neuroborreliosis.
Co-Infection Required Targeted Treatment
The patient tested positive on Western blot, and treatment was adjusted to include intravenous ceftriaxone for 14 days. He also required management for an autolimited antiphospholipid syndrome.
This case underscores the importance of considering co-infections in patients with complex or evolving symptoms. Recognition of Lyme disease alongside malaria altered management and may have prevented further neurologic complications.
Patients with persistent or atypical symptoms may benefit from evaluation of coinfections, review of Lyme disease symptoms, and individualized approaches to recovery.
References
- Neves N, Silva-Pinto A, Rocha H, et al. Plasmodium spp. and Borrelia burgdorferi co-infection associated with antiphospholipid syndrome in a returned traveler: a case report. Clin Case Rep. 2017;5(4):471-476.
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
Why is it not that Malaria is a Co-infection to Chronic Lyme as Babesia (Cousin to Malaria) and Bartonella are co-infections to Lyme (Borrelia Burgdorferi)? When will they finally admit that B. Burgdorferi is the root to so many debilitating disorders? They are all symptoms of Chronic Lyme. Its a terrible disgrace how we are being lied to and denied appropriate health care.
That would be due to the biology of the pathogens and which hosts they prefer as a vector. Babesia spp. and Borrelia spp. have developed mechanisms directly aimed at their tick vectors. Malaria have developed mechanisms to interact with their mosquito vectors. Not saying it is impossible for mosquito to transmit babesia or a tick to transmit malaria, but I do certainly believe the chances would be minimal. For how you are being lied to I suggest to start reading at https://www.truthcures.org
Thanks for your comments. The co-infection term has been used for more than one infection from a tick. The authors are using the term as two infections. In the author’s case, it would appear to be two infections from two vectors. Do you have a better term when there are two vectors?
Thanks for your question. Many us us use the term co-infection when we are referring more than one infection from a tick. The authors are using the co-infection term to refer to an infection from a tick and from a mosquito. Do you have a better term?
Someone I know was diagnosed with Lyme disease approximately 2 years ago (Ottawa area) and now says he has Lyme related Malaria. He has not traveled outside Canada. Is this possible?
They are likely referring to Babesia, a blood borne parasite in the same tick that carries Lyme disease. The treatment for Malaria and Babesia use some of the same medications. Babesia has been reported in Canada.
Understand frustration with deplorable healthcare (live in US) for Lyme patients. Diagnosed with late-stage, IGENex Lab and Dr 78 miles from home. Brought tick to City Health Dept. “get tested…unusually large male deer tick”. Blood test same week “negative”. Now know tested to soon for antigens to build up for accurate testing. Over time antigens diminish as infection moves into muscle, joint and bone. Went to ER, 2006, with beet-red expanding rash (have pictures). Dr “don’t know…”.
Recently told by Rheumatologist “I don’t believe in Lyme disease” and Hematologist “Drs. (facility) don’t…”. Wouldn’t make appt with PCP and Neurosurgeon referrals at another hospital Infectious Disease. Hematologist “wouldn’t see…Drs. (that facility) don’t believe…”. All testing points to coinfections of Lyme like Autonomic Dysfunction (2008 Disabled/2018 testing “significantly progressed”), Tryptase/Mast Cell disease 21.7 ug/L (range 1,000 Dr appts/MRIs, etc. Downhill skied, PADI cert scuba diver, have motorcycle license, camped entire life until I physically couldn’t, and now barely move. On 3D CT before shoulder surgery (glenoid: “approx 50% fragmented and displaced from the normal…”). Many years of excruciating pain. Impossible, especially for late-stage Lyme, to get the correct diagnosis before being “untreatable”.