Could Borrelia miyamotoi infections explain persistent symptoms in Lyme disease patients?
Antibodies were identified in patients with persistent symptoms
Pain and sleepiness were more prominent in antibody-positive patients
The study could not establish that the infection caused ongoing illness
Borrelia miyamotoi persistent symptoms and long-term effects remain important questions for clinicians evaluating patients with suspected tick-borne illness. Some patients with fatigue, pain, cognitive problems, or sleep disturbances after tick exposure may have an infection that was not initially recognized.
Borrelia miyamotoi is a tick-borne relapsing fever bacterium transmitted by the same Ixodes ticks that transmit Lyme disease. Unlike Lyme disease, however, erythema migrans rashes and arthralgias are uncommon, the authors reported in Frontiers in Medicine.
Investigators examined 82 patients seeking a second opinion for persistent symptoms and suspected tick-borne illness. Common complaints included fatigue, pain, neurocognitive difficulties, and psychiatric symptoms.
Twenty-one of the 82 patients—or 26%—tested positive for Borrelia miyamotoi antibodies using a GlpQ IgG enzyme immunoassay. Five of these 21 patients also met the study’s criteria for probable or definite Lyme disease.
Compared with patients who tested positive only for Lyme disease antibodies, the Borrelia miyamotoi antibody-positive group reported significantly more sleepiness on the Epworth Sleepiness Scale and more pain on a visual analog pain scale.
Eight of the 21 antibody-positive patients reported being hospitalized after their symptoms began. These included three hospitalizations for cardiac abnormalities and two for neurologic abnormalities.
All 21 antibody-positive patients had previously received antibiotics, and 20 had received at least two weeks of doxycycline or amoxicillin. However, a positive antibody result could not determine whether active Borrelia miyamotoi infection remained present during the evaluation.
Sixteen of the 21 antibody-positive patients lived in the Northeast or Mid-Atlantic region. The remaining five included two patients from California, two from Florida, and one from Illinois.
Study insights into Borrelia miyamotoi persistent symptoms
The study found that clinicians rarely tested for Borrelia miyamotoi. Of the 82 participants, 80—or 98%—had not previously been tested for the infection.
Many patients also reported that clinicians had dismissed the possibility of a tick-borne illness and attributed their symptoms to psychological stress.
The authors noted that delayed diagnosis and treatment are associated with prolonged symptoms in Lyme disease and raised the question of whether the same might prove true for Borrelia miyamotoi disease.
However, the study did not establish that Borrelia miyamotoi caused the participants’ persistent symptoms. It identified antibodies suggesting previous exposure, and the researchers called for prospective studies to determine whether the infection can produce post-treatment or long-term effects.
Borrelia miyamotoi may therefore be one consideration in selected patients with persistent Lyme disease symptoms, neurologic complaints, pain, unusual sleepiness, or suspected tick-borne coinfections.
Why Borrelia miyamotoi can be missed
Borrelia miyamotoi can be overlooked because it may not produce the classic findings many clinicians associate with Lyme disease. An erythema migrans rash is uncommon, and not every patient experiences recognizable relapsing fevers.
Symptoms such as fatigue, headaches, pain, sleepiness, cognitive problems, and psychiatric complaints can overlap with Lyme disease and other illnesses. This overlap can make diagnosis difficult, particularly when prior Lyme disease tests have been negative.
Patients with persistent symptoms may need a broader clinical evaluation that considers Lyme disease, Borrelia miyamotoi, other tick-borne infections, and noninfectious explanations.
How is Borrelia miyamotoi diagnosed?
PCR and antibody testing serve different purposes. PCR may help confirm an acute Borrelia miyamotoi infection by detecting bacterial genetic material. Its usefulness can decline as the amount of bacteria circulating in the blood decreases.
GlpQ enzyme immunoassays detect antibodies associated with relapsing fever Borrelia. The study used a GlpQ IgG antibody assay rather than PCR. All 21 positive participants had IgG antibodies but not IgM antibodies.
A positive GlpQ IgG result supports previous exposure but does not prove that an active infection is responsible for current symptoms. GlpQ antibodies may also cross-react with other relapsing fever Borrelia species, and it remains uncertain how long the antibodies persist after infection.
What are the possible Borrelia miyamotoi long-term effects?
The long-term effects of Borrelia miyamotoi are not yet well defined. Patients in this study reported persistent fatigue, pain, sleep disturbances, headaches, cognitive problems, psychiatric symptoms, and reduced quality of life.
The most significant differences between the groups involved sleepiness and pain. The study did not establish that Borrelia miyamotoi caused every reported symptom or that antibody positivity represented an ongoing infection.
Possible long-term neurologic concerns must also be distinguished from the recognized acute complication of meningoencephalitis, which has been reported most often in older or immunocompromised patients. Patients with overlapping neurologic complaints may experience symptoms discussed in neurologic Lyme disease.
Additional prospective research is needed to determine how often persistent symptoms follow confirmed acute Borrelia miyamotoi infection, how long they last, and whether they represent ongoing infection, post-infectious effects, another tick-borne illness, or an unrelated condition.
Frequently Asked Questions
Can Borrelia miyamotoi cause persistent symptoms?
Persistent symptoms have been reported in patients with Borrelia miyamotoi antibodies, including fatigue, pain, sleepiness, headaches, and cognitive complaints. However, the study could not establish that the infection caused the ongoing symptoms.
What are the long-term effects of Borrelia miyamotoi?
Possible long-term effects may include persistent fatigue, pain, sleep disturbances, headaches, cognitive symptoms, and reduced daily functioning. The long-term natural history remains uncertain, and more prospective research is needed.
Is Borrelia miyamotoi the same as Lyme disease?
No. Borrelia miyamotoi and Lyme disease are caused by different bacteria, although they are transmitted by the same types of Ixodes ticks. Rash and arthralgias are less common with Borrelia miyamotoi disease.
How is Borrelia miyamotoi diagnosed?
PCR may help identify an acute infection, while GlpQ-based serology can provide evidence of previous exposure. A positive GlpQ IgG result does not by itself confirm an active infection or prove the cause of persistent symptoms.
Can someone have Borrelia miyamotoi for years without knowing?
The infection may initially be missed because a rash is uncommon and symptoms can overlap with other illnesses. However, a positive antibody test years later cannot determine precisely when infection occurred or whether the bacteria remain active.
Does Borrelia miyamotoi ever go away completely?
Many recognized acute infections are treated with antibiotics, but the frequency and duration of symptoms following treatment have not been adequately established. Persistent symptoms require an individualized evaluation for infectious and noninfectious explanations.
Clinical Takeaway
Borrelia miyamotoi should be considered in selected patients with persistent symptoms after tick exposure, particularly when pain, sleepiness, headaches, cognitive complaints, or neurologic symptoms are present without a typical Lyme disease rash.
PCR and antibody testing provide different information, and a positive GlpQ IgG result supports previous exposure rather than confirming active infection. Other tick-borne and noninfectious explanations should remain part of the clinical evaluation.
The study raises an important possibility, but it does not prove that Borrelia miyamotoi caused the patients’ persistent symptoms.
Related Articles
These articles provide additional information about Borrelia miyamotoi, diagnostic uncertainty, and persistent illness.
The best antibiotics to treat Borrelia miyamotoi?
Doctors face challenges in diagnosing Borrelia miyamotoi
Don’t count on a relapsing fever to diagnose Borrelia miyamotoi
Persistent Lyme disease symptoms
References
- Delaney SL, Murray LA, Aasen CE, Bennett CE, Brown E, Fallon BA. Borrelia miyamotoi serology in a clinical population with persistent symptoms and suspected tick-borne illness. Front Med (Lausanne). 2020;7:567350.
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
In early summer 2006, at 45, while on vacation at a rural and heavily forested lake property in northern Ontario, I had a very large bullseye rash above one knee. At the time I assumed it was a very bad reaction to poison ivy as I was always planting and weeding outdoors. It was never investigated or treated. It wasn’t until 2014 I requested a Lyme test from my American RA doc as I made a connection to the former rash and recent news about Lyme. American doctors have been dismissive even though they are aware of my severe debilitating chronic fatigue for well over a decade, joint, memory, heart and periodic swollen lymph node issues no one can account for. Since I have been suffering from a multitude of ailments for 15 years now, and an antibody test in 2014 came back negative, no Dr takes this seriously. The interesting thing is, on the rare occasion I was on a two or three week course of clarithromycin for any bronchial infection, I felt totally normal again afterward for a very short period of time, until I pick up another infection or allergies start up again. I made this connection but again, docs ignore it. Since I was never treated initially, is there any hope for recovery or help for me? I’ve lost out on the last 15 years of my life due to the horrible fatigue. I recently got modafinil to help wake/energize me but is this my only choice, and to individually treat each symptom for the rest of my life? Is this what others go through? Advice?
The laboratory tests for Lyme disease and co-infections are not as reliable as we would like. I advise my patients to seek a second opinion from a doctor familiar with Lyme disease when the tests are negative. I also have to look for other illnesses.
I had a tick bite years ago. A round rash appeared and I went to four doctors who laughed at the probability of Lyme Disease. I have suffered much these past years…paralysis, numbness, neuropathy, backache, fatigue, surgeries, etc. Lately, I have read of many cases of Chronic Lyme Disease.
Dr. Cameron, do you think borrelia miyamotoi is likely to be treatable by some of the newer, experimental borrelia treatments, e.g. disulfiram, methylene blue, daptomycin, etc?
It is hard to study borrelia miyamotoi treatment as there or typically other tick borne infections from the same tick. It is too early to tell what is the best treatment.
I had a tick bite while visiting my daughter who lives in France (August 2013). I knew a little about Lyme Disease in Canada where I live but not France. Turns out the rash is different, the species of Borrelia is different, and so I ignored it. Once home a week later I began to have sweats and chills with no other symptoms. In another week I was having brain fog, headaches, fatigue. I told my naturopathic doctor and he sent me to a Lyme specialist MD in the USA. I was put on 3 antibiotics all at once plus an anti-yeast. I got better and tapered down the antibiotics under this doctor’s direction. I relapsed and 2 more times I tried to taper off the antibiotics and relapsed again. Since then, I take my antibiotics and am very careful about the food I eat. This means not eating sugar starch (starch is repeating glucose units ie. sugar). Meat and non-starchy vegetables make up most of my diet – good thing I like cabbage, broccoli, zucchini (squash family) and other cabbage family vegs. I do eat very small amounts of other squash- family vegs. which are dense in starch. I eat very small amounts of fruit steering clear of normal serving and being aware of the differences in sweetness (sugar) in the types of fruit. It seems that the fruit-growing industry is breeding fruit to make them sweeter. I used to buy tart apples – can’t find them any more.