Borrelia Miyamotoi Symptoms: Mild to Severe

Borrelia miyamotoi symptoms can range from mild flu-like illness to severe neurologic disease depending on the patient’s immune status. This tick-borne infection, transmitted by the same ticks that spread Lyme disease, often causes fever, fatigue, and relapsing illness that can easily be mistaken for other infections.

According to Cleveland and colleagues, immunocompetent patients typically experience milder Borrelia miyamotoi symptoms including fever, fatigue, sleepiness, chills, muscle stiffness, joint aches, and nausea. Relapses of febrile illness may occur, although they are uncommon.

Because these Borrelia miyamotoi symptoms can be mild, some individuals with Borrelia miyamotoi disease may not seek medical care.

Severe Borrelia Miyamotoi Symptoms in Immunocompromised Patients

Immunocompromised individuals may experience much more severe Borrelia miyamotoi symptoms. Cleveland and colleagues report that these patients can develop neurologic complications caused by meningoencephalitis.

Symptoms may include reduced cognition, disturbed gait, memory deficits, confusion, and other neurologic impairments. The authors also report cases involving hearing loss, weight loss, uveitis, iritis, neck stiffness, and photophobia.

In severe cases, Borrelia miyamotoi symptoms can be serious enough to require hospitalization.

Who Is Considered Immunocompromised?

The designation of “immunocompromised” covers a wide range of patients. However, severe Borrelia miyamotoi disease is most frequently reported in individuals receiving immune-suppressing therapies.

Hospitalized cases are commonly seen in patients receiving B-cell depletion therapies such as rituximab, cancer immunotherapies, or immunosuppressive medications used to treat conditions like rheumatoid arthritis.

Treatment for Borrelia Miyamotoi Symptoms

Several antibiotics have been used to treat Borrelia miyamotoi disease (BMD). Doxycycline and ceftriaxone are commonly prescribed because of their effectiveness against relapsing fever bacteria.

Other treatments reported by Cleveland and colleagues include ampicillin, azithromycin, and vancomycin, either alone or in combination.

Laboratory studies show that B. miyamotoi isolates are susceptible to doxycycline, ceftriaxone, and azithromycin, but resistant to amoxicillin.

Jarisch-Herxheimer Reaction

Although uncommon, antibiotic treatment for Borrelia miyamotoi disease can trigger a Jarisch-Herxheimer reaction. This occurs when toxins are released into the bloodstream as bacteria die rapidly during treatment.

Symptoms may include fever, chills, and temporary worsening of inflammation shortly after antibiotics begin.

Importance of Early Recognition

Recognizing Borrelia miyamotoi symptoms early is important for prompt treatment. Unlike Lyme disease, B. miyamotoi rarely causes an erythema migrans rash, which can make diagnosis more difficult.

Clinicians practicing in tick-endemic regions should consider Borrelia miyamotoi infection in patients presenting with relapsing fever and unexplained flu-like illness.