Can Blood Smears Diagnose Borrelia miyamotoi Disease?
But are they reliable for B. miyamotoi?
This study suggests they are not.
Borrelia miyamotoi diagnosis can be challenging—and some commonly suggested methods may not be reliable.
While some clinicians have proposed using blood smears to confirm Borrelia miyamotoi disease (BMD), evidence suggests this approach has significant limitations.
In a study by Telford and colleagues, researchers evaluated whether blood smears could detect B. miyamotoi in patients with confirmed infection.
What the Study Found
The study included 20 patients with acute BMD confirmed by PCR testing.
Researchers examined thick blood smears using standard malariological techniques.
- No organisms were detected after examining 100 smear fields in all 20 patients
- Only 2 of 20 patients showed evidence of infection after examining 300 fields
Key finding: blood smears failed to detect infection in the vast majority of confirmed cases.
[bctt tweet=”Blood smears have poor sensitivity for diagnosing Borrelia miyamotoi disease.” username=”DrDanielCameron”]
Why Blood Smears Fall Short
Borrelia miyamotoi may be present in the bloodstream at levels too low for reliable detection using standard microscopy.
This makes blood smear examination highly insensitive—especially compared to molecular testing methods.
Clinical issue: a negative blood smear does not rule out infection.
Recommended Diagnostic Approach
The Centers for Disease Control and Prevention (CDC) recommends using PCR and antibody-based testing to confirm B. miyamotoi infection.
These methods are more sensitive and better suited to detecting low-level bloodstream infections.
However, the sensitivity of current PCR and antibody tests remains an area of ongoing study.
Clinical Takeaway
Blood smears are not reliable for confirming Borrelia miyamotoi disease.
Clinicians should rely on PCR and serologic testing—and consider the full clinical picture—when evaluating suspected cases.
Key question: Could reliance on insensitive tests lead to missed diagnoses of emerging tick-borne infections?
Related Articles:
Borrelia miyamotoi detected in Canada
Challenges in diagnosing Borrelia miyamotoi
Best antibiotics to treat Borrelia miyamotoi
Reference:
- Telford SR, et al. Blood smears have poor sensitivity for confirming Borrelia miyamotoi disease. J Clin Microbiol. 2019.
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
Did they wait for how many hours, rechecking the findings hourly?
Those kind of spirochaetes bore themselves easily into the red blood cells as well as white blood cells. They dive to other tissues as well, particularly to bloodless ones. Like intervertebral discs, other joints, ligaments and tendons. It may take anything from 2-12 hours to see these bacteria coming out of those cells. That is when they can be seen moving in the plasma.
I summarized the frustration by the authors when testing for Borrelia miyamotoi. Hopefully your suggestion or others will lead to better tests.
Has anyone had testing for Lyme disease through urine . Ceres Urine Antigen?
My husband has been blood tested for Lyme, nope doesn’t have it. What he does have is severe abdominal pain that radiates and spends his life with the need to have a bowel movement. He is now on 2 Morphine’s , that do nothing really for the intense undiagnosed pain! He had to retire 3 years ago because he’s so ill. My son found this blog and the urine testing.
After spending all day in ER and once again checking with CT scans and bloodwork, pancreas, liver, gallbladder etc , all perfect, we need to find his problem. I think it’s Lyme disease. He’s was an avid bow hunter, always in the woods or outdoors, a tick magnet too. Walk out the door and BAM! He didn’t have to be in the woods or grass , just outside. Had the series of 3 vaccines to prevent Lyme disease when it came out in the 90’s. We live in VA, now deemed high in tick and Lyme’s.
Any help as to where to start?
I have not used the urine tests. I can not evaluate their reliability.
To Joyce Mahon – Both my husband and myself became ill with what was first diagnosed as Lymes disease. However my husband deteriorated rapidly until he put in the hospital with “diagnosis unknown”. He also most died before an excellent Infectious disease MD did blood slides and other test and discovered he had both Babesiosis & Ehrlichiosis and he was finally treated effectively, literally saving his life. Several years later I became very sick with high fevers and joint pain all over my body. I was taken to the hospital and admitted as a “toxic” patient as they could not diagnosis what I had. It was definitely not Lymes disease. Again it was finally diagnosed by an infectious disease MD as Borrelia Miyamotoi and treated appropriately and recovered. Again I am sick and the ER only checks for Lymes and tells me there is nothing wrong. So I now have an appointment with a top infectious disease specialist this week hoping it will be diagnosed properly. Please know that most ERs and physicians do not not test for these diseases and you must find a specialist who will. I urge you to do so as these diseases can leave lasting damage and potentially can be fatal.
I live on a dirt road surrounded by woods in NJ with lots of deer and other wildlife and there is little I can do about the ticks even though I use tick spray on myself and have my property sprayed several times each year. Good luck and best wishes. .
Where were you able to get blood slides. I am sure I have tick borne disease and I am near death.