Borrelia Miyamotoi in Travelers: Imported Case with Lyme Coinfection
Borrelia miyamotoi is an emerging tick-borne infection that may affect travelers returning from endemic regions. A case from Japan highlights the risk of infection after exposure in the United States.
This raises an important question: should Borrelia miyamotoi be considered in travelers with fever after tick exposure? Cases suggest that infection may be missed if clinicians focus only on Lyme disease.
Doctors described a case of Borrelia miyamotoi disease in a 63-year-old American man living in Japan. :contentReference[oaicite:0]{index=0}
He reported multiple tick bites while staying at a summer home in Minnesota. Ten days after returning, he developed malaise, headache, myalgia, arthralgia, and high fever.
Diagnosis of an Imported Infection
The patient was diagnosed with Borrelia miyamotoi disease based on seroreactivity to the rGlpQ protein, a marker used to distinguish relapsing fever Borrelia from Lyme disease.
He was also diagnosed with Lyme disease based on erythema migrans and positive IgM Western blot bands.
The authors did not report evaluation for other tick-borne infections such as Babesia, Ehrlichia, or Anaplasma, which are also present in Minnesota.
Implications for Travelers
This case highlights the importance of considering Borrelia miyamotoi in travelers presenting with febrile illness after tick exposure in endemic areas.
Coinfection with Lyme disease may occur and can complicate diagnosis if not considered.
Travelers should inform clinicians of tick exposure history, even if symptoms develop after returning home.
Treatment Considerations
Treatment for uncomplicated Borrelia miyamotoi disease is typically doxycycline (100 mg twice daily) for 7 to 14 days. Alternative agents may include amoxicillin, cefuroxime, or macrolides.
The patient in this case improved over 14 days of doxycycline therapy.
More severe cases, including meningoencephalitis, may require intravenous antibiotics.
Clinical Perspective
Borrelia miyamotoi should be considered alongside Lyme disease and other coinfections in patients with compatible symptoms and exposure history.
Patients may benefit from review of coinfections, understanding Lyme disease symptoms, and awareness of overlapping tick-borne illnesses.
Frequently Asked Questions
Can travelers get Borrelia miyamotoi?
Yes. Travelers exposed to ticks in endemic areas may develop infection after returning home.
What symptoms should travelers watch for?
Fever, headache, muscle aches, joint pain, and fatigue are common symptoms.
Can you have both Lyme disease and Borrelia miyamotoi?
Yes. This case demonstrates that coinfection can occur.
How is Borrelia miyamotoi treated?
Doxycycline is commonly used for uncomplicated cases, typically for 7–14 days.
Related Articles:
What is Borrelia miyamotoi?
Diagnosis challenges
Treatment options
→ See all Borrelia miyamotoi articles
References:
- Oda R et al. Imported Borrelia miyamotoi disease with Lyme coinfection. J Infect Chemother. 2017.
- Molloy PJ et al. Case series. Ann Intern Med. 2015.
- Schwan TG et al. GlpQ antigen. J Clin Microbiol. 1996.
- Krause PJ et al. Clinical overview. Clin Microbiol Infect. 2015.
- Gugliotta JL et al. Meningoencephalitis case. N Engl J Med. 2013.
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
It is being called Relapsing Fever Group in California by CDPH. They have found it in ticks at a rate of 1 B miyamotoi to 4 B burgdorferi in my county. Of course, no one is being tested for it, so human cases are going undiagnosed and untreated. They rarely cause EM rash according to the early human case studies.
Is it possible that Burgdafori has always been present and that ticks were bioengineered with Myamotoi, Rickettsias and a viral component.
Even the Limerex vaccine may have been designed to confuse because Myamotoi wouldn’t show up as Lyme Disease (Burgdafori).
Based on my tick research mother ticks don’t transmit Lyme to their offspring. I was always told ticks are born sterile however I’ve since learned that ticks can pass Myamotoi to their offspring.
Burgdafori would still be spread congenitally in mice,critters, humans while Myamotoi would be spread from Mother ticks to their offspring.
Throw engineered Myamotoi in with Burgdafori and you get 3 scenarios.
1. Get bit by a Myamotoi infected tick which hasn’t fed on a Burgdafori host. You would have Lyme like symptoms but will never test pos for Lyme.
2. Get bit by a Myamotoi infected tick which has fed on a Burgdafori host. You would acquire a more virulent engineered illness.
3. Get bit by a sterile tick that fed on a Burgdafori host. You would acquire an illness that appears more like what we have seen for centuries.
The speed of nerve and brain dysfunction brought on Neurological illnesses much slower.
Now we are seeing Neurological illnesses start in 20-30 yr olds. It used to be 50 and up.
This leads me to believe that Lyme basically was always here.
Based on age it seems multiple strains of Borrelia and bioengineering have basically sped the slow death two fold.