Borrelia Miyamotoi and Lyme Disease Coinfection: Study of Persistent Symptoms
Could Borrelia miyamotoi and Lyme disease coinfection help explain persistent symptoms in some patients? Borrelia miyamotoi (BM) is a tick-borne pathogen transmitted by the same Ixodes ticks that spread Lyme disease.
Unlike Lyme disease, erythema migrans rash and joint pain are uncommon in Borrelia miyamotoi infection, according to researchers writing in the journal Frontiers in Medicine.
Diagnosis of Borrelia miyamotoi infection often relies on polymerase chain reaction (PCR) testing or serologic testing using a glycerophosphodiester phosphodiesterase (GlpQ) enzyme immunoassay.
Investigators evaluated the prevalence of Borrelia miyamotoi infection in 82 patients who were seeking a second opinion for persistent symptoms including fatigue, pain, neurocognitive difficulties, and psychiatric complaints.
In this cohort, 1 out of 4 Lyme disease patients tested positive for Borrelia miyamotoi using the GlpQ test.
Patients who tested positive for BM were significantly more likely to experience sleepiness, as measured by the Epworth Sleepiness Scale, and higher levels of pain according to the McGill Visual Analog Scale. Anxiety levels were also higher based on the Zung Anxiety Scale.
Patients with Borrelia miyamotoi and Lyme disease had more severe illness
“Compared to patients who solely tested positive for Lyme disease antibodies, patients with B. miyamotoi antibodies presented with significantly more sleepiness and pain,” the authors reported.
Eight patients with Borrelia miyamotoi and Lyme disease coinfection required hospitalization.
“Eight of 21 (38%) reported hospitalization (seven medical and one psychiatric) since symptom onset, including three for cardiac abnormalities and two for neurologic complications,” the authors wrote.
Nearly all patients with both infections received antibiotic treatment. Twenty of the 21 patients were treated with at least two weeks of doxycycline or amoxicillin.
Interestingly, five of the 21 patients with both Lyme disease and Borrelia miyamotoi lived outside the Northeast and Mid-Atlantic regions. Two lived in California, two in Florida, and one in Illinois.
Study highlights challenges of diagnosing coinfection
The study also revealed that clinicians rarely test for Borrelia miyamotoi. Only one of the 82 study participants had previously been tested for the infection.
Furthermore, some patients reported that clinicians dismissed the possibility of a tick-borne illness. According to the authors, many physicians attributed symptoms to psychological stress rather than investigating possible infections.
The authors raise an important public health concern: delayed diagnosis and treatment of tick-borne infections may contribute to prolonged illness.
“In Lyme disease, delayed diagnosis and treatment is associated with prolonged symptoms. The same may prove true for B. miyamotoi disease,” the authors wrote.
Editor’s note: A coinfection with Borrelia miyamotoi and Lyme disease may help explain why some patients experience more severe or persistent symptoms. Unfortunately, there are still challenges with the reliability of testing for Borrelia miyamotoi, and uncertainty remains regarding the best treatment approach for this infection.
Frequently Asked Questions
Can Borrelia miyamotoi and Lyme disease occur together?
Yes. In this study, 1 out of 4 Lyme disease patients also tested positive for Borrelia miyamotoi using a GlpQ test.
Are coinfected patients sicker?
Yes. Patients with both infections reported significantly more sleepiness and pain. In this study, 38% required hospitalization.
Are clinicians testing for Borrelia miyamotoi?
Rarely. Only 1 out of 82 patients in this study had previously been tested for B. miyamotoi.
Could Borrelia miyamotoi explain persistent Lyme symptoms?
Possibly. Delayed diagnosis and treatment of Borrelia miyamotoi infection may contribute to prolonged symptoms, similar to untreated Lyme disease.
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Doctors face challenges in diagnosing Borrelia miyamotoi
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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.