Could Borrelia Miyamotoi Explain Persistent Lyme Symptoms?
PERSISTENT FATIGUE?
PAIN AND BRAIN FOG?
LOOK BEYOND LYME
Could Borrelia miyamotoi and Lyme disease coinfection help explain persistent symptoms in some patients?
Borrelia miyamotoi (BM) is a tick-borne infection transmitted by the same Ixodes ticks that spread Lyme disease.
Unlike Lyme disease, erythema migrans rash and joint pain are less common in Borrelia miyamotoi infection, according to researchers writing in Frontiers in Medicine.
Patients may instead present with fatigue, neurocognitive symptoms, sleep disturbances, anxiety, and widespread pain.
These symptom patterns may contribute to delayed diagnosis and prolonged illness.
One Out of Four Lyme Patients Tested Positive
Investigators evaluated 82 patients seeking second opinions for persistent symptoms including:
- Fatigue
- Pain
- Neurocognitive difficulties
- Psychiatric symptoms
In this cohort, 1 out of 4 Lyme disease patients tested positive for Borrelia miyamotoi using the GlpQ antibody test.
Patients who tested positive for BM experienced:
- Higher levels of sleepiness
- Greater pain severity
- Higher anxiety scores
For more on coinfections, see tick-borne coinfections.
Hospitalizations and Neurological Complications
“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 of the 21 patients with Borrelia miyamotoi and Lyme disease coinfection required hospitalization.
Hospitalizations included:
- Cardiac abnormalities
- Neurological complications
- Psychiatric admissions
The findings raise concerns that Borrelia miyamotoi infection may contribute to more severe or prolonged illness patterns.
Challenges Diagnosing Borrelia Miyamotoi
Diagnosis of Borrelia miyamotoi infection remains difficult.
Testing often relies on PCR or GlpQ antibody assays, which are not routinely ordered in many clinical settings.
In this study, only 1 of the 82 participants had previously been tested for BM before entering the investigation.
Some patients also reported that clinicians attributed symptoms to stress or psychological causes instead of investigating tick-borne illness.
Delayed diagnosis may contribute to persistent symptoms and uncertainty regarding long-term recovery.
For more on testing limitations, see diagnostic challenges with Borrelia miyamotoi.
Could Borrelia Miyamotoi Cause Long-Term Symptoms?
The authors raise an important concern:
“In Lyme disease, delayed diagnosis and treatment is associated with prolonged symptoms. The same may prove true for B. miyamotoi disease.”
Persistent symptoms following tick-borne infections remain an active area of research.
In clinical practice, coinfections such as Borrelia miyamotoi may help explain why some patients continue experiencing fatigue, neurological symptoms, or chronic illness despite treatment directed primarily at Lyme disease.
Editor’s note: There are still important uncertainties regarding the reliability of testing and the best treatment approaches for Borrelia miyamotoi infection.
Clinical Takeaway
Coinfection with Borrelia miyamotoi may contribute to more severe or persistent symptoms in some Lyme disease patients.
Clinicians should consider coinfections when patients experience ongoing fatigue, cognitive symptoms, pain, or unexplained neurological illness following tick exposure.
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.
Are coinfected patients sicker?
Patients with both infections reported more sleepiness, pain, and hospitalization.
Are clinicians routinely testing for Borrelia miyamotoi?
Rarely. Only 1 participant in this study had previously been tested.
Could Borrelia miyamotoi explain persistent Lyme symptoms?
Possibly. Delayed diagnosis and treatment may contribute to prolonged symptoms in some patients.
Related Articles
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
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.