Could Borrelia miyamotoi infections explain persistent symptoms in Lyme disease patients?
Borrelia miyamotoi can cause persistent symptoms
Testing is often missed in patients with suspected tick-borne illness
Coinfection may help explain fatigue, pain, and sleep problems
Borrelia miyamotoi persistent symptoms and long-term effects remain important questions for clinicians evaluating patients with suspected tick-borne illness. Some patients with fatigue, pain, cognitive problems, sleep disturbances, or persistent symptoms after tick exposure may have overlapping infections that are not routinely tested for. Borrelia miyamotoi (BM) is another tick-borne pathogen and “unlike Lyme disease, erythema migrans rash, and arthralgias are uncommon,” the authors write in the journal Frontiers in Medicine.
The infection is diagnosed with polymerase chain reaction (PCR) called glycerophosphodiester phosphodiesterase (GlpQ) enzyme immunoassay.
Investigators looked at the incidence of BM in 82 patients who were seeking a second opinion regarding persistent symptoms which included fatigue, pain, neurocognitive, and psychiatric problems.
In their study, 1 out of 4 Lyme disease patients tested positive for Borrelia miyamotoi, using a GlpQ test. The BM positive group were significantly more likely to suffer from sleepiness, according to the Epworth Sleepiness Scale, and from pain, as measured by the McGill VAS Pain Scale and Zung Anxiety Scale.
[bctt tweet=”“Compared to patients who solely tested positive for Lyme disease antibodies, patients with B. miyamotoi antibodies presented with significantly more sleepiness and pain,” report the authors of a new study.” username=”DrDanielCameron”]
Eight patients with Lyme disease and Borrelia miyamotoi were hospitalized. “Eight of 21 (38%) reported hospitalization (seven medical and one psychiatric) since symptom onset, three for cardiac and two for neurologic abnormalities,” according to the authors.
All of the patients, except for one, with Lyme disease and Borrelia miyamotoi were treated with antibiotics. “All 21 received prior antibiotic treatment, of whom 20 received at least 2 weeks of doxycycline or amoxicillin.”
Five of the 21 patients with Lyme disease and Borrelia miyamotoi lived outside the Northeast and Mid-Atlantic regions. “Two lived in California, two lived in Florida, and one lived in Illinois.”
Study insights into Borrelia miyamotoi persistent symptoms
The study found that clinicians are not testing for Borrelia miyamotoi, as only 1 out of the 82 study participants were tested for the infection.
Furthermore, clinicians were often dismissive of a tick-borne illness. “Many patients reported that their clinicians dismissed the possibility of tick-borne illness both at the onset and during the course of their illness and attributed symptoms to psychological stress,” writes Delaney.
The authors raise a public health concern: “In Lyme disease, delayed diagnosis and treatment is associated with prolonged symptoms. The same may prove true for B. miyamotoi disease.”
A co-infection with Borrelia miyamotoi may explain why some Lyme disease patients are sicker than others. This possibility is especially important in patients with persistent Lyme disease symptoms, neurologic complaints, pain, sleepiness, or suspected tick-borne coinfections.
Unfortunately, there are still problems with the reliability of testing for Borrelia miyamotoi. There is also uncertainty over the best treatment approach for the infection.
Why Borrelia miyamotoi can be missed
Borrelia miyamotoi can be overlooked because it may not produce the classic clues many clinicians associate with Lyme disease. The absence of an erythema migrans rash does not exclude a tick-borne infection, and symptoms such as fatigue, pain, sleepiness, cognitive problems, and psychiatric symptoms can overlap with other conditions.
This overlap can make diagnosis difficult, particularly when patients have been told their symptoms are due to stress or when prior Lyme disease testing has been negative. Patients with persistent symptoms may need a broader clinical evaluation that includes Lyme disease, Borrelia miyamotoi, and other tick-borne infections.
What long-term symptoms have been linked to Borrelia miyamotoi?
Patients with suspected Borrelia miyamotoi infection may report persistent fatigue, pain, sleep problems, cognitive dysfunction, headaches, psychiatric symptoms, and reduced quality of life. These symptoms overlap with Lyme disease and other tick-borne infections, making diagnosis challenging.
Reported symptoms may include fatigue, brain fog, headaches, sleep disturbances, pain syndromes, autonomic symptoms, and reduced exercise tolerance.
Although evidence remains limited, the study raises concern that delayed recognition of Borrelia miyamotoi could contribute to prolonged illness in some patients, similar to concerns raised with delayed diagnosis of Lyme disease.
Patients with overlapping neurologic complaints may also experience symptoms discussed in neurologic Lyme disease or persistent fatigue patterns described in Lyme disease fatigue.
Frequently Asked Questions
Can Borrelia miyamotoi cause persistent symptoms?
Yes. In the study, patients with Lyme disease and Borrelia miyamotoi antibodies reported persistent symptoms including fatigue, pain, sleepiness, neurocognitive symptoms, and psychiatric problems.
Is Borrelia miyamotoi the same as Lyme disease?
No. Borrelia miyamotoi is a separate tick-borne pathogen. It can overlap clinically with Lyme disease, but erythema migrans rash and arthralgias are reported to be uncommon.
How is Borrelia miyamotoi diagnosed?
Borrelia miyamotoi may be evaluated with PCR testing and GlpQ-based serology, but testing remains imperfect. A negative test does not always resolve the clinical question in a symptomatic patient.
Can Borrelia miyamotoi explain long-term symptoms after a tick bite?
It may be one possible explanation in selected patients, especially when symptoms persist and the patient has a history suggestive of tick exposure. The study authors noted that delayed diagnosis and treatment may prove important, as it is in Lyme disease.
What are the long-term effects of Borrelia miyamotoi?
Possible long-term effects may include persistent fatigue, pain, sleep disturbances, cognitive symptoms, and reduced daily functioning. More studies are needed because the long-term natural history remains uncertain.
Clinical Takeaway
Borrelia miyamotoi should be considered in patients with persistent symptoms after tick exposure, particularly when fatigue, pain, sleepiness, cognitive complaints, or neurologic symptoms are present.
Testing limitations and symptom overlap can make the diagnosis difficult. A careful clinical evaluation should consider Lyme disease, Borrelia miyamotoi, and other tick-borne infections rather than dismissing ongoing symptoms as psychological stress alone.
The key clinical point is that Borrelia miyamotoi may be an underrecognized contributor to persistent illness in some patients evaluated for Lyme disease and tick-borne infections.
Related Articles
These related articles expand on Borrelia miyamotoi, diagnostic uncertainty, and tick-borne infection overlap.
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
Persistent Lyme disease symptoms
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.