Brazil faces same problems with Lyme disease as seen in the USA

An article published in the Brazilian Journal of Microbiology entitled "Brazilian borreliosis with special emphasis on humans and horses" examines the growing number of cases in Brazil of Lyme disease, referred to, in that country, as the Lyme-like or Baggio-Yoshinari Syndrome (BYS).

by Daniel J. Cameron, MD MPH

The authors take an in-depth look at BYS and how it compares to Lyme disease (LD) found in the United States. Although there are slight differences between the diseases, BYS and LD share similarities on many fronts. [1] “Despite the increasing number of suspect cases, this disease [BYS] is still neglected in Brazil by the medical and veterinary communities,” writes Basile and colleagues.

BYS causes some of the same symptoms seen in Lyme disease, such as erythema migrans, arthritis, neurological symptoms and cardiac disease. Both are difficult to diagnose.

“The disease is often unrecognized, especially at secondary or tertiary stages when patients do not remember what occurred months or years before the current disease,” stated Basile. “Certainly, many cases of unrecognized chronic neurological or articular disease are in fact cases of BYS not identified and treated at early stage.”

The capybaras, a popular Brazilian house pet, is a known reservoir for ticks infected with the Lyme-like or Baggio-Yoshinari Syndrome (BYS).

The Brazilian disease can also be multisystemic. “Baggio-Yoshinari Syndrome has been reported to cause neurological, cardiac, ophthalmic, muscle, and joint alterations in humans.” Furthermore, it has been associated with a high morbidity “due to the presence of symptom recurrence, severe reactive manifestations such as autoimmunity, and the need for prolonged treatment.”

According to Basile and colleagues, the disease progresses with recurrences, “especially if antibiotic treatment is initiated later than three months after infection.” Thus, treating the disease in its early stages is critical.

Cystic forms have been described, as well. “Because motile and spiral spirochetes were never isolated or cultured in Brazil, researchers from LIM-17 assumed that the etiological agent in Brazil was present in cystic form.”

The Brazilian patients may also be suffering from co-infections, as investigators identified other microrganisms in the blood of BYS patients. Tests showed “the occurrence of microorganisms with morphological structures similar to Mycoplasma spp., Chlamydia spp., and non-flagellated spirochetes in the peripheral blood of patients with BYS who were seropositive for B. burgdorferi sensu lato,” according to Basile. “Those patients exhibited negative serology for Mycoplasma spp. and Chlamydia spp.”

Additionally, laboratory testing for BYS is unreliable. There is a low sensitivity and specificity with the ELISA, enzyme immunosorbent assay, or western blotting for B. burgdorferi, in part because these tests utilize antigens from B. burgdorferi stricto sensu from the Northern Hemisphere.

Domestic pets have been described as potential reservoirs for ticks carrying the disease. The capybaras, a large rodent and popular house pet in Brazil, has been identified as a likely reservoir and is thus a threat in spreading the disease.

Wild and domestic animals can be infected. “Studies indicate that LB [Lyme borreliosis] in horses has clinical signs similar to the disease in humans, including fever and lethargy, arthritis, polysynovitis, lameness, muscle stiffness, abortion, meningitis, cranial neuritis, radiculoneuritis and encephalitis, uveitis, and premature death of foals,” according to Basile.

The authors’ findings reminds us that the challenges faced in the United States in gaining recognition for a disease that is growing in numbers and has the potential to cause chronic, debilitating illness is not unique to our country. The Brazilian patients suffering from the Lyme-like or Baggio-Yoshinari Syndrome are struggling to conquer the same obstacles.

“Lyme disease is a condition of extreme importance because it is a zoonosis that causes physical and psychological sequelae in affected individuals. It remains poorly investigated in Brazil, especially in the field of veterinary medicine. Therefore, studies describing the unique aspects of the disease in Brazil and the etiological agents found are needed.”


  1. Basile, R.C., et al., Brazilian borreliosis with special emphasis on humans and horses. Braz J Microbiol, 2016.

Update: Oliveira from the Ministry of Health, Brasilia, DF, Brazil was not able confirm Lyme-like borreliosis in Brazil in a letter in the journal Travel Medicine and Infectious Disease.1 “The interpretations of the results have not followed those recommended by the CDC.” writes Oliveira. Only three cases of Lyme-like borreliosis were identified. “This evidence reinforces the hypothesis that Lyme borreliosis does not occur in Brazil.” writes Oliveira.

  1. de Oliveira SV, Faccini-Martinez AA, Cerutti Junior C. Lack of serological evidence for Lyme-like borreliosis in Brazil. Travel Med Infect Dis. 2018.


12 Replies to "Brazil faces same problems with Lyme disease as seen in the USA"

  • Dr. Rob Murray [DDS ret'd]
    03/06/2021 (7:54 pm)

    Neuropathy Mimicking Dental Pain in a Patient Diagnosed with Lyme Disease, Mello I, Peters J, Lee C, J Endod 46[9]: p1337-1339; 20-06-17:
    DOI: 10.1016/j.joen.2020.06.011

    Why dental professionals should know about the signs and symptoms of Lyme disease, Bell C, Dal News 21-02-19:
    Dr. Mello is an endodontist from Brazil and wasn’t aware of Lyme disease and couldn’t believe how much it was disrespected.

  • Emmanuel Rengade
    11/08/2020 (5:56 am)

    I live un a rural région of São Paulo were ticks are simply a part of the environment and are present at a certain time of the year, in forrests and pastures. Some are big and easy to spot and others really small but bitting and itching hard! You learn to live with them. Animals and humans are getting regularly bitten and to some extend this cannot be avoided. There are domestic and wild animals, horses, wild capivaras, dogs… it is a farm like so many others. Ticks are as normal as other insects and part of this ecosystem. However it does not mean that they necessarily transmit LD. The symptoms are so subtle that it seems to me you can likely convince yourself you have LD even if you don’t. My question would be : what percentage of ticks might be infected by Lyme? How can we know this? Can some people be infected and then cure themselves from their own body immune system? Is there a reliable way to test for LM? Thank you doctor Cameron.

    • Dr. Daniel Cameron
      11/08/2020 (6:47 am)

      These question are difficult to answer even in countries that invest more resources into tick-born illnesses.

  • Guilherme Campos
    06/24/2019 (8:18 pm)

    Capybaras are not ” a popular Brazilian house pet”. Totally misconception.

  • Sarah C
    06/21/2018 (11:18 pm)

    Hi, I got Lyme disease in a rural part of Rio De Janeiro state. I would be happy to share with you about it. No way I believe there have only been three credible cases. I know exactly where I was when exposed to ticks and found them burroughed in my hip a week later; the symptoms appeared exactly three weeks after that. I could not get a doctor to prescribe antibiotics here in Bethesda MD, because I did not test positive for any tick-transmitted illness and was told “its probably just a virus.”

    • Dr. Daniel Cameron
      06/22/2018 (12:48 pm)

      Doctors are divided over the risk of tick borne diseases in South America. You should include a doctor familiar with tick borne illnesses if you remain ill.

  • Naima Mortari-Santos
    03/13/2018 (10:23 pm)

    Dr Cameron good morning, I am an ID specialist and had the opportunity to listen from Dr Steere about the LD epidemy surrounding the Pennsylvania state.
    I would like to share some news from the Brazilian Borreliosis, as we have molecular evidence of Borrelia burgdorferi in Ixodes and in patients.
    Lopes FA et al, Rev Bras Reumatol Engl Ed, 2017
    Dall’Agnol B et al, Ticks and Tick-borne Dis, 2017

    • Dr. Daniel Cameron
      03/13/2018 (10:41 pm)

      Thanks for sharing your findings. Let me know the details.

    • John b
      03/24/2021 (10:50 pm)

      Demographics are changing. There is a vastly growing Brazilian population in the Is that often go back to Brazil. My son is in Brazil. Before he left to visit I had him tested. He tested positive for Borrelia burgdorferi Borrelia myonii anaplasma babesia and TBRF. Are there any Dr.s in Brazil qualifies to deal with this SP- now imagine multiply all the people transiting back and forth. Vector borne diseases are going to spread.

      • Dr. Daniel Cameron
        03/25/2021 (8:25 am)

        There have been a few papers in Brazil. Some support the existence of tick borne illnesses.Others disagree. I am not familiar with the doctors in Brazil.

    • John
      03/24/2021 (10:55 pm)

      Unfortunately Steere is very narrow in his take on Lyme disease. I was misdiagnosed by an ID Dr in 2007 because he couldn’t think outside the box and he was too caught up in labs rather than clinical diagnosis. He never even thought of looking at the differential diagnosis for my symptoms. Took me 9yrs and thousands of dollars before I got bit again by a tick and had an ILADS Dr look at my notes and labs from 2007 to tell me I had bartonella. IDSA guidelines are developed by a panel of Dr.s of which multiple members are conflicted with insurance companies.

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