Borrelia miyamotoi Diagnosis: Challenges for Clinicians
Borrelia miyamotoi diagnosis remains challenging, as symptoms often overlap with Lyme disease and standard testing may miss the infection.
Borrelia miyamotoi is a relapsing fever spirochete transmitted by the same ticks that carry Lyme disease. Despite this shared vector, the infection is frequently overlooked in clinical practice.
Why Borrelia miyamotoi Diagnosis Is Difficult
Patients with Borrelia miyamotoi infection often present with nonspecific symptoms such as fever, chills, headache, fatigue, and muscle aches.
These symptoms overlap with Lyme disease and other tick-borne infections, making diagnosis difficult based on clinical presentation alone.
Unlike Lyme disease, a characteristic erythema migrans rash is typically absent.
Limitations of Standard Testing
Standard Lyme disease serologic tests do not reliably detect Borrelia miyamotoi.
Diagnosis often requires specialized PCR testing or antibody assays targeting specific relapsing fever antigens, which are not widely available.
This limitation can lead to missed or delayed diagnoses.
Overlap With Lyme Disease and Co-Infections
Because the same tick species can transmit multiple pathogens, patients may be infected with both Borrelia miyamotoi and Borrelia burgdorferi.
Co-infection may complicate symptoms and prolong illness.
Failure to recognize B. miyamotoi may explain persistent symptoms in some patients treated for Lyme disease alone.
Clinical Implications
Clinicians should consider Borrelia miyamotoi in patients with:
- Fever without a rash following tick exposure
- Relapsing or persistent symptoms
- Negative Lyme disease testing despite high clinical suspicion
Early recognition can guide appropriate testing and treatment decisions.
Clinical Takeaway
Borrelia miyamotoi diagnosis requires a high index of suspicion, especially when Lyme disease testing is negative but symptoms persist.
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
B.Miyamotoi is not susceptible to amoxicillin in vitro. https://www.ncbi.nlm.nih.gov/pubmed/28674060
Current, from a single doctor in RI, miyamotoi/burgdorpheri ratio = 1/5
Using Imugen…
2014 study showing miyamotoi to burgdorpheri ratio of 1 to 2 in serum samples from New England from as far back as 1992.
https://wwwnc.cdc.gov/eid/article/20/7/pdfs/13-1587.pdf
Because Borrelia myamotoi has been seen as a biofilm embedded in amyloid plaques in Alzheimer’s brains, it is premature for Dr. Shapiro and Dr. Wormser to say that this infection is successfully treated with doxycycline and amoxicillin because in sections of the brain are harder to treat and even harder to determine if the infection is eradicated. Dr. Alan MacDonald’s work needs corroborated and patients with Borrelia myamotoi need to be followed up in a long-term multi-center international brain autopsy study, that looks for persistence of any and all Borrelia species in the brain after antibiotic treatment. We know Borrelia infections are notorious for being intracellular, and have a tropism for the human brain. We need better pathology studies done before we can draw conclusions about the curative abilities of antibiotic when a patient may have an intra-neural Borrelia infection behind the blood-brain-barrier that has been longstanding and undiagnosed for decades. Thomas Grier