Doctors face challenges in diagnosing Borrelia miyamotoi

Life seemed simpler for doctors treating Lyme disease before the discovery of numerous pathogens in ticks. The Centers for Disease Control and Prevention (CDC) now reports that “a single tick can transmit multiple pathogens, including bacteria, viruses, and parasites.” [1] In fact, between 2004 and 2016, the CDC identified 7 new tick-borne microbes capable of infecting humans.

Borrelia miyamotoi, the bacteria which causes relapsing fever, is one of the latest threats. The disease was first reported in the United States in 2013 but has become increasingly more common. B. miyamotoi is carried by black-legged ticks, the same ticks that can transmit Lyme disease. One study found that 2% of nymphal ticks collected in 11 states endemic for Lyme disease were infected with B. miyamotoi.

A recent review by Shapiro and Wormser in the Journal of the American Medical Association, points out the concerns associated with this particular tick-borne disease and how its unique presentation can make it challenging to diagnose.[2]

  • “This bacterium can be transmitted within the first 24 hours of tick attachment.”
  • “The probability of transmission increases with every day an infected tick is allowed to remain attached.”
  • While some patients with Lyme disease may exhibit a rash, “patients infected with B. miyamotoi in the United States typically do not have a rash.” But they may present with “a fever in conjunction with headache (96%), myalgia (84%), arthralgia (76%), and malaise/fatigue (82%).”
  • There are no diagnostic tests for B. miyamotoi infection that have been approved by the US Food and Drug Administration.
  • The fever may be relapsing. [Editor’s note: Fevers often do not relapse.]
  • “Laboratory abnormalities include leukopenia (51%) and thrombocytopenia (60%), which are rarely seen in Lyme disease.” [Editor’s note: These are seen in Ehrlichia and Anaplasmosis.]
  • “Severely immunocompromised patients may develop chronic meningitis.”

Fortunately, doxycycline and amoxicillin have been shown to effectively treat B. miyamotoi infection in patients, including those who are immunocompromised. [Editor’s note: Long-term outcome studies are needed.)


Related Articles:

The best antibiotics to treat Borrelia miyamotoi?

“Urban” ticks carry B. burgdorferi sl and B. miyamotoi

Don’t count on a relapsing fever to diagnose B. miyamotoi



  1. CDC Vital Signs, Weekly / May 4, 2018 / 67(17);496–501.
  2. Shapiro ED, Wormser GP. Lyme Disease in 2018: What Is New (and What Is Not). Jama. 2018;320(7):635-636.

9 Replies to "Doctors face challenges in diagnosing Borrelia miyamotoi"

  • Tom Grier
    05/05/2019 (8:46 pm)

    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

  • Lane Poor
    09/07/2018 (4:03 am)

    2014 study showing miyamotoi to burgdorpheri ratio of 1 to 2 in serum samples from New England from as far back as 1992.

  • Lane
    09/07/2018 (1:31 am)

    Current, from a single doctor in RI, miyamotoi/burgdorpheri ratio = 1/5

    Using Imugen…

  • Liz Beth
    09/07/2018 (12:49 am)

    B.Miyamotoi is not susceptible to amoxicillin in vitro.

    • Dr. Daniel Cameron
      09/07/2018 (7:26 pm)

      I am not as sure the authors are correct given the problems with testing, measurement outcomes, and little followup information.

      • Carri Bear
        01/10/2023 (4:59 pm)

        I had a fox bite in 2016, I have had reoccurring episodes for years. Nobody can figure it out. I had a urine test that showed berellia myomatoo and Berlin recurrentis(spelling are wrong). I have had meningitis episodes since then. Tested me for everything else. For awhile doxy worked. Now they are just doing spinal taps to relive pressure calling it benign Intercranial pressure. I really need help and testing. Last flare up I didn’t do any treatments til spinal tap. 10 weeks til I had a spinal tap and had relief. I have more details etc. please help diagnose me officially so I can get treatment. The urine analysis was ordered by dr stone sided in shippensburg pa. But all costs were out of pocket. I just can’t keep paying for this.

        • Carri Bear
          01/10/2023 (5:02 pm)

          I have way more details if you are interested in my case.

        • Dr. Daniel Cameron
          01/11/2023 (8:15 am)

          I am sorry to hear how complex your case has become. The test for tick borne illnesses are not as reliable as I would like. I have had to use clinical judgement for some of my patients who remain ill despite exhaustive evaluations by other specialists.

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