Doctors Face Challenges in Diagnosing Borrelia miyamotoi
Symptoms often overlap with Lyme disease
Testing limitations may delay diagnosis
Early recognition may improve outcomes
Diagnosing Borrelia miyamotoi infection can be difficult because symptoms are often nonspecific and overlap with Lyme disease, viral illnesses, and other tick-borne infections. Fever, fatigue, headaches, chills, muscle pain, and cognitive symptoms may not immediately suggest a relapsing fever infection.
Although Borrelia miyamotoi is transmitted by the same Ixodes ticks that spread Lyme disease, it belongs to the relapsing fever group of Borrelia species. This distinction may complicate recognition and testing decisions.
Why is Borrelia miyamotoi diagnosis often missed?
Physicians may miss Borrelia miyamotoi because patients often present with symptoms common to many illnesses. Unlike Lyme disease, patients may not develop erythema migrans, making diagnosis more difficult.
Low awareness among clinicians, overlapping symptoms, and limited availability of specialized testing may further contribute to delayed diagnosis.
Researchers have suggested Borrelia miyamotoi disease should be considered an emerging infectious disease requiring greater awareness among clinicians and public health officials.
What symptoms suggest Borrelia miyamotoi infection?
Common symptoms may include:
- Fever
- Chills
- Fatigue
- Headache
- Muscle aches
- Joint pain
- Nausea
- Cognitive complaints
- Relapsing fever episodes
Neurologic complications including meningoencephalitis have been reported, particularly among immunocompromised individuals.
What tests are used for Borrelia miyamotoi diagnosis?
PCR testing may be most useful early during symptomatic illness and ideally before antibiotics are started. Blood, serum, and sometimes cerebrospinal fluid can be tested.
Serologic testing may be more challenging because timing affects interpretation. IgM responses may appear early, while IgG responses generally develop later.
Some investigators suggest combining markers such as GlpQ with variable membrane proteins to improve diagnostic performance.
Blood smears may occasionally identify spirochetes during periods of higher spirochetemia, but sensitivity remains limited.
Why testing limitations matter
Testing limitations may contribute to underrecognition of Borrelia miyamotoi disease. Researchers have suggested human infection could be more common than appreciated because nonspecific symptoms, overlap with Lyme disease, and testing limitations may delay diagnosis.
Clinicians evaluating patients with tick exposure and unexplained febrile illness may need to consider Borrelia miyamotoi alongside Lyme disease, babesiosis, anaplasmosis, and other tick-borne infections.
Internal Links
Blood smear not reliable in diagnosing Borrelia miyamotoi disease
Tick-borne coinfections overview
FAQ
Can Borrelia miyamotoi be mistaken for Lyme disease?
Yes. Symptoms overlap significantly and both infections are transmitted by Ixodes ticks. However, Borrelia miyamotoi belongs to the relapsing fever group rather than the Lyme borreliosis group.
Does Borrelia miyamotoi cause a rash?
Unlike Lyme disease, Borrelia miyamotoi infection often occurs without erythema migrans.
Is PCR testing useful?
PCR testing may be most useful early in illness before antibiotic treatment because spirochetemia can decline after treatment begins.
Can Borrelia miyamotoi affect the nervous system?
Yes. Neurologic complications including meningoencephalitis have been reported, particularly among immunocompromised patients.
Clinical Perspective
Borrelia miyamotoi remains underrecognized because symptoms overlap with many infectious illnesses and diagnostic testing is still evolving. Clinicians may need to consider this infection when evaluating patients with compatible symptoms following tick exposure.
Clinical Takeaway
Borrelia miyamotoi diagnosis may be delayed by nonspecific symptoms, limited testing availability, and overlap with Lyme disease. Greater awareness of symptom patterns and diagnostic limitations may improve recognition.
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Blood smear not reliable in diagnosing Borrelia miyamotoi disease
References
- Cleveland DW, Anderson CC, Brissette CA. Borrelia miyamotoi: A Comprehensive Review. Pathogens. 2023;12(2):267.
- Hoornstra D, Azagi T, van Eck JA, et al. Prevalence and clinical manifestation of Borrelia miyamotoi in Ixodes ticks and humans in the northern hemisphere: a systematic review and meta-analysis. Lancet Microbe. 2022;3(10):e772-e786.
- Burde J, Bloch EM, Kelly JR, Krause PJ. Human Borrelia miyamotoi Infection in North America. Pathogens. 2023;12(4):553.
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