Borrelia Miyamotoi Relapsing Fever Is Not a Reliable Sign
Borrelia miyamotoi is classified as a relapsing fever spirochete, yet many patients do not develop the classic pattern of recurrent fevers. Clinical findings suggest that relapsing fever may not be a reliable diagnostic feature of this infection.
This raises an important question: does Borrelia miyamotoi behave like other relapsing fever infections? In practice, many patients present with a single febrile illness rather than repeated episodes.
“Although evidence of antigenic variation, which drives relapsing fever in other Borrelia species, has not been demonstrated clinically or in animal models for B. miyamotoi, it does possess the genetic apparatus for this variation,” according to Sudhindra.
Fever Without Relapse
In a case series of 51 individuals, nearly all patients presented with fever. However, most did not experience recurrent febrile episodes typical of classic relapsing fever. :contentReference[oaicite:0]{index=0}
The low rate of relapse may be related to early empiric antibiotic treatment in patients with suspected tick-borne illness.
Patients more commonly presented with headache, myalgias, arthralgias, and fatigue. More than 50% were initially suspected of having sepsis, and 24% required hospitalization. :contentReference[oaicite:1]{index=1}
Testing Challenges
Diagnosis of B. miyamotoi can be difficult. Cases were identified using PCR testing and confirmed by immune response to the rGlpQ protein.
Serologic testing with rGlpQ appears to have limited sensitivity early in infection, with higher positivity rates seen during convalescence. :contentReference[oaicite:2]{index=2}
Laboratory Findings and Overlap
Common laboratory abnormalities include elevated liver enzymes, neutropenia, and thrombocytopenia.
B. miyamotoi infection may resemble anaplasmosis and other tick-borne illnesses, complicating diagnosis. :contentReference[oaicite:3]{index=3}
Clinical Perspective
Relapsing fever alone is not a reliable clinical hallmark of B. miyamotoi infection.
B. miyamotoi is now recognized as one of several Ixodes-transmitted infections in the northeastern United States and should be considered in patients with febrile illness following tick exposure.
Patients may benefit from review of coinfections, understanding Lyme disease symptoms, and awareness of overlapping tick-borne illnesses.
Frequently Asked Questions
Does Borrelia miyamotoi cause relapsing fever?
It is classified as a relapsing fever organism, but many patients do not develop recurrent fevers.
Why don’t patients have relapsing fevers?
Early treatment and differences in disease expression may limit recurrence.
What symptoms are more common?
Fever, headache, muscle aches, joint pain, and fatigue.
What conditions can it resemble?
It may resemble anaplasmosis and other tick-borne infections.
Related Articles:
What is Borrelia miyamotoi?
Diagnosis challenges
Treatment considerations
C6 peptide testing
References:
- Molloy PJ et al. Borrelia miyamotoi disease case series. Ann Intern Med. 2015.
- Telford SR et al. Borrelia miyamotoi disease overview. Clin Lab Med. 2015.
- Sudhindra P et al. Borrelia miyamotoi infection insights. Diagn Microbiol Infect Dis. 2016.
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
I have been having some issues since November. I feel as if I may have Lyme disease. I have had several bites last year. Do you take GHI. ppo Emblemed health insurance? If not how much out of pocket does visit cost. Thanks
Kevin Mitchell
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What is the best treatment for Borrelia Miyamotoi?
The evidence is weak. Doxycycline and Zithromax are common recommendations but the data in people is not in.
I was positive on igenex immunoblot TBRF. one of the types they test for is miyamotoi. but there are others. is there a test available to determine which of the other “borrelias” i have ? not alot of info on proper protocols. i have also tested pos for borrelia burgdorf that was a few years ago. i think that i have irradicated that with abx treatment.
There are a growing number of test by a wide range of labs that are in production. I find it can be difficult to difficult to determine which tick-borne infections are present or resolved.
I was just diagnosed with miyamotio. I am on doxy(twice a day) 100mg pills. Should I modify my diet or take any herbal supplements?
I focus of probiotics as well as avoidance of sugar and alcohol at my first step. You may have to look at a second antibiotic if doxycycline does not work as we don’t fully know what works for Borrelia miyamotoi or if another tick borne illness is present.
Help – my 20 year old tested positive for Miyamotoi. He is allergic to Sulfa antibiotics and cephalosporins. He did a short course of azythromicin and then did 2 weeks of Biaxin 2x per day. During the 2 week period he felt better. (ONLY SYMPTOMS ARE BAD LEG PAIN THAT STARTED AND FEW MONTHS AGO). After he stopped the Biaxin (began to taper off) the leg pains came back. Was never on Doxycycline. Thoughts ??? Go back on Biaxin? For how long? Need Doxy? Mix of antibiotics? IV antibiotics?
There might be another co-infection. I would look at treatment with doxycycline. I would also consider an evaluation for Babesia. I also would look for illnesses not related to ticks.