Malaria and Lyme Disease Coinfection Reported in Traveler
A traveler developed both malaria and Lyme disease.
Neurologic symptoms raised concern for neuroborreliosis.
The case highlights the importance of considering coinfections.
“As far as we are aware, we are writing the first report of Plasmodium spp. and Borrelia burgdorferi co‐infection,” explains Neves from the Infectious Diseases Department, Centro Hospitalar São João, Portugal. [1]
The authors described a man who returned to Portugal from Angola, where he worked as a welder. Four months earlier, while living in Angola, he had been diagnosed with malaria and treated as an outpatient.
After returning home, the patient developed fever, constitutional symptoms, headaches, and blurred vision.
Malaria Initially Suspected
Malaria was suspected based on examination of thin blood smears and rapid diagnostic testing.
Treatment included:
- Intravenous quinine (600 mg every 8 hours)
- Intravenous doxycycline (100 mg every 12 hours)
“Atypical malaria has a broad differential diagnosis, of which co‐infections represent a cornerstone.”
Neurologic Symptoms Raised Concern for Lyme Disease
On the second hospital day, the patient developed altered mental status with worsening lethargy.
Neurologic evaluation revealed:
- Confusion
- Disorientation
- Marked cognitive slowing
- Mild left central facial palsy
These findings raised concern for neurologic Lyme disease.
“The concomitant diagnosis of borreliosis was based on clinical presentation and positive serology for Borrelia burgdorferi sensu lato,” according to Neves. [1]
PCR testing of cerebrospinal fluid confirmed neuroborreliosis.
Treatment Was Expanded for Neuroborreliosis
The patient tested positive for B. burgdorferi by Western blot testing.
Treatment was modified to include intravenous ceftriaxone (2 g every 12 hours) for 14 days.
The patient also required treatment for an autolimited antiphospholipid syndrome.
Why Coinfections Matter
The authors emphasized the importance of considering coinfections in patients with atypical presentations or persistent neurologic symptoms.
“Atypical malaria has a broad differential diagnosis, of which co‐infections represent a cornerstone,” writes Neves. [1]
The authors also warned that untreated neuroborreliosis may lead to serious neurologic and systemic complications.
Persistent neurologic symptoms despite initial treatment may warrant reevaluation for coinfections or overlapping diagnoses.
To learn more, see Lyme disease coinfections and neurologic Lyme disease (neuroborreliosis).
Clinical Perspective
This case illustrates how overlapping infections may complicate diagnosis and treatment decisions in returning travelers and patients with multisystem symptoms.
Coinfections can complicate diagnosis when neurologic symptoms evolve despite standard treatment.
Related Articles:
Neurologic Lyme disease (neuroborreliosis)
References:
- Neves N, Silva-Pinto A, Rocha H, et al. Plasmodium spp. and Borrelia burgdorferi co-infection associated with antiphospholipid syndrome in a returned traveler: a case report. Clin Case Rep. 2017;5(4):471-476.
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
Why is it not that Malaria is a Co-infection to Chronic Lyme as Babesia (Cousin to Malaria) and Bartonella are co-infections to Lyme (Borrelia Burgdorferi)? When will they finally admit that B. Burgdorferi is the root to so many debilitating disorders? They are all symptoms of Chronic Lyme. Its a terrible disgrace how we are being lied to and denied appropriate health care.
That would be due to the biology of the pathogens and which hosts they prefer as a vector. Babesia spp. and Borrelia spp. have developed mechanisms directly aimed at their tick vectors. Malaria have developed mechanisms to interact with their mosquito vectors. Not saying it is impossible for mosquito to transmit babesia or a tick to transmit malaria, but I do certainly believe the chances would be minimal. For how you are being lied to I suggest to start reading at https://www.truthcures.org
Thanks for your comments. The co-infection term has been used for more than one infection from a tick. The authors are using the term as two infections. In the author’s case, it would appear to be two infections from two vectors. Do you have a better term when there are two vectors?
Thanks for your question. Many us us use the term co-infection when we are referring more than one infection from a tick. The authors are using the co-infection term to refer to an infection from a tick and from a mosquito. Do you have a better term?
Someone I know was diagnosed with Lyme disease approximately 2 years ago (Ottawa area) and now says he has Lyme related Malaria. He has not traveled outside Canada. Is this possible?
They are likely referring to Babesia, a blood borne parasite in the same tick that carries Lyme disease. The treatment for Malaria and Babesia use some of the same medications. Babesia has been reported in Canada.
Understand frustration with deplorable healthcare (live in US) for Lyme patients. Diagnosed with late-stage, IGENex Lab and Dr 78 miles from home. Brought tick to City Health Dept. “get tested…unusually large male deer tick”. Blood test same week “negative”. Now know tested to soon for antigens to build up for accurate testing. Over time antigens diminish as infection moves into muscle, joint and bone. Went to ER, 2006, with beet-red expanding rash (have pictures). Dr “don’t know…”.
Recently told by Rheumatologist “I don’t believe in Lyme disease” and Hematologist “Drs. (facility) don’t…”. Wouldn’t make appt with PCP and Neurosurgeon referrals at another hospital Infectious Disease. Hematologist “wouldn’t see…Drs. (that facility) don’t believe…”. All testing points to coinfections of Lyme like Autonomic Dysfunction (2008 Disabled/2018 testing “significantly progressed”), Tryptase/Mast Cell disease 21.7 ug/L (range 1,000 Dr appts/MRIs, etc. Downhill skied, PADI cert scuba diver, have motorcycle license, camped entire life until I physically couldn’t, and now barely move. On 3D CT before shoulder surgery (glenoid: “approx 50% fragmented and displaced from the normal…”). Many years of excruciating pain. Impossible, especially for late-stage Lyme, to get the correct diagnosis before being “untreatable”.