First report of Malaria with Lyme disease as a co-infection

Malaria and Lyme disease are common vector-borne illnesses. While malaria is caused by a tropical parasite, Lyme disease is transmitted by a non-tropical bacterium, Borrelia burgdorferi (Bb). In the 2017 issue of Clinical Case Reports, doctors in Portugal describe the case of a 42-year-old man who was initially diagnosed with malaria but later found to also be infected with Borrelia. [1]

“As far as we are aware, we are writing the first report of Plasmodium spp. and Borrelia burgdorferi co‐infection (a co‐infection of a tropical parasite and a non-tropical bacterium),” explains Neves from the Infectious Diseases Department, Centro Hospitalar São João, Portugal.

The man had returned to Portugal from Angola, where he worked as a welder. Four months earlier while living in Angola, he was diagnosed with malaria and treated with an outpatient regime. But upon his return to Portugal, the man complained of fever, constitutional symptoms, headaches and blurred vision.

Malaria was suspected based on examination of thin blood smears and rapid diagnostic testing. Anti-malarial treatment was initiated and consisted of intravenous quinine (600 mg q8 h) and IV doxycycline (100 mg q12 h).

“Atypical malaria has a broad differential diagnosis, of which co‐infections represent a cornerstone.”

But on the second day of admission to the hospital, the man developed an altered mental status with increased lethargy. Doctors suspected Lyme disease during a neurological evaluation, where he showed signs of confusion, disorientation and marked cognitive slowing. “A slight left central facial palsy was described, with no other cranial neuropathies,” states Neves.

“The concomitant diagnosis of borreliosis was based on clinical presentation and positive serology for Borrelia burgdorferi sensu lato,” according Neves. “Positive PCR for B. burgdorferi sensu lato in CSF also confirmed neuroborreliosis.”

The patient tested positive for Bb on the Western blot and treatment was altered to include intravenous ceftriaxone (2 g q12 h) for 14 days. The patient also required treatment for an autolimited antiphospholipid syndrome.

In conclusion, Neves points out the importance of considering co-infections. “Atypical malaria has a broad differential diagnosis, of which co‐infections represent a cornerstone. Making such a diagnosis is of vital importance in terms of management and prognosis. This is particularly true in the case of the co‐infection of B. burgdorferi, due to the potentially devastating neurological and systemic manifestations and the therapeutic implications.”



  1. 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.

7 Replies to "First report of Malaria with Lyme disease as a co-infection"

  • Christine B.
    07/04/2019 (2:00 am)

    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”.

  • Diane Gillieson
    10/11/2018 (4:20 pm)

    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?

    • Dr. Daniel Cameron
      10/11/2018 (5:16 pm)

      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.

  • Øystein Amundsen
    07/31/2018 (2:31 pm)

    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

    • Dr. Daniel Cameron
      08/01/2018 (2:29 pm)

      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?

    • Dr. Daniel Cameron
      08/01/2018 (2:33 pm)

      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?

  • Denise
    04/29/2017 (3:04 am)

    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.

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