Borrelia Miyamotoi DNA Test: New Sequencing Method for Lyme and Co-Infections
A Novel Diagnostic Approach for Dual Detection
The Borrelia miyamotoi DNA test represents a promising new approach to diagnosing tick-borne infections that are often missed by standard testing. :contentReference[oaicite:1]{index=1}
A new DNA sequencing test capable of detecting both Borrelia miyamotoi and Borrelia burgdorferi (Lyme disease) offers hope for improved diagnosis. Krause et al. reported that B. miyamotoi can cause illness and is treatable, yet traditional Lyme disease tests cannot detect it.
This creates a significant diagnostic gap. Patients infected with B. miyamotoi may test negative on standard Lyme testing, leading to missed diagnosis and delayed treatment.
A test capable of detecting both organisms simultaneously directly addresses this limitation.
How the DNA Sequencing Test Works
Dr. Lee and colleagues at Milford Hospital described a novel DNA sequencing test that detects both organisms directly in patient blood samples.
Unlike antibody-based tests, which rely on the immune response, DNA sequencing detects the organism itself.
This approach may be particularly valuable in:
- Early infection before antibodies develop
- Immunocompromised patients
- Low bacterial density (spirochetemia)
- Off-season presentations
Direct detection may capture cases missed by traditional testing.
Why Traditional Lyme Tests Cannot Detect B. miyamotoi
Standard Lyme testing (ELISA followed by Western blot) detects antibodies against Borrelia burgdorferi.
However, B. miyamotoi expresses different surface proteins.
As a result, antibodies do not cross-react.
This creates a dangerous scenario:
Patients may have active infection, test negative, and be told they do not have tick-borne disease.
Why New Testing Matters
Currently, there is no FDA-approved test for B. miyamotoi, and clinicians face significant diagnostic challenges.
A dual-detection test could:
- Improve diagnostic accuracy
- Reduce missed co-infections
- Simplify testing decisions
Instead of ordering multiple tests, a single test could identify both infections.
Clinical Applications and Limitations
Initial studies showed strong performance against controls, but important questions remain:
- Sensitivity and specificity in real-world patients
- Performance in early vs late disease
- Detection of low-level or persistent infection
- Cost, turnaround time, and insurance coverage
Further clinical validation is needed before widespread adoption.
Geographic Distribution and Expanding Recognition
Although studied in Southern New England, B. miyamotoi has been identified in:
- The Northeast and upper Midwest
- California
- Japan and Europe
As awareness increases, this infection is likely more widespread than previously recognized.
Frequently Asked Questions
What is the Borrelia miyamotoi DNA test?
A DNA sequencing test that detects both Lyme disease and B. miyamotoi directly from blood samples.
Why can’t standard Lyme tests detect B. miyamotoi?
Because antibody tests target B. burgdorferi proteins, and B. miyamotoi has different surface proteins.
What is the advantage of DNA testing?
It detects the organism directly, improving detection in early infection or low bacterial load cases.
Is this test available?
It remains investigational. There is still no FDA-approved test for B. miyamotoi.
Clinical Takeaway
The Borrelia miyamotoi DNA test addresses a critical weakness in current Lyme disease diagnostics: the inability to detect co-infections using standard methods.
Traditional testing relies on antibody responses, which may be absent in early infection or in patients with immune dysfunction.
DNA sequencing offers a direct method to identify infection.
However, while promising, this approach requires further validation before it can be routinely used in clinical practice.
Until then, clinicians must rely on clinical judgment when evaluating patients with suspected tick-borne illness—especially when standard tests are negative.
Related Reading
- Lyme Disease Testing and Diagnosis
- Understanding Lyme Disease Test Accuracy
- Borrelia miyamotoi: What Lyme Patients Need to Know
- Understanding Lyme Disease Coinfections
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
