Tick bite co-infections are more common than many realize. A single tick can transmit multiple pathogens simultaneously, leading to complex illness that’s difficult to diagnose and treat. This case demonstrates how one man developed three tick-borne infections from a single bite.
“Two days after noting this ankle lesion, the patient noticed an erythematous rash on his neck and chest,” the authors explain. He was prescribed an antihistamine and 7-day course of trimethoprim–sulfamethoxazole.
The rash resolved after 5 days of antibiotic treatment, but the man continued to have pain and swelling in his ankle. The pain spread to his left hip and he was “diagnosed with sciatica and prescribed gabapentin.”
The patient had reportedly travelled to an endemic area of the United States. And was therefore, suspected of having a tick-borne illness.
Why Tick Bite Co-infections Are Often Missed
“Physicians must maintain a high level of suspicion for co-infection, as untreated disease can result in long term and sometimes life-threatening sequelae,” the authors suggest.
He tested positive for Borrelia burgdorferi, Anaplasma phagocytophilum and Babesia microti serologies.
The patient’s symptoms improved with treatment, but one year later, he continued to have symptoms of neuropathy at the site of the presumed insect bite.
This case highlights why clinicians should test for tick bite co-infections whenever a patient presents with tick-borne illness in an endemic area.
References
- Grant L, Mohamedy I, Loertscher L. One man, three tick-borne illnesses. BMJ Case Rep. 2021;14(4):e241004.
