What Is Borrelia Miyamotoi? Symptoms, Diagnosis, and Treatment
Borrelia miyamotoi (B. miyamotoi) is an emerging tick-borne infection transmitted by the same deer ticks that carry Borrelia burgdorferi, the bacterium responsible for Lyme disease. Although first widely reported in the United States in 2013, evidence suggests the infection may have been circulating for years.
So, what is Borrelia miyamotoi? In their article,
Della-Giustina and colleagues discuss the growing recognition of this tick-borne illness and the challenges it presents for diagnosis and treatment.
Where Is Borrelia miyamotoi Found?
Borrelia miyamotoi has been detected in several species of ticks, including the deer tick (Ixodes scapularis). Infected ticks have been identified in the northeastern and northern Midwestern United States, California, Europe, and parts of Asia.
What Stage of Ticks Transmit B. miyamotoi?
Unlike Lyme disease, which is typically transmitted by nymph or adult ticks, B. miyamotoi can be transmitted by ticks at all life stages, including the larval stage.
Studies have shown that larval ticks can harbor and transmit B. miyamotoi because the pathogen can be passed from parent ticks to their offspring. This process is known as transovarial transmission.
How Quickly Can B. miyamotoi Be Transmitted?
Transmission of B. miyamotoi may occur relatively quickly after a tick attaches.
According to the authors, “B. miyamotoi can be transmitted 10% of the time within the first 24 hours of attachment, increasing steadily to reach 73% for a complete feeding. Thus, transmission of B. miyamotoi is more rapid than transmission of B. burgdorferi.”
Borrelia Miyamotoi Symptoms
Symptoms of B. miyamotoi infection typically resemble other tick-borne illnesses and may include:
- Fever
- Malaise
- Headache
- Muscle aches (myalgias)
- Fatigue
Some patients may also develop abnormal laboratory findings such as elevated liver enzymes or a low white blood cell count. These findings are similar to those seen in Anaplasmosis, another tick-borne infection.
Unlike Lyme disease, only about 11% of patients develop an erythema migrans rash.
Diagnosing Borrelia miyamotoi
Diagnosing B. miyamotoi infection can be challenging.
“No test specific to B. miyamotoi has been approved by the U.S. Food and Drug Administration,” the authors note.
Currently, the most specific available test is polymerase chain reaction (PCR) testing of blood or cerebrospinal fluid targeting the B. miyamotoi GlpQ enzyme.
Serologic testing for IgM and IgG antibodies is available in some commercial laboratories, but results may cross-react with other spirochetal infections, complicating interpretation.
A newer experimental test, the TBD Serochip, is an array-based assay that can detect eight different tick-borne diseases including B. miyamotoi. Although promising, it has not yet become widely available.
Treatment of Borrelia miyamotoi
There are currently no large clinical trials defining the best treatment for B. miyamotoi infection.
However, doxycycline is commonly used because many patients with Lyme disease and related infections improve with this therapy.
Laboratory studies suggest that B. miyamotoi is susceptible to:
- Doxycycline
- Ceftriaxone
- Azithromycin
The organism appears to show resistance to amoxicillin in laboratory testing.
Should Antibiotics Be Used After a Tick Bite?
Because B. miyamotoi can be transmitted relatively quickly after tick attachment, some clinicians consider prophylactic antibiotic treatment following a tick bite, particularly in endemic areas.
Understanding the potential for rapid transmission may influence decisions about early treatment even when tick attachment has lasted less than 24 to 36 hours.
Frequently Asked Questions
What is Borrelia miyamotoi?
Borrelia miyamotoi is a tick-borne bacterium that causes relapsing fever–like illness. It is transmitted by the same deer ticks that spread Lyme disease.
How is B. miyamotoi different from Lyme disease?
B. miyamotoi infection may transmit faster, rarely causes an erythema migrans rash, and can be passed from adult ticks to their offspring.
What are the symptoms?
Symptoms commonly include fever, malaise, headache, fatigue, and muscle aches. Some patients develop abnormal liver tests or low white blood cell counts.
How is B. miyamotoi treated?
Doxycycline is commonly used. Laboratory studies show susceptibility to doxycycline, ceftriaxone, and azithromycin.
Related Articles:
Could Borrelia miyamotoi infections explain persistent symptoms in Lyme disease patients?
C6 peptide test may indicate Borrelia miyamotoi infection
The best antibiotics to treat Borrelia miyamotoi
References:
- Kadkhoda K, Dumouchel C, Brancato J, Gretchen A, Krause PJ. Human seroprevalence of Borrelia miyamotoi in Manitoba, Canada. CMAJ Open. 2017.
- Della-Giustina D, Duke C, Goldflam K. Underrecognized Tickborne Illnesses: Borrelia Miyamotoi and Powassan Virus. Wilderness Environ Med. 2021.
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
My son was tested by the Columbia Lyme research team positive for Miyamotoi. He also has Bartonella. There is no known time of rash. He has been suffering from encephalopathy over last five years. Treated oral Doxy, then IV Ceftriaxone and Azithromycin. Has had IVIG last three years and added Plasmapheresis 8 months ago. Much better but still many issues and unable to fully function. He is now 21 years old..