Borrelia miyamotoi: A Fast-Spreading Tick-Borne Infection
Carried by the same ticks as Lyme disease
Can be transmitted faster than Lyme
Often missed due to overlapping symptoms
Borrelia miyamotoi (B. miyamotoi) was first reported in the United States in 2013 and has since become increasingly recognized as a human pathogen. It is transmitted by the same ticks that carry Borrelia burgdorferi, the bacterium responsible for Lyme disease, highlighting its role among Lyme coinfections. :contentReference[oaicite:0]{index=0}
Where Is Borrelia miyamotoi Found?
B. miyamotoi has been detected in ticks across the northeastern and upper Midwestern United States, California, Europe, and Asia.
How Is It Transmitted?
Unlike Lyme disease, B. miyamotoi can be transmitted at all stages of the tick lifecycle, including the larval stage.
This occurs through transovarial transmission, where infected female ticks pass the pathogen directly to their offspring.
How Fast Can Transmission Occur?
Transmission can occur rapidly. According to Della-Giustina and colleagues, B. miyamotoi may be transmitted within the first 24 hours of tick attachment and increases steadily with feeding.
This faster transmission rate has important implications for early intervention and prevention strategies outlined in our Lyme disease prevention guide.
Symptoms of Borrelia miyamotoi
Symptoms may overlap with other tick-borne infections and include:
- Fever
- Malaise
- Headache
- Muscle aches
Laboratory abnormalities may include elevated liver enzymes and low white blood cell counts, similar to anaplasmosis.
Only about 11% of patients develop an erythema migrans rash, making diagnosis more difficult. These overlapping patterns are described in our Lyme disease symptoms guide.
Why Diagnosis Is Challenging
There is currently no FDA-approved test specific for B. miyamotoi.
PCR testing of blood or cerebrospinal fluid targeting the GlpQ enzyme is the most specific method available, but access is limited.
Serologic testing is available in some laboratories but may cross-react with other spirochetes, complicating interpretation.
Treatment Options
There are no large clinical trials guiding treatment. However, doxycycline has been commonly used, based on clinical experience with Lyme disease.
Laboratory studies suggest susceptibility to ceftriaxone, azithromycin, and doxycycline, with possible resistance to amoxicillin.
Should Prophylactic Treatment Be Considered?
Because B. miyamotoi can be transmitted quickly, prophylactic antibiotic treatment may be considered even when tick attachment is brief.
Understanding the rapid transmission of B. miyamotoi may influence decisions about early treatment following tick exposure.
Related Articles:
Could Borrelia miyamotoi infections explain persistent symptoms in Lyme disease patients?
References:
- Kadkhoda K, Dumouchel C, Brancato J, et al. Human seroprevalence of Borrelia miyamotoi. CMAJ Open. 2017.
- Della-Giustina D, Duke C, Goldflam K. Underrecognized Tickborne Illnesses. Wilderness Environ Med. 2021. View study
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..