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Lyme Disease Co-infections


Lyme Disease Co-infections

Tick-borne illnesses are zoonotic, which means they can spread from animals to people. When ticks, mosquitos, and fleas bite humans, they transmit diseases from animals, such as mice, rats, and squirrels, to humans. Ticks can carry and transmit a variety of bacteria, viruses, fungus, and protozoans in a single bite.

Lyme disease, babesiosis, anaplasmosis, ehrlichiosis, relapsing fever, tularemia, and Rocky Mountain spotted fever (RMSF) are the most frequent tick-borne diseases in the United States.

Coinfections are diseases that are acquired concurrently. The term “Lyme disease coinfection” usually refers to a situation in which a patient is infected with Lyme disease and one or more of the other tick-borne diseases conveyed by the ticks that spread Lyme disease.


Common Lyme disease coinfections


Babesiosis is a disease caused by Babesia infection. Babesia is a malaria-like parasite that infects red blood cells and is known as “piroplasm.” Although Babesia microti is thought to be the most prevalent piroplasm infecting people, scientists have discovered over 20 piroplasms carried by ticks.

Babesia can be passed from mother to unborn child or by a contaminated blood transfusion, in addition to tick transmission. Most blood banks do not screen the blood for babesia currently.

Symptoms of babesiosis

Babesiosis symptoms are similar to Lyme disease symptoms although babesiosis usually begins with a high fever and chills. Patients may have weariness, headaches, drenching sweats, muscle aches, chest discomfort, hip pain, and shortness of breath (“air hunger”) as the illness develops.

Babesiosis is generally so mild that it goes unnoticed, yet it can be fatal to persons who lack a spleen, the elderly, and those who have weakened immune systems. Low blood pressure, liver issues, severe hemolytic anemia (the destruction of red blood cells), and kidney failure are possible complications.



Bartonella causes an illness known as bartonellosis.

Bartonella is a type of bacteria that thrives in the lining of blood arteries. Humans, mammals, and a wide range of wild animals can be infected with them.

Bartonella henselae is a dangerous new infection that was first discovered in 1990. It is mostly transmitted by cats and causes cat scratch disease, endocarditis, etc.

Fleas, body lice, and ticks are known to carry Bartonella bacteria, and ticks are suspected of transmitting it to humans. The disease has been contracted by people who have been bitten by ticks but have not been exposed to cats. Lyme spirochete and Bartonella infections have been found in people who have been bitten by ticks.

Ticks can transfer Bartonella to mice according to a recent study. More research is needed to determine the role of ticks in the disease's spread. Furthermore, according to a recent study, Bartonella can be transferred from mother to unborn kid (perinatal transmission).

Several species of Bartonella have been identified by scientists. One variety of sand flies can be found in the Andes Mountains of Peru, Colombia, and Ecuador. Another is carried by human body lice all over the world. Bartonella is carried by European sheep ticks, and investigators found five different Bartonella strains in 19.2 percent of Ixodes pacificus ticks collected in California.

Symptoms of bartonellosis

Bartonellosis has long been thought to be a minor, transient, and self-limiting condition. However, an increasing number of clinicians are becoming aware that Bartonella can lead to long-term infection. Patients may experience relapses because Bartonella attaches to red blood cells regularly, providing a haven for the bacteria.

Fever, lethargy, headache, low appetite, and a peculiar streaking rash that resembles “stretch marks” are among early indications of bartonellosis. Swollen glands, especially around the head, neck, and arms, are common. Patients with bartonelliosis have greater neurological symptoms.

Blurred vision, numbness in the extremities, memory loss, balance issues, headaches, ataxia (unsteady gait), and tremors are frequent symptoms. Psychiatric symptoms can be triggered by bartonellosis.



Although they can be found in lice, fleas, mites, and chiggers, ticks are thought to transmit the majority of rickettsial diseases in the United States. The spotted fever group (which includes rickettsiae and ehrlichia) and the typhus group are two types of rickettsia.

Rickettsia rickettsii, Rickettsia parkeri, Rickettsia Philipii, Rickettsia helvetica are members of the spotted fever group rickettsiae (SFGR).


Rocky Mountain spotted fever

The most frequent rickettsial infection in the United States is Rocky Mountain spotted fever (RMSF). It might be anything from a minor ailment to a life-threatening condition.

High temperature, severe headache, abdominal discomfort (with or without vomiting), and muscle soreness are common early symptoms. It usually includes a spotty rash that starts around the wrists and ankles and may expand outward from there.

The course of Rocky Mountain Spotted Fever differs with patients. Others may require intravenous antibiotics, lengthy hospitalization, or intensive care to recover.

The rash in RMSF is caused by the weakening of tiny blood vessels throughout the body. This widespread damage to blood arteries allows bacteria to move to the heart and brain, resulting in death in children younger than four years, those older than 60 years, and individuals with weakened immune systems.

Other types of rickettsiosis infections

A milder form of rickettsiosis is caused by Rickettsia parkerii, which is found along the Gulf Coast, and Rickettsia phillipii, which is located on the West Coast. Although the spotted rash is less common, both can result in an eschar (scab) or necrotic region (1 cm of diameter) at the tick bite site. These other forms of rickettsiosis usually cause a mild disease that goes unnoticed. As a result, the true number of infections may be higher.



Anaplasmosis or human granulocytic ehrlichiosis (HGE) is a tick-borne bacterial disease caused by the bacterium Anaplasma phagocytophilum. It is spread via black-legged or deer tick bites (Ixodes scapularis).

Symptoms of anaplasmosis

Symptoms appear within a week or two after the tick bite and may include one or more of the following:

  • Chills
  • Fever
  • Muscle aches
  • Diarrhea
  • Nausea or vomiting
  • Loss of appetite

If it is not treated promptly, later symptoms of the disease may include:

  • Bleeding complications
  • Organ shutdown
  • Respiratory failure
  • Death



Ehrlichiosis is caused by the bacteria Ehrlichia chaffeensis, and it is transmitted to humans by the bite of infected ticks, such as the lone star tick (Ambylomma americanum) and the dog tick (Amblyomma maculatum).

Symptoms of ehrlichiosis

Early symptoms usually appear over the first five days of initial infection and can include:

  • Severe headache
  • Chills
  • Fever
  • Muscle aches
  • Upset stomach or nausea
  • Loss of appetite
  • Diarrhea
  • Confusion
  • Rash

Late-stage symptoms may include:

  • Damage to the brain or nervous system
  • Organ shutdown
  • Respiratory failure
  • Uncontrolled bleeding
  • Death


Other Lyme disease coinfections

Ticks in different geographic areas may be infected with one or more of the following Lyme disease coinfections besides the other diseases.

Borrelia miyamotoi infection

Borrelia miyamotoi infection is a tick-borne infection that has only recently been discovered in humans. Borrelia miyamotoi is a spiral-shaped bacteria that is distantly related to the bacteria that causes Lyme disease.

Symptoms of Borrelia miyamotoi

  • Chills
  • Fatigue
  • Headaches
  • Joint and body pain
  • Relapsing fever


Colorado tick fever

Colorado tick fever (CTF) is a rare disease that is spread by infected Rocky Mountain wood tick (Dermacentor andersoni). CTF is caused by an RNA virus belonging to the genus Coltivirus and is a rare disease.

Symptoms of Colorado tick fever

Symptoms usually appear within 1 to 14 days after a tick bite and may include:

  • Abdominal pain
  • Body aches
  • Chills
  • Encephalitis
  • Fatigue
  • Headache
  • Heart problems
  • Saddleback fever
  • Severe bleeding
  • Skin rash
  • Sore neck
  • Vomiting


Heartland virus infection

Heartland virus infection is a tick-borne viral disease caused by a virus from the genus Phlebovirus and transmitted by the bite of an infected lone star tick (Amblyomma americanum).

Symptoms of Heartland virus infection

Most patients experience the following symptoms:

  • Decreased appetite
  • Decreased platelet counts
  • Decreased white blood cell counts
  • Fatigue
  • Fever
  • Headache
  • Increased levels of liver enzymes
  • Joint pain
  • Muscle or joint pain


Powassan encephalitis

Powassan encephalitis is a very uncommon tick-borne disease caused by the Powassan virus, a flavivirus that can cause encephalitis or meningitis. The virus spreads significantly more quickly than many other tick-borne microorganisms, usually within 15 minutes of tick adhesion.

Symptoms of Powassan encephalitis

Initial symptoms can include:

  • Fever
  • Headache
  • Vomiting
  • Weakness

Symptoms of severe illness include:

  • Confusion
  • Dementia
  • Difficulty speaking
  • Encephalitis
  • Loss of coordination
  • Meningitis
  • Seizures
  • Death


Relapsing fever

Spirochete bacteria from Borrelia species, such as B hermsii, B parkeri, B duttoni, and B miyamotoi, cause relapsing fever, which is transmitted by ticks of the Ornithodoros species.

Symptoms of relapsing fever

Signs and symptoms can include:

  • Recurring high fevers with an irregular pattern
  • Arthralgias
  • Coma
  • Cranial nerve palsy
  • Dizziness
  • Epistaxis
  • Hemoptysis
  • High fever delirium
  • Influenza-like symptoms
  • Iridocyclitis
  • Meningeal signs
  • Myocarditis
  • Nausea
  • Pneumonitis
  • Rupture of the spleen
  • Splenomegaly
  • Vomiting


Southern tick-associated rash (STAR)

The lone star tick causes masters disease by transmitting Ambylomma americanum. The rash begins seven days after the tick bite and grows to a diameter of three inches or more resembles Lyme disease rash.

Symptoms of southern tick-associated rash

The symptoms of STAR are similar to those seen in Lyme disease, such as:

  • A red, expanding “bull’s-eye”
  • Fatigue
  • Headache
  • Fever
  • Joint and muscle pains



Tularemia is a potentially fatal disease caused by the bacterium Francisella tularensis and spread by the lone star tick (A americanum), wood tick (D andersoni), and dog tick (D andersoni).

Symptoms of tularemia

Symptoms may include:

  • Acute respiratory distress syndrome
  • Chills
  • Cough and sore throat
  • Fatigue
  • Fever
  • Headache
  • Malaise
  • Myalgia
  • Nausea or vomiting
  • Pericarditis
  • Pleural effusions
  • Pneumonia
  • Skin ulcers



Ticks have been found to carry mycoplasma species. They infiltrate human cells and disturb the immune system, resulting in weariness, musculoskeletal discomfort, and cognitive difficulties. Antibiotics can be used to treat mycoplasmas.


Q fever

Coxiella burnetii, a bacterium transmitted by cattle, sheep, and goats, causes Q fever. The symptoms are very similar to Lyme disease. A high fever is most likely to accompany Q fever. Q fever is associated with pneumonia and poor liver function. The drug of choice is doxycycline.


Tick paralysis

Ticks release toxins that cause gradual paralysis. This is usually reversible when the tick is removed.