Lyme Disease Co-Infections

In recent years, experts have identified new tick-borne co-infections capable of harming humans.

Lyme Disease Co-Infections

Lyme disease, caused by the bacterium Borrelia burgdorferi, is a well-known tick-borne illness transmitted through the bite of a black-legged (I. scapularis) tick.

However, what is less commonly known is that ticks can harbor multiple infectious pathogens, leading to the development of Lyme disease co-infections.

In recent years, health experts have identified several new tick-borne microbes capable of infecting humans.

This article takes a closer look at these Lyme disease co-infections - including Babesia, Anaplasmosis, Ehrlichia, Bartonella, Southern Tick-Associated Rash Illness (STARI), and Borrelia miyamotoi - and delves into their symptoms, diagnosis, and treatment options.

The emergence of lyme disease co-infections

The Emergence of Lyme Disease Co-Infections

Since the discovery of Lyme disease in 1975, researchers have identified numerous other tick-borne diseases that can be transmitted to humans through a tick bite or tainted blood transfusion.

A single tick can transmit multiple pathogens, including bacteria, viruses, and parasites. This has led to a rise in Lyme disease co-infections, with a single individual potentially suffering from multiple tickborne coinfections simultaneously.

Lyme disease with co-infections: a complex picture

Prevalence of Co-Infections in Ticks

Studies have found that co-infections are not uncommon in ticks. For instance, a study in Suffolk County, Long Island, revealed that more than half (67%) of the ticks collected harbored at least one pathogen.

In Lyme-endemic areas of the United States, co-infection occurs in up to 28% of black-legged ticks. Among infected ticks collected in one study, 45% were co-infected and carried up to five different pathogens.

Lyme Disease with Co-Infections: A Complex Picture

Researchers from Columbia University, Tufts Medical Center, and Yale School of Medicine examined the extent of co-infections in patients diagnosed with Lyme disease. Their findings showed that:

  • 40% of Lyme disease patients had concurrent Babesia
  • 1 in 3 patients with Babesia had concurrent Anaplasmosis
  • Two-thirds of patients with Babesiosis experienced concurrent Lyme disease, and one-third experienced concurrent Anaplasmosis.

These results highlight the complex nature of Lyme disease co-infections and the challenges healthcare professionals face in recognizing, diagnosing, and treating these conditions.

Recognizing and Treating Co-Infections

As tick populations continue to grow and expand into new geographic regions, there is increasing concern surrounding the medical community's ability to recognize, diagnose, and treat Lyme disease co-infections. One study found that nearly 1 in 4 black-legged ticks tested had multiple infections, emphasizing the need for a clinical approach that covers all infection possibilities.

Unfortunately, testing for co-infections is often overlooked. In a study of nearly 3 million specimens, only 17% were tested for non-Lyme tick-borne diseases. Accurate diagnosis is crucial since patients may require different treatments depending on the type of co-infection. For example, antibiotics prescribed for Lyme disease may be ineffective in treating parasitic or viral tick-borne diseases such as Babesia.

Most common lyme disease co-infections

Most Common Lyme Disease Co-Infections

The most frequently diagnosed tick-borne co-infections include Babesia, Anaplasmosis, Ehrlichia, Bartonella, Southern Tick-Associated Rash Illness (STARI), and Borrelia miyamotoi.

The following sections will provide an overview of each co-infection, including their symptoms, diagnosis, and treatment options.


Babesia is a parasite that infects red blood cells. This parasitic infection is primarily transmitted by a tick bite but can also be acquired through a contaminated blood transfusion. There have been rare reports of congenital transmission of Babesiosis.

Symptoms of Babesia

Symptoms of Babesia typically include irregular fevers, chills, sweats, lethargy, headaches, nausea, body aches, fatigue, and in some cases, shortness of breath. However, manifestations can vary widely, leading to challenges in diagnosis.

Babesia and Lyme Disease

Babesia is often present with Lyme disease and can increase the severity of Lyme disease symptoms. Patients co-infected with Lyme disease, and Babesia may experience more severe fatigue, headache, sweats, chills, anorexia, emotional lability, nausea, conjunctivitis, and splenomegaly compared to those with Lyme disease alone. Babesia can also increase the duration of illness with Lyme disease, with 50% of co-infected patients being symptomatic for three months or longer, compared to only 4% of patients with Lyme disease alone.

Testing and Treatment for Babesia

Current testing for Babesia can be unreliable, with the parasite detected microscopically in as few as one-third of patients. Specific amplifiable DNA and IgM antibody tests are more likely to be positive, but the reliability of these tests in practice remains to be determined.

Babesia is treated with a combination of anti-malaria medications and antibiotics, such as Atovaquone with azithromycin.


Anaplasmosis, previously known as Human Granulocytic Ehrlichiosis, is caused by the bacteria Anaplasma phagocytophilum. It can be difficult to distinguish from Ehrlichiosis, Lyme disease, and other tick-borne illnesses. This emerging infectious disease remains under-recognized in many areas of the United States.

Symptoms of Anaplasmosis

Symptoms of Anaplasmosis may include headaches, fevers, chills, malaise, and muscle aches. There have been a few reported cases describing pulmonary complications, leading some researchers to recommend including anaplasmosis in the differential diagnosis for atypical respiratory presentations. Although uncommon, there have been patients with anaplasmosis who did not exhibit any symptoms (asymptomatic), making it crucial for clinicians to be aware of potential asymptomatic anaplasmosis following a tick bite.

Testing and Treatment for Anaplasmosis

Anaplasmosis can be treated with antibiotics such as doxycycline, minocycline, and Rifampin.


Ehrlichia is a tick-borne bacteria that infects white blood cells, but it has been found in spleen, lymph node, and kidney tissue samples. An infection with Ehrlichia can lead to Ehrlichiosis, which is caused by Ehrlichia chaffeensis and Ehrlichia chagrins. The bacteria are transmitted by the Lone Star tick (Amblyomma americanum) and the black-legged tick (Ixodes scapularis).

Symptoms and Treatment of Ehrlichiosis

Symptoms of Ehrlichiosis may include fatigue, fevers, headaches, and muscle aches. If left untreated, the disease can become severe and require hospitalization. Ehrlichiosis can be treated with antibiotics such as doxycycline, minocycline, and Rifampin.


Various Bartonella species have been found in black-legged ticks in northern New Jersey and in western black-legged ticks in California. Bartonella can be contracted through a cat scratch or bite, causing "cat scratch fever." However, it can also be transmitted by a tick bite, with ticks and small rodents acting as hosts and playing a significant role in the preservation and circulation of Bartonella in nature.

Symptoms of Bartonella

Some patients with Bartonella may exhibit a streak-mark rash that resembles stretch marks. Symptoms may include fever, headaches, fatigue, and swollen glands. Several studies have found an association between Bartonella and psychiatric symptoms, with case studies describing new-onset psychiatric symptoms such as sudden agitation, panic attacks, and treatment-resistant depression possibly due to Bartonella.

Testing and Treatment for Bartonella

Bartonella can be treated with antibiotics such as doxycycline, minocycline, azithromycin, trimethoprim-sulfamethoxazole, clarithromycin, and Rifampin.

Southern Tick-Associated Rash Illness (STARI)

STARI is an emerging tick-borne illness related to Lyme disease and identified in the southeastern and south-central United States. It is believed to be transmitted by the Lone Star tick, but this has not been officially confirmed. The hallmark sign of STARI is an EM-like rash similar to that seen in Lyme disease. Symptoms may include fevers, headaches, stiff neck, joint pain, and fatigue. The long-term consequences and treatment of STARI have not been established. However, because STARI resembles early Lyme disease, physicians often treat patients with oral antibiotics.

Borrelia miyamotoi

Borrelia miyamotoi (BMD) is a spiral-shaped bacteria that causes tick-borne relapsing fevers. It is increasingly being recognized as an agent of a nonspecific febrile illness often misdiagnosed as acute Lyme disease without rash or Ehrlichiosis. BMD is a common infection in areas endemic for Lyme disease.

Symptoms and Prevalence of Borrelia miyamotoi

Symptoms of BMD generally include systemic signs such as headache and fever. Most patients present with fever, fatigue, and headache. Other symptoms may include myalgia, chills, nausea, and arthralgia. BMD is particularly concerning given that the bacterium can be transmitted to a person within the first 24 hours of tick attachment. The prevalence of BMD is unknown, but studies in New England suggest it may be as common as anaplasmosis and babesiosis.

Testing and Treatment for Borrelia miyamotoi

Diagnostic testing for BMD is limited, with blood smears having poor sensitivity for confirming the disease. The CDC recommends using PCR and antibody-based tests, but the reliability of these tests remains to be determined. Treatment for BMD is similar to that of Lyme disease, with doxycycline and amoxicillin effectively treating BMD infection in patients.

Lyme Disease Co-Infections: Final Thoughts

Lyme disease co-infections are becoming increasingly prevalent as tick populations grow and expand into new regions.

It is essential for healthcare professionals to be aware of these co-infections and their symptoms, diagnosis, and treatment options. By recognizing and addressing Lyme disease co-infections, practitioners can better serve their patients and help them on their road to recovery.

How do You Treat Lyme Disease Co-Infections?

As Lyme Disease symptoms, co-infections, and mycotoxins overlap, there is much difficulty in identifying the root cause of particular symptoms without targeted laboratory testing to determine what infection or multiple infections are present.

Unfortunately, it’s not yet standard protocol in the mainstream medical community to test for co-infections unless there’s a positive Lyme disease test. But it’s absolutely possible to have one or more of these co-infections without having Lyme disease.

That is exactly why Sponaugle Wellness partners with cutting-edge laboratories worldwide that make tick-borne illness their business. These laboratories provide the answers you need through research and development initiatives that produce precision tests for Borrelia and its coinfections.

By analyzing your test results, we can determine the root cause of your condition and create a customized treatment plan with proven therapies that’ll restore your vigor and get you back to feeling like your best self again.

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