Co-infections can be a significant complication in the effective treatment of Lyme disease. Ticks may carry more than one disease, so it’s possible for humans to get more than one type of infection from a single tick bite.
Parasitic, viral and bacterial infections besides Borrelia are commonly transmitted through tick (and other insect) bites, and complicate treatment. It is the exception, rather than the norm, for people with Lyme to be infected only with Borrelia, especially in the United States. Most people contract multiple infections, including Bartonella, Babesia and others, from a single tick bite.
Scientists currently recognize more than a dozen tick-borne infections, or illnesses in the US, although there are likely to be many more. In addition to Borreliosis, the three most common are Babesiosis, Ehrlichiosis, and Bartonellosis – referring to disease caused by a variety of species and strains of Babesia, Ehrlichia and Bartonella organisms. Babesia is a parasitic organism similar to malaria that lives in the red blood cells; Ehrlichia is an intracellular, pleomorphic rickettsia bacteria that infects white blood cells, and Bartonella is a type of bacteria that infects endothelial tissue (tissue which lines blood and lymphatic vessels) and red blood cells.
Symptoms of the most common Lyme co-infectious agents, including Babesia, Bartonella, Ehrlichia and Mycoplasma are often nonspecific and produce symptoms similar to Borrelia, which makes diagnosis and treatment difficult. Skilled, experienced Lyme-literate doctors will evaluate and treat for all of these pathogens and not assume that a patient is infected only with Borrelia, since increasingly, people have all of these, and/or additional infections.
Although conventional lab tests exist for many strains and species of these pathogens, most are unreliable. Therefore, like Borrelia, co-infections must be diagnosed clinically, or based on symptoms. Skilled doctors will also use unconventional methods of testing, such as electrodermal screening (using devices such as the ZYTO) and Applied Kinesiology, and/or in conjunction with more sophisticated lab tests such as Borrelia culture testing (for more information see the Diagnosis section).
Unfortunately, the more co-infections that are present, the more severe the illness and the longer the recovery period. Treatments for infections are also often different than those used for Borrelia. For example, doxycycline, an effective treatment for Borrelia, is also effective for Ehrlichia but not Babesia, a malarial-like parasitic organism. Similarly, Bartonella and Mycoplasma must be treated with different antibiotics. Bartonella may be the most common of all tick-borne pathogens. In addition to ticks, Bartonella can be transmitted by fleas, lice, sand flies, cat scratches and possibly other insects. The strain of Bartonella that is transmitted by ticks seems to be different than the strain that results in cat scratch disease. One indication of this is the fact that usual Bartonella medications do not work for the tick-borne strain.
Common Lyme Co-Infection Symptoms and Treatment
Bartonellosis (Bartonella) Symptoms:
- Central nervous system (CNS) symptoms such as cognitive deficits, confusion, agitation, anxiety, depression, insomnia and sometimes, seizures. These symptoms are also caused by Borrelia so when they are extreme, suspect co-infection with Borrelia.
- Lower abdominal pain
- Poor appetite
- Sore soles
- Swollen glands around the head, neck and arms
- Sore throat
- Tender subcutaneous nodules along the extremities
- Unusual skin markings, growths or other skin irregularities
- Unusually large, too many, or dark blood vessels
- Red papules of any size
- Rashes that appear as red streaks, spider veins or red papular eruptions
Most conventional lab tests for Bartonella are unreliable. Polymerase chain reaction (PCR) tests, standard blood tests and tissue biopsies can be used, although there may be a high number of false negatives. More sophisticated, but unconventional tests, such as electrodermal screening devices (such as the ZYTO) and Applied Kinesiology methods are often more effective and used by some Lyme-literate health care practitioners, in addition to a clinical diagnosis based on symptoms.
Levofloxacin is a common drug of choice for treating tick-borne Bartonella in adults. In chronic Lyme disease, many people require many months, or even years, of treatment. Adding a proton pump inhibitor may improve the effectiveness of levofloxacin. Other medications that are used to treat Bartonellosis include rifampin, gentamicin and possibly streptomycin. Since levofloxacin cannot be given to children under 18, alternatives, such as azithromycin, are used.
It should be noted that certain antibiotic combinations that are used to treat Lyme disease seem to inhibit the action of levofloxacin. Lyme-literate expert Dr. Burrascano advises against using an erythromycin-type drug but contends that combinations with cephalosporins, penicillins and tetracyclines are permissible.
While antibiotics help many people with Bartonella and other Lyme infections to recover, prolonged antibiotic treatment isn’t always sufficient or effective. For this reason, many integrative Lyme-literate doctors now combine antibiotic treatment with herbal remedies, ozonated oils, IV ozone and silver therapy, homeopathy, Rife machine therapy, chlorine dioxide, and other natural treatments. Some people respond better to protocols comprised exclusively of natural remedies, as antibiotics are often harsh on the body and strip the gut and skin of beneficial bacteria needed by the immune system to combat infection. Still, antibiotics and other drugs are often necessary and beneficial in the treatment of Bartonella and other Lyme infections. For more information on some of these, see the Treatments section.
(from the Ehrlichia organism)
There are two types of Ehrlichiosis, both caused by tick-borne rickettsial parasites that infect different kinds of white blood cells. HME (human monocytic ehrlichiosis) infects monocytes and HGE (human granulocytic ehrlichiosis), renamed anaplasmosis, infects granulocytes. The severity of Ehrlichiosis can range from mild to life-threatening.
Ehrlichosis (Ehrlichia) Symptoms:
- Sudden high fever
- Leukopenia (reduced white blood cells)
- Muscle aches
- Low white blood cell and platelet count (if severe)
- Elevated liver enzymes (if severe)
- Respiratory insufficiency (if severe)
- Anemia (if severe)
Serology tests for antibodies, standard blood smears and polymerase chain reaction (PCR) tests are largely unreliable, especially since currently available tests can only identify a small number of the many known species of this parasite. Enhanced smears are more sensitive and can identify a wider variety of species, but infection can still be missed. More sophisticated, but unconventional tests, such as electrodermal screening devices (such as the ZYTO) and Applied Kinesiology methods are often more effective and used by some Lyme-literate health care practitioners, in addition to a clinical diagnosis based on symptoms and conventional labs.
Doxycycline is the preferred treatment for the spirochete form of Borrelia, and likewise, is the most effective drug for treating Ehrlichiosis. In cases where higher, prolonged doses of doxycycline are ineffective, rifampin may be added. Like Bartonellosis, Lyme-literate doctors now often use natural treatments such as herbal remedies, frequency therapy, ozone and essential oils in lieu of, or in conjunction with, antibiotic therapy.
Babesiosis, an infection cause by a malarial-like parasite called a piroplasm infects the red blood cells. Research suggests that at least 66% of Lyme patients are co-infected with Babesia. Although Babesia microti and Babesia duncani are the most widely identified piroplasms carried by ticks, more than 20 other species have been identified and some people are infected with multiple strains of Babesia. The severity of Babesiosis can range from a mild subclinical infection to a potentially life-threatening illness.
Babesiosis (Babesia) Symptoms:
*Note: A few, some or all of these symptoms may be present. The same is true for all other Lyme infections. People may have a few, some or all possible symptoms.
- Hemolytic anemia
- High fever and chills at onset
- Persistent headaches
- Night sweats
- Muscle aches
- Severe chest wall pains
- Weight fluctuations
- Need to sleep in excess of 8.5 hours daily
- “Air hunger” or shortness of breath in the absence of another cause
- Swelling in limbs and other parts of body
- Excessive perspiration during normal daily activity
- Hot flashes
- Poor appetite
- Cognitive impairment (brain fog or slowed processing)
- Slowed thinking
Diagnostic Tests: Standard blood smears can identify Babesiosis but are only reliable during the first two weeks following infection. Other tests that may identify a few species of the protozoa include serology tests for antibodies, enhanced smears, polymerase chain reaction (PCR) and the Fluorescent In-Situ Hybridization (FISH) assay. Still, these tests aren’t that reliable for detecting Babesia since many strains of the organism exist for which tests have not yet been developed; the existing tests are not sensitive enough to detect the organism in a random blood sample, or the host may not produce an antibody response to the organism. More sophisticated, but unconventional tests, such as electrodermal screening devices (such as the ZYTO) and Applied Kinesiology methods are often more effective and used by some Lyme-literate health care practitioners, in addition to a clinical diagnosis based on symptoms.
Because piroplasms like Babesia are protozoans, not bacteria, they are not affected by standard Lyme treatment with antibiotics. Instead, Babesiosis is generally treated with a combination of two types of anti-parasite drugs: atovaquone (Mepron, Malarone) plus an erythromycin-type drug, such as azithromycin (Zithromax), clarithromycin (Biaxin), or telithromycin (Ketek). Mepron is typically used before Malarone but Babesia is increasingly developing resistance to these drugs. For this reason, some doctors may add additional medications such as Bactrim (Septra) to their patients’ regimens, and/or anti-parasitic herbal remedies such as artemisinin (sweet wormwood), or IV ozone.
Other Tick (and Other Insect-Borne) Lyme-Related Infections
In addition to Babesiosis, Ehrlichiosis and Bartonella, other tick-borne diseases or infections can be found in different geographic regions of the US and worldwide. To see where these co-infections are most prevalent, view or download the Lyme and Co-infections Chart compiled by LymeDisease.org.
STARI (Southern Tick-Associated Rash Illness) – Looks, acts and is treated like Lyme disease. Some think it is another form of Lyme disease, while others think it may be caused by the bacterium Borrellia lonestari. Doxycycline is the preferred treatment.
Colorado Tick Fever – A virus carried by the Rocky Mountain wood tick. Symptoms may include acute high fever, chills, severe headaches, fatigue and muscle pain. Treatment usually consists of over-the-counter fever reducers and pain relievers.
Tick-borne Relapsing Fever – Caused by the spirochete bacterium Borrelia hermsi. The main symptom is cycles of high fever. Can be treated with antibiotics.
Q Fever – Caused by the Coxiella burnetii bacterium. In addition to typical Lyme disease symptoms, Q fever symptoms may include a high fever at onset, pneumonia and abnormal liver function. Doxycycline is the preferred treatment.
Mycoplasma – Smaller than bacteria, mycoplasmas invade human cells and disrupt the immune system. Symptoms may include fatigue, musculoskeletal pain and cognitive deficits. Can be treated with antibiotics.
Powassan Virus – A flavi virus that causes tick-borne encephalitis. Symptoms may include fever, convulsions, headaches, nausea and vomiting, stiff neck, sleepiness, breathing distress, disorientation, tremors, lethargy, partial coma and paralysis. Fatal in 10% of cases; others may have permanent damage.
Rocky Mountain Spotted Fever – Caused by the Rickettsia rickettsii bacterium. Symptoms may include high fever, rash, headaches and bleeding problems. Can be treated with antibiotics like doxycycline or tetracycline. When left untreated, 30% of patients die.
Tick Paralysis – Caused by a toxin secreted by some ticks. Results in a progressive paralysis that is reversed when the tick is removed.
Tularemia – Also called rabbit fever. Caused by the Francisella tularensis bacterium. Symptoms may include skin ulcers, swollen and painful lymph glands, inflamed eyes, sore throat, mouth sores, fever, headaches, pneumonia, diarrhea and vomiting. Fluorinated quinolones are the most effective treatment.
Burrascano, J.J. (2008) Advanced Topics in Lyme Disease. (pp. 22-27).
“Co-infections.” LymeDisease.org. Retrieved April 26, 2015.
“Other Tick-Borne Diseases.” Lyme Disease Association, Inc. January 7, 2015.
“Specific Co-Infections.” Canadian Lyme Disease Foundation. Retrieved April 26, 2015.
Last Updated: 8/18/15