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In recent years, investigators have gained an increasing appreciation of the complexity of the
Lyme disease transmission cycle with regard to the number of pathogens involved. Babesia microti, a blood parasite that is related to the organism that causes malaria, frequently accompanies the
Lyme disease spirochete in the mouse reservoir. Recently, a newly described Ehrlichia species related to Ehrlichia equi has been found to be transmitted by the deer tick. Human infections with these agents alone and in combination are now being described, and the successful treatment of these infections may depend on proper diagnosis. The convergence of these and other organisms on the
Lyme disease transmission cycle provides a unique opportunity to study pathogen-pathogen interactions in a naturally occurring model.