Experts have known about the existence of Lyme co-infections for a long time now. Unfortunately, many patients and frontline doctors do not. This severely compounds their ability to treat Lyme patients, especially when Lyme itself is considered something of a grey area in mainstream medicine. In 2019, Lyme disease stands at an awkward crossroads. Nobody is debating that it exists; the data on it is simply too overwhelming. The subject of contention is related to the different phases of the disease. The acute phase is accepted, while the chronic phase remains unacknowledged by much of the medical community. Regrettably for patients, the chronic stage is easily the most debilitating, and the most difficult to treat. The issue of co-infections regularly gets lost among the primary debate, but to tackle the main disease effectively, you must also address this significant element of overall Lyme.
Co-infections are spread simultaneously with Lyme disease, through the same tick bite. Some are less serious than others, but all of them will debilitate the Lyme patient further, and potentially reignite Lyme symptoms during treatment. Some can even be fatal in the long term. Co-infections are caused by bacteria that the tick transfers when feeding on the host. The blood then carries the bacteria through the body, where it’s given a chance to propagate. One of the newest co-infection bacteria on Lyme experts’ radar is B. miyamotoi. So what is B. miyamotoi exactly? And is there a connection between B. miyamotoi and Lyme disease?
There is one obvious connection that’s immediately apparent. The ‘B’ in B. miyamotoi stands for Borrelia, which is the same designation as the Lyme bacteria Borrelia burgdorferi. However, it’s best to think of B. miyamotoi as a distant relative of the latter; it doesn’t cause Lyme disease, and instead is a member of the relapsing fever group of Borrelia. Lyme disease has been known and named since 1975, but the first documented human case of B. miyamotoi infection was not discovered until 2013. It has been detected in two types of North American tick: the Western black-legged tick and the primary Lyme carrier, the black-legged or deer tick. These ticks have previously been identified as carriers of prominent Lyme co-infections anaplasmosis and babesiosis, making B. miyamotoi infection a potentially dangerous and important addition.
So what are the symptoms of B. miyamotoi infection? Well, like many Lyme co-infections and even Lyme itself, the first symptoms are generalized and non-specific. The bacteria functions like any other bacteria – the immune system senses an intruder and responds accordingly. The resultant symptoms are usually a fever, chills, aches, and headache. Body and joint pain are also common, as well as fatigue. Crucially, a rash is rare with a B. miyamotoi infection. With Lyme disease, one of the main signifiers to look out for is a bullseye rash at the site of the bite, which clearly indicates the presence of a disease. The lack of a rash is a helpful distinctive tool when assessing Lyme disease and B. miyamotoi.
It’s hard to gauge the number of B. miyamotoi infections that America experiences on a yearly basis, just as it is hard to assess Lyme cases. It is very roughly estimated to be a tenth of Lyme incidences; if the latter stands at 300,000 new cases per year, then B. miyamotoi cases can be pegged at 30,000. However, many B. miyamotoi infections may be asymptomatic, self-resolving, or blended unrecognizably into Lyme and its other co-infections. Therefore, the true number is hard to gauge. Blood tests (known as ELISpot tests) can confirm whether a patient is suffering from B. miyamotoi infection, but too often these return false negatives, especially when considered with the rest of the potential infections that can be transferred via tick bite.
Infectolab Americas and BCA-clinic in Germany are Lyme disease specialists. They recognized the failings of the traditional ELISpot blood test and supported the development of a new ELISpot, designed to take in the specific considerations of chronic Lyme and its co-infections. Chronic Lyme symptoms are produced via a delicate interplay of infection and inflammation. The traditional ELISpot only tests for infection; therefore, if the infection is somewhat dormant but inflammation (produced by a malfunctioning immune system) is prominent, chronic Lyme can easily be misdiagnosed or falsely cleared.
By testing for the presence of T-cells, the new ELISpot test is much better equipped to provide a clearer picture for doctors. T-cells come in two forms: ‘attack’ and ‘memory’. The attack cells are utilized when an infection is first discovered by the immune system, and they will be dispatched to eradicate as quickly and effectively as possible. Memory cells are formed after the infection has been dealt with, and act as a safeguard in the event of recurrent infection or relapse. By testing specifically for these cells, the new ELISpot can not only tell what bacteria is in a patient’s system, but also what stage of the disease they might be at. The new ELISpot also extends to Lyme co-infections, including B. miyamotoi.
One good aspect of B. miyamotoi is that it doesn’t appear to be too serious, and is easily treated with a round of antibiotics. These antibiotics are the same course that traditionally treat Lyme in its acute stage, which is the optimum time to treat. However, like any co-infection, if left untreated, the severity of the condition could worsen critically, especially if other bacteria are at play. The best strategy for dealing with any tick-borne disease is knowledge of both contraction methods and symptoms. Like many other conditions and disorders, catching them early gives the patient the best chance of successful recovery. B. miyamotoi, although new on the Lyme scene, is no exception.