CO-INFECTIONS

While Lyme disease is the most common tick-borne disease, there are several other diseases that can be transmitted during the bite of an infected tick. Not all ticks are infected, and not all ticks have or transmit all co-infections equally. Co-infections can result is a more severe acute illness. When one is aggressively treated for Lyme, and is not able to achieve a resolution of symptoms, you should be highly suspicious of a co-infection.

There are several virus’ and other infections known to be carried in some ticks, but for our limited purposes we will present a few of the most common ones. The symptoms can often over lap those of Lyme, but the treatments may be very different, thus one must have a high level of suspicion.

Anaplasma
Anaplasmosis, is caused by the bacteria Anaplasma phagocytophilium, and it infects the white blood cells. Symptoms include sudden onset of high fever, sweats, headache, nausea, malaise, and body aches which can be mild or severe. A low white blood count, and elevated liver enzymes can be seen.
Treatment includes the use of doxycyline, which is often used in early Lyme disease.
Anaplasmosis is an emerging disease in Maine as more cases are being found farther north than in previous years, according to the Maine CDC Legislative Report 2011. In the Maine CDC Legislative Report 2012 there were 26 reported cases of Anaplasmosis in Maine in 2011.The 2017 Legislative Report states that the preliminary data shows that there were 373 cases for the 2016 year. That is a 100% increase in cases from the previous year.  That is a very large jump in numbers and should be alarming with increases at this rate.

Babesiosis
Babesia is a piroplasm, or protozoan. Babesia microti was originally thought to be the only culprit of this disease, but we now know there are many more forms of piroplasms that can infect humans, and we have no tests for most of them. As with Lyme, Babesia may need to be clinically diagnosed. The symptoms of Babesia include extreme fatigue, air hunger, aches, fever, chills, sweats (particularly at night), and possibly anemia (affecting the red blood cells). Sub-clinical infections are often missed and Babesia can recur after what is thought to be successful treatment. Babesia does pose a threat to the blood supply and has been reportedly transmitted during transfusion. Babesia is often treated with Azithromycin and Atovaquone, as well as some other antibiotic combinations. Babesia is a nationally notifiable disease as of January 1, 2011. In the 2017 Legislative Report, it is reported that the count is 83 cases for 2016.

Ehrlichiosis
Erhlichiosis is caused by the bacteria Ehrlichia chaffeensis which infects the white blood cells, or monocytes. Symptoms include fever, headache, nausea, and body aches. Ehrlichiosis is transmitted by the bite of an infected lone star tick, which is now appearing in Maine. Treatment of choice for Ehrlichia, like Anaplasma, is doxycycline. The Maine CDC Legislative Report 2012 indicated there was 1 case in Maine in 2011. The 2017 Legislative Report states there were 6 cases of Ehrlichiosis, down from 8 cases in 2014.

Powassan
Powassan is a virus that is transmitted through the bite of an infected tick. Symptoms include fever, vomiting, headache, weakness, confusion, seizures, and memory loss. There is no treatment for Powassan, The 2014 Legislative Lyme Report states that there was one confirmed case in Knox county in 2013. That person died within weeks of the infection. There was 1 case of Powassan in Maine for 2016, according to the CDC 2017 Legislative Lyme Report.

Bartonella
Bartonella is appearing more commonly in Lyme patients. It is found in ticks, and found in people who have been bitten by a tick, but the transmission has yet to be demonstrated. Bartonella is proving to be a more complex and common illness than previously thought. Because some Bartonella type illnesses don’t test positive with the usual tests, some physicians refer to this complex of symptoms as “BLO” or Bartonella like organisms. The symptoms of Bartonella include neuro-psychiatric symptoms such as increased CNS agitation, anxiety, insomnia, seizures, cognitive defects, and confusion. Other symptoms can include gastritis, lower abdominal pain, sore soles in the a.m., tender subcutaneous nodules in the limbs, red rashes, depression, bi-polar like symptoms, and headaches. Lymph nodes may be swollen and the throat sore. Bartonella is not yet a reportable disease.

Rocky Mountain Spotted Fever
RMSF is a rickettsial disease transmitted through the bite of an infected dog tick. Symptoms include fever, chills, headache, gastrointestinal symptoms and a rash, often on the palms and soles of the feet. RMSF has not been endemic to Maine, though the January 2011 Legislative reports showed 2 probable cases in Maine, and the 2012 report shows 1 case. In the 2013 Legislative Report, 3 probable cases are noted. Like other tick-borne co-infections, RMSF is an emerging disease in Maine. In the 2017 Lyme Legislative Report, there were 3 cases of RMSF reported for 2016.

Borrelia Miyamotoi and Other Emerging Pathogens
Borrelia Miyamotoi is a newly reported spirochetal disease that resembles a relapsing fever. Researchers are trying to determine how to test and treat bM. It is carried in and transmitted by the same ticks that transmit Lyme disease. Borrelia Miyomotoi can be transmitted via tick bite in a much shorter time than Borellia Burgdorferi is transmitted. One must use the same vigilant precautions against tick bite that you use for other tick borne diseases. There is no rash associated with Miyamotoi. There were 2 cases identified in Maine in 2016. Miyamotoi requires its’ own special test and will not react to the Lyme disease test.

There have recently been several other tick borne pathogens discovered and reported from around the country. Those include Borrelia Mayonii, Heartland virus and Bourbon virus. Maine has no documented cases of these diseases, but does have serological evidence of Miyamotoi and Heartland virus from either animals or humans. These are definitately disease to watch for!