Other Tick-Borne Diseases

Complicating the picture is the fact that ticks can carry a number of other parasites that can, when transmitted to a host (a human), cause diseases, that along with Lyme Disease are commonly referred to as co-infections. In the US these diseases include, but are not limited to:

  • Human Granulocytic Anaplasmosis (HGA) – Cause: bacterium Anaplasma phagocytophilum. Symptoms: acute fever, headache, chills, and muscle aches within about 2 weeks of infection – potentially fatal;
  • Babesiosis – Cause: malaria-like protozoa. Symptoms: nearly always dominated by fever but can be asymptomatic;
  • Human Monocytic Ehrlichiosis (HME) – Cause: bacterium Ehrlichia chaffeensis. Symptoms: fever, severe headaches, malaise, muscle pains, and chills, may also include: nausea, vomiting, confusion and joint pain. A rash may appear in some HME cases but unlike Lyme disease, this rash is general in nature and is not associated with the site of the tick bite – potentially fatal depending on patient’s age and general health;
  • Tick-borne Relapsing Fever – Cause: bacterial spirochetes Borellia hermsii, Borellia parkerii, or Borellia turicatae. Symptoms: recurring episodes of fever accompanied by other non-specific symptoms including headaches, muscle pain, joint pain, chills, vomiting, and abdominal pain.

Ticks in certain regions, including in nations along the eastern Baltic Sea, can also transmit tick-borne encephalitis (Lindgren et al., 2001).

Co-infections complicate Lyme Disease symptoms especially for diagnosis and treatment, as they often have similar symptomology. It is also possible for a tick to transmit one of the co-infections and not B. burgdorferi, thus further complicating diagnosis.

Despite some misleading information available to the contrary Lyme Disease is not always accompanied by co-infections. Among early Lyme disease patients, depending on their location in the US, 2–12% will also have HGA and 2–40% will have babesiosis (Wormser, 2006). There is little evidence for simultaneous Lyme-Bartonella infection (Lantos and Wormser, 2014).

Treatment for several of these co-infections is often a course of antibiotics (except for babesiosis) the same as or similar as prescribed for Lyme Disease (Wormser et al., 2006Bratton and Corey, 2005, Gayle and Ringdahl, 2001).

The most common tick-borne bacteria in Australia is Rickettsia. It can be transmitted by a a tick, flea or mite bite. Rickettsiae (and their associated diseases) of particular importance in Australia are R. australis (Queensland tick typhus, Spotted fever), R. tsutsugamushi (Scrub typhus), R. honei (Flinders Island spotted fever) and R. typhi (murine typhus).

Treatment is usually with the tetracycline antibiotic doxycycline which reduces the duration and severity of infection.

Despite the name, Rickettsia bacteria do not cause rickets, which is the result of a Vitamin D deficiency. Rather, they are named after Howard Taylor Ricketts.

A systematic review of the scientific literature showed no evidence to support the evidence of chronic atypical tick-borne co-infections in patients diagnosed with chronic Lyme Disease (Lantos and Wormser, 2014).

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Websites And Links

Centers for Disease Control and Prevention (CDC) page on Lyme Disease

American Lyme Disease Foundation

Infectious Diseases Society of America

University of Sydney’s Tick Borne Diseases Unit

US National Institute of Health

US National Institute of Allergy and Infectious Diseases (Lyme Disease Page)

Books

Institute of Medicine (US) Committee on Lyme Disease and Other Tick-Borne Diseases: The State of the Science. Critical Needs and Gaps in Understanding Prevention, Amelioration, and Resolution of Lyme and Other Tick-Borne Diseases: The Short-Term and Long-Term Outcomes: Workshop Report. Washington (DC): National Academies Press (US); 2011. Available from: http://www.ncbi.nlm.nih.gov/books/NBK57020/

Lyme Disease: the Great Controversy Halperin, J.J., Baker, P., and Wormser, G.P. In, “Lyme Disease: An Evidence-based Approach”(American Lyme Disease Foundation) (Link to Chapter 17 pdf)

Wang, G. (2015). Chapter 104 – Borrelia burgdorferi and other Borrelia species, Molecular Medical Microbiology (Second Edition), Pages 1867–1909, Elsevier Ltd.

Radolf, J. D., et al. (2010). Lyme disease in humans, Caister Academic Press.

Journal Articles

Halperin, J. J. “Nervous system Lyme disease, chronic Lyme disease, and none of the above.” Acta Neurol Belg, 2016, 116(1): 1-6.

Lantos, P. M. “Chronic Lyme disease.” Infect Dis Clin North Am, 2015, 29(2): 325-340.

Aucott, J. N. “Posttreatment Lyme disease syndrome.” Infect Dis Clin North Am, 2015, 29(2): 309-323.

Mayne, P. J. “Clinical determinants of Lyme borreliosis, babesiosis, bartonellosis, anaplasmosis, and ehrlichiosis in an Australian cohort.” Int J Gen Med, 2015, 8: 15-26.

Gofton, A. W., et al. “Inhibition of the endosymbiont “Candidatus Midichloria mitochondrii” during 16S rRNA gene profiling reveals potential pathogens in Ixodes ticks from Australia.” Parasit Vectors, 2015, 8: 345.

Gofton, A. W., et al. “Bacterial profiling reveals novel “Ca. Neoehrlichia”, Ehrlichia, and Anaplasma species in Australian human-biting ticks.” PLoS One, 2015, 10(12): e0145449/0145441-e0145449/0145416.

Patrick, D. M., et al. “Lyme Disease Diagnosed by Alternative Methods: A Phenotype Similar to That of Chronic Fatigue Syndrome.” Clin Infect Dis, 2015.

Ostfeld, R. S. and J. L. Brunner. “Climate change and Ixodes tick-borne diseases of humans.” Philos Trans R Soc Lond B Biol Sci, 2015, 370(1665).

Aguero-Rosenfeld, M. E. and G. P. Wormser. “Lyme disease: diagnostic issues and controversies.” Expert Rev. Mol. Diagn., 2015, 15(1): 1-4.

Halperin, J. J. “Chronic Lyme disease: misconceptions and challenges for patient management.” Infect Drug Resist, 2015, 8: 119-128.

Borchers, A. T., et al. “Lyme disease: a rigorous review of diagnostic criteria and treatment.” J Autoimmun, 2015, 57: 82-115.

Mayne, P., et al. “Evidence for Ixodes holocyclus (Acarina: Ixodidae) as a Vector for Human Lyme Borreliosis Infection in Australia.” J Insect Sci, 2014, 14(1).

Lantos, P. M. and G. P. Wormser. “Chronic coinfections in patients diagnosed with chronic lyme disease: a systematic review.” Am J Med, 2014, 127(11): 1105-1110.

DeBiasi, R. L. “A concise critical analysis of serologic testing for the diagnosis of lyme disease.” Curr Infect Dis Rep, 2014, 16(12): 450.

Brissette, C. A. and R. A. Gaultney. “That’s my story, and I’m sticking to it–an update on B. burgdorferi adhesins.” Front Cell Infect Microbiol, 2014, 4: 41.

Groshong, A. M. and J. S. Blevins. “Insights into the biology of Borrelia burgdorferi gained through the application of molecular genetics.” Adv. Appl. Microbiol., 2014, 86: 41-143.

Lantos, P. M., et al. “A systematic review of Borrelia burgdorferi morphologic variants does not support a role in chronic Lyme disease.” Clin Infect Dis, 2014, 58(5): 663-671.

Pavia, C. S. and G. P. Wormser. “Culture of the entire mouse to determine whether cultivable Borrelia burgdorferi persists in infected mice treated with a five-day course of ceftriaxone.” Antimicrob. Agents Chemother., 2014, 58(11): 6701-6703, 6704 pp.

O’Day, D. H. and A. Catalano. “A lack of correlation between the incidence of lyme disease and deaths due to Alzheimer’s disease.” J Alzheimers Dis, 2014, 42(1): 115-118.

Strle, K., et al. “Elevated Levels of IL-23 in a Subset of Patients With Post-Lyme Disease Symptoms Following Erythema Migrans.” Clin. Infect. Dis., 2014, 58(3): 372-380.

Halperin, J. J., et al. “Common misconceptions about Lyme disease.” Am J Med, 2013, 126(3): 264.e261-267.

Klempner, M. S., et al. “Treatment trials for post-Lyme disease symptoms revisited.” Am J Med, 2013, 126(8): 665-669.

Kobayashi, Y., et al. “A novel macrolide solithromycin exerts superior anti-inflammatory effect via NF-κB inhibition.” J Pharmacol Exp Ther, 2013, 345(1): 76-84.

Ajamian, M., et al. “Serologic markers of lyme disease in children with autism.” JAMA, J. Am. Med. Assoc., 2013, 309(17): 1771-1772.

Burbelo, P. D., et al. “Lack of serum antibodies against Borrelia burgdorferi in children with autism.” Clin. Vaccine Immunol., 2013, 20(7): 1092-1093.

Krut, J. J., et al. “Cerebrospinal fluid Alzheimer’s biomarker profiles in CNS infections.” J. Neurol., 2013, 260(2): 620-626.

Barbour, A. “Remains of infection.J. Clin. Invest., 2012, 122(7): 2344-2346.

Bockenstedt, L. K., et al. “Spirochete antigens persist near cartilage after murine Lyme borreliosis therapy.J. Clin. Invest., 2012, 122(7): 2652-2660.

Embers, M. E., et al. “Persistence of Borrelia burgdorferi in rhesus macaques following antibiotic treatment of disseminated infection.PLoS One, 2012, 7(1): e29914.

Huyshe-Shires, S. “Lyme disease antiscience.” Lancet Infect Dis, 2012, 12(5): 361; author reply 362-363.

Perronne, C. “Lyme disease antiscience.” Lancet Infect Dis, 2012, 12(5): 361-362; author reply 362-363.

Tuttle, C. “Lyme disease antiscience.” Lancet Infect Dis, 2012, 12(5): 362; author reply 362-363.

Auwaerter, P. G., et al. “Lyme disease antiscience – Authors’ reply.” Lancet Infect Dis, 2012, 12(5): 362-363.

Bastos, L. F. S., et al. “Tetracyclines and pain.” Naunyn-Schmiedeberg’s Arch. Pharmacol., 2012, 385(3): 225-241.

Auwaerter, P. G., et al. “Antiscience and ethical concerns associated with advocacy of Lyme disease.” Lancet Infect Dis, 2011, 11(9): 713-719.

Chandra, A., et al. “Anti-Borrelia burgdorferi antibody profile in post-Lyme disease syndrome.” Clin. Vaccine Immunol., 2011, 18(5): 767-771.

Stricker, R. B. and L. Johnson. ““Lyme literacy” and physicians in Connecticut.” J Pediatr, 2011, 158(3): 518-519; author reply 519-520.

Lantos, P. M. “Chronic Lyme disease: the controversies and the science.” Expert Rev Anti Infect Ther, 2011, 9(7): 787-797.

Halperin, J. J. “Nervous system lyme disease: is there a controversy?” Semin Neurol, 2011, 31(3): 317-324.

Schutzer, S. E., et al. “Distinct cerebrospinal fluid proteomes differentiate Post-Treatment Lyme disease from Chronic Fatigue syndrome.” PLoS One, 2011, 6(2): e17287.

Kanjwal, K., et al. “Postural orthostatic tachycardia syndrome following Lyme disease.” Cardiol J, 2011, 18(1): 63-66.

Johnson, M. and H. M. Feder, Jr. “Chronic Lyme disease: a survey of Connecticut primary care physicians.” J Pediatr, 2010, 157(6): 1025-1029.e1021-1022.

Holzbauer, S. M., et al. “Death due to community-associated Clostridium difficile in a woman receiving prolonged antibiotic therapy for suspected lyme disease.” Clin Infect Dis, 2010, 51(3): 369-370.

Feder, H. M., Jr. “Reply.” J Pediatr, 2010, 158(3): 519-520.

Berende, A., et al. “Activation of innate host defense mechanisms by Borrelia.” Eur. Cytokine Network, 2010, 21(1): 7-18.

Nau, R., et al. “Lyme disease–current state of knowledge.” Dtsch Arztebl Int, 2009, 106(5): 72-81.

Wormser, G. P. and E. D. Shapiro. “Implications of gender in chronic Lyme disease.” J Womens Health (Larchmt), 2009, 18(6): 831-834.

Wahlberg, P. and D. Nyman. “Chronic Lyme borreliosis–fact or fiction?” Duodecim, 2009, 125(12): 1269-1276.

Qureshi, M., et al. “Lyme disease serology in amyotrophic lateral sclerosis.” Muscle Nerve, 2009, 40(4): 626-628.

ALSUntangled update 1: investigating a bug (Lyme Disease) and a drug (Iplex) on behalf of people with ALS.” Amyotrophic Lateral Sclerosis, 2009, 10: 248-250.

Allan, E. J., et al. “Bacterial L-forms.” Adv. Appl. Microbiol., 2009, 68: 1-39.

Wormser, G. P. and I. Schwartz. “Antibiotic treatment of animals infected with Borrelia burgdorferi.” Clin. Microbiol. Rev., 2009, 22(3): 387-395.

Wormser, G. P., et al. “Impact of clinical variables on Borrelia burgdorferi-specific antibody seropositivity in acute-phase sera from patients in North America with culture-confirmed early lyme disease.” Clin. Vaccine Immunol., 2008, 15(10): 1519-1522.

Marques, A. “Chronic Lyme disease: a review.” Infect Dis Clin North Am, 2008, 22(2): 341-360, vii-viii.

Dandache, P. and R. B. Nadelman. “Erythema migrans.” Infect Dis Clin North Am, 2008, 22(2): 235-260, vi.

Steere, A. C., et al. “Prospective study of serologic tests for lyme disease.” Clin Infect Dis, 2008, 47(2): 188-195.

Fallon, B. A., et al. “A randomized, placebo-controlled trial of repeated IV antibiotic therapy for Lyme encephalopathy.” Neurology, 2008, 70(13, Pt. 1): 992-1003.

Hodzic, E., et al. “Persistence of Borrelia burgdorferi following antibiotic treatment in mice.” Antimicrob. Agents Chemother., 2008, 52(5): 1728-1736.

Wilske, B., et al. “Microbiological and serological diagnosis of Lyme borreliosis.” FEMS Immunol. Med. Microbiol., 2007, 49(1): 13-21.

Feder, H. M., Jr., et al. “A critical appraisal of “chronic Lyme disease”.” N. Engl. J. Med., 2007, 357(14): 1422-1430.

Auwaerter, P. G. “Point: antibiotic therapy is not the answer for patients with persisting symptoms attributable to lyme disease.” Clin. Infect. Dis., 2007, 45(2): 143-148.

Stricker, R. B. “Counterpoint: long-term antibiotic therapy improves persistent symptoms associated with lyme disease.” Clin. Infect. Dis., 2007, 45(2): 149-157.

Wormser, G. P. “Clinical practice. Early Lyme disease.” N Engl J Med, 2006, 354(26): 2794-2801.

Wormser, G. P., et al. “The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America.” Clin Infect Dis, 2006, 43(9): 1089-1134.

Steere, A. C. and S. M. Angelis. “Therapy for Lyme arthritis.” Arthritis Rheum., 2006, 54(10): 3079-3086.

Ivetic Tkalcevic, V., et al. “Anti-inflammatory activity of azithromycin attenuates the effects of lipopolysaccharide administration in mice.” Eur. J. Pharmacol., 2006, 539(1-2): 131-138.

Aguero-Rosenfeld, M. E., et al. “Diagnosis of Lyme borreliosis.” Clin. Microbiol. Rev., 2005, 18(3): 484-509.

Bratton, R. L. and R. Corey. “Tick-borne disease.” Am Fam Physician, 2005, 71(12): 2323-2330.

Rothstein, J. D., et al. “β-Lactam antibiotics offer neuroprotection by increasing glutamate transporter expression.” Nature, 2005, 433(7021): 73-77.

Sanz, M.-J., et al. “Erythromycin exerts in vivo anti-inflammatory activity downregulating cell adhesion molecule expression.” Br J Pharmacol, 2005, 144(2): 190-201.

Cameron, D., et al. “Evidence-based guidelines for the management of Lyme disease.” Expert Rev Anti Infect Ther, 2004, 2(1 Suppl): S1-13.

Steere, A. C., et al. “The emergence of Lyme disease.” J. Clin. Invest., 2004, 113(8): 1093-1101.

Auwaerter, P. G., et al. “Lyme borreliosis (Lyme disease): molecular and cellular pathobiology and prospects for prevention, diagnosis and treatment.” Expert Rev Mol Med, 2004, 6(2): 1-22.

Domercq, M. and C. Matute. “Neuroprotection by tetracyclines.” Trends Pharmacol. Sci., 2004, 25(12): 609-612.

Tamaoki, J., et al. “Clinical implications of the immunomodulatory effects of macrolides.” Am. J. Med., 2004, 117(Suppl. 9A): 5S-11S.

Brownstein, J. S., et al. “A climate-based model predicts the spatial distribution of the Lyme disease vector Ixodes scapularis in the United States.” Environ Health Perspect, 2003, 111(9): 1152-1157

Krupp, L. B., et al. “Study and treatment of post Lyme disease (STOP-LD): a randomized double masked clinical trial.” Neurology, 2003, 60(12): 1923-1930.

Kaplan, R. F., et al. “Cognitive function in post-treatment Lyme disease. Do additional antibiotics help?” Neurology, 2003, 60(12): 1916-1922.

Sood, S. K. “Effective retrieval of Lyme disease information on the Web.” Clin Infect Dis, 2002, 35(4): 451-464.

Donta, S. T. “Late and chronic Lyme disease.” Med Clin North Am, 2002, 86(2): 341-349, vii.

Collignon, P. J. “11 Antibiotic resistance.” Med J Aust, 2002, 177(6): 325-329.

Alexopoulou, L., et al. “Hyporesponsiveness to vaccination with Borrelia burgdorferi OspA in humans and in TLR1- and TLR2-deficient mice.” Nat. Med., 2002, 8(8): 878-884.

Bockenstedt, L. K., et al. “Detection of attenuated, noninfectious spirochetes in Borrelia burgdorferi-infected mice after antibiotic treatment.” J Infect Dis, 2002, 186(10): 1430-1437.

Klempner, M. S., et al. “Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease.” N. Engl. J. Med., 2001, 345(2): 85-92.

Wooten, R. M. and J. J. Weis. “Host-pathogen interactions promoting inflammatory Lyme arthritis: Use of mouse models for dissection of disease processes.” Curr. Opin. Microbiol., 2001, 4(3): 274-279.

Steere, A. C. “Lyme disease.” N Engl J Med, 2001, 345(2): 115-125.

Lindgren, E. and R. Gustafson. “Tick-borne encephalitis in Sweden and climate change.” The Lancet, 2001, 358(9275): 16-18.

Gayle, A. and E. Ringdahl. “Tick-borne diseases.” Am Fam Physician, 2001, 64(3): 461-466.

Patel, R., et al. “Death from Inappropriate Therapy for Lyme Disease.” Clin. Infect. Dis., 2000, 31(4): 1107-1109.

Ozinsky, A., et al. “The repertoire for pattern recognition of pathogens by the innate immune system is defined by cooperation between toll-like receptors.” Proc Natl Acad Sci U S A, 2000, 97(25): 13766-13771.

Marques, A. R., et al. “Lack of evidence of Borrelia involvement in Alzheimer’s disease.” J Infect Dis, 2000, 182(3): 1006-1007.

Hirschfeld, M., et al. “Cutting edge: Inflammatory signaling by Borrelia burgdorferi lipoproteins is mediated by toll-like receptor 2.” J. Immunol., 1999, 163(5): 2382-2386.

Lien, E., et al. “Toll-like receptor 2 functions as a pattern recognition receptor for diverse bacterial products.” J. Biol. Chem., 1999, 274(47): 33419-33425.

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