[Online ahead of print]

Assessment of Anaplasma Phagocytophilum Presence in Early Lyme Borreliosis Manifested by Erythema Migrans Skin Lesions


Background: To investigate to what extent early Lyme borreliosis patients with erythema migrans are infected with Anaplasma phagocytophilum.

Methods: 310 patients from Poland with erythema migrans were included in the study. One hundred and eighty-three patients (59%) agreed to have both skin biopsy and blood samples analysed for Borrelia burgdorferi, A. phagocytophilum and ‘Candidatus Neoehrlichia mikurensis’, with PCR. Positive samples were confirmed with sequencing.


  • B. burgdorferi DNA was detected in 49.7% of the skin samples 
  • B. b was detected in 1.1% of the blood samples
  • A. phagocytophilum DNA was found in 7.1% blood samples
  • A. phagocytophilium was found 8.2% of the skin biopsies
  • in four patients, A. phagocytophilum DNA was detected only in blood
  • in one case A. phagocytophilum DNA was found simultaneously in blood and skin and additionally in this patients’ blood Borrelia DNA was detected.
  • in four skin samples B. burgdorferi DNA was detected simultaneously with A. phagocytophilum DNA, indicative of a co-infection.

Conclusions: A. phagocytophilum may be present in early Lyme borreliosis characterized by erythema migrans and should always be considered as a differential diagnostic following a tick bite and considered in treatment schemes, as these differs (in early stage of Lyme borreliosis doxycycline, amoxicillin, cefuroxime axetil and azithromycin are recommended, while in anaplasmosis the most effective courses of treatment are doxycycline, rifampin and levofloxacin). Consequently, the role of A. phagocytophilum in erythema migrans should be further studied.



Please note that only 1% of patients had Bb in the blood – yet blood tests are precisely what our renowned CDC uses as the determination of infection.  Having the EM rash is clinical PROOF you have Lyme disease.  Period.  No testing required. End of discussion. Unfortunately, many never have the rash:

Also note that one again the EM rash IS required criteria for the study as well as being an early Lyme patient.

There’s oodles and oodles of research on this patient group. What we desperately need is for researchers to wake up and do work on those who don’t get the rash and are left to smolder for months and years before being diagnosed.

As to the rash, anywhere from 25%-80% get it despite the CDC stating 80% get it: and 1976circularletterpdf (first ever patient group – only 25% had the rash)


For more: