Published online 2020 May 30. doi: 10.1186/s12941-020-00364-0
PMCID: PMC7260789
PMID: 32473652

Presence of Borrelia miyamotoi infection in a highly endemic area of Lyme disease


A series of cases in the Northeast of the US during 2013–2015 described a new Borrelia species, Borrelia miyamotoi, which is transmitted by the same tick species that transmits Lyme disease and causes a relapsing fever-like illness. The geographic expansion of B. miyamotoi in the US also extends to other Lyme endemic areas such as the Midwestern US. Co-infections with other tick borne diseases (TBD) may contribute to the severity of the disease. On Long Island, NY, 3–5% of ticks are infected by B. miyamotoi, but little is known about the frequency of B. miyamotoi infections in humans in this particular region. The aim of this study was to perform a chart review in all patients diagnosed with B. miyamotoi infection in Stony Brook Medicine (SBM) system to describe the clinical and epidemiological features of B. miyamotoi infection in Suffolk County, NY. In a 5 year time period (2013–2017), a total of 28 cases were positive for either IgG EIA (n = 19) or PCR (n = 9).

All 9 PCR-positive cases (median age: 67; range: 22–90 years) had clinical findings suggestive of acute or relapsing infection.

All these patients were thought to have a TBD, prompting the healthcare provider to order the TBD panel which includes a B. miyamotoi PCR test.

In conclusion, B. miyamotoi infection should be considered in the differential diagnosis for flu-like syndromes during the summer after a deer tick bite and to prevent labeling a case with Lyme disease.



Dr. Cameron states:  “Until now, there have been no treatment guidelines for B. miyamotoi and regimes have been empirically based on the treatment for Lyme disease. ‘The antimicrobial susceptibility of B. miyamotoi has not yet been elucidated, due to difficulties with cultivation of B. miyamotoi spirochetes in vitro,’ according to Koetsveld.  The study authors demonstrated that B. miyamotoi is susceptible to doxycycline, azithromycin, and ceftriaxone but resistant to amoxicillin in vitro. The next step would be to show whether these drugs work in patients.”

For more:
You might assume a patient infected with Borrelia miyamotoi, a relapsing fever spirochete, to present with a relapsing fever. However, your assumption would be wrong 48 out of 50 times, according to a case series published in the Annals of Internal Medicine. [1] The authors found that only 2 out of 50 patients infected with the relapsing spirochete B. miyamotoi actually presented with a relapsing fever. [1]….The individuals exhibited symptoms similar to those found in other tick-borne illnesses.
The majority presented with headaches, myalgias, arthralgias, and malaise/fatigue. ‘More than 50% were suspected of having sepsis, and 24% required hospitalization,’ states Molloy. [1]…..’Serologic testing using the rGlpQ EIA seems insensitive in diagnosing acute BMD infection given that it was positive for IgG or IgM in only 16% of the case patient samples at the time of clinical presentation,’ states Molloy. The rGlpQ was positive after the fact in 86% of the patients during convalescence. [1]….Elevated liver enzyme levels, neutropenia, and thrombocytopenia were common in 75%, 60% and 51% respectively.
‘Borrelia miyamotoi disease may be clinically similar to or be confused with human anaplasmosis,’ according to Molloy….B. miyamotoi has emerged as a leading cause of hard tick-transmitted infections but lacks a clear diagnostic criteria. According to Molloy, “Infection with B. miyamotoi is the fifth recognized Ixodes-transmitted infection in the northeastern United States and should be part of the differential diagnosis of febrile patientsfrom areas where deer tick–transmitted infections are endemic.’”
%d bloggers like this: