Madison Area Lyme Support Group

Background: Borrelia-related diseases (Lyme disease and relapsing fevers) are increasingly prevalent, severe, difficult to diagnose and treat. The high failure rate of tick-borne infection testing undermine treatments‘ strategy and monitoring.
Aims: The goal of this contribution is to bring the focus on the importance to enlarge borreliosis-related testing targets and shed some light on high prevalence of B. miyamotoi presence both in ticks and late stage undiagnosed patients.

Methods: Bacteriophages could become a diagnostic tool based on the principle that if there are phages it is because there are living bacteria. Phelix Charity together with Leicester University microbiology department have recently developed a Borrelia Phage-based PCR test searching for 3 major Borrelia groups (Borrelia burgdorferi sl (including B. burgdorferi ss, B. afzelii, B. garinii, B. spielmanii, etc), Borrelia miyamotoi and Relapsing fever group (B. recurrentis, B. hermsii, etc). This method is efficiently used to assess both human samples and ticks.

Results: Since July 2019, over 2100 results from patients originating various countries have been obtained. Testing included mainly late stage / chronic patients and the aggregated data are showing 30 % negative results and 70% positive among which over 60 % indicated the presence of specific Borrelia miyamotoi phages. Furthermore, ticks from 2019 and 2020 have been analyzed by the same method. The obtained results on ticks showed that over 60% were found positive for Borrelia miyamotoi and only 15% for B. burgdorferi sl.

Conclusion: This is the first large scale report on prevalence of B. miyamotoi in the ticks, as well as in late stages of borreliosis. Seen a high prevalence of B. miyamotoi in tested ticks, further supported by similar percentages found in tested patients, one can hypothesize that the high failure rate of current two-tier screening testing, searching for B. burgdorferi sl only, might be due to the wrong testing target. In other words, the overall high expansion of undiagnosed Lyme disease cases worldwide might be linked to the screening choice focusing only on B. burgdorferi sl and only rarely testing for B. miyamotoi while the later one seems to be much more prevalent. Further accumulation of data both from the patients and ticks should bring the answer to the question are we searching for a wrong culprit. Searching for actual bacterial presence using phage-based testing might pacify the debate and controversies on testing choices and late/chronic stage patients.