Archive for the ‘Testing’ Category

California’s First CDC-Confirmed Case of Borrelia Miyamotoi

California’s first CDC-confirmed case of Borrelia miyamotoi

By Lonnie Marcum

May 4, 2023

A recent case reminds us that Lyme disease isn’t the only tick-borne disease we need to worry about.

Last year, the CDC confirmed California’s first known case of Borrelia miyamotoi—a tick-borne pathogen that causes a relapsing-fever illness in humans.

This discovery highlights the need for increased awareness and surveillance of emerging tick-borne illnesses across the United States.

In this case, a man from Marin County, California, sought care at a neurology clinic in San Francisco. His symptoms included recurring fever, night sweats, mild vision changes and nausea. The fevers typically lasted one day and would recur every 10-14 days. At the time, he was also undergoing monoclonal antibody therapy for multiple sclerosis.

His standard blood work was negative for fungi, Lyme disease, brucellosis and leptospirosis. Chest x-rays and abdominal CT scans were negative as well.

The only notable blood findings were a positive antigen for Epstein-Barr virus, a low platelet count (thrombocytopenia), an elevated C-reactive protein (an inflammatory marker), and an elevated procalcitonin—a biomarker that is released in response to bacterial infections.

Specialty lab testing

Considering the patient’s immunocompromised status and continued relapsing fevers, his blood was sent to a specialty lab for next-generation DNA sequencing. The specialty lab, Karius,  says it can identify over 1000 clinically relevant pathogens including bacteria, DNA viruses, fungi, and parasites from a single blood sample.

The DNA test results came back positive for Borrelia miyamotoi and were sent to the CDC for confirmation. The CDC confirmed the patient’s blood was positive for Borrelia miyamotoi and 100% identical to an isolate that had been previously collected from an Ixodes pacificus tick in Marin County. This indicates the patient acquired the infection in California.

Borrelia miyamotoi, first identified in Japan in 1995, is considered an emerging infectious disease in Asia, Europe and the United States.

A recent study found widespread evidence of Borrelia miyamotoi in human blood samples of people living in the northeastern United States. An earlier study found evidence of tick-borne relapsing fever (TBRF) Borrelia, including Borrelia miyamotoi in the blood of 26 out of 101 samples of residents of Mendocino County, California in the 1980s.

Another study found multiple species of relapsing fever Borrelia in blood samples drawn from patients in 16 out of 24 California counties. And a 13-year-long study found Borrelia miyamotoi in ticks found in 24 out of 48 counties in California (see map below).

Borrelia miyamotoi is transmitted to humans through the bite of infected blacklegged ticks. These are the same  hardbodied ticks (Ixodes scapularis, Ixodes pacificus) that transmit Lyme disease to humans and animals. Other types of North American tick-borne relapsing fever Borrelia (B. hermsii, B. turicatae, B. parkeri), are transmitted by soft-bodied ticks.

The symptoms of Borrelia miyamotoi disease are similar to those of other tick-borne illnesses, such as Lyme disease. But standard Lyme tests will be negative, making the diagnosis challenging.


According to the CDC, the main symptoms of TBRF are high fever, headache, muscle and joint pain. Fewer than 1 in 10 patients will develop a rash. Left untreated, the symptoms typically repeat, producing a telltale pattern of relapsing fever lasting 1-3 days, followed by 7-10 days without a fever, followed by another 1-3 days of fever.

The CDC website says: “Confirmation of a diagnosis relies on 1) the use of polymerase chain reaction (PCR) tests that detect DNA from the organism or 2) antibody-based tests. Both types of tests are under development and not widely commercially available but can be ordered from a limited number of CLIA-approved laboratories.”

Treatment for TBRF involves the use of antibiotics, such as doxycycline, amoxicillin or cefuroxime . In this case the man was given a 4-week course of doxycycline and achieved complete resolution of his symptoms. One month after completing antibiotics ,follow-up laboratory testing showed complete resolution of thrombocytopenia and normalization of inflammatory markers.

All tick-borne diseases are a significant health concern worldwide, particularly in areas where ticks are prevalent. These illnesses can present with a range of symptoms, some of which can be mysterious and difficult to diagnose.

While relapsing fever Borrelia has been detected in California before, this is the first CDC-confirmed case of Borrelia miyamotoi in California.  This case highlights the need for continued education and awareness of tick-borne diseases.

As with all tick-borne illnesses, prevention is key. To reduce the risk of tick bites, take precautions when spending time outdoors, such as pre-treating shoes and clothing with permethrin, using insect repellant on yourself, your children and your pets, and performing thorough tick checks after being outdoors.

LymeSci is written by Lonnie Marcum, a Licensed Physical Therapist and mother of a daughter with Lyme. She served two terms on a subcommittee of the federal Tick-Borne Disease Working Group. Follow her on Twitter: @LonnieRhea  Email her at:


Rubio LA, Kjemtrup AM, Marx GE, Cronan S, Kilonzo C, Saunders MEM, et al. Borrelia miyamotoi infection in immunocompromised man, California, USA, 2021. Emerg Infect Dis. 2023 May DOI: 10.3201/eid2905.221638

Padgett K, Bonilla D, Kjemtrup A, Vilcins I-M, Yoshimizu MH, Hui L, et al. (2014) Large Scale Spatial Risk and Comparative Prevalence of Borrelia miyamotoi and Borrelia burgdorferi Sensu Lato in Ixodes pacificus. PLoS ONE 9(10): e110853.

Additional Resources

Stanford: Tick-borne disease risk high in SF Bay Area

Yale: Tick-borne Borrelia miyamotoi widespread in northeastern US

LYME SCI: Infected ticks in California? It’s complicated.

LYME SCI: B. miyamotoi has been in California ticks for a long time

LYME SCI: Lyme-carrying ticks in West differ from their Eastern cousins

LYME SCI: How many “negative” Lyme tests are due to B. miyamotoi?

LYME SCI: Tick infection rates as high as 31% in some coastal areas of California

BALF: New interactive maps show where citizen scientists found infected ticks

For more:

And the question begging to be asked is: how many people with B. miyamotoi are falling through the cracks?  It isn’t even reportable to the CDC yet (which notoriously undercounts all things tick-borne-related).

For more:

This article points out the confusion with B. miyamotoi: 

  • many separate it from other tick-borne relapsing fevers
  • while it can cause relapsing fevers, it sometimes doesn’t
  • it appears to be the only TBRF transmitted from a hard bodied tick, unlike TBRF which is mainly transmitted from a soft bodied tick (I remain skeptical of this as ticks have repeatedly been found to transmit things they shouldn’t – just like they are found in places they shouldn’t be.)
  • symptoms often resemble Lyme disease
  • you can be infected with BOTH B. miyamotoi AND Lyme disease (as well as numerous other coinfections) which will complicate symptom presentation
  • testing for B. miyamotoi is just as abysmal as it is for Lyme/MSIDS:

Lyme Times Open Assess For May – Lyme Awareness Month

In honor of Lyme Disease Awareness Month, the latest issue of the Lyme Times is open-access–freely available to all.

This special issue offers articles from 10 prominent Lyme-treating physicians on such topics as:
  • New treatments for chronic Lyme
  • An overview of Lyme testing
  • Lyme carditis
  • Brain inflammation
  • Lyme in young children

COVID Outbreak at CDC Conference: Yet More Proof CDC Guidance is Worthless

Disease detectives gathered at CDC event—a COVID outbreak erupted

Some attendees reportedly did not mask, distance, or take other precautions.
Huge facade for CDC headquarters against a beautiful sky.

Disease detectives with the Centers for Disease Control and Prevention are on the case of a new COVID-19 outbreak—the one at their very own conference, which has sickened around 35 attendees as of Tuesday.

Last week, the CDC hosted the 2023 Epidemic Intelligence Service (EIS) Conference in Atlanta, the first time the conference has been held in person since 2019. The annual event, which dates back seven decades, was fully virtual last year and was canceled entirely in 2020 and 2021 while EIS officers were immersed in the pandemic response.

“The COVID-19 pandemic has been hard on everyone and especially for our public health workforce. … We are thankful you are back with us at the EIS conference,” EIS leaders wrote in the preface of this year’s conference agenda, celebrating the return of the in-person gathering.

But signs of trouble turned up quickly. Several attendees reportedly tested positive during the conference, which spanned Monday, April 24 to Thursday, April 27, and drew about 2,000 participants. Some told The Washington Post that moderators at the conference warned several times about positive cases. CDC spokesperson Kristen Nordlund told Ars in an email that EIS leaders noted the cases during the closing session of the conference. The conference leaders also canceled an in-person training, emailed all officers with current CDC guidance, and offered to extend the hotel stays of sick attendees who needed to isolate, according to the Post. (See link for article)



The irony here is palpable.

The CDC, NIH, HHS, and FDA need to be disbanded forever.

Study: SOT Potential Treatment For Viruses & Lyme Disease

Supportive Oligonucleotide Therapy (SOT) as a Potential Treatment for Viral Infections and Lyme Disease: Preliminary Results

Free PMC article


Antisense therapy is widely used as an alternative therapeutic option for various diseases. RNA interference might be effective in infections, through the degradation of messenger RNA and, therefore, translation process. Hence, proteins essential for microorganisms and viruses’ proliferation and metabolism are inhibited, leading to their elimination. The present study aimed to evaluate the use of oligonucleotide in patients infected by Epstein-Barr (EBV) or Herpes Simplex Viruses 1/2 or with Lyme Disease caused by Borrelia burgdorferi. Blood samples were collected from 115 patients and the different species were characterized using molecular biology techniques. Then, SOT molecules (Supportive Oligonucleotide Therapy), which are specific small interfering RNA (siRNA), were designed, produced, and evaluated, for each specific strain. Oligonucleotides were administered intravenously to patients and then a quantitative Polymerase Chain Reaction was used to evaluate the effectiveness of SOT. This study revealed that for Lyme Disease, one or two SOT administrations can lead to a statistically significant decrease in DNA copies, while for viruses, two or three administrations are required to achieve a statistically significant reduction in the genetic material. These preliminary results indicate that antisense SOT therapy can be considered a potential treatment for viral as well as Lyme diseases.

For more:

The challenge with Lyme is correctly identifying the patient’s infections as they are typically coinfected with many. Further, it’s all based on using PCR to detect the DNA of various bacteria which is known to find Lyme only 30% of the time.  Further, many of the organisms with Lyme/MSIDS aren’t found in the blood so trying to detect it there is futile (another reason this is so hard to test, diagnose, and treat.)

Using genetic code for a treatment for this is like trying to catch a greased pig.  Lyme in particular changes its outer surface protein which means what goes into you isn’t what comes out of you as the organism mutates to survive.  Yet another reason it’s difficult treating this and why there has never and will never be a Lyme vaccine worth its weight in salt.  You can’t pin something down that changes.

Personally, all this work on treatments using genetics scares the bajeebers out of me.  Hopefully the past three years have caused all of us to pause and consider the implications of using genes and their ability to alter genetic code.  Also, what works in a petri dish often doesn’t work in reality.

Of course, at the end of the day, we are all big boys and girls and have to make our own decisions.  What works for one often doesn’t work for another and if you do your reading, are convinced of its merits, and want to try this, then by all means do it.  If you have success, or if you don’t, please let me know.  Often the best way we move forward is by educating one another on various treatments and health changes.

CPAC Warns: Lyme Risk Higher Than Ever

CAPC warns that Lyme disease risk is higher than ever

April 20, 2023

The nonprofit Companion Animal Parasite Council (CAPC) — the nation’s leading source on parasitic diseases that threaten the health of pets and people — is warning that the risk of Lyme disease is higher than ever.

In its 2023 Parasite Forecast, CAPC documents how the blacklegged ticks that spread Lyme disease are expanding into new geographical areas. This increases the risk of Lyme disease outside of historically endemic places like the Northeast and Upper Midwest.

Parasite infections are real and can be harmful and even deadly to pets and people. Lyme disease is a predominant One Health issue, an approach calling for the collaborative efforts of multiple disciplines working to attain optimal health for animals, people and the environment.

11 years of forecasts

“Because of the zoonotic potential of pathogens like Lyme disease, we started providing annual forecasts eleven years ago to alert communities about the risks they pose to people and pets,” says Dr. Christopher Carpenter, DVM, and Chief Executive Officer of CAPC.

“Lyme disease, in particular, is an important One Health pathogen that occurs in both veterinary and human medical settings. CAPC’s Pet Parasite Forecast is critical to alerting pet owners, veterinarians and physicians to the risks this year and reinforcing CAPC’s recommendation that all pets need to be annually tested and protected year-round.”

In its 2023 annual forecast, CAPC reports the risk of acquiring Lyme disease in 2023 is elevated due to the expansive nature of the blacklegged tick vector (Ixodes scapularis).

This increase in Lyme prevalence can be attributed to land use, human population growth, urbanization, and changes in wildlife host density and location. Risks have also increased due to rehoming of pets, as well as changes in:

  • Distribution and prevalence of vector (tick) populations
  • Shifting wildlife populations and their infiltration into newly developed and reclaimed areas
  • Short- and long-term changes in climatic conditions
  • Changes in habitat due to natural or human-induced processes

Lyme Disease Forecast

For 2023, CAPC predicts Lyme disease is a high threat and continues to expand southward and westward outside of the historically high-risk areas in the Northeast and Upper Midwest, including Wisconsin, Minnesota and the upper peninsula of Michigan.

There is a higher-than-average seroprevalence predicted in northeastern Tennessee, western Michigan and Ohio, with high-risk “hot spots” expected in northwestern and southwestern Michigan, and southern and northeastern Ohio.

A higher-than-normal risk is also expected in North Dakota, northeastern South Dakota, Iowa, Illinois, and eastern Kentucky. The southward movement of Lyme is evident in the increasing risk in the Carolinas and Tennessee.

In addition, CAPC reports a northern expansion into Canada, including southern regions of Ontario, Quebec and Manitoba, as well as on New Brunswick and Nova Scotia, due to increased Lyme detection in Canadian dogs. Pets living in or traveling to these areas are considered at high risk.

Testing and Prevention Strategies

The 2023 forecasts – supported by ongoing research by parasitologists and statisticians in leading academic institutions across the United States – highlight areas where more should be done to lower the risk of companion animals’ exposure to disease vectors, such as ticks.

The foundation of these prevention strategies are recommendations that veterinarians and pet owners test their pets annually for disease and protect their pets with products that kill or repel ticks year-round.

A vaccination for Lyme disease should always be considered for pets in high-risk areas. Lyme disease, in particular, is an important One Health pathogen that impacts the health of both pets and people.

Veterinarians play an important role in preventing zoonotic disease in pets, as well as people, by implementing effective parasite control programs. In regions with historically high prevalence and in forecasted regions of increased risk, veterinarians should reinforce their recommendations of aggressive tick control.

CAPC One Health Study

Research conducted by CAPC underscores the value of CAPC’s prevalence maps and emphasizes the importance of a One Health approach to tick-borne diseases. In 2019, a CAPC study confirmed dogs safeguard humans serving as sentinels to alert humans where they are at greatest risk for tick-borne Lyme disease.

“With dogs being tested annually for exposure to the pathogen that causes Lyme disease, we were able to study over seven years of nationwide canine diagnostic data, representing more than 16 million data points — something difficult to achieve when studying ticks and the environment directly. And unlike the challenges with access to human medical records, anonymous veterinary data does not have these privacy concerns,” said Dr. Michael Yabsley, a CAPC Board Member and professor in the Department of Population Health, College of Veterinary Medicine and Warnell School of Forestry and Natural Resources at the University of Georgia.

Results from the study – “Quantifying the relationship between human Lyme disease and Borrelia burgdorferi exposure in domestic dogs” – published in the prestigious, peer-reviewed Geospatial Health quantified the relationship between incidences of tick exposure in domestic dogs to human Lyme disease. The model established in this research broke new ground by giving residents, travelers and health care providers a county-level map to help them identify areas of high Lyme risk across the country.

“By combining sophisticated statistical modeling with this invaluable canine data, we’re enabling veterinary medicine to benefit human medicine,” said Dr. Stella Self, assistant professor in the Department of Epidemiology and Biostatistics at University of South Carolina. “This research represents the first step on the long road to developing a forecast for human Lyme disease.”

30-Day Forecast Maps for Pet Owners

Pet owners who want to monitor the activity in their county throughout the year have access to 30-Day Parasite Forecast Maps at These maps, developed exclusively by CAPC, provide a local forecast for every county in the continental United States on a monthly basis. This free service helps to remind pet owners of the continuous risk in their area and the importance of annual parasite testing and year-round protection.

“Because tick-borne diseases like Lyme are ever-changing, the 30-Day Pet Parasite forecasts at are an invaluable tool to protect both pets and people with monthly updates that show the risk for Lyme disease in their area,” said Dr. Rick Marrinson, Past President/Board Member for CAPC and owner of Longwood Veterinary Clinic in Longwood, Florida.

Other Parasite Spread in 2023

In addition to Lyme disease, CAPC forecasts that heartworm disease, which is transmitted by mosquitoes, and tick-borne diseases ehrlichiosis and anaplasmosis, continue to spread throughout the United States in 2023. Veterinarians and pet owners are encouraged to discuss how to effectively address the increased prevalence. Annual testing and year-round use of preventive products remains the best means of providing comprehensive parasite control and disease prevention.

How the Forecasts are Created

The annual CAPC Pet Parasite Forecasts are a collaborative effort between parasitologists and statisticians in leading academic institutions across the United States. These scientists engage in ongoing research and data interpretation to better understand and monitor vector-borne disease agent transmission and changing life cycles of parasites. The forecasts are based on many factors, including temperature, precipitation, and population density.

About the Companion Animal Parasite Council

The Companion Animal Parasite Council is an independent not-for-profit foundation comprised of parasitologists, veterinarians, as well as medical, public health and other professionals, who provide information for the optimal control of internal and external parasites that threaten the health of pets and people.

Formed in 2002, CAPC works to help veterinary professionals and pet owners develop the best practices in parasite management that protect pets from parasitic infections and reduce the risk of zoonotic parasite transmission.

SOURCE OF PRESS RELEASE: The Companion Animal Parasite Council