Archive for the ‘Tickborne Relapsing Fever’ Category

“Ehrlichia,” Rhapsody in Discomfort #6

TOUCHED BY LYME: “Ehrlichia,” Rhapsody in Discomfort #6

April 11, 2022

Dan Flanagan is a professional violinist and composer based in Northern California. He takes pleasure in creating music for solo violins and small ensembles. He often pairs his compositions with paintings from artists who inspire him—sort of a multi-media artistic approach, if you will.

I haven’t met him. But in the introduction to the following YouTube video, Dan comes across like a playful guy with an impish sense of humor.

Yet beneath the surface, there is much more to his story.

Dan has made his way in the music world despite severe muscle, joint and nerve pain—and other unpleasant realities—that have plagued him since the age of 12.

Finally, a diagnosis

Five years ago, at 37, after years of seeking out different doctors in search of relief from his agony, he was finally diagnosed with Borrelia (Lyme), Bartonella, Babesia, Ehrlichia, relapsing fever, and Epstein-Barr virus. (He does not recall ever being bitten by a tick.) Since the diagnosis, he’s undergone a wide variety of treatments that so far haven’t achieved the level of healing he has long sought.

“While it’s possible that these things have helped a little or at least slowed down the progression, I’m still miserable,” he says.

Physically playing the violin is a struggle for Dan, because of stiff muscles and other symptoms. But he says that music is what keeps him going, his raison d’etre, what gives meaning to his life. So, he carries on.

Putting pain to music

In the spirit of focusing on what he loves to do, Dan recently composed a short piece of music entitled “Ehrlichia,” Rhapsody in Discomfort #6.

Here’s how he explains it:

“Ehrlichia” is written in Rondo form. The repeated Rondo theme, representing the disease traveling through the body, is a fast moving, feverish collection of scales in C minor.

Each digression represents a different symptom experienced by the victim, and each return of the Rondo theme mutates as the disease develops.

Traditional harmonies, tonal clusters, and extended techniques combine to create feelings of discomfort, exhaustion, confusion, fear, and hope. Indeed, toward the end of the piece, the violin represents the attack of antibiotics with piercing and relentless C major chords, followed by temporary calm.

Beginning with a pizzicato tick bite, “Ehrlichia” brings the listener through the tribulations of a Lyme disease patient, ending with joyous relief and tranquility… followed by relapse.

With the aid of a financial grant from IntermusicSF, an arts advocacy organization, Dan has created a video of his three-person ensemble performing this work. He has made it available for all to see.

In the video above, Dan is playing with his friends Paul and Vicky Ehrlich. Amused that their last name closely resembles one of his infections, he chose the title “Ehrlichia” for this piece of music. Their ensemble goes by the name “Trio Solano.”

The video also features a painting that Dan commissioned from East Coast artist Nancy Schroeder, who also has Lyme disease and co-infections (including Ehrlichia).

At the end of the video, he includes information about Lyme and other tick-borne diseases, with URLs for more information.

“Ehrlichia,” Rhapsody in Discomfort #6 is a remarkable piece of music and the video is beautifully shot and edited. However, the musicians sit in a grassy meadow. I must admit, I found myself nervously hoping they were all wearing permethrin-treated clothing, with bug repellent on their bare skin!

I emailed Dan to ask him about it—and he assured me, the three took proper precautions to protect themselves from ticks. Whew! Good to know.

The Bow and the Brush

He continues to work on the music that sustains him. He will make his Carnegie Hall debut with “The Bow and the Brush,” a solo violin recital on October 3. Every piece on the program will be a world premiere, commissioned or composed by Dan, with images of the art projected during the performance.

The West Coast Premiere of “The Bow and the Brush” will take place at UC Berkeley on October 16. Learn more about Dan’s work and his upcoming performances at his website.

Photo credit: Russ Gold

Click here to learn how to protect yourself from ticks

TOUCHED BY LYME is written by Dorothy Kupcha Leland,’s Vice-president and Director of Communications. She is co-author of When Your Child Has Lyme Disease: A Parent’s Survival Guide. Contact her at



Yes, it definitely makes my skin crawl and fantastically represents Lyme/MSIDS audibly.

My first concern was about the musicians sitting in grassy woods….glad they took precautions as that would have seriously impeded my ability to listen!

For more:

Know Your Ticks

Know your ticks

Easy to read table shows the most common ticks found in the U.S. that transmit pathogens to humans.
Note: only a partial list. To learn more about tick-bite prevention and how to be Tick AWARE, click here

Click here to download the Tick Table

Tick Table

For more:

Remember, in Wisconsin, ticks are found in every county in the state. Researchers are also finding them in bright, open, mowed lawns.

Dr. Burrascano on Tick-borne Illness Testing

http://  Approx. 15 Min

IGeneX 2021 Presentation Wisconsin Naturopathic Doctors Association (WNDA)

May 10, 2021

See Dr. Joseph Burrascano presenting on behalf of IGeneX Laboratory at the annual WNDA conference. Topics cover testing for Lyme Disease, Tick-Borne Relapsing Fever, Bartonella, Babesia, Rickettsia, Anaplasma, and Ehrlichia.

Dr. Burrascano discusses the Lyme ImmunoBlot test for early Lyme, validated with CDC test samples, that will identify 93% of cases.

He discussed a 2018 study of over 10,000 patient samples from nearly every state which found patients testing positive for the following pathogens:

  • nearly 38% for Babesia
  • 32% for Lyme borrelia
  • nearly 28% for TBRF borrelia
  • 19% for Bartonella
  • nearly 17% for Anaplasma
  • nearly 13% for Rickettsia
  • nearly 7% for Ehrlichia


  • 40% tested positive for 2 pathogens
  • 15% for 3
  • 4.6% for 4
  • 0.7% for 5

1st Cases of Natural Infections With Borrelia Hispanica in European Dogs and Cat

First Cases of Natural Infections with Borrelia hispanica in Two Dogs and a Cat from Europe

Free PMC article


Canine cases of relapsing fever (RF) borreliosis have been described in Israel and the USA, where two RF species, Borrelia turicatae and Borrelia hermsii, can cause similar clinical signs to the Borrelia persica in dogs and cats reported from Israel, including fever, lethargy, anorexia, thrombocytopenia, and spirochetemia. In this report, we describe the first clinical cases of two dogs and a cat from Spain (Cordoba, Valencia, and Seville) caused by the RF species Borrelia hispanica. Spirochetes were present in the blood smears of all three animals, and clinical signs included lethargy, pale mucosa, anorexia, cachexia, or mild abdominal respiration. Laboratory findings, like thrombocytopenia in both dogs, may have been caused by co-infecting pathogens (i.e., Babesia vogeli, confirmed in one dog). Anemia was noticed in one of the dogs and in the cat. Borrelia hispanica was confirmed as an infecting agent by molecular analysis of the 16S rRNA locus. Molecular analysis of housekeeping genes and phylogenetic analyses, as well as successful in vitro culture of the feline isolate confirmed the causative agent as B. hispanica.



Our feline and canine friends are sentinels for human diseases and these cases are no different.

To date, 23 TBRF-related Borrelia species have been confirmed, but additional species are proposed (2). B. hispanica is the primary TBRF-related Borrelia species identified in Spain (3,4), where it is endemic.  It is transmitted mainly through the bite of O. erraticus ticks (5) but also can be transmitted by O. occidentalis ticks (4). B. hispanica also has been found in Portugal (6), Morocco (4,7,8), and Tunisia (4).

As of 2015, B. hispanica is considered an emerging infectious agent causing Neuroborreliosis:

Please keep in mind that migrating birds and animals are transporting ticks everywhere and spreading the pathogens they carry.

O. erraticus ticks feed nocturnally on multiple warm- blooded vertebrate hosts, including humans, and are found living buried in soil of traditional pigpens:

Regarding O. occidentals ticks, according to this 2020 article,

“we have not sampled Ornithodoros ticks to evaluate densities and infection rates, nor have we collected samples from small mammals to investigate the reservoir of Borrelia spp.” 19-0745

Important excerpt:

Because the spirochetemia phase is short and laboratory diagnosis is exclusively dependent on the observer, we believe TBRF is underdiagnosed, even in areas where suspicion should be relatively high. 19-0745

A Case of Borrelia Miyamotoi

Case 32-2020: A 63-Year-Old Man with Confusion, Fatigue, and Garbled Speech

Authors:  Shibani S. Mukerji, M.D., Ph.D., Kevin L. Ard, M.D., Pamela W. Schaefer, M.D., and John A. Branda, M.D.

The following was obtained from the case presented in the link above in the New England Journal of Medicine.A 63-year-old retired government employee who lived with his wife in northern New England had recently traveled to Florida and to rural Canada to hunt was evaluated at the hospital because of:

  • fever
  • confusion
  • headache
  • garbled speech
  • fatigue
  • vision changes & floaters
  • lymphocytic pleocytosis
  • elevated protein level in the cerebrospinal fluid (CSF)
  • worsening proteinuria and hypertension
  • flash of light accompanied by transient sharp pain in the left retro-orbital area and forehead, with monocular blurry vision
  • garbled and nonsensical speech with impaired comprehension
  • word-finding difficulty
  • photophobia
  • sonophobia
  • staring spells that lasted for 1 minute
  • low-grade fever 
  • somnolence
  • generalized weakness
  • unsteadiness
  • mild neck stiffness
  • unintentional weight loss of 10 kg in the past 6 months
  • nocturia
  • cachectic appearing
  • perseverative thoughts
  • unable to name days of the week backward
  • when asked to remember three words, he could recall only one word after 5 minutes
  • he reported that nine quarters equaled $4.25
  • dilated-eye examination revealed edema in both optic nerves

Interestingly, after IV acyclovir, ceftriaxone, ampicillin, vancomycin, and thiamine, he developed myoclonic jerks with marked lethargy, and the photophobia, and nonsensical speech persisted. He was intermittently impulsive and uncooperative. After 4 days of IV treatment he reported feeling better and having increased strength, allowing him to walk. On the fifth hospital day, he was calm and cooperative; oriented to person, place, and time; and able to follow complex commands.

Administration of broad-spectrum antimicrobial agents resulted in rapid improvement in his clinical condition within days despite increasing neurologic symptoms over the course of several months, findings that suggested meningoencephalitis.  Despite an extensive evaluation for likely causes of meningoencephalitis, a definitive diagnosis was not established. This patient’s presentation and clinical course are emblematic of challenges faced by clinicians, given that the causative agent in meningoencephalitis is identified in only 30 to 60% of cases, despite extensive and invasive testing.1,2

There are three important clinical features of this patient’s presentation:

  • uveitis associated with meningoencephalitis
  • subacute cognitive decline
  • clinical improvement after the administration of antimicrobial therapy

A unique feature of this patient’s presentation is his exposure to rituximab, a humanized chimeric anti-CD20 monoclonal antibody that causes B-cell depletion. The effects of rituximab should be considered when interpreting the results of IgG and IgM serologic tests. This concern is relevant to testing for West Nile virus infection and eastern equine encephalitis, both of which can cause neuroinvasive viral encephalitis and are endemic in the northeastern United States. The antibody response during these infections can be delayed or absent in patients with B-cell depletion.4,5 Such a response may also occur in Powassan virus infection, an emerging cause of viral meningoencephalitis in the United States that is transmitted by ticks.6

A key question remains: What pathogen can cause uveitis and meningoencephalitis and result in rapid clinical improvement after the administration of vancomycin, ampicillin, ceftriaxone, and acyclovir?

The authors point out that spirochete infections can cause uveitis and meningoencephalitis.

Due to the patient’s history of living in an endemic area for tick-borne diseases, is an avid hunter, whose condition improved dramatically after IV antibiotics, infection with borrelia species seemed a logical diagnosis.

The authors point out the problem with testing:

Testing for Lyme disease occurs as a part of a two-tiered algorithm and measures a person’s antibody response to the spirochete. Whether treatment with rituximab delays formation of antibodies in blood and CSF is unknown, thus complicating the interpretation of this patient’s serologic test results.

They further state that those with neurological Lyme infection often have abnormal imaging findings of the head or spine but that this patient had neither.

Then they state that B. miyamotoi, another borrelia species, causes a symptom complex that is consistent with this patient and that there are two case reports of meningoencephalitis in immunocompromised patients receiving rituximab, where B. miyamotoi was the causative agent.  These patients received rituximab for hematologic cancers, and in both, Wright-Giemsa staining of CSF showed spirochetes, and a definitive diagnosis of B. miyamotoi infection was made based on nucleic acid testing of the blood.

The authors state the patient’s recurrent fever but lack of rash also support a B. miyamotoi infection, but that the opthalmologic findings do not.  They admit; however, that there is limited understanding of B. miyamotoi but since other spirochetes can cause eye issues, B. miyamotoi is likely no different. ( I must add here that I know many Lyme disease patients who get recurrent fevers and have never seen a rash.  This is a perfect example of how researchers and doctors have falsely pigeon-holed Lyme symptoms into a box of their own making).  For more:

Regarding testing, a lumbar puncture targeting the glpQ gene of borrelia that causes relapsing fever, which is absent in Lyme disease, was positive. Serum showed strong reactivity on the ELISA that detects IgG antibodies directed against the GlpQ protein of B. miyamotoi.  Corresponding IgM ELISA was negative, consistent of B. miyamotoi infection of several months duration.

Unfortunately there are no randomized controlled trials and no formal treatment recommendations.  Patients typically receive Lyme disease treatment.  An in vitro study showed B. miyamotoi was susceptible to doxycycline, azithromycin, and ceftriaxone but not amoxicillin. (Again, I must add that current Lyme disease treatment advocated by the CDC/IDSA only works for a small percentage of patients and that studies from the beginning have shown treatment failures using their approach.  For more:

The patient was sent home with 4 weeks of IV ceftriaxone but developed a facial rash and was switched to doxycycline.  After 3 weeks all symptoms had resolved but the blurry vision which improved slowly over 3 months.

This patient should be followed up for years, but won’t be.
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: