Co-infections in Persons With Early Lyme Disease, New York, USA

Gary P. Wormser; Donna McKenna; Carol Scavarda; Denise Cooper; Marc Y. El Khoury; John Nowakowski; Praveen Sudhindra; Alexander Ladenheim; Guiqing Wang; Carol L. Karmen; Valerie Demarest; Alan P. Dupuis II; Susan J. Wong

Disclosures

Emerging Infectious Diseases. 2019;25(4):748-752. 

In This Article

Abstract and Introduction

Abstract

In certain regions of New York state, USA, Ixodes scapularis ticks can potentially transmit 4 pathogens in addition to Borrelia burgdorferi: Anaplasma phagocytophilum, Babesia microti, Borrelia miyamotoi, and the deer tick virus subtype of Powassan virus. In a prospective study, we systematically evaluated 52 adult patients with erythema migrans, the most common clinical manifestation of B. burgdorferi infection (Lyme disease), who had not received treatment for Lyme disease. We used serologic testing to evaluate these patients for evidence of co-infection with any of the 4 other tickborne pathogens. Evidence of co-infection was found for B. microti only; 4–6 patients were co-infected with Babesia microti. Nearly 90% of the patients evaluated had no evidence of co-infection. Our finding of B. microti co-infection documents the increasing clinical relevance of this emerging infection.

Introduction

Lyme disease, caused by Borrelia burgdorferi, is the most common tickborne infection in North America.[1,2] The Lower Hudson Valley, in the US state of New York, is a region of high risk for bites from Ixodes scapularis ticks.[3] I. scapularis ticks in this region, and in certain other geographic areas in New York and the northeastern United States, are responsible for transmission of 4 other pathogens besides B. burgdorferi: Anaplasma phagocytophilum, the cause of human granulocytic anaplasmosis; Babesia microti; Borrelia miyamotoi; and the deer tick virus subtype of Powassan virus (POWV).[4–9] The earliest and most common clinical manifestation of Lyme disease is the lesion erythema migrans. To look for evidence of co-infection with these 4 tickborne pathogens, we tested the serum of 52 adult patients with erythema migrans who had not received treatment for Lyme disease.

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