What Are Lyme Disease Co-Infections? Everything You Need To Know About The Other Tick-Borne Illnesses Hiding In Plain Sight

Lyme disease is a complex, multi-faceted illness that has far-reaching effects on our health. But, it rarely travels alone. This tick-borne illness often brings along companions, known as co-infections, further complicating a person’s diagnosis and treatment. In fact, research shows (1) that the majority of people with Lyme disease have at least one co-infection while 30% have two or more.

As a functional medicine practitioner, it’s my mission to demystify these often misunderstood conditions and empower you with the education and tools you need to reclaim your health. So if you haven’t heard of co-infections before this, you're not alone. Let’s take a look at some of the most common co-infections, their symptoms, and what you can do to start healing.

What are Lyme disease co-infections?

Lyme disease co-infections refer to additional pathogens transmitted by the same tick that carries the bacterium Borrelia burgdorferi that results in Lyme disease. These co-infections can include various bacteria, parasites, and other microorganisms such as Babesia, Anaplasma, Ehrlichia, Bartonella, and Mycoplasma and can be a problem for several reasons:

1. Increased difficulty in diagnosis

Lyme disease itself is challenging to diagnose due to its diverse and often vague symptoms. When co-infections are present, symptoms can overlap with each other, making it even more challenging for your doctor to accurately diagnose the specific pathogens involved.

Plus, different pathogens require different treatment approaches. Co-infections can complicate treatment protocols as antibiotics or medications effective for one infection might not be as effective for others. This necessitates a more comprehensive and tailored treatment plan, often requiring a combination of therapies to address each co-infection.

2. Varied symptoms 

Each co-infection can cause its own set of symptoms, ranging from flu-like symptoms to neurological issues, joint pain, fatigue, and more. These diverse symptoms often mimic other illnesses, leading to misdiagnosis or delayed diagnosis. 

3. Increased risk for chronic illness

Co-infections, especially when not correctly identified and treated, can contribute to the development of chronic Lyme disease. Chronic Lyme disease is characterized by persistent symptoms that can significantly impact a person's quality of life and even trigger the onset of other chronic health problems like chronic fatigue and autoimmune conditions.

Types of Lyme disease co-infections

Currently there are close to 19 different types (2) of tick-borne infections that people can get, but researchers don’t believe they have completely identified all of the possible infections that ticks can transmit.

1. Babesia

This malaria-like parasite infects your red blood cells and can lead to the development of the condition, Babesiosis. Scientifically classified as a piroplasm, researchers have found that this is the most common piroplasm infection in humans and once infected, can be transmitted to other people through blood transfusions and from mother to baby while in the womb.

Symptoms: According to the CDC, (3) symptoms of babesiosis include chills and a high fever and can also include fatigue sweats, muscle aches, headaches, hip pain, and shortness of breath. If left unaddressed, babesiosis can result in liver problems, kidney failure, low blood pressure, and hemolytic anemia - a breakdown of your red blood cells.

Diagnoses: As of right now, tests can only identify two strains of Babesia in your blood, whether that is for a current infection or antibiotics to Babesia which would indicate a prior infection.

Treatment: If caught early, conventional treatment typically includes antibiotics and antimalarial drugs.

2. Bartonella

Bartonella is a class of bacteria that can cause multiple different diseases and is typically transmitted to humans through scratches or bites from infected animals - particularly cats or fleas and ticks. Bartonella henselae, is one of the most well-known types of Bartonella which is responsible for cat scratch disease (CSD) in humans. The Bartonella bacteria likes to target (4) your body’s CD34+ cells - a type of specialized white blood cell - that act as precursors for endothelial cells that line your blood vessels and other tissues.

Symptoms: Symptoms of Cat Scratch Disease include swollen lymph nodes near the site of the scratch or bite, fever, headache, fatigue. A major tell-tale sign that someone has been infected with Bartonella is a streak-like rash that looks like stretch marks. Bartonella has also been known to cause more neurological problems than other types of co-infections with symptoms including blurred vision, memory loss, difficulty balancing, numbness in extremities, tremors, and headaches. 

Another strain of this bacteria, B. angiomatosis, can cause Carrion’s disease (5) which is characterized by a high fever known as Oroya fever, alongside anemia, enlargement of spleen and liver, bleeding into lymph nodes, and the destruction of blood vessels.

Diagnoses: To diagnose Bartonella, doctors utilize a combination of PCR tests and tissue biopsies, however these tests aren’t always the most reliable as they can produce false negatives and positives.

Treatment: Treatment for Bartonella infections typically involves antibiotics like Fluoroquinolones and doxycycline, but the specific medication and duration of treatment may vary depending on the severity of your infection and your overall health.

3. Rickettsia

Rickettsia (6) is another class of bacteria that includes several species known to cause diseases in humans. These bacteria are obligate intracellular parasites, meaning they can only live and multiply inside the cells of a host organism, such as humans, animals, or you guessed it - ticks. There are quite a few diseases that are caused by the rickettsia bacteria with the most common being:

Rocky Mountain spotted fever (RMSF): This is one of the most severe rickettsial diseases, transmitted primarily through the bite of infected ticks. 

• Symptoms: Fever, headache, rash, muscle aches, and in severe cases, complications affecting multiple organs.

Typhus: There are different forms of typhus, including epidemic typhus and murine typhus, both caused by different species of Rickettsia. Typhus is transmitted to humans through the bite of infected fleas or lice. 

• Symptoms: Fever, rash, headache, muscle pain, and in severe cases, organ failure.

Spotted fever group rickettsioses: Apart from Rocky Mountain spotted fever, there are other rickettsial infections belonging to the spotted fever group, such as Mediterranean spotted fever and African tick bite fever, which are transmitted by ticks.

• Symptoms: Fever, rash, and flu-like illness similar to Rocky Mountain Spotted Fever
• Diagnoses: Rickettsia diseases are notoriously difficult to diagnose but can be done so through various PCR and antibody tests.
• Treatment: Due to the rapid progression of Rickettsia diseases, the CDC recommends (7) treatment with tetracycline medications like doxycycline as soon as possible if infection is suspected - even before results are confirmed.

4. Ehrlichia and Anaplasma

Ehrlichia and Anaplasma are both types of bacteria that belong to the family Anaplasmataceae. These bacteria are transmitted primarily through the bite of infected ticks and can cause similar illnesses in humans and animals.

Ehrlichia: Ehrlichia are bacteria that infect white blood cells and are responsible for diseases known as ehrlichiosis. The most common species (8) causing human ehrlichiosis in the United States are Ehrlichia chaffeensis, Ehrlichia ewingii, and Ehrlichia muris eauclairensis.

• Symptoms: Fever, headache, muscle aches, fatigue, and in more severe cases, complications affecting multiple organs. 
• Diagnoses: To diagnose Ehrlichia infections, your doctor will likely recommend PCR and antibody tests for this bacteria. They may also look (9) to see if your white blood cells and blood platelet cells are low.
• Treatment: Doxycycline is the preferred treatment method for this infection.

Anaplasma: Anaplasma bacteria infect white blood cells as well, causing diseases collectively known as anaplasmosis. The primary species affecting humans in the United States is Anaplasma phagocytophilum.

• Symptoms: Symptoms of anaplasmosis are similar to ehrlichiosis and can include fever, headache, muscle aches, and fatigue. 
• Diagnoses: The diagnosis of Anaplasma infections is similar to that of Ehrlichia infections through a PCR and antibody test along with an assessment of your white blood cells and platelet cells.
• Treatment: Since its symptoms are similar to Ehrlichia-induced diseases, doxycycline is also the preferred treatment for this infection.

Seeking help from a functional medicine expert

Ultimately, researchers are still learning more and more about co-infections and their implications on our overall health. From their difficulty to diagnose and the overlapping of symptoms, many people go on for years without knowing the real cause of their chronic health problems. In my telehealth functional medicine clinic, we specialize in uncovering these various co-infections so that you can finally get answers to why you feel the way that you do. By working on lowering inflammation, optimizing detoxification, and more, we can start to overcome these infections naturally from these infections by unlocking your body’s innate ability to heal.

If you have Lyme disease or think that one of these co-infections is a factor in your health case, schedule a telehealth consultation today to learn more about how we can help you with functional medicine.

As one of the first functional medicine telehealth clinics in the world, we provide webcam health consultations for people around the globe.