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Lyme disease is the most common vector-borne disease in the US. It is also one of the most controversial diseases. While in many people it can be treated successfully with antibiotics, there is a number of those who continue to experience symptoms for months and years after the treatment. Read on to learn more about Borrelia, the bacterium that causes Lyme disease. You will discover what is known about Lyme so far, and natural substances that can help you combat this disease.
What is Lyme Disease?
Borrelia the Bacteria
Borrelia is a group of bacteria, best known for causing Lyme disease [R].
There are over 50 species of Borrelia. These bacteria cause diseases that are transmitted by ticks or lice, including:
- Lyme disease
- Relapsing fever
- Borrelia miyamotoi disease
Around a dozen of the Borrelia species are known to cause Lyme disease (also called borreliosis). All are transmitted by ticks. Four species, B. burgdorferi, B. afzelii, B. garinii, and B. bavariensis cause the majority of human disease in Europe, whereas only a single species, B. burgdorferi, causes Lyme disease in the United States [R].
People get the bacteria when they are bitten by infected ticks [R].
Small mammals (like mice) and birds are reservoirs/carriers of Lyme disease. Humans accidental hosts [R].
Borrelia enters the skin at the site of the tick bite. From there, it can disperse and cause inflammation in the heart, joints, or the brain [R].
How Prevalent is Lyme Disease?
Lyme disease is the most common vector-borne disease in the US, Europe and Northern Asia [R].
20,000–30,000 cases are now reported to CDC each year [R].
There are about 85,000 cases reported each year in Europe. However, this number is also largely underestimated, as many infections go undiagnosed [R].
Who’s at Risk?
Those with High Exposure
The risk of Lyme disease is related to tick abundance and exposure. Therefore you are more likely to get infected if you [R]:
- live in rural areas
- work as forestry or farm workers
- do hunting, mushroom gathering or berry picking [R].
Most infections occur in the spring, summer, and early autumn, when the ticks are in the immature (nymph) stage and people are more likely to be active [R].
Those Living in Endemic Areas
In the US, 93% of the reported cases were identified in 10 states: Connecticut, Delaware, Massachusetts, Maryland, Minnesota, New Jersey, New York, Pennsylvania, Rhode Island, and Wisconsin [R].
Lyme disease also occurs, although much less frequently, on the Pacific Coast, primarily in Northern California and Oregon [R].
In highly endemic areas of the United States, such as Connecticut and Southern New York, there is about 1 case per 2,000 persons a year. The incidence is highest in children aged 5 to 10 years [R].
In Europe, most cases occur in Scandinavia and the southern part of central Europe (Germany, Austria, north-east Italy, and Slovenia). The reported incidence is more than 3 cases per 1000 people [R].
As the range of ticks’ continues to expand, it is likely that Lyme case numbers will continue to rise [R].
Those of Certain Age
Children are at the highest risk of Lyme disease [R].
The peak incidence is found in children aged 5–9 years [R].
Adults aged 45–59 years are also frequently infected [R].
Ways to Prevent Lyme Disease
Reduce the Risk of Tick Bites
Reducing the risk of tick bites is the best strategy to prevent Lyme disease.
Infection can be prevented by avoiding tick-infested environments. When in such environments, one should cover as much bare skin as possible and use tick repellents on skin or clothing [R].
In endemic areas, clearing brush and trees, removing leaf litter and woodpiles, and keeping grass mowed may reduce exposure to ticks. Application of pesticides to residential properties is effective but may be harmful to other wildlife and people [R].
Tick and insect repellents that contain DEET applied to the skin provide additional protection but require frequent reapplication [R].
Serious neurological complications in children from the frequent or excessive application of DEET-containing repellents have been reported, but these are rare and the risk is low when these products are used according to instructions on the labels [R].
Check for Ticks Regularly
Practice daily showers and tick checks when living in or visiting Lyme-endemic sites [R].
The risk of Lyme disease is higher from bites that are unrecognized because the tick can feed to repletion and is more likely to transmit the infection [R].
A good strategy is to inspect oneself and children’s bodies and clothing daily after possible exposure to ticks [R].
Remove Ticks Promptly
It is important to know that not all ticks are infected. Even when they are infected, transmission does not occur in all subjects [R].
For the transmission to happen, the tick needs to be allowed to feed for an extended duration of time. Borrelia lives in the gut of the tick, which needs to become engorged with blood before it can migrate to the salivary glands and the saliva, through which the bacteria are injected into humans [R].
Based on animal studies, to transmit the disease, an infected immature tick must feed for at least 36 to 48 hours and an infected adult tick must feed for at least 72 hours [R].
Case in point: in an area with a high incidence of Lyme disease, only 75/397 ticks were carriers of the disease, and only 1/64 subjects bitten by infected ticks developed symptoms of Lyme disease in the following 3 months [R].
A study shows that in humans, the risk of transmission from ticks was 25% for immature ticks that had fed for at least 72 hours and 0% for those that had fed for less than 72 hours [R].
Because most people who recognize that they were bitten by a tick remove the tick within 48 hours, the risk of Lyme disease from recognized tick bites is low (approximately 1–3% in areas with a high incidence of Lyme disease) [R].
An attached tick should be grasped with tweezers as close to the skin as possible and removed by gently pulling the tick straight out [R].
If parts remain embedded in the skin, they should be left alone. They are thrust out eventually. Attempts to remove them can result in unnecessary damage to tissue and may increase the risk of local bacterial infection [R].
Taking antibiotics as preventive agents can further reduce the risk of developing Lyme disease after tick removal [R].
A single dose of doxycycline was 87% effective in preventing Lyme disease (482 subjects) [R].
However, this requires recognizing the tick bite and identifying the type of tick. People often mistake the more common and larger wood or dog ticks for the small deer tick [R].
An individual exposed to a tick must weigh the risk of developing Lyme disease against the cost and risks from potentially unnecessary antibiotic administration [R].
Some are against the routine use of antibiotics to prevent Lyme disease. This is because even in highly endemic areas, the overall risk of Lyme disease is low (1–3%), and if Lyme disease develops, treatment is effective [R].
Don’t Let Your Guard Down
Previous infection (whether with or without symptoms) does not make you immune to Lyme disease. You remain vulnerable to reinfection [R].
Symptoms and Diagnosis
Symptoms of Lyme disease can be classified into 3 stages: early stage, dissemination stage, and late disease [R].
You may experience some of the symptoms described below, or none at all.
In the US, the frequency of infections without symptoms is between 0% and 50% [R].
Early recognition is important because proper antibiotic treatment decreases acute and long-term symptoms [R].
The rash expands and fades over weeks [R].
It can persist without other symptoms. It may also be itchy or painful. Or it can be accompanied by flu-like symptoms such as fever, malaise, headache, fatigue, neck stiffness, muscle or joint pain [R, R].
In the absence of the rash, Lyme disease can be difficult to diagnose due to these non-specific flu-like symptoms [R].
All the signs and symptoms of the disease, including the skin lesions, usually disappear spontaneously after about 1 month [R].
Although it will resolve without treatment, antibiotics hasten rash and flu-like symptom resolution [R].
Days to weeks after the infection, the disease progresses onto a dissemination stage. This is when the bacteria travel away from the site of the tick bite through the bloodstream to invade and colonize various tissues, such as the heart, joints, and the brain [R].
Patients can develop a secondary rash away from the original site of the bite/infection [R].
A solitary bluish-red swelling (borrelial lymphocytoma) can sometimes be found on the earlobe in children, or in the breast region in adults. It arises later and is of longer duration than the usual rash, but also resolves spontaneously [R].
Symptoms, such as fever, muscle and joint pain, headache, or fatigue, are common in this stage of Lyme disease [R].
Late infection, the third stage of disease, develops months to years after exposure [R].
It is not unusual for patients to initially address the doctor with late-stage disease [R].
If left untreated, the infection can lead to complications such as [R]:
- Neurological symptoms
- Carditis (Inflammation of the heart)
- Skin disorders
From 2001 to 2010, the CDC reports that 31% of confirmed Lyme disease cases presented with Lyme arthritis, 14% with neurologic symptoms, and 1% with heart involvement [R].
Children experience shorter-lasting symptoms and have better outcomes [R].
Months after the infection, untreated patients can develop arthritis which can last for several years with marked joint swelling and pain, primarily in large joints, especially the knee [R].
In fact, arthritis is the most frequent late-stage symptom of Lyme disease in the US.
Children are more likely to develop arthritis than adults and are also more likely to have arthritis as the sole presenting symptom of disease [R].
Neurological symptoms are more often encountered in people infected with B. garinii, the Lyme disease-causing bacterium found in Europe [R].
The American B. burgdorferi can also cause neurological symptoms, however not at such a high rate [R].
Although it occurs in only a few cases, the invasion of a child’s nervous system by B. burgdorferi can cause facial palsy and meningitis, the most common clinical manifestation of pediatric Lyme disease [R].
Facial palsy occurs in about 5% of children with Lyme disease [R].
Lyme meningitis is diagnosed in about 2% of children with Lyme disease. About 13% of aseptic meningitis diagnosed in an endemic region during the peak period of Lyme disease are due to Lyme disease [R].
Similarly, studies carried out in Scandinavia and the USA have found that Lyme disease was the cause of 34–65% of facial palsy cases [R].
4–10% of adults and 1-16% of children with Lyme disease develop carditis (heart inflammation) [R].
In a small percentage of cases, people can develop dangerous heart arrhythmias [R].
In 110 individuals with recent-onset unexplained dilated cardiomyopathy, Borrelia DNA was found in 22 (20%) subjects. These patients were subsequently treated with intravenous ceftriaxone for 21 days in addition to conventional heart failure medication. A significant improvement in heart failure symptoms was observed [R].
Skin disorders are more often encountered in infections with B. afzelii, another European species [R].
Infected people can develop rash, benign bluish-red lumps on the skin (lymphocytoma), and acrodermatitis chronica atrophicans – a chronically progressive condition that leads to widespread atrophy of the skin [R].
Lyme Disease Tests
Testing for Lyme disease remains problematic [R].
However, antibody test results are generally not useful for the diagnosis of Lyme disease for the following reasons:
- the rash usually develops before antibodies are detectable. IgM antibodies are undetectable until 2–3 weeks after the appearance of skin lesions, and IgG antibodies can only be detected after 4 weeks [R].
- the sensitivity of the two-tier approach in Lyme disease patients tested at least 4 to 6 weeks after infection is only 44% to 56%, which is inadequate for a clinical diagnostic test [R].
- the antibody test result is often negative in the acute phase even in those with multiple skin lesions [R].
- although antibody levels wane over time, some people who have recovered fully will continue to have measurable antibody levels for years. Thus, a positive result does not necessarily mean there is an ongoing infection [R].
- negative results are not indicative of cure. Many patients treated for Lyme disease do not develop a measurable IgG response following antibiotic therapy [R].
- antibody tests for Lyme disease will be falsely positive. An erroneous diagnosis of Lyme disease frequently is made, and such patients often are treated with antimicrobials unnecessarily [R].
- Some degree of cross-reactivity occurs between Borrelia that causes Lyme disease, relapsing fever and B. miyamotoi disease [R].
Low specificity of these tests explains why most experts do not suggest immunological tests but believe it is enough to know that a person lives in an endemic area and has one or more of the characteristic skin lesions [R].
Molecular testing for B. burgdorferi has been unreliable and expensive [R].
Direct molecular tests in blood for early Lyme disease can be insensitive due to a low amount of circulating bacteria. Results of a DNA analysis showed detection of B. burgdorferi in 13 of 21 patients (62%) [R].
However, new methods are constantly being developed and improved. We can hope for better tests in the near future [R].
Lyme disease patients usually respond well to antibiotics, when they are administered early [R].
Chronic cases require prolonged treatment, and treatment is often less effective [R].
Antibiotics such as penicillin, amoxicillin, ceftriaxone, doxycycline, and erythromycin are the most commonly prescribed for the treatment of Lyme disease [R].
Nonspecific symptoms, such as fatigue, joint or muscle pain, may persist for several weeks even in patients with early Lyme disease who are treated successfully. These nonspecific symptoms will usually resolve without additional antimicrobial therapy [R].
Most adult cases of Lyme arthritis resolve after 4 weeks of oral antibiotic treatment. 10% of people have persistent arthritis that requires a second course of antibiotics, and 1–3% of these develop refractory disease requiring treatment with intra-articular steroids, synovectomy, or immunomodulating agents [R].
Additional treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) may help with inflammation [R].
IV immunoglobulin has been useful for cases of autoimmune polyneuropathy secondary to Lyme disease [R].
Neurontin (gabapentin) was effective in reducing Lyme-induced neuropathic pain [R].
Patients with antibiotic-refractory arthritis may benefit from synovectomy [R].
Two vaccines for Lyme disease were developed in the 1990s and were shown to be safe and efficacious in placebo-controlled studies in the US [R].
They were also well tolerated and immunogenic in children 4 to 18 years of age (4087 children) [R].
However, an assumption that these might trigger arthritis in some recipients, contributed to the limited acceptance and subsequent discontinuation of the vaccine in 2002 [R].
The assumption was since then proven wrong [R].
With over 1.4 million Lyme vaccine doses distributed in the US, there were 905 reports of mild self-limited reactions and 59 reports of arthritis associated with vaccination. The arthritis incidence in the patients receiving Lyme vaccine occurred at the same rate as in unvaccinated individuals [R].
In addition, the data did not show a temporal spike in arthritis diagnoses after the second and third vaccine dose expected for an immune-mediated disease. The FDA found no suggestion that the Lyme vaccine caused harm to its recipients [R].
Some studies, however, indicate that an OspA Lyme vaccine may result in autoimmunity in genetically predisposed individuals. Although causality was difficult to demonstrate, one study reported four male patients with the DR4+ genotype who developed autoimmune arthritis after receiving the vaccine [R].
The withdrawal of vaccines from the market is a loss of a powerful tool for Lyme disease prevention [R].
Ironically, the vaccine is available for dogs but not for humans.
However, new vaccines are being tested in Europe, and hopefully, they will soon be available again.
The protection the vaccine provides diminishes over time. So if you received a vaccine before 2002, it’s safe to assume you are no longer protected.
Persistent Lyme Disease
One of the most controversial issues in Lyme disease is whether it can be easily treated by conventional antibiotics, or whether it is a persistent, recurrent and difficult to eradicate infection [R].
The fact is that some Lyme disease patients continue to experience mild symptoms even after appropriate antibiotic treatment. These symptoms may resolve within six months without further treatment; however, a small subset of patients continue to experience symptoms for longer periods [R].
How Frequent is It?
The CDC estimates that 10% to 20% of patients appropriately treated for the infection will remain symptomatic for an unspecified and variable period of time [R].
Symptoms include fatigue, muscle and joint pain, brain fog, and/or radiating pain persisting for over 6 months [R].
In 9 clinical trials, 10 to 20 days of antibiotic therapy failed to restore 16% to 48% of patients to their pre-Lyme health status [R].
Another study reported that 36% of patients treated with 3 weeks of doxycycline experienced disease manifestations during the 3 to 6-month after the treatment (63 participants) [R].
In a study involving 1087 people with persistent Lyme disease, 72% rated their health as fair or poor compared with 16% of a general population of similar age. 39% percent had stopped working, and an additional 28% had reduced their work hours [R].
Is it Real?
According to the Infectious Diseases Society of America (IDSA), Lyme disease is ‘hard to catch and easy to cure’. Chronic Lyme infection is rare or nonexistent [R].
Those who say this syndrome is not real, suggest instead that patients are reporting symptoms commonly seen in the general population or those of a secondary condition such as fibromyalgia or chronic fatigue syndrome [R, R, R].
Sometimes, indeed, the symptoms are due to reinfection. In 17 patients, a DNA test showed that each of the subsequent episodes of rash was due to a new infection (presumably transmitted from a new tick bite) rather than a persistent chronic infection [R].
The International Lyme and Associated Diseases Society (ILADS), on the other hand, argues that Lyme disease is not rare. Furthermore, because it is spread by rodents, deer, and birds, it can be found in an around the world accompanied by other tick-borne co-infections that may complicate the disease [R].
Tick bites often go unnoticed and commercial laboratory testing for Lyme disease is inaccurate. Consequently, the disease is often not recognized and may persist in a large number of patients who are untreated or undertreated [R].
Animal models of Lyme disease in gerbils, hamsters, mice, dogs, monkeys, and horses provided evidence for persistent Lyme infection. In many of these models, infection persisted despite the equivalent of short-course antibiotic therapy [R, R, R].
Clinical and experimental studies have shown that tick-borne coinfections may also have chronic phases [R].
An NIH-sponsored study in humans found that uninfected ticks acquired B. burgdorferi DNA from feeding on a persistently symptomatic patient who had been treated for Lyme disease more than 1 year earlier [R].
The mechanisms responsible for persistent Lyme disease are not fully understood.
Borrelia can form cell-wall deficient forms, called cysts or round bodies, that can revert to viable forms of the bacteria. Resistance of cystic forms to antibiotic therapy has been documented [R].
Currently, the only antibiotic that reliably targets the cyst form of B. burgdorferi is metronidazole or its derivatives [R].
Another mechanism of chronic infection involves the formation of biofilm. These protect bacteria from the hostile host environment and facilitate persistent infection [R].
Chronic Lyme Disease Treatment
In fact, prolonged or repeated antibiotic therapy for persistent Lyme disease is potentially harmful and therefore discouraged [R].
Instead, because of the substantial overlap of symptoms with chronic fatigue syndrome and fibromyalgia, treatment recommendations mainly include nonpharmacological approaches: regular low-impact aerobic exercise programs, and cognitive behavioral therapy [R].
Exercise, regular activity, sleep and managing and reducing stress may all be beneficial in treating persistent Lyme disease [R].
Th1 and Th2 Response in Lyme Disease
After the body has recognized Borrelia, it increases NF-kappaB, resulting in the production of pro-inflammatory cytokines [R]. Cytokines IL-6, IL-10, IL-12, TNF-α, and IL-1β are released from innate immune system cells [R].
Subsequently, as T-helper cells are activated, they transform into a combination of Th1, Th2, Th17, or T regulatory cells, resulting in a polarized immune response [R].
Different individuals can mount immune responses with varying polarization, and researchers think that this polarization may influence the overall outcome of B. burgdorferi infection [R].
Children and adults have different immune responses to B. burgdorferi. Adults have a strong Th1 response (with high INF-gamma), whereas children seem to have a more balanced Th1/Th2 response (with both IFN-gamma and IL-4 elevated)[R, R].
People with nonchronic Lyme disease-associated nerve disorder (neuroborreliosis) have an initial increase in INF-gamma (Th1), followed by an increase in IL-4 (Th2), corresponding to bacterial clearance. On the other hand, in people who experience chronic nerve disorder, the initial IFN-gamma response is not followed by IL-4 elevation suggesting a persistent Th1 response [R].
Additionally, your genes have a say in how you react to infection. In animal studies, different strains of mice had reacted differently to B. burgdorferi [R].
These Help Against Borrelia:
Stevia is an effective agent against B. burgdorferi (in laboratory studies) [R].
3) Grapefruit Seed Extract
Grapefruit seed extract is powerful against both motile and cystic forms of B. burgdorferi in laboratory experiments [R].
4) Cistus creticus
Patients from self-help groups report considerable pain relief after ingestion of the rock rose – Cistus creticus. C. creticus leaf extracts reduce the total number of bacteria by 98% in laboratory experiments [R].
Calcitriol decreases arthritic damage and symptoms in mice infected with B. burgdorferi [R].
6) Omega-3 fatty acids
Omega-3 fatty acids can suppress chronic inflammatory and autoimmune diseases. Fish oil reduced the production of inflammatory molecules in mice infected with Borrelia [R].
7) Vitamin A
In forestry workers with antibodies against B. burgdorferi (78 infected subjects and 39 controls), blood vitamin A and E were significantly lower [R].
In fact, vitamin A deficiency predisposes the host for a strong inflammatory response. Mice with vitamin A deficiency had earlier and stronger IL-12, IFN-gamma, and TNF responses to B. burgdorferi [R].
Acupuncture, applied kinesiology, and breathing exercises were successful in treating a 9-year-old boy with facial paralysis due to Lyme disease [R].
These Help With Lyme Disease Symptoms:
You would want to boost the immune system while lowering inflammation. It is important to:
- Eat healthy food high in antioxidants (fresh fruits and veggies)
- Get enough sleep/rest
- Manage Stress. Even 2-3 years after Lyme disease, patients can have elevated cortisol responses (20 patients and 23 controls) [R].
These supplements may also be beneficial:
- Andrographis – anti-inflammatory, antibacterial, beneficial for the brain and helps with arthritis
- Ashwagandha – anti-inflammatory, enhances brain function, antibacterial
- Boswellia – anti-inflammatory, antibacterial, pain-reliever
- Probiotics – anti-inflammatory, improve mood and brain function, improve sleep, reduce fatigue, help with arthritis and pain, boost immunity
- Curcumin/Turmeric – anti-inflammatory, antibacterial, helps with arthritis
- Quercetin – anti-inflammatory, antibacterial, eases arthritis, enhances the immune system
- Vitamin D -anti-inflammatory, improves sleep, beneficial in arthritis
- Vitamin B6 – helps with inflammation, improves brain function and sleep, helps manage pain
- Magnesium – can relieve chronic fatigue syndrome, improves brain function
- Lithium – reduces inflammation, improves mood and brain function
- CoQ10 – improves fibromyalgia
- Green Tea – anti-inflammatory, antibacterial, improves brain function
- Theanine – improves brain function and sleep (but increases Th1)
- Alpha-Lipoic Acid – anti-inflammatory, helps manage pain
- Reishi – anti-inflammatory, improves sleep, enhances brain function and immune system
- Lion’s Mane – anti-inflammatory, antibacterial, improves brain function, may help with fatigue
- Oregano Oil – reduces inflammation
- Pau d’Arco – anti-inflammatory, antibacterial
- Resveratrol – antibacterial
- N-Acetyl Cysteine – decreases inflammation, improves mood and sleep
- Melatonin – improves sleep and brain function
Strategies To Fight Persistent Lyme Disease
If you have persistent Lyme disease, most likely you have an elevated Th1 response. You may benefit by trying some of the supplements/regimes that help lower Th1. Read more about them here.
You may also want to focus on targeting specific cytokines. All of these can be elevated by Lyme infection:
Finally, Borrelia makes biofilms [R, R, R]. You can learn more about biofilms and ways to decrease them here.
FDA warns against using bismacine (also known as chromacine), an injectable product that has been used by some to treat Lyme disease. Bismacine contains high amounts of bismuth, a heavy metal used in some medications taken by mouth to treat a bacterium that can cause stomach ulcers (Helicobacter pylori). It is not approved for use by injection [R].
There are one death report and several injury reports related to bismacine treatment. Possible effects of bismuth poisoning include heart and kidney failure [R].
Genes and SNPs Relevant to Lyme Disease
Following infection with B. burgdorferi, people with this gene variant may have an increased risk of developing chronic treatment-resistant arthritis [R].
An OspA Lyme vaccine might result in autoimmunity in these genetically predisposed individuals. Although causality is difficult to demonstrate, one study reported four male patients with this variant who developed autoimmune arthritis after receiving the LYMErix™ vaccine [R].
Other Borrelia Diseases
Relapsing fever is also caused by bacteria of the Borrelia group. It is transmitted by soft ticks or lice. However, in most respects, relapsing fever is a very severe, acute disease compared to Lyme disease [R].
It is endemic in the western United States, southern British Columbia, the plateau regions of Mexico, Central and South America, the Mediterranean, Central Asia, and throughout much of Africa [R].
In the United States, exposure sites typically are in limestone caves in central Texas and in forested areas at varying elevations in mountainous regions (Cascade, Rocky Mountain, San Bernardino, and Sierra Nevada ranges) [R].
The average incubation period is 7 days (range, 4 to more than 18 days) [R].
The fever attacks last from several hours to 4 days (up to 10 days), and are accompanied by chills, headache, nausea and vomiting, sweating, stomach pain, joint pain and cough. Diarrhea may occur in 25% of cases [R].
Persons with lice-transmitted relapsing fever are more likely to have jaundice, nervous disorders, red spots on the body, and blood-tinged sputum [R].
The average time between the first episode and the first relapse is 7 to 9 days. The patient may have symptoms such as malaise between fevers or may feel well [R].
Complications can include the liver, spleen, lung, heart, gut, eyes, or the brain [R].
There is a bunch of fever-associated diseases relapsing fever can be confused with. A history of travel, place of residence, and animal exposures is useful [R].
Relapsing fever bacteria are successfully treated with antibiotics [R].
Prevention includes avoiding rodent and tick-infested dwellings and infested natural sites, such as animal burrows or caves, rodent-proofing of homes, and chemical treatment of rodent-infested areas [R].
Borrelia Miyamotoi Disease
B. miyamotoi is transmitted by the same hard-bodied tick species that transmit Lyme disease [R].
B. miyamotoi infection should be checked for in patients with acute fever who have been exposed to ticks in a region where Lyme disease occurs [R].
Virtually all patients present with fever. The next most common signs and symptoms were chills, nausea and muscle and joint pain (30–60% of the patients). Rashes were observed in fewer than 10% of the patients [R].
Symptoms of the infection generally resolve within a week of the start of antibiotic therapy [R].
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