Lyme Awareness Month: Part 1 Co-Infections


Tick borne infections are zoonotic, meaning that they are passed from an animal to a human. Small insects, or vectors like ticks, mosquitos and fleas transmit disease to animals and humans when they bite them. Ticks can carry many different viruses, bacteria, fungi and protozoans, and can transmit them with one bite. Lyme is the most common tick borne disease in the United States, but babesiosis, anaplasmosis, ehrlichiosis, tularemia and Rocky Mountain Spotted Fever are other ones. Disease that is acquired at the same time are known as co infections.


Co infections are common for most Lyme patients. A recently published study in the United States found that over 50% of Lyme patients had one co infection, with 30% having two or more. Similar rates were found in Canada. (Paige has Borrelia, Babesia, Ehrlichia, Brucela, Powassan Encephalitis, Epstein Bar, Cox Saki Virus, Brachyspira and Parvo. Along with a couple other viruses, heavy metal toxicity, candida and 3 strains of Lyme)


A person with Lyme co infections, usually experience more severe symptoms and recovery takes longer.


Babesia is a parasite with over 100 known species, but only a few cause concerns for humans. Babesia is a co infection to Lyme and can be potentially fatal. It mimics malaria and looks like malaria under a microscope. It is said that Lyme is the Great Imitator and Babesia is no different. Babesia infects the red blood cells like malaria.  The most common way to get Babesia is from a tick bite, but it can also be transmitted from a mother to her unborn child and through contaminated blood transfusions. It isn’t easily treated and can be deadly in patients with weakened immune systems and the elderly.


The severity of illness can vary from person to person. Most will have flu like symptoms including fevers, chills, sweats, headache, lethargy, body aches, nausea and fatigue. Babesia can also cause anemia since the parasite destroys red blood cells.

More than 40% of patients with Lyme Disease also have Babesia. These patients can have more severe symptoms and illness; and if they have additional co infections it just intensifies the longevity of the disease and its symptoms.  Patients have presented with atrial fibrillation, noncardiogenic pulmonary edema and anemia. Kidney and liver failure are a real concerns in patients with both Lyme and Babesia. Of those hospitalized for Babesiosis, 1 in 20 die.


Babesia is a symptom Merry Go Round. Symptoms come and go, sometimes several times throughout a day.

Babesia is difficult to diagnose with current testing. It is detected in as few as 1/3 of those tested.

Some other symptoms include:

Severe hot flashes, often wake up at night drenched with sweat. (Paige has this symptom pretty severe)

Thermal dysregulation, can’t get comfortable in your own skin. They can be hot, clammy and cold all at the same time. When Paige has one of her episodes we notice this. Her hands and feet are freezing, her body is warm and her head is hot and clammy. She also shakes with jackhammer like shivers but her body is warm/hot.


Babesia headaches are usually in the frontal region and behind one or both eyes. Some may think it is a sinus headache, but it isn’t. They are usually caused by inflamed meninges or high intracranial pressure. This is exactly where Paige gets her headaches/migraines. She said it feels like someone is stabbing her behind the eye. She does have brain swelling which we believe is causing these headaches.

The inflamed meninges can affect your autonomic nervous system. This can range from mood swings, insomnia, depression, anxiety, balance problems, dizziness and headaches. You can have all of these symptoms at once, or they can change day to day, hour to hour, but it seems like there is always a problem above your shoulders.

Heart irregularities are almost standard for Babesia. The organism can rest in your heart and cause issues with your heart, pulse and blood pressure. Paige’s symptoms started with severe chest pain and heart racing. Classic symptoms of Babesia.

Babesia can cause panic attack like symptoms, you feel like you can’t get enough air and it is terrifying. During these episodes your oxygenation is normal, as are your blood gasses. The doctors see that ‘labs’ are normal and say there is nothing wrong and misdiagnose as a panic attack. This happened twice at 2 different ER visits for Paige, she had an elevated heart rate, blood pressure and heart rate, but because she was getting enough oxygen they said it must be a panic attack.

Insomnia is also a major issue for people with Babesia. It can mean they can’t fall asleep at a decent your, or they can’t stay asleep or they get a fitful night’s sleep. Either way, they are not getting the rest that they need.




Ehrilichiosis is another bacterium that is transmitted by tick bites and is a co infection to Lyme Disease. It kills the white blood cells. If left untreated it can become severe and may require hospitalization. It is a very serious illness and can be fatal if not treated correctly, even in previously healthy people. The fatality rate of JUST Ehrlichia is 1.8%, this goes up with Lyme and other co infections (according to the CDC website)


Ehrlichia used to only be recognized as a veterinary pathogen, it wasn’t until 1986 that it was first identified in a human. The number of cases have grown significantly since that first report and currently stands at about 500 per year. However, like Lyme and other co infections, the rate of actual cases is presumed to be much greater than those reported.

Since the first reported case in humans wasn’t that long ago, the pathogen isn’t well understood yet. Most of the symptoms are non-specific which makes diagnosis hard. Like many of the other co infections there isn’t a simple blood test to diagnose Ehrlichia.

Anaplasma and Ehrlichia are so similar they are often grouped together. 

Symptoms include low platelet count, anemia, prolonged fever, headache, chills, nausea, confusion, muscle pain, elevated liver enzymes, kidney failure, seizures, coma, toxic shock like symptoms and breathing difficulties. Most cases of Ehrlichia are uncomplicated, but is can be a serious illness. Hospital rates among the symptomatic are 40-50% and fatalities run in the 2-3% range. Patients who are immunosuppressed are at greater risk for complications.




The Bartonella bacteria can cause several diseases in humans and is one of Lyme diseases most troublesome coinfection. It can be contracted through a tick bite or a cat scratch. There are 5 different strains of Bartonella in California and 19.2% off all ticks test positive for at least one strain. The Western Black-legged is the most common tick in California, and it carries bartonella. Knowing that this is a common co infection in Ca, Paige’s doctor was shocked that she didn’t test positive for it.  The bacterial lives primarily in the lining of blood vessels.

Symptoms can present as a mild infection or produce serious symptoms that affect the whole body. Like Lyme and other co infections, the more you have, the worse the symptoms will be. Some common symptoms include fever, fatigue, headaches and a rash, poor appetite, gastritis, abdominal, rash that resembles stretch marks, blurred vision, numbness in extremities, memory loss, balance problems, unsteady gait, tremors, eye irritation, bone pain, sores on the bottom of the feet, body aches, muscle pain, liver and spleen enlargement, anemia, shortness of breath, chest pain, palpitations, heart valve damage, abdominal pain, loose stools and swollen glands. Patients with both Borrelia and Bartonella seem to have more severe symptoms.


It is not uncommon for patients with both Lyme and Bartonella to have encephalitis, a brain disorder or disease. Up to 50% of patients who develop encephalopathy can have seizures, migraines and cognitive dysfunction. When the patient is immunocompromised, a high number of bacteria persists in the blood and tissues, and can cause ongoing symptoms. Chronic Lyme patients and patients with other co infections are all virtually immunocompromised.

Like Lyme and the other co infections, there is no easy or fool proof test to diagnose Bartonella. For those that are immunocompromised, false negatives occur often. The bacteria are very slow growing and come in different shapes, this makes it hard to isolate in the lab. The bacteria can live inside cells to protect themselves from antibiotics, which also makes it harder to kill.


Fleas and lice carry bartonella, but it is believed that only ticks can transmit it to humans. However, some think that body lice are responsible for ‘trench fever’ during WW1. Bartonella Quintana (trench fever) affected soldiers who lived in tight, desperate and debilitating conditions during the war. The symptoms are similar to those of the Lyme Co infection.

Cat Scratch Fever is another strain or Bartonella.

There is evidence that Bartonella can be passed to the fetus during pregnancy and to a partner during intimacy. (we will talk about these in more detail on a different day)


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