Co-infections / Other Tick-Borne Diseases

This information was gathered from several sources, including the websites of the Centers for Disease Control (CDC), the Texas Department of State Health Services (TDSHS), lymedisease.org, (CALDA), PubMed Health, and the Minnesota Department of Health.

Ticks bites can be dangerous. Ticks can carry a variety of disease-causing bacteria and viruses, many still unknown. Some of these can be fatal if untreated, and they can be misdiagnosed if the physician does not consider vector borne disease. Many patients are unaware that a tick bite has occurred since ticks can be as small as a poppy seed. A rash is not always visible even though you might have been infected by a tick bite. Patients can be infected with a single infection or multiple infections, leading to more debilitating symptoms, intractable cases, and complicated presentations for a physician to diagnose. Different diseases are carried by ticks in other states and in other nations outside the U.S. People can contract these diseases either in Texas or while traveling outside the state. In severe cases of Lyme disease, patients should be tested for co-infections.

The following are the best known tick-borne diseases in addition to Lyme. Please bear in mind that this is not a complete list. The rarer diseases are not listed here, and more remain to be discovered and studied.

Rocky Mountain Spotted Fever

Rocky Mountain spotted fever (RMSF) is a potentially fatal disease caused by the bacterium Rickettsia rickettsii transmitted to humans by the bite of an infected tick. According to the CDC, it is not transmitted by the same species of ticks that transmit Lyme disease; however, patients in Texas have been known to be infected with both. RMSF can be carried by the American dog tick (Dermacentor variabilis), and according to the TDSHS, other ticks, including the lone star tick, black-legged ticks, and brown dog ticks may also carry it. Typical symptoms include: a sudden onset of high fever, headache, abdominal pain, vomiting, and muscle pain. The rash that gives RMSF its name may also develop, but is often absent in the first few days, and in some patients, never develops. If a rash appears, it will begin on the soles of the feet and the palms of the hands and spread rapidly over the whole body. RMSF can be severe or even fatal if not treated in the first few days of symptoms. Doxycycline is the treatment for adults and children of all ages, and is most effective if started before the fifth day of symptoms. The initial diagnosis must be made based on clinical signs and symptoms, and medical history, and can later be confirmed by using specialized laboratory tests. Unfortunately, doctors who have not seen a case of RMSF may not have the experience necessary to make a clinical diagnosis. If patients suspect they have been bitten by a tick, this information can be critical to obtaining the correct treatment. If you have been bitten by a tick and develop a high fever within two weeks of the bite, or as early as 3 days after the bite, seek medical help immediately and inform the physician that you have been bitten by a tick.
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Ehrlichea

Ehrlichea can cause fatal infections, particularly in the elderly or people with immune suppression. There are two kinds of ehrlichiosis that affect humans, both transmitted by tick bites. HME or human monocytic ehrlichiosis infects the monocytes, white blood cells that play multiple roles in immune function. HGE, human granulocytic ehrlichiosis, which has been renamed human anaplasmosis (HA), infects the granulocytes, different white blood cells that comprise the majority of white blood cells in the body. Other ehrlichea species that have not yet been identified are also carried by ticks. It is thought that HME is transmitted by the lone star tick and HA by deer ticks. HA is known to infect cats, dogs, cattle, sheep and horses in addition to humans. The symptoms of HME and HA are the same: a sudden high fever accompanied by headache, fatigue and muscle aches. Laboratory tests in advanced cases may show low white blood cell counts, low platelets, anemia, elevated liver enzymes, kidney failure and respiratory insufficiency, but in early infection, no abnormal blood counts may show. Alternatively, since there are tests for only these two of the many species of Ehrlichea, a patient may test negative for Ehrlichea, yet develop some of the laboratory deficiencies commonly caused by it. If this is the case, or if a patient does not respond well to treatment for Lyme disease, ehrlichiosis should be considered.
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Babesia

Babesiosis is a malaria-like disease caused by a parasite, or piroplasm, spread only by ticks, blood transfusion or childbirth. The most likely piroplasm to cause babesiosis in Texans is Babesia microti, but at least 20 variants of Babesia have been discovered. Babesia attacks the red blood cells and can be fatal in humans with missing spleens, the elderly, and people with weak immune systems. Symptoms are like the symptoms of Lyme disease, but more often start with a higher fever and chills. Later symptoms include nausea and vomiting, fatigue, drenching sweats, and muscle aches. Complications of Babesia can be very low blood pressure, severe hemolytic anemia (a breakdown of red blood cells), liver problems, and kidney failure. If Babesia is present in addition to Lyme, a patient may exhibit fully disseminated symptoms much sooner. Diagnosis of Babesia can be difficult. A blood smear examined under a microscope may reveal the organism in red blood cells, but only during the first two weeks of infection. A PCR test (polymerase chain reaction) may detect Babesia DNA in the blood. The FISH (Fluorescent In-Situ Hybridization) assay may detect the ribosomal RNA of Babesia in a thin blood smear. Treatment for Babesia is different from treatment for Lyme and includes two anti-parasitical drugs, Mepron and an erythromycin-type antibiotic (azithromycin, clarithromycin, telithromycin). Longer term cases may require more than one course of treatment.
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Bartonella

Bartonella is a type of bacteria that can be transmitted by different insect vectors, including ticks, fleas, mosquitos and sand flies. Many variants are known to exist, and of these 8 are known to infect humans. Different species of Bartonella may be found in different hosts, including rats, mice, squirrels, and domestic cats. Bartonella henselae is best known as cat scratch fever, when transmitted to humans via a cat scratch, but it can also cause Bacillary angiomatosis, Peliosis hepatic, Endocarditis, Bacteremia with fever and Neuroretinitis. Bartonella is not discussed as a tick-borne disease on either the CDC website or the TDSHS website, but many Lyme patients have been found infected with Bartonella as well. Also, some Bartonella patients have been bitten by a tick with no exposure to cats. Bartonella is often mild. Early signs can be fever, fatigue, headache, low appetite, and an unusual streaked rash, with swollen glands around the head, neck and arms being typical. Chronic disease may lead to recurring neurological symptoms such as shortness of breath, memory loss, muscle weakness, and fatigue. When Lyme and Bartonella are both present, more severe neurological symptoms, gastritis, lower abdominal pain, sore soles of the feet, tender subcutaneous nodules along the extremities, and sore throat have been reported. Diagnosis of Bartonella is complicated by the insensitivity of PCR, tissue biopsy and standard blood tests. Treatment for vector-borne Bartonella may require different antibiotics from the erythromycin and doxycycline which are often successful in cases of cat scratch fever. Research at North Carolina State University has recently been published in Emerging Infectious Diseases showing that Bartonella may be implicated in human rheumatoid illnesses, such as arthritis. Testing found several Bartonella species in the patients, including the first documentation in humans of B. melophagi, a newly discovered Bartonella species, whose most likely host is sheep. A rapid expansion in known species of Bartonella has occurred primarily as a result of the research conducted by Edward Breitschwerdt, MD, and Dr. Ricardo Maggi at NC State, who have also discovered that some species of Bartonella can be transmitted to human fetuses by an infected mother, leading to chronic illness or infant death and raising the possibility of infection-caused birth defects.
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Master's Disease (Southern Tick-Associated Rash Illness or STARI)

STARI was discovered by Dr. Ed Masters of Missouri, who had patients with Lyme disease symptoms who tested negative for Lyme. He discovered a strain of Borrelia that was found to exist in at least 9 states and most commonly carried by the lone star tick, so called because of the white spot on its back, B. lonestari. This tick has been found in half the states of the U.S. and on birds migrating to Canada. Adult lone star ticks are larger than deer ticks, but the nymphal stage is smaller than a poppy seed. Standard blood tests for Lyme will not detect STARI, so patients with symptoms of Lyme disease who have tested negative and or been denied treatment for Lyme should find a doctor capable of making a clinical diagnosis of STARI. Since currently available tests cannot detect STARI, many Texas patients are likely to have been overlooked. Since both Lyme and STARI are caused by Borrelia, symptoms and treatment are largely the same. The CDC does not acknowledge that STARI can cause the same long-term debilitations as Lyme, but little research has been done, largely because with the absence of an easy test, confirming a case of STARI is very difficult.
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Mycoplasma

Mycoplasma are the smallest known free-living organisms. They invade the cells and disrupt the immune system. At least 17 species of mycoplasma have been found in humans, including M. pneumoniae, the cause of bronchitis and walking pneumonia. Symptoms include fatigue, musculoskeletal symptoms, and cognitive problems. Mycoplasma can be successfully treated with antibiotics.
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Powassan (POW)

POW is a virus related to some mosquito viruses, such as West Nile virus. It was named for Powassan, Ontario, where it was first discovered in the 1950s. Although it is unlikely that a Texan will be infected with POW in Texas, travelers should be aware of its presence in northern states, Canada, and Northern Asia. Infection is most likely to occur from May to October. It is carried by Ixodes scapularis, the black-legged deer tick that is the most common carrier of Lyme. A second form of POW is carried by Ixodes cookie, a tick that feeds on woodchucks and is believed to bite humans very rarely. A study with mice shows that it may take only minutes for a tick to transmit POW to a human. POW virus infects the central nervous system and causes encephalitis (inflammation of the brain) and meningitis (inflammation of the membranes surrounding the brain and spinal cord). Symptoms include fever, headache, vomiting, weakness, confusion, loss of coordination, difficulty with speech and memory loss. Encephalitis and meningitis are serious illnesses and often require hospital care.
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Tick-Borne Relapsing fever

Tick-borne relapsing fever (TBRF) is caused by the spirochetes Borrelia duttoni, Borrelia hermsii, and Borrelia parkerii and carried by soft (Omithodoros) ticks in the Western States, Canada, Spain, Northern Africa, and Asia. (A second form of relapsing fever is transmitted by lice (LBRF).) As its name suggests, it is characterized by cycles of high fevers, which begin within 2 weeks of infection, last up to 3 days, and recur every 2 weeks or less. The fever episodes end with shaking chills, intense sweating, falling body temperature, and low blood pressure. Up to 10% of cases can result in death. In the case of LBRF, it ranges from 10 to 70%. If untreated, TBRF may lead to seizures, stupor and/or coma. The spirochetes can invade the heart and liver, leading to myocarditis and hepatitis, respectively. Other possible complications include widespread bleeding and pneumonia. A clinical diagnosis is usually made on the basis of the cycling fevers culminating in a crisis and the patient's exposure to ticks or lice in an endemic area. Tests may include a blood smear to look for the cause of the infection or blood antibody tests, but as with Lyme disease, these are often unreliable. Treatment involves the use of antibiotics. In the case of a high fever that recurs within two weeks, see a doctor immediately.
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Tularemia

Tularemia (rabbit fever) is caused by the bacteria Francisella tularensis. It is common in rodents and can be transmitted to humans via the bite of an infected tick, horsefly or mosquito, breathing in infected dirt or plant material, eating infected meat, or direct contact through a break in the skin with an infected animal. Symptoms can include fever, chills, headache, joint stiffness, mouth sores, sore throat, skin ulcers, swollen and painful lymph nodes, inflamed eyes, diarrhea, vomiting, and pneumonia. Other complications include bone infection, pericarditis (infection of the sac around the heart), and meningitis. Tularemia may be detected by blood culture for tularemia bacteria, antibody tests to the infection, chest x-ray, and/or PCR test of a sample from a skin ulcer. It is usually treated with antibiotics, streptomycin along with tetracycline.
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Morgellons Disease

Morgellons is a multi-symptom disease that is just now starting to be researched and understood. Its primary symptoms include: spontaneously erupting skin lesions, sensation of crawling, biting on and under the skin, appearance of blue, black or red fibers and granules beneath and/or extruding from the skin, fatigue, short-term memory loss, attention deficit, bipolar or obsessive-compulsive disorders, impaired thought processing (brain fog), depression and feelings of isolation. It is frequently misdiagnosed as delusional parasitosis or an obsessive picking disorder. Most cases are from specific geographical regions, including California, Texas, and Florida, although cases have been reported from all 50 states. The causative factor of Morgellons has not been discovered, and it is not known for certain how it is transmitted. Some doctors believe it is related to an infectious agent, possibly in the same family as Lyme disease. What is known is that 97% of Morgellons patients also have Lyme disease. Medical research on Morgellons was only started in earnest by Dr. Randy Wymore at Oklahoma State University in 2005. As more is discovered about this painful disease, we will post it here.
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