Common co-infections

A co-infection is a simultaneous infection by multiple pathogenic microorganisms’ species. In regards to Lyme disease, various tick-borne illnesses can be acquired via a single tick bite because saliva from a tick can carry various microbes/parasites and settle into organs and tissues. Co-infections are quite significant as they can trigger various pathological conditions, require special antibiotic combinations, and can significantly prolong the duration of antimicrobial therapy.

Why do we need to worry about identification of specific co-infections?
First, various tick-borne illnesses can cause problems which may not be attributed to the infectious processes at all. Some of these include anxiety, hallucination, shortness of breath of ‘unknown nature’, gastroparesis, unexplained obesity, postural orthostatic tachycardia syndrome (POTS). Merely treating the presented problem, for example, shortness of breath is doing nothing to fixing the underlying infection.

Second, specific co-infections may require different therapy from classical borreliosis treatment. Many times patients suffering from a co-infection are frequently labeled with ‘resistant Lyme disease’ because they are getting treated for Lyme disease, but they are not getting treated for the co-infection.

From a clinical standpoint, symptoms of co-infections to some degree can be similar to symptoms of Lyme disease. However, each of the individual co-infections has its own clinical signature.

Common co-infections frequently observed in Lyme patients include:

Anaplasmosis

Clinical presentations:
• Anemia
• Arthralgia
• Confusion
• Cough
• Diarrhea
• Elevated ESR and CRP
• Elevated liver enzymes ALT or AST
• Elevated serum creatinine
• Fever
• Headache
• Leukopenia (low white cell count)
• Lymphopenia (low lymphocyte count)
• Malaise
• Myalgia
• Nausea
• Rashes
• Stiff neck
• Thrombocytopenia (low platelet count)
• Vomiting

Babesiosis

Clinical presentations:
• Anemia
• Anxiety and panic attacks
• Chronic fatigue
• Coagulopathy (blood clot formation)
• Cognitive impairment
• Hallucination
• Headaches
• Hepatomegaly (liver enlargement)
• Leukopenia (low white cell count)
• Myalgia (muscle pain)
• Nausea
• Psychosis
• Renal insufficiency
• Shortness of breath
• Splenomegaly (spleen enlargement)
• Vomiting

Bartonellosis

Clinical presentations:
• Bell’s palsy
• Coagulopathy (blood clot formation)
• Deep bone pain
• Endocarditis
• Granulomatous conjunctivitis
• Headaches
• Hepatomegaly (liver enlargement)
• Lupus-like illness
• Lymphadenopathy
• Lytic bone lesions
• Optic neuritis
• Pneumonitis and pleural effusion
• Polycystic ovaries
• Recurrent canker sores
• Seizures
• Splenomegaly (spleen enlargement)
• Trigeminal neuralgia
• Unexplained obesity
• Unexplained weight loss
• Various skin lesions, including pink stria (linear skin lesions)

Ehrlichiosis

Clinical presentations:
• Abdominal pain
• Adult respiratory distress syndrome
• Congestive heart failure
• Cough
• Elevated liver enzymes
• Erythroderma that typically spares the face, palms, and soles of the feet
• Fever
• Headaches
• Hemophagocytic lymphohistiocytosis
• Hyponatremia
• Interstitial pneumonia
• Joint pain
• Leukopenia (low white cell count)
• Meningitis
• Meningoencephalitis
• Myalgia
• Nausea
• Seizures
• Thrombocytopenia (low platelet count)
• Vomiting

Ricketsiosis (Rocky Mountain Spotted Fever) 

Clinical presentations:
• Abdominal pain
• Conjunctival injection (red eyes)
• Fever
• Guillain-Barré syndrome
• Headaches
• Lack of appetite
• Muscle and joint pain
• Myocarditis
• Nausea
• Renal failure
• Skin rash that begins on the extremities and travels proximally to involve the trunk
• Thrombocytopenia (low platelet count)
• Vasculitis (inflammation of blood vessels)
• Vomiting

lyme co-infection symptom table