A tick bite may not only deliver Borrelia but also co-infections which further complicates the picture.

There are many known but the most significant is Babesia, which has the highest incidence. In the USA, B. microti is more common, but B. duncani is also growing in number.

Babesia

60% of Lyme sufferers also have Babesia (Dr J. Schaller, Babesia 2008). Babesia is a protozoa like malaria and it has a more complex life cycle.

For more detailed explanation visit: http://www.stanford.edu/group/parasites/ParaSites2006/Babesiosis/lifecycle.html

In the host Babesia survives in red blood cells. The symptoms of Babesiosis following a tick bite can start early or develop later. They include tiredness, loss of appetite, general ill feeling, fever, drenching sweats, muscle aches and headache.

The diagnosis using clinical tests includes a blood test to check for antibodies to Babesia. The test is not available for people in Australia – it is only available for cattle as it is considered a cattle disease though humans can also be a host. The other test involves visualisation of Babesia in red blood cells under the microscope.

If untreated and if the patient is immunosuppressed then complications can occur. The complications include low blood pressure, liver problems, haemolytic anaemia etc. The existence of Borrelia with Babesia creates an even more conducive environment for Borrelia to penetrate because Babesia creates a more anaerobic environment for Borrelia to proliferate.

For more information on Babesia treatment visit: http://emedicine.medscape.com/article/780914-treatment

Please note this link only considers scenarios where the patient has only one infection.

Treatment involves anti-protozoal medications. If Borrelia is present the common medication is Atovaquone with azithromycin or clindamycin. The killing process can give rise to a Herxheimer reaction. The dose needs to be tailored to the patient as the patient is already taking antibiotics for Borreliosis.

Rickettsia

Rickettsia is a very common in Australian ticks, fleas and mites.

The Aust Rickettsia Lab link provides testing and explaination of different types of Rickettsia. For further information visit: http://www.diagnosticlab.org.au/index.php

Rickettsia can be divided into three groups:

1. Spotted fever - R.australis, Queensland tick typhus
2. Epidemic typhus group - R.typhi
3. Scrub typhus - R. tsutsugamushi

Normally if the infection is rickettsia alone then a course of antibiotics such as doxycycline will help it to get the infection under control but when Rickettsia is present with Borrelia, Babesia and Ehrlichia then the infection becomes chronic and the patient requires monitoring and extended antibiotic treatment.

Rickettsia enters the body through a tick or flea or mite bite and spreads from cell to cell. Prominent effects include increased vascular permeability, water retention into tissues, reduced blood volume, low blood pressure and low albumin with low blood osmolarity.

Ehrlichlia and Anaplasma

Ehrlichlia and Anaplasma are very similar microorganisms. Ehrlichlia is a tick-borne bacterial infection of the family Anaplasmataceae genera Ehrlichlia. Anaplasma is of the same family but part of genera Anaplasma. The most common in humans is Anaplasma phagocytophilum – human granulocytic anaplasma and the other common one is E. chaffeensis – human monocytic ehrlichosis.

Symptoms include headaches, muscle aches and fatigue. Because white blood cells are infected the ability to mount an immune response to Borrelia and other Lyme co-infections becomes very limited. Hence the importance of treating co-infections cannot be stressed enough.

Doxycycline is the drug of choice in this co-infection too.

For further information on clinical symptoms visit: http://emedicine.medscape.com/article/235839-overview

NOTE: These links only consider scenerios where the patient has one infection.

Bartonella

Bartonella is an emerging pathogen. There are twenty subspecies. Nine have been shown to cause illness in humans (Woolley et al, 2007). It is transmitted by lice, fleas, ticks and infected cats. Other common names are cat-scratch disease and trench fever in WWI. B. quintana is more likely to cause endocarditis and angiomatosis. The red blood cells are the reservoir in the host. Here Bartonella multiples and destroys these cells and then goes on to infect endothelial cells. B. henselae, B. vinsonii also cause infection in humans causing cat scratch disease.

For further information visit: http://emedicine.medscape.com/article/213169-overview

NOTE: These links only consider scenerios where the patient has one infection.

Opportunistic or Secondary Infections

Opportunistic infections can appear because the immune system is overwhelmed by borreliosis and co-infections. The opportunistic infections further complicate the clinical picture and treatment.

The opportunistic infections that predominate depend on the patient’s previous micro-organism exposure and load.For example Chlamydia pneumoniae is believed to be very common. Some go on to develop community-acquired pneumonia which can be controlled after two weeks of treatment but it is not eradicated, and the spread of infection can continue.

Chalmydia

C. pneumoniae exists in two phases - the elementary body (extracellular) is transported via moist airborne droplets between hosts and into the lungs. Once inside the cell it becomes the reticulate body (intracellular) which is very difficult to eradicate. C. pneumoniae is implicated in sarcoidosis, lung cancer, chronic obstructive pulmonary disease (COPD), asthma, atherosclerosis and Alzheimer’s.

The main symptoms are pharyngitis, bronchitis, atypical pneumonia, cough, fever, difficulty breathing, whitening of the back of the tongue and nasal congestion. When C. pneumoniae symptoms surface in the presence of Borrelia and co-infections, it is very hard to differentiate between specific symptoms of each pathogen due to overlap so the individual infectious processes becomes even more complicated. Fortunately the antibiotics that kill Borrelia are also effective against C. pneumoniae.

For an excellent site about information and help with Chylamydia infections and complications visit: http://www.cpnhelp.org

For a general information website (that does not go in debt into the infection) visit: http://emedicine.medscape.com/article/297351-overview

NOTE: This is a general information website and only considers a mono infection scenario.

Mycoplasma

Mycoplasma is the smallest of the cell-wall-free bacteria. It has sterols in its cell membrane requiring cholesterol for growth and stability. These sterols are not present in other bacteria and virus. Also it utilises dead host cells conveniently destroyed by borreliosis and/or other infections, ie it is saphrotrophic like mushrooms. It can cause pneumonia, neurological symptoms such as encephalitis, meningitis, brain-stem dysfunction, cerebellar dysfunction.

Mycoplasma fermentans is thought to be important in Lyme co-infections especially with neuroborreliosis.

See Prof. Garth Nicolson’s institute website http://www.immed.org/index.htm

For more general information visit:
http://emedicine.medscape.com/article/966785-overview

Some co-infections and opportunistic infections are known, but there are probably many that have not been characterised ie are of unknown aetiology.

Prevention of infections is better than trying to find a cure.