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Lyme Disease Coinfections

Posted Aug 25 2008 3:36pm

So, you've been diagnosed with Lyme disease, but not getting well with your Lyme treatment regimen. If you and your doctor are wondering why you're not getting well, it's time to suspect a coinfection.

"Piroplasms are not bacteria, they are protozoans. Therefore, they will not be eradicated by any of the currently used Lyme treatment regimens. Therein lies the significance of co-infections — if a Lyme patient has been extensively treated yet is still ill, suspect a co-infection."

"Babesia infection is becoming more commonly recognized, especially in patients who already have Lyme Disease. It has been published that as many as 66% of Lyme patients show evidence of co-infection with Babesia. It has also been reported that Babesial infections can range in severity from mild, subclinical infection, to fulminant, potentially life-threatening illness. The more severe presentations are more likely to be seen in immunocompromised and elderly patients. Milder infections are often missed because the symptoms are incorrectly ascribed to Lyme. Babesial infections, even mild ones, may recrudesce and cause severe illness. This phenomenon has been reported to occur at any time, even up to several years after the initial infection."

Krause, PJ. Spielman, A, Telford, SR Persistent parasitemia after acute Babesiosis N Engl J Med 1998. 339:160

“Furthermore, physicians tend not to recognize Babesial infection in those who are co-infected with the agent of Lyme Disease, because Babesial symptoms tend to be ascribed to Lyme Disease.”

“Physicians caring for patients with moderate to severe Lyme disease should consider obtaining diagnostic tests for Babesiosis and possibly other tick-borne pathogens... especially in patients experiencing "atypical Lyme disease” or patients in whom the response to antibiotic treatment is delayed or absent.”
Canadian Lyme Disease Foundation

According to The International Lyme and Associated Diseases Society, the three most common coinfections with Lyme disease are Babesiosis , Bartonella , and Ehrlichiosis . Studies have shown these infections to be increasingly noted in patients with chronic Lyme disease (reference The ILADS Evidence-based guidelines for the management of Lyme disease).


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Lyme Info, Coinfections: A Synopsis

" Babesiosis

Explanation: Protozoa that invade, infect, and kill the red blood cells

Symptoms: Fatigue, night sweats, fever, chills, weakness, weight loss, nausea, abdominal pain, diarrhea, cough, shortness of breath, headache, neck and back stiffness, dark urine or blood in urine

Treatment: Atovaquone (Mepron) plus Azithromycin (Zithromax), Clindamycin and oral Quinine

Other: Alternative treatment may include Riamet or Artemisinin


Explanation: Bartonella spp. bacterium

Symptoms: Fever, chills, headache and severe pain in the tibia, weight loss, sore throat, papular or angiomatous rash

Treatment: Erythromycin, plus a Fluoroquinolone or Rifampin

Ehrlichiosis (HGE and HME)

Explanation: Rickettsiae that infect the white blood cells

Symptoms: Anemia, fever, chills, headache, muscle pain, rigors, gastrointestinal symptoms, anorexia, fatigue

Treatment: Doxycycline, Rifampin"

Here is another list, with a bit of variance in symptom description, of the same coinfections. Source:


Babesia is a protozoan spread by ticks, blood transfusion, and in utero. Despite there being 13 known forms to date, current testing only looks for two of them .

Air hunger






Imbalance without true vertigo

Mild encephalopathy

Shaking chills


Bartonella (Bartonellosis, also known as cat scratch fever)

Spread by bites from infected ticks and in utero

abnormal liver enzymes



flu-like malaise


hemolysis with anemia


high fever

immune deficiency





papular or angiomatous rash


sore throat


weakened immune response

Ehrlichia (Ehrlichiosis)

Bites from infected ticks

elevated liver enzymes



ongoing fatigue

persistent leukopenia


As therapy for these coinfections is changing rapidly as research and recognition is increasing, the above mentioned treatments should be discussed with your healthcare provider and should be researched prior to instigation.

In doing research regarding Lyme disease coinfections I found there to be an overwhelming amount of information available. Again, this should all be reviewed by you and your physician.


Canadian Lyme Disease Foundation

The International Lyme and Associated Diseases Society
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