Borrelia miyamotoi (BMD) relapsing fever group spirochetes are increasing in numbers in ticks in the United States
Dr. Richard Horowitz
Borrelia
miyamotoi (BMD) relapsing fever group spirochetes are increasing in
numbers in ticks in the United States. This spirochete can be
transmitted transovarially from the
mother tick directly to her eggs, between 6-73% of the time, increasing
the prevalence of infected ticks. This article discusses the
transmission time for Bm disease, concluding that "single I. scapularis
nymphs effectively transmit B. miyamotoi relapsing fever group
spirochetes while feeding..and that transmission can occur within the
first 24 hours of nymphal attachment, with the probability of
transmission increasing with the duration of nymphal attachment.".
Clinicians therefore need to be aware that infection is possible during
the first 24 hours of tick feeding, similar to Lyme disease spirochetes
(if they are in the salivary glands of infected ticks).
Since standard Lyme testing will not pick up Borrelia miyamotoi
infection, clinicians need to be vigilant for clinical presentations
that can be confused with viral infections, i.e., high fever, chills,
marked headache, and myalgia (muscle pains) or arthralgia (joint pains).
Some patients have required hospitalization secondary to the severity
of the illness. Elevated liver enzyme levels, neutropenia (low
neutrophil counts), and thrombocytopenia (low platelet counts) can also
be seen, resembling an infection with Anaplasma/Ehrlichia (and BMD does
respond to treatment with doxycycline). In prior scientific
publications, only 16% of patients presenting with BMD were seropositive
for IgG and/or IgM antibody to B. miyamotoi rGlpQ, so PCR should also
be considered in patients with a history of tick bites and appropriate
clinical manifestations ( Borrelia miyamotoi Disease in the Northeastern
United States: A Case Series. Philip J. Molloy, MD et al. Ann Int Med,
21 July 2015)
