Borrelia miyamotoi, a relapsing fever borrelia, has symptoms similar to Lyme disease. Standard two-tiered testing for Lyme disease won't discover it. As per the report from the HHS Other Tick-borne Diseases and Co-infection Working Group:
"if an acute blood sample is received for confirmation of a diagnosis of B. miyamotoi infection, molecular detection assays for B. microti and A. phagocytophilum should also be performed (Molloy et al., 2015). Some Clinical Testing laboratories (CTLs) offer a tick-borne disease panel, including multiplex serological platforms, which may reduce the costs for added testing (Tokarz et al., 2018)....The lack of a gold standard for diagnosis of different Borrelia species makes producing accurate statistics difficult. Since B. miyamotoi disease (BMD) does not usually cross react with B. burgdorferi tests, antibody testing for Lyme is not an effective tool for discovering BMD, and antibodies to the GlpQ protein will not identify early disease but can instead be used in convalescent illness. A new approach by Koetsveld et al. (2018) increases sensitivity in early infection by adding the variable major protein (vmp) as a recombinant antigen for EIA. ". In our patients, co-infections are the rule. Those suffering with Lyme-like syndromes who test negative for Borrelia burgdorferi should be tested for a broad panel of tick-borne pathogens. Chapters 5 and 6 in "How Can I Get Better" discuss bacterial, viral and parasitic infections carried by ticks.
https://www.healthline.com/health-news/the-new-lyme-disease#5
Disclaimer: The views expressed are those of Dr Richard Horowitz, and do not represent the views of the Tick-Borne Disease Working Group, HHS or the United States
