Disease‐Specific Diagnosis of Coinfecting Tickborne Zoonoses: Babesiosis, Human Granulocytic Ehrlichiosis, and Lyme Disease

Abstract

To determine whether a unique group of clinical and laboratory manifestations characterize certain major deer tick-transmitted human pathogens in North America, we compared the symptoms, short-term complications, and laboratory test results of New England residents who became ill due to > or =1 of these pathogens. Patients completed a uniformly structured questionnaire and submitted blood samples for serologic and polymerase chain reaction (PCR) testing after developing symptoms of Lyme disease, human babesiosis, or human granulocytic ehrlichiosis (HGE). Complete blood count with thin blood smear, PCR, and immunoglobulin M antibody tests helped differentiate the acute manifestations of these diseases. Physicians should consider use of tests designed to diagnose babesiosis and HGE in patients with Lyme disease who experience a prolonged flulike illness that fails to respond to appropriate antiborrelial therapy.

Impact of Co-Infections in Lyme Disease

“…In this study leukopenia and thrombocytopenia were reported more frequently in HGA alone than in co-infections, even if this difference was not statistically significant [15]. In Literature conflicting data about the severity of co-infection compared to LD or HGA alone are available [7,10,17,18].…”

“…In contrast with other reports [33,36,37], Krause et al found that the presence of a co-infection does not help Bb to spread more rapidly into blood, skin, joint, nervous system and heart [10].…”

“…Since Bb, Anaplasma phagocitophilum and Babesia may be co-transmitted by Ixodes ticks bite, the clinical features of acute and chronic disease can be atypical, complex and variable [10].…”

“…In an original study, Krause et al [10] analysed clinical and laboratory features as well as short-term complications in 192 people living in New England who experienced infections due to Bb and or Babesia and Ehrlichia. The Authors found that erythema migrans is very peculiar of LD alone, whereas flu-like symptoms are more suggestive of LD concurrent with babesiosis and/or HGA.…”

“…However the actual burden of co-infections in the natural disease history has not been unravelled yet. When two or more pathogens infect a patient, clarifying which is the major responsible of the clinical pictures can be challenging, since LD can share common clinical features with other conditions transmitted by Ixodes ticks bite especially in early stages [3,9,10]. The difficulties in diagnosis and management of co-infections in LD are more related to late and chronic LD since co-infecting agents might cause chronic forms of diseases too [3,7].…”