Screen and treat tick-borne co-infections

A single Ixodes persulcatus tick in the Russian Far East can simultaneously carry Borrelia, tick-borne encephalitis virus (TBEV), Anaplasma phagocytophilum, Ehrlichia muris, and Babesia microti, with co-infection rates of 4-12% per tick. Request a comprehensive co-infection panel including blood smear and PCR for Babesia, Anaplasma/Ehrlichia serology, and TBEV antibodies.

Why It Works

Co-infections alter the clinical presentation and can worsen outcomes. Babesia suppresses immune function, potentially allowing Borrelia to persist more effectively. Anaplasmosis requires doxycycline treatment (which fortunately overlaps with Lyme treatment), while Babesia requires atovaquone plus azithromycin. Unrecognized co-infections are a common reason for treatment failure.

Tips

• Doxycycline treats both Borrelia and Anaplasma/Ehrlichia simultaneously
• Babesia requires separate treatment: atovaquone 750 mg twice daily plus azithromycin 500-1000 mg on day 1, then 250 mg daily for 7-10 days
• TBE is viral and has no specific antiviral treatment; management is supportive
• Persistent symptoms despite adequate Lyme treatment should prompt co-infection investigation