Clinical research study
Chronic Coinfections in Patients Diagnosed with Chronic Lyme Disease: A Systematic Review

https://doi.org/10.1016/j.amjmed.2014.05.036Get rights and content

Abstract

Purpose

Often, the controversial diagnosis of chronic Lyme disease is given to patients with prolonged, medically unexplained physical symptoms. Many such patients also are treated for chronic coinfections with Babesia, Anaplasma, or Bartonella in the absence of typical presentations, objective clinical findings, or laboratory confirmation of active infection. We have undertaken a systematic review of the literature to evaluate several aspects of this practice.

Methods

Five systematic literature searches were performed using Boolean operators and the PubMed search engine.

Results

The literature searches did not demonstrate convincing evidence of: 1) chronic anaplasmosis infection; 2) treatment-responsive symptomatic chronic babesiosis in immunocompetent persons in the absence of fever, laboratory abnormalities, and detectable parasitemia; 3) either geographically widespread or treatment-responsive symptomatic chronic infection with Babesia duncani in the absence of fever, laboratory abnormalities, and detectable parasitemia; 4) tick-borne transmission of Bartonella species; or 5) simultaneous Lyme disease and Bartonella infection.

Conclusions

The medical literature does not support the diagnosis of chronic, atypical tick-borne coinfections in patients with chronic, nonspecific illnesses.

Section snippets

Methods

In order to identify relevant articles, we performed the following Boolean searches of the indexed medical literature using the PubMed search engine.

Search 1: Persistent, Chronic, or Recurrent Human Granulocytic Anaplasmosis

This search yielded 252 articles. The vast majority of scientific articles yielded by these search terms were animal studies. Many addressed microorganisms other than A. phagocytophilum. Ultimately, only 2 studies were appropriate for further review based on our inclusion criteria. In the first, 2 febrile asplenic patients were diagnosed with HGA based on blood smear examination.2 One developed neurologic symptoms including left-sided weakness, left hemi-neglect, and delirium within 12 days of

Discussion

There is no debate in the scientific community that Ixodes spp. ticks transmit a number of important human pathogens, and sometimes in combination. In addition to B. burgdorferi, the causative agent of Lyme disease, Ixodes ticks may transmit B. microti and other human Babesia species, A. phagocytophilum, tick-borne encephalitis virus, Powassan virus, and emerging pathogens such as Borrelia miyamotoi. These infections may occur in isolation or in various combinations, and it is well established

Conclusion

The Ixodes spp. ticks that transmit B. burgdorferi are capable vectors of several human pathogens. In all cases, however, these infections produce defined clinical syndromes that are corroborated by objective clinical and laboratory findings. This is true for well-established Babesia-Lyme and Anaplasma-Lyme coinfections. Treatment and diagnosis of chronic coinfections, however, is clearly not justifiable in the absence of convincing objective evidence that these infections are present and

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    Funding: PML was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number KL2TR001115. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

    Conflicts of Interest: GPW received research grants from the Centers for Disease Control and Prevention, National Institutes of Health, Immunetics, Inc., Bio-Rad, DiaSorin, Inc., and BioMerieux holds equity in Abbott. GPW was he was an expert witness in malpractice cases involving Lyme disease; an unpaid board member of the American Lyme Disease Foundation; expert witness regarding Lyme disease in a disciplinary action for the Missouri Board of Registration for the Healing Arts; and a consultant to Baxter for Lyme vaccine development. PML has no potential conflicts of interest to report.

    Authorship: Both authors had access to all data and took part in writing this manuscript.

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