Lyme disease is frequently accompanied by co-infections which may go unrecognised and untreated, exacerbating the symptoms of Lyme disease and even thwarting successful treatment.
The most commonly noted co-infections in Lyme disease are caused by various species of Bartonella, primarily Bartonella henselae, Chlamydia trachomatis, Chlamydophila pneumoniae, Yersinia enterocolitica, and Mycoplasma pneumoniae.
Mycoplasmosis, was found in 36% of patients with Lyme disease in a recent review by Berghoff (2012) but this co-infection of Lyme disease is often overlooked, with potentially dangerous consequences. Symptoms of Mycoplasmosis may be similar to those of Lyme disease, making it unlikely that a physician unfamiliar with the likelihood of co-infection will carry out the relevant tests. Co-infections with Lyme disease can occur as a result of the same tick bite or sexual transmission, as well as being transmitted through an alternative vector or method.
Lyme Co-Infection with Mycoplasmosis – Overlapping Symptoms
Mycoplasmosis can present with very similar symptoms to those of Lyme disease, including:
- Central nervous system dysfunction and nervous system issues
- Musculoskeletal problems (e.g. joint pain, and muscle aches)
- Heart problems (e.g. myocarditis, palpitations)
- Kidney problems
- Vision disturbances (e.g. uveitis, conjunctivitis, optic neuritis)
- Genitourinary symptoms
- Reactive arthritis
- Skin lesions
- Gastrointestinal problems
- Headaches, fatigue, lethargy
- Guillan-Barré syndrome
Co-infections of Lyme disease not only cause their own set of symptoms they might also make existing symptoms of Lyme disease worse by altering immune system activity. This can cause resistance to antibiotic therapy and affect test results, especially in cases of multiple co-infections.
In late-stage Lyme disease new co-infections may be missed. Blood tests may not be ideal for diagnosis in such cases, as residual antibodies from an earlier infection may cloud the diagnostic process. Synovial fluid may offer an alternative testing opportunity to detect mycoplasma infection.
Testing for Mycoplasmosis can be difficult as it takes several weeks for antibodies to build up (like with Lyme), and seropositivity does not necessarily indicate active infection or symptomatic disease. Polymerase chain reaction (PCR) testing can be done for Mycoplasmosis but it is difficult and is not routinely used. Likewise, the lymphocyte transformation test is not routinely used for diagnosing Mycoplasmosis, nor has it been validated for such use.
Respiratory Symptoms of Mycoplasmosis
Mycoplasmosis is the most important pathogen of atypical pneumonia but this respiratory issue only occurs in around 3-10% of those infected with Mycoplasma pneumoniae. Symptoms to watch out for if co-infection with Lyme disease is suspected include:
- Banal bronchitis
Positive blood tests along with medical history, current symptoms and signs of infection are all part of diagnosing Mycoplasmosis as a co-infection of Lyme disease and both infections can be treated successfully with doxycycline, the most commonly used Lyme disease antibiotic.
Treating Co-infections with Lyme Disease
You might be wondering if it really matters is Lyme disease is co-existing with other infections as antibiotic treatment that eradicates Lyme will also get rid of other undesirable organisms, right? Not quite. Some antibiotics do not work on both Lyme disease and its many co-infections or a longer course of treatment or treatment with additional drugs may be necessary for successful treatment.
Tetracyclines, macrolides, and some quinolones are the only antibiotics that have been used successfully to treat both Lyme disease and Mycoplasmosis. Cephalosporins and carbapenems do not appear to work against Mycoplasmosis, while neither infection is responsive to trimethoprim and sulfamethoxazole, or rifampicin (which may be used to treat other co-infections such as Bartonella, Chlamydophila pneumoniae and Chlamydia trachomatis.
As such, third generation cephalosporins should only be considered appropriate in cases of Lyme disease with no signs of co-infection. The same applies to carbapenems, except in the case of diagnosed co-infection with Yersinia enterocolitica which also responds to these types of medications. Tetracyclines and macrolides are almost always indicated for Lyme disease where co-infections are suspected or confirmed, while quinolones are usually reserved for alternative treatment if tetracyclines and macrolides are contraindicated.
Walter Berghoff, Chronic Lyme Disease and Co-infections: Differential Diagnosis, Open Neurol J. 2012; 6: 158–178.