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Overview of the many frequent co-infections accompanying Lyme Disease


Ehrlichia / Anaplasma
Anaplasma phgocytophilum (gram-negative, obligatory intracellular in granulocytes)
Vector: Ixodes ricinus
Spectrum of hosts: wild animals (e.g. deer), domestic animals, productive livestock, humans
Symptoms: (incubation period: days up to 4 weeks): Flu-like symptoms with fever, headaches and muscle pain with “sharp and stabbing, often located behind the eyes”, neurologic symptoms (duration 1 up to 60 days) up to lethal ending, sometimes diffuse erythema (reddening of the skin) including palms of hands and soles of feet
Risk factors: elderly people, severe basic underlying diseases, immune suppression
- Activity test: Elispot®-LTT (Lymphocytes Transformation Test)
- Ehrlichia-PCR in blood (EDTA-blood): direct detection
- Pathogen detection in Giemsa stain
- Antibodies for Ehrlichia-IgM and Ehrlichia-IgG: indirect detection

- Leucopenia / Thrombocytopenia / Anemia
- Transaminase increase


Babesia microti, Babesia divergens
Vector/Transmission: Ixodes ricinus, blood transfusion
Spectrum of hosts: wild animals (e.g. deer), domestic animals, productive animals, humans
Symptoms: (incubation period 5 days – 9 weeks): Sweating, neck stiffness, nausea, vomiting, loss of appetite, fatigue, feeling of weakness, constant exhaustion especially during stress, haemolytic anaemia, haemoglobinnuria, fever up to 40º C, shivering, sometimes hepatosplenomegaly, muscle pain, strong headaches, dizziness, coagulation dysfunction (blood-clotting disorder, hypercoagulability), stomach ache, emotional instability, mental dullness, kidney failure, dyspnoea, influenza-flu-like symptoms (up to a lethal level)
Risk factors: Splenectomia, HIV, immune suppression, organ transplantation, elderly people
- Babesia-PCR in blood (EDTA-blood): direct detection
- Blood smear: direct detection
- Antibodies of Babesia-IgM and Babesia-IgG: indirect detection


Bartonella henselae (gram-negative, optional intracellular in endothelial cells / Erythrocytes) and/or BLO = Bartonella like organisms
Vector/Transmission: surface wounds/scratch from cats, Ixodes ricinus
Symptoms: (incubation period 3 – 38 days): headache (80%), fatigue (100%), muscle twitches, tremors, cramps, shivering, fever in the mornings (30%, in thrusts up to 6 weeks, otherwise 1 – 3 weeks), swollen lymph nodes, arthralgia (often), myalgia, insomnia, depression, agitation, amentia, concentration and attention disorder, dizziness, restlessness, gastritis, intestinal problems, sore feet soles (especially in the morning), hypodermic nodules along the extremities, no or minimal joint pain (important according to J.J. Burrascano)
Severe progression: endocarditis, retinitis, epilepsy, aseptic meningitis, hepatosplenomegalia
Risk factors: immune suppression
- PCR on Bartonella in blood (EDTA-blood): direct detection
- Histology (hemangiome/lymphadenitis)
- Antibodies on bartonella henselae-IgM and bartonella henselae-IgG: indirect detection

- Elevated vascular endothelial growth factor (VEGF), only rarely increased


Rickettsia conorii, R. rickettsii, R. helvetica, R. slovaca, R. prowazekii (not gramstainable, obligatory intracellular in endothelial cells)
Vector/hosts: rodents, dogs, humans, Ixodes ricinus
Symptoms: (incubation period 5 - 7 days): fever, lymphadenitis, exanthema (roseola to macupapulous)
Complications: (app. 13%): peri-/myocarditis, renal insufficiency, pneumonia, encephalitis, gastrointestinal bleedings, anemia, hepatitis, myalgia
- PCR on Rickettsia in blood (EDTA-blood): direct detection
- Antibodies Rickettsia-IgM and Rickettsia-IgG: indirect detection 


Chlamydia pneumoniae
Chlamydophila pneumoniae (gram-negative, intracellular)
Transmission: airborne infection (aerogen), human to human, affection of epithelial cells of air passages
Symptoms: slight throat pain, hoarseness, sinusitis, atypical pneumonia, meningoencephalitis, bronchiolitis obliterans, myocarditis, Guillain-Barre-Syndrom
Post-infection Symptoms: (4-6 weeks): arthritis, tendovaginitis
Associations: e.g. Morbus Alzheimer, Multiple Sclerosis, Fibromyalgia, Chronic Fatigue Syndrome (CFS), problems with prostate gland, heart attacks, apoplectic stroke, arteriosclerosis
Risk factors: immunosuppression
- Activity test: Elispot-LTT (Lymphocytes transformation test)
- PCR on chlamydia pneumoniae in sputum/secretion of the throat: direct detection
- Antibodies on chlamydia pneumoniae-IgA and chlamydia pneumoniae-IgG: indirect detection 


Chlamydia trachomatis
Chlamydophila trachomatis (gram-negative, intracellular)
Transmission: sexual contact, human to human
Symptoms: cervicitis, sterility, urethritis, trachoma, acute conjunctivitis, lymphogranuloma venereum
Post-infection Symptoms: (4-6 weeks): arthritis, tendovaginitis
Risk factors: immunosuppression
- Activity determination: Elispot-LTT (Lymphocytes transformation test)
- Chlamydia trachomatis PCR in urine/urogenital smear: direct detection
- Antibodies on Chlamydia trachomatis-IgA and Chlamydia trachomatis-IgG: indirect detection 


Mycoplasma pneumoniae/fermentans (gram-positive, intracellular)
Transmission: airborne infection (aerogen), human to human
Symptoms: tiredness (100%), fever, joint pain, swollen joints, muscles pain, headache, insomnia, anxiety, emotional instability, lack of concentration, lack of alertness and memory, confusion
Risk factors: immunosuppression (e.g. AIDS), Chronic Fatigue Syndrome (CFS), "Gulf War Syndrome"
- Bacterial culture of special nutriment medium
- PCR on chlamydia pneumoniae in sputum/secretion: direct detection
- Antibodies on Mycoplasma pneumoniae-IgM, Mycoplasma pneumoniae-IgA and Mycoplasma pneumoniae-IgG: indirect detection 


Other potential coinfections include: Yersinia enterocolitica, Toxoplasma, Hepatitis C-Virus, Herpes simplex Virus, Typ I/II Epstein-Barr-Virus, HIV-Virus, Cytomegalie-Virus, Borna-Virus