Daniel Cameron MD, May Awareness Guest Blog – Borrelia Miyamotoi

May Awareness LDA Guest Blogger

Cameron picture without background

Dr. Daniel Cameron graduated from the University of Minnesota School of Medicine and their Department of Epidemiology. He completed residencies at both Beth Israel Medical Center and Mt. Sinai in New York City.

Dr. Daniel Cameron has led International Lyme and Associated Disease Society (ILADS) twice as their president. He is widely recognized as author of ILADS practice guidelines, Lyme disease science blogs, and Inside Lyme Podcasts. His latest book is titled, “An Expert’s Guide on Navigating Lyme disease.”

He continues to see patients in his private practice in Mt. Kisco, New York.

Borrelia Miyamotoi

Borrelia miyamotoi (B. miyamotoi)
Borrelia miyamotoi (B. miyamotoi) can be transmitted by the same tick that carries Borrelia burgdorferi, the Lyme disease pathogen. B. miyamotoi can lead to B. miyamotoi disease.

Where is B. miyamotoi found?
B. miyamotoi was first identified in Japan in 1995. In the United States, as many as 15.4% of the blacklegged ticks were found to be infected with B. miyamotoi, compared with up to 4% in Europe and Japan (1). Ten percent of individuals living in Manitoba, Canada were seropositive for B. miyamotoi (2). “Seroprevalence studies in New England suggest that B. miyamotoi infection may be as common as anaplasmosis and babesiosis,” wrote Kadkhoda and colleagues (2). 

What stage of deer ticks transmit B. miyamotoi?
B. miyamotoi can be transmitted from mother ticks through their eggs to the larva. As a result, B. miyamotoi can be transmitted from all stages of a tick including the larval stage.

How fast can B. miyamotoi be transmitted?
B. miyamotoi can be transmitted to mice initially through the salivary glands and subsequently transmitted through the midgut. “B. miyamotoi can be transmitted 10% of the time within the first 24 hours of attachment, increasing steadily to reach 73% for a complete feeding. Thus, transmission of B. miyamotoi is more rapid than transmission of B. burgdorferi,” wrote Della-Giustina (3). 

Symptoms and signs of B. miyamotoi
Although B. miyamotoi is a type of relapsing fever, only 2 out of 50 patients infected with B. miyamotoi actually exhibited a relapsing fever (4). Instead, the symptoms include fever, fatigue, sleepiness, chills, muscle and joint stiffness, aches and pains, and nausea (5). Only 11% of B. miyamotoi patients presented with an erythema migrans rash. Some patients present with an elevated liver test, low white count, and abnormal liver tests that have been described in Anaplasmosis, another tick-borne illness.

Immunocompromised individuals may experience reduced cognition, disturbed gait, memory deficits, confusion, and other neurological deficiencies resultant of meningoencephalitis, wrote Cleveland and colleagues (5). The authors added, “Additionally, hearing loss, weight loss, uveitis, iritis, neck stiffness, and photophobia have been reported,” the authors wrote. The symptoms can be severe enough to lead to hospitalization.

Making the diagnosis
It can be difficult to diagnose B. miyamotoi. A polymerase chain reaction (PCR) testing of blood and cerebrospinal fluid for the B. miyamotoi GlpQ enzyme has been used. “Serologic testing using the rGlpQ EIA seems insensitive in diagnosing an acute B. miyamotoi was positive for IgG or IgM in only 16% of the case patient samples at the time of clinical presentation,” wrote Molloy (4). It can also be hard to interpret these tests, as they may cross-react to other spirochetes.

Treatment of B. miyamotoi
The best treatment needs to be determined. Doxycycline and ceftriaxone have been prescribed given their use in relapsing fever. “In vitro analysis has shown the susceptibility of B. miyamotoi to ceftriaxone, azithromycin, and doxycycline, with resistance to amoxicillin,” wrote Della-Giustina and colleagues (3). “Ampicillin, azithromycin, and vancomycin, or a combination thereof, have also been used to treat BMD,” wrote Cleveland and colleagues (5).

Citations
1.Koetsveld J, Draga ROP, Wagemakers A, et al. In Vitro Susceptibility of the Relapsing-Fever Spirochete Borrelia miyamotoi to Antimicrobial Agents. Antimicrob Agents Chemother. Sep 2017;61(9)doi:10.1128/AAC.00535-17

2Kadkhoda K, Dumouchel C, Brancato J, Gretchen A, Krause PJ. Human seroprevalence of Borrelia miyamotoi in Manitoba, Canada, in 2011-2014: a cross-sectional study. CMAJ Open. Sep 6 2017;5(3):E690-E693. doi:10.9778/cmajo.20170070
3Della-Giustina D, Duke C, Goldflam K. Underrecognized Tickborne Illnesses: Borrelia Miyamotoi and Powassan Virus. Wilderness Environ Med. Jun 2021;32(2):240-246. doi:10.1016/j.wem.2021.01.005
4Molloy PJ, Telford SR, 3rd, Chowdri HR, et al. Borrelia miyamotoi Disease in the Northeastern United States: A Case Series. Ann Intern Med. Jul 21 2015;163(2):91-8. doi:10.7326/M15-0333
5Cleveland DW, Anderson CC, Brissette CA. Borrelia miyamotoi: A Comprehensive Review. Pathogens. Feb 7 2023;12(2)doi:10.3390/pathogens12020267