Identification of co-infections in a cohort of patients diagnosed with Lyme Disease

Objective: Lyme disease (LD) is the most common zoonosis in most
regions of the world. The disease can be difficult to diagnose due to the
wide range of symptoms that patients present with. There is extensive
evidence of polymicrobial infections in Ticks, but very little data on
multiple infections in humans . The purpose of this study was to
investigate the occurrence of  co-infecting pathogens, and to
provide data to help manage the diagnosis and treatment of each case.
Design: This was a prospective observational study of Lyme
Disease and co-infections. Setting: The study was conducted at a
private Infectious Disease clinic in Dublin Ireland and approved 
by the Mater Misericordiae University Hospital Research Ethics committee.
Participants: Blood samples were taken prior to a first
consultation from a group of 54 patients with suspected Lyme disease
during the period 8/12/2016 to 7/2/2017. Samples were tested for a group
of infections at ArminLabs, Augsburg, Germany. Results: A total
of 29 patients had LD confirmed with positive serology and 90% of these
had one of more co-infections. 33% had one of the target diseases and 57%
had two or more co-infections. Three patients (10%) had 4 co-infections
along with Borrelia. The most common co-infection was Chlamydia pneumoniae
with 76% of LD patients positive, then Anaplasma phagocytophilum
(ehrlichia) 38%, Mycoplasma pneumoniae 24%, Epstein-Barr 21%, Herpes
simplex 10% and with cytomegalovirus, with Yersinia, varicella-zoster,
toxoplasmosis and Chlamydia trachomatis infections  identified in
less than 10% of cases. Conclusions: Very high rates of
co-infections (90%) were found in patients diagnosed with LD based on
symptoms and positive serology tests. There is very little published data
on co-infections in humans and it is recommended that further studies
should be implemented in other locations with the aim of guiding
management of patients with multiple tick-borne and other co-infections.