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.Blood samples were taken prior to first consultation at a Private infectious disease clinic in Dublin Ireland for suspected Lyme disease during the period 8/12/2016 to 7/2/2017. A total of 54 patient samples were tested for a group of infections at ArminLabs, Augsburg, Germany