Infectiologic differential diagnosis of chronic Lyme disease and so ...

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In cases of Lyme disease (LD), other infections, whose pathological synergism
exacerbate the disease state or induce the same disease manifestations, can exist
concurrently. Such concomitant infections are termed coinfections. The coinfections
can also be transmitted by ticks as LD is, i.e. a tick bite can result in multiple
infections. A fraction of the coinfections is transmitted independently of ticks, or in
addition to tick transmission there are other modes of transmission.
The coinfections that are transmitted by ticks are given in Table 1; the coinfections
that are independent of ticks are compiled in Table 2.
In Europe ticks are not only infected by Borrelia burgdorferi but also by other
pathogens i.e. Human Granulocytic Anaplasmosis, Rickettsia, Coxiella burnetii,
Babesia microti and Babesia divergens [351-354].
The coinfections favor the expression of disease states by means of immune system
modulation and are considered to be a major reason for therapy resistances [176 -
192].
The importance of the coinfections for the pathological process—i.e. their
pathogenicity compared to Lyme disease—has not been clarified. Thus, in cases of
double or multiple infections, a decision cannot be made as to which infection
dominates in the pathological process.
In the symptomatology there are substantial overlaps between Lyme disease and the
coinfections so that an unequivocal assignment of the disease manifestations to the
existing infections is impossible. Many symptoms can thus be due to both a Lyme
disease and the so-called coinfections.
The problematic nature of Lyme disease and coinfections always concerns the
chronic course. The coinfections are thus only of importance for chronic Lyme
disease (late stage, stage III). On the other hand, the synergic-pathological
mechanism requires that the coinfections also are present in a chronic persistent
form.