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Although the risk of human coinfection differs by geographic location, the true prevalence of coinfecting pathogens among\n              <jats:italic>Ixodes<\/jats:italic>\n              ticks remains largely unknown for the majority of geographic locations. The prevalence of dually infected\n              <jats:italic>Ixodes<\/jats:italic>\n              ticks appears highest among ticks from regions of North America and Europe where LD is endemic, with reported prevalences of \u226428%. In North America and Europe, the majority of tick-borne coinfections occur among humans with diagnosed LD. Humans coinfected with LD and babesiosis appear to have more intense, prolonged symptoms than those with LD alone. Coinfected persons can also manifest diverse, influenza-like symptoms, and abnormal laboratory test results are frequently observed. Coinfecting pathogens might alter the efficiency of transmission, cause cooperative or competitive pathogen interactions, and alter disease severity among hosts. No prospective studies to assess the immunologic effects of coinfection among humans have been conducted, but animal models demonstrate that certain coinfections can modulate the immune response. Clinicians should consider the likelihood of coinfection when pursuing laboratory testing or selecting therapy for patients with tick-borne illness.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1128\/cmr.00011-06","type":"journal-article","created":{"date-parts":[[2006,10,14]],"date-time":"2006-10-14T15:23:21Z","timestamp":1160839401000},"page":"708-727","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":304,"title":["Coinfections Acquired from\n            <i>Ixodes<\/i>\n            Ticks"],"prefix":"10.1128","volume":"19","author":[{"given":"Stephen J.","family":"Swanson","sequence":"first","affiliation":[{"name":"Epidemic Intelligence Service Program, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia"},{"name":"Acute Disease Investigation and Control, Minnesota Department of Health, St. Paul, Minnesota"},{"name":"Marshfield Clinic Research Foundation, Marshfield, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Neitzel","sequence":"additional","affiliation":[{"name":"Epidemic Intelligence Service Program, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia"},{"name":"Acute Disease Investigation and Control, Minnesota Department of Health, St. Paul, Minnesota"},{"name":"Marshfield Clinic Research Foundation, Marshfield, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kurt D.","family":"Reed","sequence":"additional","affiliation":[{"name":"Epidemic Intelligence Service Program, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia"},{"name":"Acute Disease Investigation and Control, Minnesota Department of Health, St. Paul, Minnesota"},{"name":"Marshfield Clinic Research Foundation, Marshfield, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward A.","family":"Belongia","sequence":"additional","affiliation":[{"name":"Epidemic Intelligence Service Program, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia"},{"name":"Acute Disease Investigation and Control, Minnesota Department of Health, St. Paul, Minnesota"},{"name":"Marshfield Clinic Research Foundation, Marshfield, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.42.6.2799-2801.2004"},{"key":"e_1_3_2_3_2","first-page":"120","volume":"2","year":"1921","unstructured":"Afzelius, A. 1921. 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