{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T17:15:49Z","timestamp":1792602949677,"version":"4.5.0"},"reference-count":312,"publisher":"Bentham Science Publishers Ltd.","issue":"1","license":[{"start":{"date-parts":[[2012,12,28]],"date-time":"2012-12-28T00:00:00Z","timestamp":1356652800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/legalcode"}],"content-domain":{"domain":["openneurologyjournal.com","benthamopen.com"],"crossmark-restriction":true},"short-container-title":["TONEUJ"],"published-print":{"date-parts":[[2012,12,28]]},"abstract":"\n In Lyme disease concurrent infections frequently occur. The clinical and pathological impact of co-infections was first recognized in the 1990th,\n i.e.<\/jats:italic>\n approximately ten years after the discovery of Lyme disease. Their pathological synergism can exacerbate Lyme disease or induce similar disease manifestations. Co-infecting agents can be transmitted together with\n Borrelia burgdorferi<\/jats:italic>\n by tick bite resulting in multiple infections but a fraction of co-infections occur independently of tick bite. Clinically relevant co-infections are caused by Bartonella species,\n Yersinia enterocolitica<\/jats:italic>\n ,\n Chlamydophila pneumoniae<\/jats:italic>\n ,\n Chlamydia trachomatis<\/jats:italic>\n , and\n Mycoplasma pneumoniae<\/jats:italic>\n . In contrast to the USA, human granulocytic anaplasmosis (HGA) and babesiosis are not of major importance in Europe. Infections caused by these pathogens in patients not infected by\n Borrelia burgdorferi<\/jats:italic>\n can result in clinical symptoms similar to those occurring in Lyme disease. This applies particularly to infections caused by\n Bartonella henselae<\/jats:italic>\n ,\n Yersinia enterocolitica<\/jats:italic>\n , and\n Mycoplasma pneumoniae<\/jats:italic>\n .\n Chlamydia trachomatis<\/jats:italic>\n primarily causes polyarthritis.\n Chlamydophila pneumoniae<\/jats:italic>\n not only causes arthritis but also affects the nervous system and the heart, which renders the differential diagnosis difficult. The diagnosis is even more complex when co-infections occur in association with Lyme disease. Treatment recommendations are based on individual expert opinions. In antibiotic therapy, the use of third generation cephalosporins should only be considered in cases of Lyme disease. The same applies to carbapenems, which however are used occasionally in infections caused by\n Yersinia enterocolitica<\/jats:italic>\n . For the remaining infections predominantly tetracyclines and macrolides are used. Quinolones are for alternative treatment, particularly gemifloxacin. For\n Bartonella henselae<\/jats:italic>\n ,\n Chlamydia trachomatis<\/jats:italic>\n , and\n Chlamydophila pneumoniae<\/jats:italic>\n the combination with rifampicin is recommended. Erythromycin is the drug of choice for\n Campylobacter jejuni<\/jats:italic>\n .\n <\/jats:p>","DOI":"10.2174\/1874205x01206010158","type":"journal-article","created":{"date-parts":[[2013,1,11]],"date-time":"2013-01-11T01:25:57Z","timestamp":1357867557000},"page":"158-178","update-policy":"https:\/\/doi.org\/10.2174\/crossmark_policy","source":"Crossref","is-referenced-by-count":63,"title":["Chronic Lyme Disease and Co-infections: Differential Diagnosis"],"prefix":"10.2174","volume":"06","author":[{"given":"Walter","family":"Berghoff","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"965","reference":[{"key":"refR1","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1001\/archneur.58.9.1357","volume":"58","author":"Eskow E","year":"2001","unstructured":"Eskow E, Rao RV, Mordechai E. \n Concurrent infection of the central nervous system by Borrelia burgdorferi and Bartonella henselae:evidence for a noveltick-borne disease complex \n Arch Neurol \n 2001; \n 58\n (9)\n : 1357-63.","journal-title":"Arch Neurol"},{"key":"refR2","doi-asserted-by":"crossref","first-page":"1420","DOI":"10.1128\/CVI.00308-07","volume":"14","author":"Grab DJ","year":"2007","unstructured":"Grab DJ, Nyarko E, Barat NC, Nikolskaia OV, Dumler JS. \n Anaplasma phagocytophilum-Borrelia burgdorferi co-infection enhances chemokine, cytokine, and matrix metalloprotease expression by human brainmicrovascular endothelial cells \n Clin Vaccine Immunol \n 2007; \n 14\n (11)\n : 1420-4.","journal-title":"Clin Vaccine Immunol"},{"key":"refR3","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1128\/jcm.34.3.724-727.1996","volume":"34","author":"Mitchell PD","year":"1996","unstructured":"Mitchell PD, Reed KD, Hofkes JM. \n Immunoserologic evidence of co-infectionwith Borreliaburgdorferi, Babesia microti, and human granulocytic Ehrlichia species in residents of Wisconsin and Minnesota \n J Clin Microbiol \n 1996; \n 34\n (3)\n : 724-.","journal-title":"J Clin Microbiol"},{"key":"refR4","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1080\/10790268.2003.11754578","volume":"26","author":"Oleson CV","year":"2003","unstructured":"Oleson CV, Sivalingam JJ, O\u2019Neill BJ, Staas WE Jr. \n Transverse myelitis secondary to coexistent Lyme disease and babesiosis \n J Spinal Cord Med \n 2003; \n 26\n (2)\n : 168-71.","journal-title":"J Spinal Cord Med"},{"key":"refR5","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1016\/j.mehy.2006.03.046","volume":"67","author":"Owen DC","year":"2006","unstructured":"Owen DC. \n Is Lyme disease always poly microbial?--The jigsaw hypothesis \n Med Hypotheses \n 2006; \n 67\n (4)\n : 860-4.","journal-title":"Med Hypotheses"},{"key":"refR6","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1128\/CMR.00011-06","volume":"19","author":"Swanson SJ","year":"2006","unstructured":"Swanson SJ, Neitzel D, Reed KD, Belongia EA. \n Co-infections acquired from ixodes ticks \n Clin Microbiol Rev \n 2006; \n 19\n (4)\n : 708-27.","journal-title":"Clin Microbiol Rev"},{"key":"refR7","doi-asserted-by":"crossref","first-page":"3359","DOI":"10.1128\/IAI.69.5.3359-3371.2001","volume":"69","author":"Thomas V","year":"2001","unstructured":"Thomas V, Anguita J, Barthold SW, Fikrig E. \n Co-infection with Borrelia burgdorferi and the agent of human granulocytic ehrlichiosis alters murine immune responses, pathogen burden, and severity of Lyme arthritis \n Infect Immun \n 2001; \n 69\n (5)\n : 3359-71.","journal-title":"Infect Immun"},{"key":"refR8","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1046\/j.1365-3024.2000.00339.x","volume":"22","author":"Zeidner NS","year":"2000","unstructured":"Zeidner NS, Dolan MC, Massung R, Piesman J, Fish D. \n Co-infection with Borrelia burgdorferi and the agent of human granulocytic ehrlichiosissuppresses IL-2 and IFN gamma production and promotes an IL-4 responsein C3H\/HeJ mice \n Parasite Immunol \n 2000; \n 22\n (11)\n : 581-8.","journal-title":"Parasite Immunol"},{"key":"refR9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1086\/314053","volume":"31","author":"Wormser GP","year":"2000","unstructured":"Wormser GP, Nadelman RB, Dattwyler RJ, et al. \n Practice guidelines for the treatment of Lyme disease.The Infectious Diseases Society of America \n Clin Infect Dis \n 2000; \n 31\n (Suppl 1)\n : 1-14.","journal-title":"Clin Infect Dis"},{"key":"refR10","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1055\/s-2008-1068546","volume":"111","author":"Kristoferitsch W","year":"1986","unstructured":"Kristoferitsch W, Stanek G, Kunz C. \n [Double infection with early summer meningoencephalitis virus and Borrelia burgdorferi. 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