{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T04:36:51Z","timestamp":1793162211795,"version":"4.5.0"},"reference-count":203,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2023,11,20]],"date-time":"2023-11-20T00:00:00Z","timestamp":1700438400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Department of Defense","award":["HT94252310830"],"award-info":[{"award-number":["HT94252310830"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Co-infections are a poorly understood aspect of tick-borne diseases. In the United States alone, nineteen different tick-borne pathogens have been identified. The majority of these agents are transmitted by only two tick species, Ixodes scapularis and Amblyomma americanum. Surveillance studies have demonstrated the presence of multiple pathogens in individual ticks suggesting a risk of polymicrobial transmission to humans. However, relatively few studies have explored this relationship and its impact on human disease. One of the key factors for this deficiency are the intrinsic limitations associated with molecular and serologic assays employed for the diagnosis of tick-borne diseases. Limitations in the sensitivity, specificity and most importantly, the capacity for inclusion of multiple agents within a single assay represent the primary challenges for the accurate detection of polymicrobial tick-borne infections. This review will focus on outlining these limitations and discuss potential solutions for the enhanced diagnosis of tick-borne co-infections.<\/jats:p>","DOI":"10.3390\/pathogens12111371","type":"journal-article","created":{"date-parts":[[2023,11,20]],"date-time":"2023-11-20T10:32:32Z","timestamp":1700476352000},"page":"1371","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Tick-Borne Co-Infections: Challenges in Molecular and Serologic Diagnoses"],"prefix":"10.3390","volume":"12","author":[{"given":"Santiago","family":"Sanchez-Vicente","sequence":"first","affiliation":[{"name":"Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, NY 10032, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafal","family":"Tokarz","sequence":"additional","affiliation":[{"name":"Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, NY 10032, USA"},{"name":"Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,11,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1289\/ehp.00108119","article-title":"Impact of climatic change on the northern latitude limit and population density of the disease-transmitting European tick Ixodes ricinus","volume":"108","author":"Lindgren","year":"2000","journal-title":"Environ. 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