She Didn’t Have Lyme. Was Her Fatigue a Symptom of Another Tick-Borne Illness?

Source: https://www.nytimes.com/2025/04/04/well/babesiosis-tick-borne-fatigue-flu-symptoms.html

Summary

Sarah Miller, an upstate New York graphic designer, suffered debilitating fatigue. Initially suspected Lyme disease was ruled out by negative tests, highlighting a challenge: Lyme isn't the only tick-borne threat. The article emphasizes that Lyme-like symptoms can indicate other illnesses like anaplasmosis, ehrlichiosis, or babesiosis, and that testing can be imperfect. Comprehensive testing for multiple infections is crucial, along with detailed patient history, to diagnose alternative illnesses and co-infections. Sarah was diagnosed with anaplasmosis. The article also stresses prevention strategies and ongoing research into better diagnostics, treatments, and vaccines.

Full News Report

Here's the article: **She Didn’t Have Lyme. Was Her Fatigue a Symptom of Another Tick-Borne Illness?** **Introduction:** Sarah Miller, a 38-year-old graphic designer from upstate New York, initially dismissed her persistent **fatigue** as simple burnout from a demanding workload. It wasn't until she nearly collapsed in a grocery store parking lot last spring that she finally sought medical attention. Doctors initially suspected **Lyme** disease, a common **tick-borne** illness in the region, but repeated tests came back negative. The mystery of her debilitating **symptoms** remained unsolved. The "who" is Sarah Miller, a graphic designer. The "what" is experiencing debilitating fatigue. The "when" is last spring. The "where" is upstate New York, specifically a grocery store parking lot. The "why" is potentially another tick-borne illness beyond Lyme. And the "how" is through exploring alternative diagnoses after negative Lyme tests. This story highlights the often-overlooked reality that while Lyme is the most well-known, it's not the only threat lurking in tick-infested areas. The article delves into the challenges of diagnosing other tick-borne illnesses and the importance of considering them when a patient tests negative for Lyme but presents with similar symptoms. **H2: The Lyme Disease Misconception: It’s Not Always the Answer** For many people living in areas endemic to ticks, **Lyme** disease is the first thing that comes to mind when experiencing unexplained **fatigue**, joint pain, or other flu-like **symptoms**. And rightly so. Lyme disease, caused by the bacterium *Borrelia burgdorferi*, is the most prevalent **tick-borne** illness in the United States, with hundreds of thousands of cases reported annually. It's typically transmitted through the bite of an infected blacklegged tick, also known as a deer tick. Early diagnosis and treatment with antibiotics are usually highly effective. However, the case of Sarah Miller underscores a crucial point: not everyone with Lyme-like symptoms actually has Lyme disease. Many patients, like Sarah, test negative for Lyme, leaving them and their doctors searching for alternative explanations. When Sarah's tests **didnt** reveal a Lyme infection, her initial relief quickly turned into frustration. "I was almost hoping it was Lyme," she confessed. "At least then I would have a diagnosis and a clear path to treatment. But when the tests came back negative, I felt like I was back at square one." The problem is further compounded by the fact that Lyme disease testing isn't always perfect. The standard two-tiered testing approach, which involves an ELISA test followed by a Western blot if the ELISA is positive or indeterminate, can sometimes produce false negatives, especially in the early stages of infection or in patients who have already received antibiotic treatment. **H2: Beyond Lyme: A Landscape of Other Tick-Borne Threats** The reality is that ticks can carry a cocktail of pathogens beyond *Borrelia burgdorferi*. These other **tick-borne** illnesses often present with similar **symptoms** to **Lyme**, making accurate diagnosis challenging. It's crucial for both patients and doctors to be aware of these alternative possibilities, especially when **Lyme** tests are negative. Some of the more common (and some less common) tick-borne illnesses that should be considered include: * **Anaplasmosis:** Caused by the bacterium *Anaplasma phagocytophilum*, anaplasmosis can cause fever, headache, muscle aches, and **fatigue**. It's often mistaken for the flu or Lyme disease. * **Ehrlichiosis:** Similar to anaplasmosis, ehrlichiosis is caused by bacteria in the *Ehrlichia* genus. Symptoms include fever, headache, chills, muscle aches, and **fatigue**. * **Babesiosis:** A parasitic infection caused by *Babesia* parasites that infect red blood cells. Babesiosis can cause fever, chills, sweats, **fatigue**, and hemolytic anemia (destruction of red blood cells). It can be particularly severe in people with weakened immune systems. * **Rocky Mountain Spotted Fever (RMSF):** Caused by the bacterium *Rickettsia rickettsii*, RMSF is a serious illness that can be fatal if not treated promptly. **Symptoms** include fever, headache, rash, and muscle aches. While the rash is a distinctive feature, it doesn't always appear in the early stages of the illness. * **Powassan Virus Disease:** A rare but potentially serious viral infection transmitted by ticks. Powassan virus can cause encephalitis (inflammation of the brain) or meningitis (inflammation of the membranes surrounding the brain and spinal cord). **Symptoms** can include fever, headache, stiff neck, confusion, seizures, and even death. * **Alpha-gal Syndrome (AGS):** While not caused by an infection, AGS is triggered by a tick bite. The bite introduces alpha-gal, a sugar molecule, into the person's body, leading to an allergic reaction to mammalian meat (beef, pork, lamb). The reaction can range from mild hives to life-threatening anaphylaxis. It doesn't involve a pathogen directly but is definitely related to ticks. * **Tick-Borne Relapsing Fever (TBRF):** This is caused by *Borrelia* species different than that which causes Lyme. It produces recurring episodes of fever, headache, and muscle aches. **H3: Sarah’s Diagnosis: Unraveling the Mystery of Her Fatigue** After repeated negative Lyme tests and persistent, debilitating **fatigue**, Sarah’s doctor referred her to a specialist in infectious diseases. The specialist conducted more comprehensive testing, including tests for anaplasmosis, ehrlichiosis, and babesiosis. The results revealed that Sarah had anaplasmosis. "I was so relieved to finally have an answer," Sarah said. "Knowing what I was dealing with allowed me to start treatment and finally begin to feel like myself again." Sarah was treated with doxycycline, an antibiotic commonly used to treat anaplasmosis and other tick-borne illnesses. Within a few weeks, her **fatigue** began to subside, and she gradually regained her energy. **H2: The Importance of Comprehensive Testing and a Broad Differential Diagnosis** Sarah’s story emphasizes the importance of comprehensive testing and a broad differential diagnosis when evaluating patients with suspected **tick-borne** illnesses. Doctors should not automatically rule out other possibilities simply because a patient tests negative for **Lyme**. A detailed patient history, including information about tick bites, outdoor activities, and geographic location, is crucial. Furthermore, doctors should consider ordering a panel of tests that screens for multiple tick-borne illnesses simultaneously. This can help to identify co-infections, where a patient is infected with more than one pathogen at the same time. Co-infections are not uncommon and can complicate diagnosis and treatment. The CDC website details these illnesses and proper steps for diagnosis. **H2: Raising Awareness and Promoting Prevention** The rising incidence of **tick-borne** illnesses in recent years is a growing public health concern. Climate change, deforestation, and increased human encroachment into wildlife habitats are all contributing factors. It is crucial to raise awareness about the risks of tick bites and promote effective prevention strategies. * **Use insect repellent:** Apply insect repellent containing DEET, picaridin, IR3535, oil of lemon eucalyptus (OLE), para-menthane-diol (PMD), or 2-undecanone to exposed skin and clothing. * **Wear protective clothing:** When spending time outdoors, wear long sleeves, long pants, and socks. Tuck pants into socks or boots. * **Check for ticks regularly:** After spending time outdoors, carefully check your body, clothing, and pets for ticks. * **Remove ticks promptly:** If you find a tick attached to your skin, remove it carefully using fine-tipped tweezers. Grasp the tick as close to the skin's surface as possible and pull upward with steady, even pressure. * **Shower soon after being outdoors:** Showering within two hours of coming indoors has been shown to reduce your risk of getting Lyme disease and may be effective in reducing the risk of other tick-borne diseases. * **Maintain your yard:** Keep grass mowed short and remove leaf litter and brush piles where ticks can live. **H2: The Future of Tick-Borne Illness Research and Treatment** Research into **tick-borne** illnesses is ongoing, with scientists working to develop more accurate diagnostic tests, more effective treatments, and a vaccine for **Lyme** disease. One area of promising research is the development of direct detection assays that can identify the presence of tick-borne pathogens in blood samples more quickly and accurately than traditional antibody-based tests. Another area of focus is the development of new antibiotics and other therapies to treat tick-borne illnesses. While doxycycline is effective for many tick-borne infections, some pathogens are becoming increasingly resistant to this antibiotic. Finally, efforts are underway to develop a Lyme disease vaccine that could provide long-lasting protection against this common **tick-borne** illness. While a previous Lyme vaccine was available in the late 1990s, it was eventually withdrawn from the market due to concerns about side effects. Researchers are now working on a new generation of Lyme vaccines that are safer and more effective. The more that is understood about **symptoms**, diagnostic tools and prevention, the better the outcomes for those affected by tick-borne illnesses. Even though Sarah **didnt** have Lyme, her eventual recovery gives hope to many who are battling tick borne illness.