When it comes to tick-borne infections, Lyme disease is the one that gets all the attention.

What most people don’t realize: A single tick bite can transmit many disease-causing organisms. These so-called “co-infections” can and often do persist even after a person takes anti­biotics (the standard treatment for Lyme).

Unfortunately, most doctors assume that people who test positive for Lyme disease have only Lyme—and they don’t have an answer if these patients fail to get better.

A hidden threat: Despite treatment, about 25% of patients with early Lyme disease go on to develop a persistent infection that doesn’t adequately respond to antibiotics. Even when the infection appears to be gone based on blood tests, these patients can suffer headaches, joint pain, fever, difficulty concentrating and other symptoms that can last for months or even years.

I call this condition Lyme-MSIDS (Multiple Systemic Infectious Disease Syndrome).* Many doctors believe that Lyme and other tick-borne infections are unlikely to persist after a monthlong course of antibiotics. However, based on my 31 years of experience treating Lyme patients and reviewing the scientific, peer-reviewed medical literature, I’m convinced that Lyme-MSIDS does occur and that patients can remain ill due to overlapping causes of inflammation. These include chronic bacterial, parasitic, viral and fungal infections…sleep disorders…food allergies/sensitivities that result from leaky gut…dysbiosis, an imbalance of bacteria in the gastrointestinal tract…and environmental toxins associated with autoimmunity and nutritional deficiencies. These can contribute to mitochondrial damage and hormonal and nervous system imbalances, which further increase the likelihood of symptoms such as fatigue and pain.

What you need to know…


If you have Lyme-like symptoms that don’t improve after a month of antibiotic treatment, ask your doctor to check for other tick-borne infections and co-infections. Even if you have tested negative for Lyme, you could still be infected with other organisms that causes Lyme-like symptoms but aren’t detectable with the standard tests for Lyme.

Tick-borne co-infections… 

Babesiosis. This parasitic infection is spreading rapidly in the US. It typically causes increased fatigue, headaches and mood swings with malaria-like symptoms—such as chills, sweating and fever—that occur intermittently, sometimes for years. It also can cause anemia, shortness of breath and an unexplained cough.

How it’s diagnosed: Blood tests that check for the infecting organism (Babesia). It’s important to test for different Babesia species—and do DNA and RNA testing if babesiosis is suspected but the antibody titer is negative.

Typical treatment: I often rotate combinations of different antibiotics with antimalarial drugs and herbs. Example: Clindamycin (Cleocin) combined with quinine, or more commonly with atovaquone (Mepron) and azithromycin (Zithromax) and/or sulfamethoxazole/trimethoprim (Septra) with the herbs artemisia and cryptolepis. I have found these regimens help reduce Babesia symptoms.

Also helpful: Curcumin, the yellow plant pigment in the spice turmeric. It reduces inflammation that may be caused by babesiosis as well as Lyme disease. If you want to try a curcumin supplement, follow label directions.

Ehrlichiosis/anaplasmosis. This is a bacterial infection that typically causes a high fever accompanied by severe headaches, muscle pain and fatigue. It’s among the most common co-infections found in Lyme patients.

How it’s diagnosed: Antibody blood tests help to diagnose ­ehrlichiosis/anaplasmosis, but a low white blood cell count, low platelet count and elevated liver enzymes are also signs that the infection is present.

Typical treatment: Doxycycline or other tetracycline antibiotics should be started as soon as the infection is suspected—even before laboratory diagnosis has been confirmed.

Bartonellosis. Also known as cat scratch disease, this bacterial illness was once thought to be transmitted to people only from cat scratches or bites. It is now known that Bartonella bacteria also can be spread by ticks, fleas and biting flies.

A classic Bartonella infection usually causes a rash or papule (a small, red, raised bump on the skin) along with swelling of the lymph nodes. But patients who also have Lyme-MSIDS usually have more intense symptoms. For example, they may not have a rash but could experience seizures and severe nerve pain, burning, tingling or numbness as well as severe memory and concentration problems.

How it’s diagnosed: Antibody blood tests as well as DNA and RNA testing.

Typical treatment: Doxycycline combined with the antibiotic rifampin or other medications such as a quinolone antibiotic such as Cipro.

Rocky Mountain spotted fever (RMSF). A bacterial infection transmitted by dog and wood ticks carrying Rickettsia rickettsii infection, if left untreated, RMSF can damage the kidneys, gastrointestinal tract, heart, lungs and brain and can lead to serious infection, amputation and death. Although first identified in the Rocky Mountain region, RMSF can be found throughout the Western hemisphere.

RMSF can be a difficult disease to diagnose in its early stages because early symptoms are nonspecific. Symptoms typically include high fever, chills, severe headache, muscle aches, abdominal pain, nausea and/or vomiting and/or confusion within the first week to 14 days after infection…followed in 90% of cases by a distinctive rash at wrists and ankles two to five days after fever onset, spreading to palms, soles of feet and up arms and legs to torso.

How it is diagnosed: Blood test, rash specimen or the tick itself, when possible.

Typical treatment: Complications are more likely avoided if antibiotics are started within five days of developing symptoms. Doxycycline is the most effective antibiotic, including for children and pregnant women (short courses are safe). Rifampin also can be effective (but is not the first line therapy).

Rabbit fever. Also called tularemia, rabbit fever is spread by ticks and deer flies, by inhaling the bacteria or by touching an infected dead animal. There are several forms of the disease which can attack the skin, eyes, lymph nodes, gastrointestinal tract and/or lungs. Depending on the form, symptoms include an ulcer at the site of the bite, swollen/painful lymph glands, fever, chills, sore throat, headache, muscle and joint pain, dry cough, exhaustion, diarrhea and occasionally sepsis. Additionally, oculoglandular tularemia causes eye pain, redness, swelling, discharge, ulcer on the inside of the eyelid and sensitivity to light…and oropharyngeal tularemia (from eating undercooked contaminated wild meat or drinking contaminated water) causes mouth ulcers, vomiting, diarrhea and inflamed tonsils.

How it is diagnosed: Antibody and DNA blood test…rarely, a culture…chest X-ray to check for signs of pneumonia.

Typical treatment: Antibiotic injections, such as streptomycin, gentamicin…oral antibiotics such as doxycycline and ciprofloxacin…plus additional therapies for complications such as meningitis or pneumonia.

Powassan virus (POWV). This is found mostly in the northeastern and Great Lakes regions of the US. Symptoms usually appear within one week to one month of being bitten by an infected tick (the disease can be transmitted within 15 minutes of attachment) and include fever, headache, vomiting, weakness, confusion, loss of coordination, difficulties with speech, paralysis, seizures…and can lead to inflammation of the brain (encephalitis) or the membranes surrounding the brain (meningitis). POWV encephalitis is fatal in 10% of cases, and half of survivors of neuroinvasive forms of the disease have severe, permanent neurological symptoms.

How it is diagnosed: A combination of antibody tests, nucleic/viral antigen blood tests, spinal fluid tests, signs and symptoms.

Typical treatment: No specific drug, although severe illness may require hospitalization, respiratory support and intravenous fluids.


The majority of patients with Lyme disease will recover completely—and quickly—when they take anti­biotics within two to four weeks after a bite from an infected tick.

If you do not get better within a month after taking antibiotics, and additional testing shows that you do not have a tick-borne co-infection, it’s possible that blood tests missed the infection, you have one or more other tick-borne co-­infections, you’re still infected with the Lyme bacterium and/or you have other overlapping causes of inflammation/dysregulation found on the MSIDS map.

Helpful: Because inflammation can cause—or increase—the symptoms of Lyme and other tick-borne infections, I often advise patients to take small doses of naltrexone (ReVia). This prescription medication, which is also used for alcohol/opiate dependency, reduces inflammation and helps regulate an overstimulated immune system.

Naltrexone can be combined with over-the-counter anti-inflammatory supplements including the antioxidant glutathione (liposomal is best for absorption), which helps reduce fatigue and pain, and green tea extract and resveratrol.


Your best defense is to avoid getting bitten by a tick in the first place. Wear permethrin-treated clothing, and spray bare skin with IR3535, picaridin, or 25% DEET (“deep woods” version). Once indoors, check your clothing and pets for ticks—and don’t forget to do a full body check.

*If you’ve been treated for Lyme and your symptoms don’t improve, you may want to see a Lyme-MSIDS specialist. To find such a doctor in your area, consult the Lyme Disease Association, LymeDiseaseAssociation.org, or the International Lyme and Associated Diseases Society, ILADS.org.

For more from our report “Frightening Tick Alert—What You Need to Know Now,” please see the following stories…