Borrelia miyamotoi Disease


Borrelia miyamotoi

Borrelia miyamotoi

Where Found

Borrelia miyamotoi disease, sometimes called hard tick relapsing fever, has been reported as the cause of human infection in the Upper Midwest, the Northeast, and the mid-Atlantic states, in places where Lyme disease occurs. Unlike Lyme disease, which is most common in June and July, Borrelia miyamotoi infection occurs most commonly in July and August and may be spread by larval blacklegged ticks.

Incubation Period

Days to weeks, specific ranges are unknown

Signs and Symptoms

  • Fever
  • Chills
  • Fatigue
  • Severe headache
  • Arthralgia/myalgia
  • Dizziness, confusion, vertigo (uncommon)
  • Rash (uncommon)
  • Dyspnea (uncommon)
  • Nausea, abdominal pain, diarrhea, and anorexia (uncommon)

General Laboratory Findings

  • Leukopenia
  • Thrombocytopenia
  • Elevated hepatic transaminase values

Laboratory Diagnosis

  • Diagnosis relies on signs and symptoms coupled with:
    1. Polymerase chain reaction (PCR) tests that detect DNA from the organism; or
    2. Antibody-based tests
  • Tests are available from a limited number of CLIA-approved reference laboratories.
  • Recent studies indicate that the C6 peptide ELISA test (a first-tier test for Lyme disease) may be positive in patients infected with B. miyamotoi.


To date, there are no comprehensive studies to evaluate treatment regimens, but in published case series, patients were successfully treated with antibiotics and dosages used for Lyme disease.


Chowdri HR, Gugliotta JL, Berardi VP, et al. Borrelia miyamotoi infection presenting as human granulocytic anaplasmosis: a case report. Ann Intern Med 2013 Jul 2;159(1):21-7.

Jobe DA, Lovrich SD, Oldenburg DG, et al. Borrelia miyamotoi infection in patients from Upper Midwestern United States, 2014-2015. Emerg Infect Dis 2016 Aug;22(8):1471-3.

Krause PJ, Schwab J, Narasimhan S, et al. Hard tick relapsing fever caused by Borrelia miyamotoi in a child. Pediatr Infect Dis J 2016 Dec;35(12):1352-1354.

Molloy PJ, Telford SR 3rd, Chowdri HR, et al. Borrelia miyamotoi disease in the northeastern United States: a case series. Ann Intern Med 2015 Jul 21;163(2):91-8.

Molloy PJ, Weeks KE, Todd B, et al. Seroreactivity to the C6 peptide in Borrelia miyamotoi infections occurring in the northeastern United StatesExternal. Clin Infect Dis 2017 Ahead of print.

Wormser GP, Pritt B. Update and commentary on four emerging tick-borne infections: Ehrlichia muris-like agent, Borrelia miyamotoi, deer tick virus, Heartland virus, and whether ticks play a role in transmission of Bartonella henselae. Infect Dis Clin North Am 2015 Jun;29(2):371-81.

Wroblewski D, Gebhardt L, Prusinski MA, et al. Detection of Borrelia miyamotoi and other tick-borne pathogens in human clinical specimens and Ixodes scapularis ticks in New York State, 2012-2015. Ticks Tick Borne Dis 2017 Mar;8(3):407-411.