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Sneaky Lyme Coinfections: Could You Have Them?

If you’re fighting Lyme disease, you should know that it may not be the only stealth infection you’re up against.

Borrelia, the type of bacteria that causes Lyme disease, has some pretty nasty friends. Babesia and Bartonella are two of the coinfections that often occur alongside Lyme disease. But there are others.

In one survey, more than half of those with chronic Lyme disease had at least one coinfection. And, almost 30% of them had at least two coinfections. (1)

Additionally, as Lyme and coinfections weaken your immune system, other infections may take root or reignite. These “opportunistic” infections are also stumbling blocks to getting better.

Here’s a closer look at common Lyme coinfections and symptoms, as well as a peek at opportunistic infections. Plus, find out how to bolster your immune system and prepare your body to battle these pathogens. 

What Is a Lyme Coinfection?

When you’re bitten by a tick or other insect that transmits Borrelia, you may become infected with other harmful microbes. Because they’re commonly transmitted at the same time as Lyme bacteria, they’re called coinfections. 

Ticks and other biting insects harbor many pathogens. In fact, ticks may spread more than 200 different types of harmful bacteria and many types of pathogens. (2, 3, 4, 5)

Some common Lyme coinfections are Babesia, Bartonella, Ehrlichia, and Rickettsia. In this list, all the microbes are bacteria except Babesia. That one is a parasite.

In one survey, more than 3,000 people with chronic Lyme disease were asked if they had coinfections. The percentage of people reporting common Lyme coinfections were: (1)

  • Babesia: 32.3%
  • Bartonella: 28.3%
  • Ehrlichia: 14.5%
  • Rickettsia: 5.6%

These numbers are likely underestimates of the prevalence of Lyme coinfections. The people surveyed were only counted as having a coinfection if it had been confirmed in a lab test. But many coinfections can be challenging to detect in blood tests. 

For example, Bartonella is tough to confirm using a blood test because it can hide in your cells. You may not get a positive test result even if you have the coinfection. (6, 7)

But overlooking a coinfection could stall your healing journey.

Coinfections can make Lyme disease more severe. They add to the burden on your immune system. And if coinfections aren’t treated, you may not fully recover, despite addressing Lyme. (8)

You should also note that it’s possible to have a Lyme coinfection without having Lyme disease. In addition, as you’ll read below, some coinfections can be transmitted in ways besides tick bites. (9)



Babesia is a single-celled parasite that can infect your red blood cells. It’s distantly related to the malaria parasite, which also invades red blood cells. (10, 11)

More than 100 different species of Babesia exist, but only a few are known to infect people. Babesia microti is the type most often found in people. (11)

The parasite is most commonly transmitted by ticks, particularly in the nymph stage. These young ticks are about the size of a poppyseed. So, you may not even know you’ve been bitten. (12)

You could also pick up Babesia from an organ transplant or blood transfusion. These aren’t screened for the parasite. In addition, a mom can transfer the infection to her baby in the womb or during childbirth. (12, 13)

What does Babesia do in your body?

This critter is cunning. Though many microbes can’t get inside your red blood cells, Babesia can. That gives it some protection from your immune system. (13)

Once inside your red blood cells, Babesia reproduces and damages the cell membranes. The red blood cells split apart, releasing the new batches of parasites. They go on to invade other red blood cells in the same way. (14)

Meanwhile, Babesia is working hard to hide from your immune system. It can rapidly change its gene expression to make different proteins that identify it. This is like a chameleon that’s always changing its color to blend into its surroundings. Your immune system won’t recognize it. (15)

Due to these stealth activities, Babesia can cause long-term infections. 

What are the symptoms of Babesia infection?

The symptoms of Babesia can range from mild to severe, depending on the strength of your immune system. You’ll be at higher risk of severe symptoms if you’re fighting other infections. The same goes if you are taking medicine that suppresses your immune system. (16)

Also, if you’ve had your spleen removed, the infection is quite risky and requires immediate medical attention. Your spleen helps intercept invaders like Babesia and filter them out. (17)

Some of the milder, more common symptoms of Babesia are flu-like and may include: (11, 14

  • Chills
  • Cough
  • Drenching sweats
  • Fatigue
  • Fever
  • Headaches
  • Joint pain
  • Muscle aches
  • Nausea
  • Reduced appetite

Blood tests may reveal signs of the infection as well. A common sign is hemolytic anemia. As the parasite destroys your red blood cells, your body may struggle to replace them quickly. A shortage of red blood cells is called anemia.

Remember, you need red blood cells to help transport oxygen. So a shortage can lead to hypoxia, meaning low oxygen levels. That can result in fatigue.

On a blood test, possible signs of hemolytic anemia include low hemoglobin and high lactic dehydrogenase (LDH). The latter is a general marker of increased cell and tissue destruction. (11)

Other possible signs of Babesia on blood tests are elevated liver enzymes and low blood platelets. Without enough platelets, you’re prone to heavier bleeding. (14

Lastly, in severe cases of Babesia infection, you may develop fluid buildup in your lungs or heart. You could also develop liver or kidney failure. (14


Scientists have identified around 20 different species of Bartonella bacteria. But only a few are generally found in people. (6)

The most common species that infect people and the diseases they cause include:

  • Bartonella henselae: It causes “cat-scratch fever.” As you might guess, you can get it from the scratch of an infected cat. It’s unclear whether you can get it from a cat bite. (18)
  • Bartonella bacilliformis: It causes Carrion’s disease, which is transmitted by sand flies (also called sand gnats). Infected sand flies are commonly found at higher elevations of South America, particularly in Peru. (19, 20)
  • Bartonella quintana: It causes trench fever, which is transmitted by body lice. It’s been found in North America, Europe, China, and Africa. (19, 20)

In addition to cat scratches, sand flies, and lice, you can also get Bartonella infections from ticks and fleas. And, some evidence suggests you could get the infection from bed bugs, spiders, red ants, and mites. (18)

What does Bartonella do in your body?

One of Bartonella’s targets is your endothelial cells. These line your blood vessels. (6)

After Bartonella enters endothelial cells, it changes their behavior. It prevents the cells from self-destructing. And the microbe forms a protective armor around itself. (6)

That’s not all. After Bartonella sets up shop in your blood vessels, it can move into your red blood cells. It may invade your lymph nodes as well. (19, 21)

Bartonella also uses several methods to outsmart your immune system. For example, it may stimulate your body’s secretion of molecules that suppress your immune cells. Scientists are still studying the many ways Bartonella may manipulate your cells. (19, 22)

What are the symptoms of Bartonella infection?

Bartonella’s effects on you depend on the strength of your immune system. Symptoms can range from mild to severe. (23

Symptoms like fatigue and brain fog can happen in Bartonella. But those problems are common in many complex, chronic illnesses. 

Some of the more unique symptoms of Bartonella include: (6, 23, 24)

  • Blurred vision
  • Headaches (back of your head)
  • Intense anxiety or depression
  • Memory loss
  • Muscle and joint pain
  • Pain on soles of your feet
  • Recurring low-grade fever
  • Swollen lymph nodes
  • Streaked skin rash
  • Super sensitive to stimuli (sound, food, touch, etc.)

As you might notice, some of these symptoms overlap with chronic Lyme disease and mold toxicity. A functional medicine practitioner can help you identify the most likely culprits behind your symptoms.


Ehrlichia can cause a cough

Ehrlichia and Anaplasma bacteria are often discussed together. That’s because some species of Ehrlichia were reclassified into the Anaplasma group a couple of decades ago. But both are in the same bacterial family. These Lyme coinfections also cause similar symptoms. (25)

Three kinds of Ehrlichia/Anaplasma known to infect people are: (26)

  • Ehrlichia chaffeensis 
  • Ehrlichia ewingii 
  • Anaplasma phagocytophilum (formerly Ehrlichia phagocytophilum)

Among this list, E. chaffeensis is the most common human infection. It’s transmitted by the lone star tick, which is identified by a single white spot on its back. (That’s the same tick that can trigger red meat allergy.) It’s widespread in the south-central and eastern United States. (27)

Like Babesia, you can also get Ehrlichia from blood transfusions and organ transplants. The bacteria can survive in refrigerated blood for at least a week. (27)

The number of people diagnosed with Ehrlichia is rising. This may be partly due to practitioners’ improved ability to recognize and diagnose the infection. Also, the lone star tick is expanding its territory, so more people could be bitten. (28)

What does Ehrlichia do in your body?

One target of Ehrlichia in your body is certain white blood cells. But it may also invade your lymph nodes, spleen, and bone marrow. (28, 29

To thrive in your body, Ehrlichia steals some of your cholesterol. Its cell membrane is rich in cholesterol, but it can’t make its own. So, it has to take cholesterol from its host. Without enough cholesterol, it can’t reproduce. (30

Lastly, similar to other Lyme coinfections, Ehrlichia uses several tricks to hide from your immune system. It interferes with your immune system’s ability to recognize the pathogen. And, it prevents the cells that it infects from self-destructing. (28)

What are the symptoms of Ehrlichia infection?

The symptoms of Ehrlichia generally begin within two weeks after you’re infected. They are mostly flu-like symptoms. 

Some of the possible symptoms of Ehrlichia infections include: (28)

  • Body aches
  • Chills
  • Cough
  • Diarrhea
  • Fatigue 
  • High fever
  • Muscle pains
  • Nausea
  • Rash
  • Severe headaches

Though the symptoms are vague, a complete blood count (CBC) test may help with diagnosis. In cases of Ehrlichia infection, you may have low white blood cells and low platelets. Blood tests may also show you have moderately high liver enzymes (called AST and ALT). (31)

Later in the illness, you may experience anemia. And severe cases of the infection may lead to meningitis. That’s inflammation of the membranes covering your brain and spinal cord. Another serious complication is fluid buildup in your lungs. But those are rare outcomes. (28)


At least 26 different species of Rickettsia have been identified. Among this group, Rickettsia rickettsii is the bacteria that causes the most common and severe infection in North America. This infection is called Rocky Mountain Spotted Fever. (32)

Despite its name, this infection isn’t limited to the Rocky Mountain region in western North America. The infection has also been reported in Central America and parts of Africa. (33, 34)

A brief tick bite that you don’t even notice could potentially give you Rickettsia. The infection can enter your blood quickly after a tick bite. It doesn’t need much time to be transmitted. (32)

What does Rickettsia do in your body?

Rickettsia tends to infect the lining of the small and medium blood vessels in your body. This creates inflammation. (32)

This inflammation can weaken the structure of your blood vessels. They can become more permeable. And, the infection and inflammation can spread to other tissues. (32)

In Rocky Mountain Spotted Fever, the inflammation can damage the blood vessels in your arms, legs, fingers, and toes. This can be permanent and, in some cases, may lead to amputation. (35)

As with other Lyme coinfections, Rickettsia also suppresses your immune system. This enables it to spread more easily. (32)

What are the symptoms of Rickettsia infection?

All the Lyme coinfections can cause illness. But Rocky Mountain Spotted Fever can result in significant damage and possibly death if it’s not treated soon after infection. If you suspect you have it, you should see a doctor right away. (36

Many of the symptoms of Rickettsia and Rocky Mountain Spotted Fever are similar to the flu. Common symptoms include: (32, 35, 37)

  • Confused thinking
  • Fatigue
  • Fever
  • Headache
  • Light sensitivity
  • Muscle aches
  • Nausea
  • Poor appetite
  • Rash
  • Stomach pain

About 85% of people infected with this bacteria get a rash within 2–4 days after developing a fever. The rash may appear on your wrists, ankles, and abdomen. It may look like red splotches or small red dots on your skin. (35, 37)

Other signs of Rickettsia infection may show up on lab tests. These include anemia, low blood sodium, low blood platelets, and high liver enzymes. (37)

Opportunistic Pathogens

As mentioned earlier, Lyme coinfections are so-named because they’re often transmitted at the same time as Borrelia. Lyme bacteria and coinfections weaken your immune system to promote their own survival. (8)

Weakened immunity also opens the door for other infections to move in or for existing ones to reactivate. For this reason, some infections are called opportunistic. These infections can add to your symptoms in complex, chronic illness. 

A few of the bacteria and pathogens commonly involved in opportunistic infections alongside Lyme disease are: (8

  • Chlamydia pneumoniae
  • Mycoplasma pneumoniae
  • Coxsackievirus
  • Cytomegalovirus
  • Epstein-Barr virus
  • Human parvovirus

You may find some of these pathogens are also called coinfections. That’s because ticks can transmit them. But you may also have them before you get Lyme. Regardless of how you classify them, they can take a toll on your health.

Also, having Lyme and coinfections could make you more susceptible to “everyday” infections. You may succumb to the cold and flu easily. And, you may harbor several parasites. You need to tune up your immune system and fight back. (38)

Fighting Back Against Coinfections

Fighting back against coinfections

You may need to address some coinfections directly. But you should start the process by supporting your drainage, detoxification, and immune system. This lays the groundwork for reining in the microbes that are making you feel miserable.

Also, remember that killing foreign invaders releases toxic byproducts. You need to ship these toxins out of your body quickly. If toxins build up, you could feel worse.

Some additional ways that may help in your fight against Lyme coinfections and opportunistic pathogens include:

  • Drainage: Good drainage or “taking out the garbage” is critical for healing from infections, such as supporting the lymphatic system. This will help ensure you’re naturally eliminating toxins through your stools. 
  • Minerals: You need minerals like zinc for a healthy immune system that can effectively fight infections. Look for natural ways to add more essential minerals to your daily intake. 
  • Parasite-fighting herbs: Parasites are a big drain on your immune system. Some also harbor Borrelia and other pathogens. Taking parasite-fighting herbs may help you take down the critters. 

As with other complex, chronic illnesses, addressing these fundamental aspects of healing are essential when taking on Lyme coinfections.

Lousy Lyme Friends

Remember, Lyme often has company. You may be fighting coinfections like Babesia and Bartonella alongside chronic Lyme disease. And, opportunistic infections like Mycoplasma and Epstein-Barr may gain ground if your immune system is weak.

Unfortunately, many symptoms of these infections aren’t very specific. They often resemble the flu. So, don’t conclude you do or don’t have Lyme coinfections based on a symptom list.

You also can’t exclude the possibility that you have a coinfection based on standard laboratory tests. Many of them aren’t very accurate.  

Here’s the bottom line: If you have Lyme disease, there’s a strong chance that you have at least one coinfection. You may also have opportunistic infections. 

So, take a holistic approach to tackle all these infections. This means supporting your drainage, detoxification, and immune function.

Do you suspect you have a Lyme coinfection? What are you going to do to help your body fight back?