Rosenheimer Str. 6-8, 83043 Bad Aibling, Germany · info@clinicum-stgeorg.de
Tick-Borne Co-Infections
Ticks carry far more than Borrelia. An estimated 50-80% of chronic Lyme patients harbor one or more co-infections that complicate diagnosis, alter symptoms, and require targeted treatment beyond standard Lyme protocols.
Night sweats nobody asked about. Pain in the soles of your feet in the morning. Anxiety that arrived out of nowhere, in a life that was not anxious before. You were treated for one organism. The tick did not carry only one.
This page explains which co-infections we test for, how each one changes the picture, and how they are treated.
When co-infections are present alongside Borrelia, the clinical picture becomes more complex and severe. Patients with co-infections typically experience more intense symptoms, slower response to treatment, and greater diagnostic confusion.
Signs that co-infections may be present include:
Co-infections are among the most overlooked factors in chronic Lyme disease. Many patients are treated only for Borrelia while harboring additional infections that prevent recovery.
Most physicians who diagnose Lyme disease do not order co-infection testing. Standard Lyme workups focus exclusively on Borrelia, ignoring the fact that the same tick bite can transmit multiple pathogens simultaneously. Without specific testing, co-infections remain invisible.
Available tests for many co-infections suffer from the same limitations as standard Lyme tests. Antibody-based tests miss infections in patients with suppressed immune responses, and many co-infecting organisms are difficult to culture or detect by PCR in routine blood samples.
Co-infection symptoms overlap extensively with Lyme disease symptoms and with each other. Without specific expertise in tick-borne illness, distinguishing between Borrelia-driven symptoms and co-infection-driven symptoms is nearly impossible, leading to incomplete treatment plans.
Bartonella species (particularly B. henselae and B. quintana) are intracellular bacteria transmitted through tick bites, flea bites, cat scratches, and potentially other insect vectors. Bartonella infection is increasingly recognized as one of the most common and clinically significant Lyme co-infections.
Bartonella has a particular affinity for endothelial cells (blood vessel lining) and red blood cells, which explains its wide-ranging vascular and neurological symptoms. It can cause vasculitis, neuroinflammation, and psychiatric manifestations that are frequently misdiagnosed as primary mental health conditions.
Bartonella requires specific antibiotic combinations, typically including agents that achieve high intracellular concentrations such as azithromycin, rifampin, or fluoroquinolones. Treatment duration is often longer than for Borrelia alone, and response monitoring is essential.
Babesia species (B. microti, B. duncani, and others) are protozoan parasites that infect red blood cells, similar to malaria. Babesia is transmitted by the same Ixodes ticks that carry Borrelia and is frequently found in Lyme patients. Because it is a parasite rather than a bacterium, it does not respond to antibiotics used for Lyme disease.
Babesiosis causes hemolytic anemia as parasites rupture red blood cells, leading to characteristic symptoms of air hunger, drenching sweats, and profound fatigue. It can be life-threatening in immunocompromised patients and is particularly difficult to eradicate in patients with concurrent Borrelia infection.
Babesia requires antimalarial and antiparasitic agents, typically atovaquone with azithromycin or clindamycin with quinine. Treatment must continue until parasitemia clears and symptoms resolve, which often takes longer than anticipated. Whole-body hyperthermia also demonstrates anti-parasitic effects.
Ehrlichia and Anaplasma are obligate intracellular bacteria that infect white blood cells. Ehrlichia chaffeensis infects monocytes (human monocytic ehrlichiosis), while Anaplasma phagocytophilum infects granulocytes (human granulocytic anaplasmosis). Both are transmitted by ticks and can cause acute and chronic illness.
These infections directly compromise immune function by infecting the very cells responsible for fighting infection. This immune suppression can make concurrent Borrelia infection more difficult to clear and can mask the typical immune responses used for serological diagnosis.
Doxycycline is the first-line treatment for both Ehrlichia and Anaplasma. In chronic co-infection, longer treatment courses are often necessary, and monitoring of white blood cell counts and liver function guides treatment duration.
Beyond the major tick-borne co-infections, chronic Lyme patients frequently harbor additional opportunistic infections that contribute to their symptom burden and complicate recovery:
Our comprehensive co-infection panel tests for all of the above pathogens using a combination of serological, molecular, and cellular immune testing. Results are interpreted by physicians with specific expertise in tick-borne illness to create targeted treatment plans that address every identified infection.
At St. George Hospital, co-infection treatment is not an afterthought. It is an integral part of every Lyme disease treatment plan. Our approach recognizes that treating Borrelia alone while co-infections persist will never achieve lasting improvement.
The primary treatment for co-infections is Intravenous Low-Level Laser Therapy (LLLT), delivered as 10 sessions in the dedicated Co-Infection Module. A fiber-optic catheter is inserted into a peripheral vein, delivering laser light directly into the bloodstream. The therapy stimulates mitochondrial function and ATP synthesis at the cellular level. Six wavelengths target different therapeutic effects: blue (405 nm) with Riboflavin for antimicrobial action against Bartonella, Babesia, and intracellular pathogens; green (532 nm) for improved oxygen uptake via hemoglobin binding; yellow (589 nm) for detoxification and serotonin metabolism support; red (635 nm) for deep tissue anti-inflammatory effect and microcirculation improvement; infrared (810 nm) for deepest tissue penetration (5–7 cm) and stem cell activation; and UV light for immune activation and direct pathogen inactivation. This is combined with apheresis blood purification, and in severe cases, Plasma Exchange or Red Blood Cell Exchange.
Our complete co-infection treatment strategy includes:
Clinical evidence consistently demonstrates that untreated co-infections are a primary reason for treatment failure in chronic Lyme disease. Key research findings include:
Our clinical experience since 1995 confirms these findings. Patients who present with persistent symptoms despite prior Lyme treatment frequently improve when co-infections are identified and targeted. This is why comprehensive testing is a non-negotiable part of our diagnostic protocol.
“In our experience, the single most common reason that chronic Lyme patients fail to improve is the presence of undiagnosed and untreated co-infections.”
St. George Hospital Medical Team
Blood filtration removes inflammatory complexes and pathogen-associated toxins that drive co-infection symptoms.
What H.E.L.P. apheresis involves →Medical ozone has direct antimicrobial properties against co-infection organisms and enhances immune function.
What ozone therapy involves →Controlled fever therapy targets heat-sensitive co-infection organisms like Babesia and Bartonella while boosting immune activity.
What a whole-body hyperthermia session involves →Strengthens the immune system's ability to control and clear persistent co-infection organisms that evade standard antibiotics.
What immune therapy involves →Antimicrobial photodynamic therapy targets biofilm-protected organisms that are resistant to conventional antibiotic treatment.
What photodynamic therapy involves →A video consultation in English before you travel. A physician reviews your findings first; we reply by email within one business day (Mon–Fri).
Mon–Thu 08:00–17:00, Fri 08:00–14:00 (CET/CEST)+49 8061 398-0info@clinicum-stgeorg.de
St. George Hospital is a specialist hospital, not an emergency department. In a medical emergency in Germany, dial 112.
