A 70-Year-Old Man Had 3 Tickborne Diseases at Once—Here’s How That Happens

 

The idea of having one tickborne illness is terrifying enough, but one man is recovering after being diagnosed with three at the same time.

The 70-year-old man’s health ordeal made it into BMJ Case Reports published in April, which detailed his diagnosis and recovery. According to the report, the man went to the ER with a fever, swelling in his ankle, and nausea. Doctors discovered that he had leg pain, too, and lab tests showed that he had anemia, low blood platelets, injury to his kidney, and elevated aminotransaminases, which usually suggests a person has liver issues.

The man mentioned he had small red bump on his ankle about a month before, and assumed he had been bitten by a bug. He was eventually diagnosed with Lyme disease, babesiosis, and anaplasmosis—three major diseases transmitted by ticks.

The man was treated with a combination of antibiotics, an anti-fungal, and an anti-parasitic medication, and he eventually recovered.

Being diagnosed with three separate diseases may seem like a lot after a tick bite—and it is—but doctors say these so-called co-infections happen more than people realize.

What is a co-infection?

A co-infection is when a person is infected with more than one illness at the same time, according to the Centers for Disease Control and Prevention (CDC). You can have a co-infection with just about any illness, from tickborne diseases to HIV and hepatitis.

While co-infections occur with tickborne illnesses—especially with Lyme disease and another infection—it’s pretty rare for someone to have three of these diseases at once, says William Schaffner, M.D., an infectious disease specialist and professor at the Vanderbilt University School of Medicine. “Three is Olympic gold medal-worthy,” he says.

How does someone get more than one tickborne illness at once?

The same tick could carry several diseases at once, explains infectious disease expert Amesh A. Adalja, M.D., senior scholar at the Johns Hopkins Center for Health Security. The black-legged tick, for example, can transmit Lyme disease, babesiosis, and anaplasmosis and “the same tick can infect the same person,” Dr. Adalja says.

Even though that’s possible, it’s still rare. “It’s relatively uncommon for a tick to have all three diseases,” says Thomas Russo, M.D., professor and chief of infectious disease at the University at Buffalo in New York. “It’s more common for a tick to have two out of three, and most common for a tick to have one.”

It’s also possible for you to be bitten by several ticks and not realize it. “Tick bites are often unnoticed,” Dr. Schaffner says. “A person can have more than one bite and get a co-infection that way.”

Do doctors usually check for tickborne co-infections?

“Most people who get tested for these things will also have routine blood work done,” Dr. Adalja says. Diseases like babesiosis and anaplasmosis will give abnormal results on these routine tests, like lower white blood cell counts and elevated markers for liver issues. However, doctors “don’t routinely test a patient for all three unless they have some reason to do so,” Dr. Adalja says, like if they practice in an area that has a high tick population.

How are tickborne co-infections treated?

It depends on which tickborne infections you have. Anaplasmosis and Lyme disease are treated the same, Dr. Adalja says, so, “it doesn’t make too much of a difference in whether both are caught.”

But treatment for babesiosis is different—it involves an anti-parasitic and anti-fungal medication that you wouldn’t use to treat anaplasmosis and Lyme disease. “It makes things more complicated and, because of that, it’s very important to make the diagnosis,” Dr. Schaffner says. If a patient has a co-infection and isn’t properly treated for babesiosis, they will continue to feel symptoms of the illness or even suffer complications.

If you’re diagnosed with a tickborne infection and you’re not getting better with treatment, Dr. Russo says that it’s important to speak up and keep pushing for answers. “Advocate for yourself,” he says. “If there is concern for one tickborne infection, there should be concern for all.”