Lyme Disease & Co-infections www.lyme disease.org Disease/ Pathogen (U.S.) Vector (U.S.) Symptoms Condition

Alpha-gal *Allergy to a sugar Lone star tick, blacklegged tick Life-threatening allergic reactions, rash, syndrome molecule found in (Ixodes scapularis, Ixodes hives, nausea, difficulty breathing, drop red meats and meat- pacificus; presumptive), and in blood pressure, dizziness, fainting, related products. chiggers severe stomach pain

Anaplasmosis Anaplasma Blacklegged tick Flu-like symptoms (fever, chills, head- () phagocytophilum (I. scapularis, I. pacificus) ache, fatigue, pain)

Babesiosis Babesia microti, Blacklegged tick (I. Fever, chills, night sweats, fatigue, (Parasite) Babesia duncani, scapularis, I. Pacificus), headache, pain, shortness of breath, Babesia divergens, winter tick “air hunger” Babesia MO-1 quintana, Tick, , louse, sand fly, Low-grade fever, enlarged tender lymph (aka cat-scratch B. bacilliformis, cat scratch nodes, severe muscle pain, pustule at disease) B. henselae, site of bite/scratch, striated rash, shin (Bacteria) B. vinsonii & more… bone pain, pain in soles of feet

Borrelia miyamotoi Borrelia miyamotoi Blacklegged tick High fever, abdominal pain, vomiting, disease (Bacteria) (I. scapularis, I. pacificus) headache, pain, petechiae rash, recurring fevers, chills Bourbon virus Bourbon virus Lone star tick Fever, fatigue, rash, headache, pain, (thogotovirus) (presumptive) nausea, vomiting

Colorado tick fever Colorado tick fever Rocky Mountain wood tick Flu-like symptoms, nausea, fever/symp- (Virus) virus (coltivirus) toms may return after short period of feeling well

Ehrlichiosis , Lone star tick, blacklegged Flu-like symptoms, nausea/vomiting, (Bacteria) , tick (I. scapularis, fatigue, swollen lymph nodes, rash Ehrlichia muris I. pacificus)

Heartland virus Heartland virus Lone star tick Fever, fatigue, headache, nausea, (phlebovirus) diarrhea, pain

Lyme disease Borrelia burgdorferi, Blacklegged tick ACUTE: Flu-like symptoms, rash (bull’s- (Bacteria) Borrelia mayonii (I. scapularis, I. pacificus) eye or other), heart block, migrating arthritis, Bell’s palsy CHRONIC: Fatigue, joint/muscle pain, cognitive impairment, sleep disturbance, psychiatric symptoms, neuropathy

Pacific coast tick Rickettsia philipii Pacific Coast tick Flu-like symptoms, recurring fever, fever (Bacteria) eschar (dark scab at site of bite)

Rocky Mountain Rickettsia American dog tick, brown High fever, chills, severe headache, pain, rickettsii dog tick, Rocky Mountain fatigue, nausea, vomiting, confusion, (Bacteria) wood tick, Pacific Coast tick rash Q-fever (Bacteria) Brown dog tick, Rocky Flu-like symptoms, high fever, Mountain wood tick, lone star tick, Pacific Coast tick

Rickettsiosis Gulf coast tick Fever, headache, pain, spotted rash, (Bacteria) eschar (dark scab at site of bite)

Powassan virus Powassan virus Blacklegged tick, ground- Fever, headache, sore throat, nausea, disease (flavivirus) hog tick vomiting, fatigue, confusion, seizures, weakness, paralysis

Southern tick- Borrelia lonestari Lone star tick Similar symptoms as Lyme disease associated rash (presumptive) illness (STARI) (Unknown)

Tick-borne Borrelia hermsii, Soft ticks, High fever, abdominal pain, vomiting, Borrelia turicata, Ornithodoros species headache, pain, petechiae rash, (Bacteria) Borrelia parkeri recurring fevers, chills

Tick paralysis Toxin in tick saliva* American dog tick, Rocky Fatigue, flaccid paralysis, tongue & (aka tick toxicosis) (presumptive) Mountain wood tick facial paralysis, convulsions (Unknown)

Tularemia Francisella American dog tick, Rocky Skin ulcers, swollen lymph nodes, (Bacteria) tularensis Mountain wood tick, lone inflamed eyes, sore throat, star tick, Pacific Coast tick, pneumonia, nausea deer fly, infected animals