title: Chronic coinfections in patients diagnosed with chronic lyme disease: a systematic review.
abstract: OBJECTIVE
  Often, the controversial diagnosis of chronic Lyme disease is given to patients with prolonged, medically unexplained physical symptoms. Many such patients also are treated for chronic coinfections with Babesia, Anaplasma, or Bartonella in the absence of typical presentations, objective clinical findings, or laboratory confirmation of active infection. We have undertaken a systematic review of the literature to evaluate several aspects of this practice.
  
  
  METHODS
  Five systematic literature searches were performed using Boolean operators and the PubMed search engine.
  
  
  RESULTS
  The literature searches did not demonstrate convincing evidence of: 1) chronic anaplasmosis infection; 2) treatment-responsive symptomatic chronic babesiosis in immunocompetent persons in the absence of fever, laboratory abnormalities, and detectable parasitemia; 3) either geographically widespread or treatment-responsive symptomatic chronic infection with Babesia duncani in the absence of fever, laboratory abnormalities, and detectable parasitemia; 4) tick-borne transmission of Bartonella species; or 5) simultaneous Lyme disease and Bartonella infection.
  
  
  CONCLUSIONS
  The medical literature does not support the diagnosis of chronic, atypical tick-borne coinfections in patients with chronic, nonspecific illnesses.
authors.affiliation: Division of Pediatric Infectious Diseases, Duke University School of Medicine, Durham, NC; Division of General Internal Medicine, Duke University School of Medicine, Durham, NC. Electronic address: Paul.lantos@duke.edu.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Lantos
authors.affiliation: Division of Infectious Diseases, New York Medical College, Valhalla.
authors.forename: Gary P
authors.initials: GP
authors.lastname: Wormser
mesh_terms: D000712:Anaplasmosis / Q000150:complications; D000818:Animals; D001404:Babesiosis / Q000150:complications; D001474:Bartonella Infections / Q000150:complications; D002908:Chronic Disease; D006801:Humans; D016867:Immunocompromised Host; D008193:Lyme Disease / Q000150:complications*
keywords: Anaplasma; Babesia; Bartonella; Borrelia burgdorferi; Coinfection; Lyme disease