Lyme disease (LD), caused by Borrelia burgdorferi sensu lato (s.l.), is the most common tick-borne disease (TBD) in North America and Eurasia. Besides LD, ticks are also capable of transmission of other bacterial pathogens, including those of the genera Anaplasma, Ehrlichia, Babesia, Rickettsia, as well as various viruses. The last two decades have seen a sharp increase in the TBDs with around 300,000 LD cases every year in the US, and 100,000 cases in Europe, though there is little data about TBD worldwide Considering the low sensitivity of current diagnostic methods, the number of actual cases is likely much higher than the reported number. The concept of Lyme, coinfections and TBD is a controversial topic. Much of the debate surrounding this issue is due to a lack of understanding of the fundamental microbiology of tick-pathogen-human interactions.

Ticks carry multiple pathogens, including opportunistic pathogens, which can infect people following the ticks’ bite, resulting in multi-species infections, or ‘coinfections’. Comorbid human infection with more than one tick-borne pathogen is relatively common, with serologic studies from Europe and the US revealing that 4%-45% of LD patients suffer from coinfections. In addition, coinfections usually cause more serious health problems than single infections alone. Pathogens do not always act independently during coinfection, they may interact with each other directly or indirectly via the host’s cell resources or the immune response. Therefore, coinfections make diagnosis and treatment of TBDs both more difficult and more complicated. To help clinicians diagnose and treat patients, it is vital to have a thorough and systematic understanding of LD coinfection in the context of TBDs. Further research on the molecular biology behind TBDs, and promoting public awareness, are therefore essential.

As little is known about the prevalence of tick-borne pathogen-caused coinfections worldwide, our first goal is to understand the prevalence of tick-borne coinfections globally. Our second goal is to understand how coinfecting pathogens interact with each other and the host immune system during tick-borne coinfections. Our final goal is to discuss the development of more effective diagnosis and treatment strategies for tick-borne diseases.

In this Topic we welcome the submission of Original Research articles, Methods, Perspectives, and Reviews, focusing on the following themes of tick-borne coinfections. Involved pathogens include: Borrelia, Bartonella, Babesia, Rickettsia, Ehrlichia, Anaplasma, tick-borne virus, and so on.

• Molecular mechanisms of tick-borne coinfections.
• In vitro and in vivo studies on the mechanism of bacteria and virus pathogenesis and host-pathogen interactions and interaction among the tick-borne pathogens during coinfection.
• Host immune responses of the tick-borne coinfections.
• Development of diagnosis and treatment methods for tick-borne coinfections.

Image Credits: Tao Lin, Richard Lin, Alkek Center for Metagenomics and Microbiome Research, Department of Molecular Virology and Microbiology, Baylor College of Medicine

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