Caroline serves as Chief Operating Officer of Indigo Integrative Health Clinic, where she drives the expansion of Indigo’s pioneering root-cause approach to medical care.
Drawing on her extensive experience as a Parsley Health provider, educator and board-certified Health Coach, Caroline combines operational leadership with clinical insight to advance Indigo’s mission of delivering transformative, personalized care.
A standard Lyme test checks only for Lyme. It does not detect common tick-borne co-infections like Babesia, Anaplasma, and Ehrlichia, which each need their own test and their own treatment. Bartonella, spread mainly by fleas and cat scratches rather than ticks, can appear in the same patients. A negative Lyme test does not rule any of these out.
Many people who reach us spent years feeling sick while being told their test results looked normal. Often, the reason is an infection the standard testing was never designed to catch.
Co-infections are one of the most common reasons patients with Lyme stay sick after treatment. They are also one of the most consistently missed. The standard Lyme test was built to look for one infection. When another infection is also present, that test can come back clean while the underlying problem goes unnamed. In a 2024 study of more than 3,500 people diagnosed with babesiosis, 42% also carried another tick-borne infection, most often Lyme itself (Ssentongo et al., 2024).
Ticks are not picky eaters. A tick feeds at each stage of its life, usually on a different animal, and picks up whatever pathogens that host was carrying. By the time it reaches you, a single bite can pass on more than one infection.
That overlap is becoming more common. A 2025 study in the journal Ecosphere tracked more than 2,000 ticks at a long-running Northeast research site for nearly ten years. By the end, about 1 in 10 carried two or more pathogens, and the most common pairing was the Lyme bacterium and the parasite Babesia. Closer to home, five years of Maryland tick surveillance found Babesia and Anaplasma spreading across the state. Carrying two infections at once is still fairly uncommon here (Joyner et al., 2026).
These four turn up most often alongside Lyme, and a standard panel checks for none of them. They are not the only co-infections, but they are the ones most likely to be missed. Each needs its own test. Each needs its own treatment.
| Infection | What it is | How it spreads | Most common symptoms | Standard Lyme antibiotic treats it? |
|---|---|---|---|---|
| Babesia | A parasite that behaves like malaria | The same tick that carries Lyme | Night sweats, air hunger, waves of fatigue, headaches that come and go | No. Babesia is a parasite and needs antiparasitic treatment. |
| Bartonella | A bacterium linked to nerve and blood-vessel symptoms | Mainly fleas and cat scratches, not ticks | Burning or crawling skin, sudden anxiety, brain fog, a streaky rash | Often not. It usually needs a different approach. |
| Ehrlichia | A bacterium that attacks infection-fighting cells | Mainly the lone star tick | High fever, body aches, a drop in blood cell counts | Yes, usually, at the right dose and length. |
| Anaplasma | A bacterium that attacks infection-fighting cells | The same tick that carries Lyme | High fever, body aches, a drop in blood cell counts | Yes, usually, at the right dose and length. |
The standard Lyme antibiotic does nothing to Babesia, because Babesia is a parasite rather than a bacterium. Treat only the Lyme, and the parasite keeps going, and so do the symptoms.
It brings night sweats, waves of fatigue, and headaches that come and go. Another common sign is air hunger, the unsettling feeling of not being able to get a full breath. A Lyme test only checks whether your body fought the Lyme bacteria. Babesia needs its own blood test, and no standard panel includes it.
The crawling skin and the anxiety that came out of nowhere may not be random. Bartonella affects blood vessels and is linked to nerve and brain symptoms. Those include burning or crawling skin, sudden anxiety, brain fog, and a streaky rash that can look like stretch marks.
Bartonella is not a tick infection the way the others are. The species behind most human cases is Bartonella henselae, the cause of cat scratch disease. It spreads mainly through cat scratches and bites, the fleas that cats carry, and body lice. The CDC says there is no solid evidence that ticks pass Bartonella to people. A 2024 study even found the bacteria are rarely present in the ticks that carry Lyme (Parasites & Vectors, 2024). It shows up alongside tick-borne infections because someone with heavy outdoor or animal exposure often meets both ticks and fleas.
That distinction matters for testing. Finding Bartonella takes a test built to detect it, and no standard Lyme or tick-borne panel includes one. A 2025 case report followed one family, children included. They carried both Bartonella and Babesia, and earlier workups had missed the nerve and brain symptoms. It was one household rather than a population study. It raises questions more than it settles them, and the authors called for larger studies to see how often this pattern holds.
These two can drop your blood cell counts within days. They attack the white blood cells your body uses to fight infection, bringing high fever, body aches, and falling counts that worsen fast if no one catches them.
They do not always travel together. Anaplasma rides the same tick that carries Lyme, while Ehrlichia usually comes from the lone star tick, which is well established across Virginia, Maryland, and DC.
The standard Lyme antibiotic treats both, so a Lyme course often clears them at the right dose and length, per CDC guidance on ehrlichiosis and anaplasmosis. But that same drug does nothing for Babesia and is often not enough for Bartonella. One course can quietly resolve the two easy infections while the two hardest keep running.
The standard Lyme test looks for one thing: signs your body fought the Lyme bacteria. It was never built to look for anything else, and that narrow focus is the problem. Babesia, Bartonella, Ehrlichia, and Anaplasma each need their own test, and most providers never order them because the standard guidelines do not ask for them.
The rules themselves are the problem here. They were never written to catch something this layered, and most doctors are simply following the panel they were handed.
A full course of standard Lyme treatment can clear the Lyme itself and still leave you sick, when a co-infection was never tested and never treated.
Treating one infection while the others keep running gives those hidden infections a head start, which is why so many people improve a little and then stall. The labels pile up: unexplained illness, anxiety, lingering symptoms after antibiotics. Every month in that loop has a price: more tests that come back normal, more treatments aimed at the wrong target, more time lost. This is also part of why symptoms can linger even after Lyme treatment.
We see this pattern regularly in our practice. Snejana Sharkar, FNP, RND, ACNP, co-founded Indigo after her own experience with missed tick-borne illness. She built our diagnostic approach around this exact gap.
A complete workup runs a separate, targeted test for each infection the standard panel skips. That means specialty labs that catch what routine labs miss, and a close read of your full symptom history next to your numbers. Your location raises the odds. Patients in Virginia, Maryland, and the DC area live in one of the highest tick-burden regions in the country. Both blacklegged and lone star ticks are established here. People are now catching babesiosis right here in Maryland, Virginia, and DC (Stromdahl et al., 2025). We read your test numbers and your full symptom history together.
A negative Lyme test alongside ongoing symptoms usually means the full set of questions was never asked. The Johns Hopkins Lyme Disease Research Center states plainly that no reliable blood test exists to confirm that treatment worked. The NIH funds research into why people stay sick after antibiotics, and co-infections are on its list of active investigations. Researchers are also testing blood markers that could one day show whether treatment worked. That work is still in the lab, not the clinic yet (Nayak et al., 2025). This is not fringe medicine. Major academic medical centers are publishing on it right now.
Indigo is a virtual clinic serving patients across the DMV, so our care starts wherever you are. A complimentary Discovery Call is where every Indigo patient starts. It is a 20-minute phone call, and a team member walks through your symptom history, your past testing, and what you have already tried. You come away with a clear read on whether your case is one we can help with, and what a fuller workup would look for. No cost, no commitment, just a straight answer on whether this is worth pursuing.
This content is for educational purposes only. It is not medical advice, a diagnosis, or a treatment recommendation. Always work with a qualified health provider regarding your own health.
This content is provided by Indigo Integrative Health Clinic for educational purposes only. It does not constitute medical advice, a diagnosis, or a treatment recommendation, and does not establish a provider-patient relationship. Individual health conditions vary — information presented here may not apply to your specific situation. Always consult a qualified, licensed healthcare provider before making decisions about your health, medications, supplements, or treatment plan.
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